Social marketing: The bottom line is behavior change Demographics / Ray Olderman Informing people about how to take

care of themselves or how to make changes for the good of society can be like getting a kid to take icky-tasting medicine. It doesn't go down easy. We're constantly surrounded by messages selling something. Most of us don't want to listen to the ones that mandate personal changes. So, if you need to get the word out on an issue of any kind you need social marketing. It offers a system for promoting positive behavior changes. What is social marketing? Social marketing uses techniques adapted from commercial marketing to plan and implement programs designed to bring about social change. Let's say you want women to get mammogram tests. Changing behavior is a big goal. Your immediate goal is to get the attention of the women who really need to hear your message.

How well do you understand your community? To see a detailed demographic profile, enter a ZIP code here and click "Go":

As a social marketer, you adapt the commercial techniques normally used to get people to buy a product or service the techniques of attraction and persuasion. You'd use these to get your audience's attention and "sell" them information and education instead of running shoes. The goal of social marketing is to get carefully selected audiences to alter old ideas, understand and accept new ideas and value their new awareness enough to change attitudes and take positive action. Is social marketing right for you? Social marketing's systematic approach is designed especially for:

nonprofit organizations government agencies community-based organizations private foundations social issue coalitions health issue coalitions environmental issue coalitions any group that wants to affect a social change

Social marketing benefits specific target audiences and the general society, not the company doing the selling. Commercial marketers focus on tangible products and services. It's all a matter of commerce to the marketer. Social marketers deal with intangible concepts, ideas and attitudes. It has to be a matter of the heart for the social marketer. You have to begin with a passion to inspire change.

Consumer market research helps social marketers. Population data available through the tools on this site will help you understand your target audience. Are there consumer product categories tied to the belief or awareness you are promoting? Check out the Household Spending tool for a profile of users of that product. For example, the "ice cream and related products" category may provide useful information to a social marketer promoting weight loss. A realistic look at success in social marketing Changing attitudes and beliefs takes time. You may not be able to start out suggesting a change in behavior. Your audience may not even know they have a problem that needs fixing. You're not selling soap or soft drinks. Attitudes and beliefs actually do mean more to people than their choice of consumer products even if it doesn't seem that way sometimes. To be realistic and plan your strategy, you should recognize the stages your audience will go through before they arrive at change: 1. 2. 3. 4. 5. 6. They become aware of your message. (You've caught their attention.) They understand what the message is saying. (You've been heard.) They agree that the message is good and that people should listen to it. They recognize they could benefit from the message. They change their attitude. Their new attitude leads them to change their behavior.

This process influences the focus of your marketing efforts. You need to organize them into three phases:

Raise awareness. Change attitudes. Encourage action.

You can see how these are really three different goals. And you really need to know your

audience to know which one you need to pursue. Researching your audience Don't think you can just direct your message to the general public. Even if it's a big issue that people have heard about like drug abuse or adoption you still need to know your audience's attitudes. How much do they know? What are their points of resistance? What appeal would attract their attention? And what benefit would persuade them to change? In this sense, knowing your audience is even more important for social marketing than for commercial marketing. The appeal is based on the associations you suggest with your message. Let's say you are talking to a Latino audience about getting tested for HIV. Research shows Latinos place high value on family. You'd appeal to their sense of family and offer the benefits of peace of mind and safety for loved ones. Do some research to get an overview of your audience. Then interview some "key informants," or bring a group of them together to interview in a focus group. Key informants are people who know the community or segment of the population you want to target. Their responses can usually be generalized to a larger but similar population. Now that you know your audience, you can begin to plan. Ultimately you will want to arrive at a strategy, but first you need to set the context. You need to see the total marketing picture. Begin by customizing the commercial "marketing mix." What is your commercial marketing mix? Commercial marketing uses the four Ps to define the total marketing picture: 1. 2. 3. 4. Product the individual item to be marketed Price the cost of obtaining the product Place the distribution plan Promotion all the advertising, public relations and promotional efforts a company employs to get an audience to buy a product.

How to adapt the commercial mix to social marketing 1. (Product) Define the unique value of the concept you are trying to sell the specific change in awareness, attitude and behavior. 2. (Price) Redefine the meaning of "costs," and address them as barriers you need to overcome. In commercial marketing the benefits to the consumer clearly outweigh the cost of a product or service. In social marketing the costs are primarily psychological. For instance, what does it cost you to change your attitude toward practicing safe sex? What does it cost you to actually practice safe sex? In some cases there are also financial costs. For example, if you are selling energy efficiency, people need to invest before they see any savings benefit. 3. (Place) Create an effective distribution plan. Are you producing ads and brochures to get the word out? Posters and radio commercials? What media channels can you afford? Do you need people to literally hand out your materials? Look for partners to help you get the message seen and heard. If you do press releases, call first. Talk with someone about an angle you can use to help the press justify taking space for your information.

4. (Promotion) Create a marketing plan that details:

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The audience you have chosen to target. The phase they are in. Do they need raised awareness? Are they ready for a direct appeal to attitude change? Are they already receptive to a call for changed behavior? The most effective uses of advertising, promotions and public information to achieve the goals of public information and education.

Now add three more Ps to the mix: partnership, policy and politics. 1. Partnership: A single organization may not be able to make a dent in solving complex social issues. Team up with other organizations, partners and agencies to stretch your resources. 2. Policy: Behavioral modifications may not be sustained if a community or cultural environment is not supportive. You may need to organize campaigns around seeking policy changes to help achieve your goals. For example, if you are trying to counter tobacco use, you may need to campaign for changes in tax policy, compliance checks or drug classification. 3. Politics: The issues involved in a social campaign are often complex and controversial. You may need some political diplomacy to gain support from partners, like-minded organizations, other stakeholders, allies and policy makers. Strategies for social marketing Now you are ready for the challenges of social marketing. Devise your marketing mix strategy. This is your strategy for how to address a specific audience and persuade them to change their awareness, attitudes or behavior. Here are some sample scenarios.

Strategy A. When the costs are small compared to the benefits. Communicate the benefits of the change in awareness, attitudes or behavior. Make sure the resources for adopting the change are easily available. For example, let's say you want people to call a phone number to get assistance with medical issues. The benefits of making the call are clear and can be presented compellingly. The cost is only a phone call. For some people that is hard, but the benefits outweigh the effort needed to make the call. Strategy B. When there are no direct benefits for the individual. Use your research to find what would make the change attractive and convenient for the audience. For example, installing renewable energy equipment is too costly to have anything but an intangible benefit. Interviews may reveal that your audience might take on the expense for their children and future generations. You can use that to appeal for change. Strategy C. When the costs for social change outweigh the benefits. Here, there are two possibilities: find a more direct benefit for the target audience or aim the campaign at a small portion of the target audience. Social marketers frequently isolate a group of pioneer types and appeal to them first. This strategy works best when you can take the next step and get the small committed audience to use their leverage in their community.

What is Social Marketing? by Nedra Kline Weinreich

The health communications field has been rapidly changing over the past two decades. It has evolved from a one-dimensional reliance on public service announcements to a more sophisticated approach which draws from successful techniques used by commercial marketers, termed "social marketing." Rather than dictating the way that information is to be conveyed from the top-down, public health professionals are learning to listen to the needs and desires of the target audience themselves, and building the program from there. This focus on the "consumer" involves in-depth research and constant re-evaluation of every aspect of the program. In fact, research and evaluation together form the very cornerstone of the social marketing process. Social marketing was "born" as a discipline in the 1970s, when Philip Kotler and Gerald Zaltman realized that the same marketing principles that were being used to sell products to consumers could be used to "sell" ideas, attitudes and behaviors. Kotler and Andreasen define social marketing as "differing from other areas of marketing only with respect to the objectives of the marketer and his or her organization. Social marketing seeks to influence social behaviors not to benefit the marketer, but to benefit the target audience and the general society." This technique has been used extensively in international health programs, especially for contraceptives and oral rehydration therapy (ORT), and is being used with more frequency in the United States for such diverse topics as drug abuse, heart disease and organ donation. Like commercial marketing, the primary focus is on the consumer--on learning what people want and need rather than trying to persuade them to buy what we happen to be producing. Marketing talks to the consumer, not about the product. The planning process takes this consumer focus into account by addressing the elements of the "marketing mix." This refers to decisions about 1) the conception of a Product, 2) Price, 3) distribution (Place), and 4) Promotion. These are often called the "Four Ps" of marketing. Social marketing also adds a few more "P's." At the end is an example of the marketing mix. Product The social marketing "product" is not necessarily a physical offering. A continuum of products exists, ranging from tangible, physical products (e.g., condoms), to services (e.g., medical exams), practices (e.g., breastfeeding, ORT or eating a heart-healthy diet) and finally, more intangible ideas (e.g., environmental protection). In order to have a viable product, people must first perceive that they have a genuine problem, and that the product offering is a good solution for that problem. The role of research here is to discover the consumers' perceptions of the problem and the product, and to determine how important they feel it is to take action against the problem. Price "Price" refers to what the consumer must do in order to obtain the social marketing product. This cost may be monetary, or it may instead require the consumer to give up intangibles, such as time or effort, or to risk embarrassment and disapproval. If the costs outweigh the benefits for an individual, the perceived value of the offering will be low and it will be unlikely to be adopted. However, if the benefits are perceived as greater than their costs, chances of trial and adoption of the product is much greater. In setting the price, particularly for a physical product, such as contraceptives, there are many issues to consider. If the product is priced too low, or provided free of charge, the consumer may perceive it as being low in quality. On the other hand, if the price is too high, some will not be able to afford it. Social marketers must balance these considerations, and often end up charging at least a nominal fee to increase perceptions of quality and to confer a sense of "dignity" to the transaction. These perceptions of costs and benefits can be determined through research, and used in positioning the product.

Place "Place" describes the way that the product reaches the consumer. For a tangible product, this refers to the distribution system--including the warehouse, trucks, sales force, retail outlets where it is sold, or places where it is given out for free. For an intangible product, place is less clear-cut, but refers to decisions about the channels through which consumers are reached with information or training. This may include doctors' offices, shopping malls, mass media vehicles or in-home demonstrations. Another element of place is deciding how to ensure accessibility of the offering and quality of the service delivery. By determining the activities and habits of the target audience, as well as their experience and satisfaction with the existing delivery system, researchers can pinpoint the most ideal means of distribution for the offering. Promotion Finally, the last "P" is promotion. Because of its visibility, this element is often mistakenly thought of as comprising the whole of social marketing. However, as can be seen by the previous discussion, it is only one piece. Promotion consists of the integrated use of advertising, public relations, promotions, media advocacy, personal selling and entertainment vehicles. The focus is on creating and sustaining demand for the product. Public service announcements or paid ads are one way, but there are other methods such as coupons, media events, editorials, "Tupperware"-style parties or in-store displays. Research is crucial to determine the most effective and efficient vehicles to reach the target audience and increase demand. The primary research findings themselves can also be used to gain publicity for the program at media events and in news stories. Additional Social Marketing "P's" Publics--Social marketers often have many different audiences that their program has to address in order to be successful. "Publics" refers to both the external and internal groups involved in the program. External publics include the target audience, secondary audiences, policymakers, and gatekeepers, while the internal publics are those who are involved in some way with either approval or implementation of the program. Partnership--Social and health issues are often so complex that one agency can't make a dent by itself. You need to team up with other organizations in the community to really be effective. You need to figure out which organizations have similar goals to yours--not necessarily the same goals--and identify ways you can work together. Policy--Social marketing programs can do well in motivating individual behavior change, but that is difficult to sustain unless the environment they're in supports that change for the long run. Often, policy change is needed, and media advocacy programs can be an effective complement to a social marketing program. Purse Strings--Most organizations that develop social marketing programs operate through funds provided by sources such as foundations, governmental grants or donations. This adds another dimension to the strategy development-namely, where will you get the money to create your program?

Example of a Marketing Mix Strategy As an example, the marketing mix strategy for a breast cancer screening campaign for older women might include the following elements:

The product could be any of these three behaviors: getting an annual mammogram, seeing a physician each year for a breast exam and performing monthly breast self-exams.

The price of engaging in these behaviors includes the monetary costs of the mammogram and exam, potential discomfort and/or embarrassment, time and even the possibility of actually finding a lump. The place that these medical and educational services are offered might be a mobile van, local hospitals, clinics and worksites, depending upon the needs of the target audience. Promotion could be done through public service announcements, billboards, mass mailings, media events and community outreach. The "publics" you might need to address include your target audience (let's say low-income women age 40 to 65), the people who influence their decisions like their husbands or physicians, policymakers, public service directors at local radio stations, as well as your board of directors and office staff. Partnerships could be cultivated with local or national women's groups, corporate sponsors, medical organizations, service clubs or media outlets. The policy aspects of the campaign might focus on increasing access to mammograms through lower costs, requiring insurance and Medicaid coverage of mammograms or increasing federal funding for breast cancer research. The purse strings, or where the funding will come from, may be governmental grants, such as from the National Cancer Institute or the local health department, foundation grants or an organization like the American Cancer Society.

Each element of the marketing mix should be taken into consideration as the program is developed, for they are the core of the marketing effort. Research is used to elucidate and shape the final product, price, place, promotion and related decisions.

Building Social Marketing Into Your Program by Nedra Kline Weinreich

First-time social marketers often feel overwhelmed by the rigorous market research processes they see in other large-scale programs. They may hesitate to incorporate social marketing activities into their own programs, unsure whether they have the resources and expertise to undertake such a project. The following ten tips are designed to help those new to the field to understand the basic principles of social marketing, with practical suggestions on how to implement these concepts in any type of program. 1. Talk to your customers. The key to effective social marketing is talking (and listening!) to the people you are trying to reach. Social marketing is a customer-driven process. All aspects of your program must be developed with the wants and needs of the target audience as the central focus. In order to learn what your customers want, you must ask them! A little ingenuity may be necessary to find cheap and easy ways of gathering information. It may be as simple as going to where the people are and talking to them. For example, sit out in the reception area and talk to people waiting to use your services. Go to the local mall to talk to teenagers hanging out there. Go to the laundromat and talk to people as they wait for their clothes. Ask them if they know of your organization and what you offer. See how they talk about experiences they have had with your issue and find out what they need to help them use your services or perform the behavior you're promoting. You'd be surprised at how willing people are to talk about themselves and how delighted they are to be asked for their opinions. 2. Segment your audience.

Good marketers know that there is no such thing as selling to the general public. Men and women, adults and teenagers respond differently to particular approaches. To be most effective, you need to segment your target audiences into groups that are as similar to each other as possible and to create messages specifically for each segment. Typical attributes for segmentation include sex, age, geographical location and race/ethnicity. You can also segment your audience by behavior. For example, rather than targeting all teenagers, a smoking prevention program might focus upon African American girls between the ages of 12 and 18 who have never smoked. A smoking prevention program for middle-aged men who are ex-smokers would use a very different approach. Of course, people still vary greatly within these segments, but the more specific you can get, the greater your potential impact. The audience segments targeted may not always be the same people your campaign addresses. If your research shows the people you want to reach are more likely to listen to their family members or doctor, you may have more success with a message to those secondary groups urging them to talk about the issue with the person whose behavior you ultimately want to change. A nonprofit organization may have several audiences it needs to address: its "customers," its donors, the media, policymakers and the board of directors. Each of these groups requires its own marketing strategy. 3. Position your product. In social marketing, our products are often hard to promote because of their high "price." Products like behaviors and attitudes require longterm commitments and do not sell as easily as a bar of soap or a car. The cost of a social marketing product often includes a person's time and effort (to attend a class or use services), giving up things he likes (high fat food), embarrassment or inconvenience (buying and using condoms), or social disapproval (resisting peer pressure to smoke). To counteract factors working against adoption of the product, we need to acknowledge these potential problems and address them. Your product positioning determines how the people in your target audience think about your product as compared to the competition. Just as various cigarette brands bill themselves as the freshest, the most fun, the most athletic, the least expensive, the classiest, or the most feminine, your product needs to be positioned in relation to the alternatives. Product positioning is usually based on either the benefits of the product (what will it do for me?) or removal of barriers (how difficult is it for me to do?). By talking about your product with the target audience, you can learn the benefits they value most and the barriers they foresee. For example, women may feel that breastfeeding is a way to bond with their babies, is healthier, and makes them better mothers. However, they may also think that breastfeeding doesn't fit into their lives, is difficult to do, and is painful. In this case, a program could either promote and reinforce the positive aspects of breastfeeding or provide ways to get around the barriers, by explaining how to work breastfeeding into a busy schedule and teaching the proper way to do it to avoid discomfort. 4. Know your competition. In the commercial sector, successful companies watch every move their competitors make. They know their selling environment intimately and are ready to react as soon as conditions change. Social marketers also need to be aware of the competing messages pulling on their target audiences. Your product's competition may be another product, such as french fries versus fruit, or it may be nonperformance of the behavior you are promoting; inaction is nearly always easier than adopting a new behavior. Your product must be more attractive than the alternatives to be accepted. Just as Coke creates its marketing strategies based on what Pepsi is doing, we can take advantage of our competitors' tactics to promote our own products. Many successful health campaigns against tobacco and alcohol have parodied the well-known cigarette and beer slogans, creating ads that grab our attention because of their new twist on familiar images.

Other environmental factors may also affect people's reactions to your program. Political changes may require new approaches, news events may change the context in which people hear your message, and work done by other organizations in your field may affect how you portray your message. You must be able to monitor these changes in the environment and adjust your program accordingly. 5. Go to where your audience is. People will not go out of their way to find your message. You will need to put your message in places your target audience will encounter. When you talk to your customers, ask them where they get their news, what radio stations they listen to, where they go in their free time. If you learn that your target audience tends to read the local newspaper, place your ads there and work with that paper's reporters to get coverage of your issue. If the people in your audience are the ones who do the grocery shopping, work with local supermarkets to put information on healthy eating in their stores. If the people you are targeting like a particular type of music, go to rock concerts and pass out your materials. Bring a mobile mammography van to people's worksites. You can research the audience demographics of local media outlets (i.e., television, radio, newspapers) in order to match your target group's characteristics with their favorite media. The only limit to reaching your audience is the extent of your creativity. 6. Utilize a variety of approaches. Social marketing involves much more than television advertising campaigns. The most effective programs use a combination of mass media, community, small group and individual activities. When a simple, clear message is repeated in many places and formats throughout the community, it is more likely to be seen and remembered. A social marketing program might contain television and radio spots, print ads, a community event, a poster contest, giveaways of your products or coupons for your services, a toll-free hotline for individual counseling or referrals, or classes on your topic offered in the community. The variety of approaches you use will depend on your program's budget and what will be most effective with the target audience. No matter what you do in your campaign, try to stick to one main "look" and slogan, or people may not realize all the pieces are from your organization. Consistency and continuity are key to a successful campaign. 7. Use models that work. As with any field, social marketers design programs using the most effective and useful models available to them. In one model that incorporates elements of several well-established health behavior theories ("Stages of Change"), people move through several steps in a continuum before adopting a new behavior. In the first stage, precontemplation, a person may not feel at risk for the condition or think the behavior is relevant to him. People at this stage must first be made aware of the problem and possible risk factors to move to the next stage, contemplation. To move from contemplation to action, messages should promote the benefits of performing the behavior and minimize the perceived costs. In this stage, the behavior should be portrayed as something that many other people do and agree with; skill-building messages and demonstrations of the behavior by others similar to themselves will help them move to action. Once they have tried the behavior, the last and often most difficult stage is maintenance. Motivational and reinforcing messages are necessary to prevent relapse to the contemplation stage. This model provides a useful framework for segmenting the target audience. A program could address people in each stage over a period of time or select just those at a particular stage of the process. 8. Test, test, test.

All of the products, promotional materials, and services you develop for your program should be tested with your target audience to gauge their potential effectiveness. Social marketing recognizes that the customers are the experts on what works best for them. Even the best minds on Madison Avenue test their ideas with their consumers (and consequently avoid spending lots of money on concepts that don't work). One of the methods most associated with social marketing is the focus group. This involves bringing together 8 to 12 people with particular characteristics relevant to the program and leading them through a focused discussion on a given topic. Focus groups can be used to learn how people in the target audience think about the issue and why, the language they use to talk about the issue, and their reactions to messages or materials you've developed. Surveys are a more generalizable method to find out people's knowledge, attitudes and behaviors regarding a particular topic. They work best when you have very specific questions that don't require the respondents to explain their answers (e.g., "yes" or "no" questions). These don't have to be very complicated, but do require care in administration and interpretation. 9. Build partnerships with key allies. Just as the power of a choir derives from its union of many voices, a powerful message requires groups throughout the community to come together in a coordinated effort. Organizations concerned with your issue can sing the melody along with you, while other groups--the media, schools, businesses, government agencies--can provide the harmony, complementing your efforts through their involvement. By pooling resources with other organizations working toward the same goal, you can have a greater impact as well as access to new audiences. Build connections with key people and organizations who have the potential to bring attention and credibility to your program. You can develop beneficial relationships with the reporters covering your issue at key media outlets; pitch stories to them with a fresh news angle, provide them with fact sheets or lists of experts they can contact for their stories, and be available when they call for information. Include your local politicians in activities to help them understand and support your issue. Invite businesses to sponsor your projects, exchanging positive corporate publicity for their financial support. Other potential allies include professional associations, local service organizations (e.g., Kiwanis, Rotary Club), religious groups and existing community coalitions. 10. See what you can do better next time. The cornerstone of social marketing is evaluation--determining what you accomplished so you can use that information to improve your program. Evaluation occurs throughout the social marketing process. As you develop your program, you need to test and refine your messages or products with members of the target audience. When the program is implemented, you need to monitor activities to assess whether they are occurring as planned. How many brochures were disseminated? How many media "hits," or mentions of your program, did you achieve? Are the people in your target audience the ones who are using your program? The answers to these questions will let you know whether you need to make adjustments while you have the opportunity to do so. The big question, though, is: Did you make a difference? There are two ways this can be answered. One way is to see whether members of the target audience engaged in the desired behavior as a result of the program. This can be determined quantitatively through survey research with the people who participated in the program or who were exposed to the message. A second way requires a longer-term perspective, investigating whether performing the behavior induced the desired change (e.g., a reduction in related mortality and/or morbidity). The actual impact of a social marketing program is difficult to assess accurately. Can a public service announcement reduce mortality from heart disease? Probably not, but many such efforts can combine synergistically over time. The only way to establish a cause-and-effect relationship between your social marketing program and changes in

behavior and health outcomes is to conduct a community intervention study. At whatever level you perform evaluation, the information gained should be used to improve your program in the future.

This article originally appeared in the July 1995 issue of the Social Marketing Quarterly.

Getting Your Message Out Through the Media

by Nedra Kline Weinreich

While many consider the media a fearsome adversary, it can be a powerful ally if approached strategically. Carefully considering your answers to the following questions will help you build a strategy for working with media professionals to get your message out to the people you want to reach. 1. Why do you want media attention? Your organization's goals will point you to the most appropriate media strategies. Do you want to build awareness of your program within the community? Promote a particular attitude or behavior? Advocate for policy change? The answers to these questions will shape whom you want to reach with your message and which media outlets you target. For example, parents of young children probably have very different viewing and reading habits than State legislators. 2. What is your "news?" Often, what we consider newsworthy and exciting in our own programs would make a reporter yawn. The news media have their own criteria for judging what is worth covering, so to get their attention you will need to frame the issue in an appealing way. Try to find a current news issue, event, or annual celebration that you can use as a "peg" for your story. For example, if the media brings attention to a case of child maltreatment in your community, use this as an opportunity to talk about preventing child abuse. Provide a local angle to national news stories, such as a family in jeopardy because Congress may cut funding for your program. The media like stories with conflict, human interest, novelty, or superlatives (biggest, best, etc.). 3. What type of media coverage do you want? The term "media" refers to many different types of entities--radio, television, newspapers, magazines--that vary extensively within each category. Each of these channels provides different opportunities to reach particular audiences with a specific type of message. If you want to ensure that your message is stated in the best possible way, you may consider submitting an opinion editorial (op-ed) stating your position on an issue to the newspaper, writing a letter to the editor, or creating a public service announcement (PSA). A news format provides greater credibility and exposure, but you will have less control over the content and slant of the story. 4. Whom will you contact in the media?

The key to implementing your media strategy is getting your information to the right people at the right places. Your public library should have media reference books listing the media outlets in your area, such as television and radio stations, daily and weekly newspapers, college newspapers, regional magazines, and news wire services. Call each outlet to find out who covers children and family issues, health and welfare, violence, or other topics of interest to your program. Ask about deadlines, audience demographics, preferences for receiving information (e.g., phone, fax, or mail), options for submitting opinion pieces, and other special formats, such as community calendars, that you can use. 5. How will you contact the media? Once you have identified your media contacts, start to establish beneficial working relationships with them before you need to pitch them a story. Write to reporters or producers who cover your issues to give them reactions to their stories and provide them with an information packet on your organization for future reference. When you have news or an event to promote, send out a press release or news advisory containing the most important information to your media list. Follow up with a phone call as close to the event as possible. Most news organizations work under tight timeframes, so ask if the person is on deadline before going into your pitch. Be ready to follow up with additional information, and be enthusiastic about the topic as you explain why it is newsworthy. 6. What do you have to offer? Keep in mind that the news media need people like you to help them fill column inches and airtime. You know the topic, you have ideas for interesting stories, and you have access to the people the stories are about. Succinct information, such as fact sheets and backgrounders, will help the reporter quickly understand the issue. The more "pieces" of the story you can provide-real people affected by the issue, experts, copies of relevant studies--the more likely it will be covered. If you want television coverage, make sure you have visuals to offer, such as children playing at a family support center, a counselor speaking with parents, or other compelling action shots. 7. How will you respond when the media call you? Even if you do not actively seek them out, the media may come to you for information or your reaction to a news story. When this happens, do not panic! Designate a contact within your organization who is comfortable talking to the media and has the authority to speak for the organization. Always be honest, and if you don't know the answer to a question, say so. Find out the reporter's deadline and either call back with the answer or make a referral to other sources who could speak on that point. Speak in plain English, without jargon or acronyms, and repeat your main message in different ways. Avoid mumbling or speaking too fast when talking to media that will edit tape for "sound bites." Once you establish yourself as a credible, reliable source, the media will continue to come to you on related stories and will be more receptive to your own story ideas. 8. Which media strategies can your available resources support? Although getting news coverage is often thought of as free publicity, those press conferences, news releases, and slick media kits aren't cheap! The resources and effort your staff puts in makes it "earned media" rather than free. But when you compare the price of these activities to that of a mass media campaign and/or buying airtime or advertising space, pitching stories seems like a bargain. Of course, there is a time and place for investing in such a campaign if you have

the resources; when done well, you can reach large numbers of people in your target audience with your carefully crafted message. Make sure, in any case, that your organization has the capacity to respond if your chosen strategy is successful. If you are promoting a phone number to order a brochure or to speak with a counselor, for example, be prepared with adequate staff and phone lines as well as a large supply of brochures. 9. What other sources of free publicity are available in your community? Your community may have many media resources available to organizations like yours free of charge. Many cable companies provide free production facilities and airtime on their public access channel; for very little expense, your organization could develop programs on various topics. Local radio and television talk shows often look for guests with interesting stories or strong opinions on community issues. Public transit systems often offer free public service advertising space on their buses or subways. Television stations may be willing to work with your organization to create and air an ongoing campaign, giving your message better exposure than if you had sent your own public service announcements. Businesses might co-sponsor your campaign, supermarkets could place your message on their grocery bags, fast food restaurants could put your design on their placemats. Be creative and don't be afraid to ask for what you want . . . the worst they can say is "no" and more likely it will be "yes." 10. How will you know if you've been effective? Look back at your chosen media strategies. Did you achieve the goals and objectives you laid out? You can track the number of media "hits," or responses to your pitches, using clippings bureaus. These companies scan metropolitan and local community newspapers, television and radio news, and news wire services to provide you with clippings or transcripts of all stories mentioning your organization, a specific event, or topics of interest. If your goal was to increase the number of clients signing up for a program, look at enrollment before and after your media activities. If you wanted to increase community awareness of an issue, conduct a before-and-after survey to evaluate your campaign. Have the media come to rely on you as a trusted source? Has the level of attention to your issue heightened in the media since you began your efforts? You may be successful on many different levels, so be sure to identify all your accomplishments. Use each encounter with the media as a learning experience for the future.
Nedra Kline Weinreich developed these tips for the National Clearinghouse on Child Abuse and Neglect Information, a service of the National Center on Child Abuse and Neglect, U.S. Department of Health and Human Services.

Research in the Social Marketing Process

by Nedra Kline Weinreich

The social marketing approach differs greatly from how public health agencies have typically gone about developing programs or materials. In the past, health educators often focused on providing information to the general public about a particular topic, with the hope that the people who needed it would realize they are at risk and change their behavior as a result. In contrast, social marketers know that there is no such thing as "targeting" the general public. To be most effective, a program must precisely specify its target audience and use very customized methods to reach those people. In addition, social marketing does not rely solely upon educating people about an issue, but uses persuasive messages developed through research with members

of the target audience. The participation of the people for whom the program is intended is critical. A social marketing program has as its core the wants and needs of its consumers. These are determined through market research methods that aim to learn as much about the target audience and how it thinks, feels and behaves in relation to the issue the program is addressing. These methods include quantitative research, such as a knowledge, attitude and behavior (KAB) survey, which reveals how many people think or do something. Qualitative research, on the other hand, provides insight into why people think or do what they do, through techniques such as focus groups and individual interviews. The process of developing a social marketing program involves research at every stage, with constant reevaluation to assess whether the program is on track. This process consists of five general stages, each of which involves several different types of activities: 1) Planning; 2) Message and materials development; 3) Pretesting; 4) Implementation; and 5) Evaluation and feedback. The figure below visually depicts the process as a pyramid of sequential steps; in practice, social marketing is not necessarily a clear series of linear steps but rather a process of feedback and adjustment that might require revisiting past stages to make

changes based on new information.

The planning phase (Step 1) forms the foundation on which the rest of the process is built. To create an effective social marketing program, you must understand the problem you are addressing, the audiences you are targeting, and the environment in which the program will operate. Research is used to analyze these factors and to develop a workable strategy for effecting behavior change. The message and materials development phase (Step 2) uses the information learned in the planning phase to design the messages to be conveyed as well as the materials that will carry the messages to the target audience.

The pretesting phase (Step 3) involves using various methods to test messages, materials and proposed tactics with the target audience members to determine what works best to accomplish the program's objectives. It is not uncommon to go back and forth several times between development and pretesting as you make necessary changes in the messages, materials or overall strategy and explore whether the new approach works. In the implementation phase (Step 4) the program is introduced to the target audience. Preparation is essential for success and implementation must be monitored to ensure that every element proceeds as planned. Finally, the evaluation and feedback phase (Step 5) assesses the effects of the program as a whole as well as the individual elements of the strategy. Evaluation occurs throughout the process of program development, not just at the end, and feedback is used at each stage to improve the program.

Research in the Social Marketing Process

continued from Overview

Planning
An effective social marketing strategy must be built on the foundation of solid research. Without this, creative ideas may emerge, but like the lost pilot breaking the speed record described by Bill Bernbach, the wrong destination will be reached even more quickly. The purpose of research in this stage is to learn as much about the target audience and market as possible, in order to steer the program in the right direction. This may include both reviewing secondary research sources and conducting primary research, such as surveys, focus groups or in-depth interviews.

Secondary Research Review

When beginning a program, the crucial first step is to find any available information that is applicable to the marketing effort. Secondary data is information that has already been collected for another purpose--in journals, popular media, computer databases or other sources. A secondary research review can help to provide preliminary answers to questions about the scope of the public health or social problem, previous attempts to address the problem, who the probable target audience is, who the "competition" is (non-adoption of the "product" may be the main competitor) and information about potential media vehicles. In social marketing, key sources of information include technical and professional journals; national public opinion polls, health and consumer surveys; past coverage of the issue in newspapers, trade journals and consumer magazines; census statistics and other demographic surveys; government health departments; radio and television stations and local advertising agencies and market research firms. Each can provide different types of information, so it is desirable to be as thorough as possible in the research review. This method of information-gathering can be a relatively quick and inexpensive way to become familiar with the market and identify areas requiring further primary research. However, data from these sources may not always be current or accurate. In addition, the questions investigated in someone else's study may not be relevant to the program.

Focus Groups
Focus groups are an excellent method for obtaining information about the target audience's perceptions, beliefs and language regarding a particular topic. It is a qualitative method, which probes into the reasons that people feel and act the way they do. Focus groups give more depth of information than do surveys or other quantitative methods. By bringing together a group of similar people, a forum is provided for them to discuss a particular issue and react to each other's comments in a directed way that is not possible through individual interviews or participant observation. Focus groups are used often throughout the social marketing process, from the planning stages to development and refinement of the message and materials. In situations where time and cost are important considerations, focus groups may be the most efficient method of data collection. Among their many uses are: generating ideas about services or products, and pretesting product positioning, message concepts or pre finished communication materials. A focus group generally consists of eight to ten unacquainted participants, who are fairly similar to each other in terms of sex, age, ethnic background, risk factors and other relevant characteristics related to the target audience. The group is led by a trained moderator, who poses open-ended questions from a discussion outline and tries to involve everyone in the discussion. This occurs in a comfortable, non-threatening environment where participants are encouraged to speak what's on their minds, especially if it is different than what other people are saying. The discussion is usually recorded on audio or video tape, and lasts one to two hours. Although focus groups are an excellent technique for obtaining qualitative information from several respondents at once, there are some disadvantages to the method. First, people may be reticent to discuss sensitive subjects, such as sexual behavior, in front of a group. For certain topics, it may be more appropriate to conduct individual in-depth interviews, which use the qualitative probing questions of focus groups, but afford more privacy to the respondent. Another disadvantage is that focus group results are not directly projectable back to the target population (i.e., one can't report that "2 out of 5 gay men don't want to practice safer sex..."). However, after hearing the same thing from a number of participants, it is likely that their views are common to many in the target audience. The qualitative nature of the research and small sample sizes preclude the use of focus group results as baseline data for program evaluation.

Baseline KAP Study

Based upon the information unearthed by the secondary research review and/or focus groups, it should be possible to narrow down the scope of the problem. Prior to the implementation of a program, data are needed regarding audience awareness, knowledge, attitudes and behaviors related to the program issue. In order to guide the development of the marketing strategy and to provide a baseline from which to determine whether the program accomplishes its goals, a KAP (knowledge, attitudes and practices) study should be conducted. Using the preliminary research, the survey is drafted and pre-tested in order to evaluate its validity, reliability and to identify any other problems with its design. As with any survey, the interviewers must be trained, interviews must be conducted and data must be entered and analyzed. This can be an expensive and time-consuming undertaking. However, this type of survey can be very useful for identifying and understanding the audience better in terms of their demographics, psychographics and behaviors. Depending upon the validity of the technique used, the survey can help estimate how many in the population are "users" of the product (e.g., how many practice safer sex), identify

their attitudes toward the product and learn other quantitative information on the attributes of users and non-users. Many other important facts can be determined from the results of the KAP study. A crucial issue is the consumer's readiness to adopt the product. Within the population, there are many segments of people who have different levels of awareness, knowledge or adoption of the behavior. In Prochaska's "Stages of Change" model, consumers are thought to move along a "readiness continuum," consisting of different stages--from being unaware to aware, to knowledgeable, interested, motivated, ready-to-try, users, and then possibly non-users. The strategy that will be used for the program depends upon the point on the continuum at which the majority of the target audience is located. For example, gay males in San Francisco who may need help in maintaining their safer sex behavior would merit a much different approach than that used to create awareness among heterosexual females in the midwest. Depending upon the extensiveness of the study, other factors which can be identified may include the level of consumer demand for the social marketing product, insight into how to position the product, benefits and barriers to use of the product and the media habits of the target audience. A thorough qualitative analysis of the potential target audience should be conducted either as part of the development of the KAP survey or to further explore issues that arose from the survey. Once the target audience has been identified, the next step is to learn as much about them as possible. If this is done before the KAP questionnaire is developed, the information can be used to make the survey even more useful by giving insight into the consumers' lives, determining the language used by the target audience about the topic and identifying key issues which the researchers might not have recognized themselves. The most common methods used to gather this qualitative information are focus groups and marketing databases.

Marketing Databases
In addition to information about attitudes and behaviors related to a particular topic, social marketers need to know about their target audience's other habits in order to reach them most effectively and efficiently. Major marketing surveys, such as the DDB Needham Lifestyle Study, MRI (Mediamark Research, Inc.), Simmons Market Research Bureau's Study of Media and Markets (SMRB) and the Mendelsohn Research Survey of Adults and Markets of Affluence, provide a more in-depth understanding of target markets than standard demographic or consumer surveys. They provide extensive information on demographics, consumer buying habits and use of media. Another database, PRIZM, clusters similar types of consumers demographically, based upon their zip codes. Once the target audience has been identified, the database can be used to provide additional information about those people. In some cases, social marketers may want to better understand other groups who may influence those in the target audience. These may include spouses, parents, in-laws, doctors, policymakers or other influentials in their lives. For example, the parents of asthmatic children or husbands of women with breast cancer may be just as important to understand and target. This can be done through any of the methodologies described above.

Media Analysis
If the social marketing campaign will be using mass media to promote the message (as most will), it is crucial to identify the optimal media channels for placement efforts. Media planning and analysis are an important investment, even if relying upon stations to run public service announcements. If messages miss the target audience, the effort is wasted and will not be

successful. Two ways to increase the chances of reaching the target audience are: first, identifying the appropriate media vehicles and second, understanding the media "gatekeepers" who control the content and flow of information that reaches the target audience. In order to plan a successful media campaign, social marketers must know how best to reach the target audience. There are many sources of information on consumer media habits. Among these are the aforementioned marketing databases, along with the Scarborough Ratings Study and Arbitron/Nielsen Ratings. These databases provide information on demographics and media habits: television viewing (types of shows, dayparts, networks), radio listening (networks, formats and dayparts), magazines and newspapers read. These services can help to compare which types of media, and specifically which vehicles, are used most by the target audience. Based upon the cost of each, and the estimated gross impressions for the target audience (how many people it will reach), the most effective and efficient vehicles for the campaign can be determined. All of these databases vary, however, in terms of geographic breakdown, income levels sampled and information beyond bare demographics. For example, the Mendelsohn Research Survey of Adults and Markets of Influence samples only people with household incomes above $60,000. These databases may not be a very good source of information on lower-SES audiences, for they are difficult to reach through phone surveys, and are not of much interest to marketers because of their low amount of expendable income. There are a couple of sources that focus on minority media habits, such as the US Hispanic Market, from Strategy Research Corporation. After identifying the key media vehicles for the campaign, social marketers must research and understand the media gatekeepers at these vehicles who are most important to their program. These people include editors, producers, writers, talk show hosts, public service directors and other influentials in associations and organizations. Ideally, a survey should be conducted to determine their awareness, knowledge and attitudes on the issue, their interest in the topic and their perceptions of how their audience views the topic. A gatekeeper audit aids in predicting how these influential people will react to the social marketing program, allowing proactive strategizing. Combining the information gleaned from all of the sources in the planning stages will produce a strong foundation for building an effective program.

Integrating Quantitative and Qualitative Methods in Social Marketing Research by Nedra Kline Weinreich
Introduction
Traditionally, research in the field of health promotion has followed in the footsteps of its "older brother," medicine. However, the reductionistic model of disease causation cannot adequately describe the complex mechanisms that influence health behavior. Social marketers working to promote health have learned that rigorous quantitative research surveys do not necessarily provide all of the data needed to develop effective communications. Consequently, qualitative methods such as focus groups and in-depth interviews, as well as less precise but useful semiquantitative approaches, such as intercept surveys, have emerged as part of their research repertoire. In an ideal social marketing program, researchers use both quantitative and qualitative data to provide a more complete picture of the issue being addressed, the target audience and the effectiveness of the program itself. The purpose of this paper is to look at how these two different research approaches can be integrated to inform the development of an effective social marketing program.

Qualitative and Quantitative Methods: A Comparison

An examination of the quantitative and qualitative paradigms will help to identify their strengths and weaknesses and how their divergent approaches can complement each other. In most cases, researchers fall into one of the two camps--either relying exclusively upon "objective" survey questionnaires and statistical analyses and eschewing warm and fuzzy qualitative methods, or using only qualitative methodologies, rejecting the quantitative approach as decontextualizing human behavior. However, social marketing researchers recognize that each approach has positive attributes, and that combining different methods can result in gaining the best of both research worlds. Quantitative research uses methods adopted from the physical sciences that are designed to ensure objectivity, generalizability and reliability. These techniques cover the ways research participants are selected randomly from the study population in an unbiased manner, the standardized questionnaire or intervention they receive and the statistical methods used to test predetermined hypotheses regarding the relationships between specific variables. The researcher is considered external to the actual research, and results are expected to be replicable no matter who conducts the research. The strengths of the quantitative paradigm are that its methods produce quantifiable, reliable data that are usually generalizable to some larger population. Quantitative measures are often most appropriate for conducting needs assessments or for evaluations comparing outcomes with baseline data. This paradigm breaks down when the phenomenon under study is difficult to measure or quantify. The greatest weakness of the quantitative approach is that it decontextualizes human behavior in a way that removes the event from its real world setting and ignores the effects of variables that have not been included in the model. Qualitative research methodologies are designed to provide the researcher with the perspective of target audience members through immersion in a culture or situation and direct interaction with the people under study. Qualitative methods used in social marketing include observations, in-depth interviews and focus groups. These methods are designed to help researchers understand the meanings people assign to social phenomena and to elucidate the mental processes underlying behaviors. Hypotheses are generated during data collection and analysis, and measurement tends to be subjective. In the qualitative paradigm, the researcher becomes the instrument of data collection, and results may vary greatly depending upon who conducts the research. The advantage of using qualitative methods is that they generate rich, detailed data that leave the participants' perspectives intact and provide a context for health behavior. The focus upon processes and "reasons why" differs from that of quantitative research, which addresses correlations between variables. A disadvantage is that data collection and analysis may be labor intensive and time-consuming. In addition, these methods are not yet totally accepted by the mainstream public health community and qualitative researchers may find their results challenged as invalid by those outside the field of social marketing.

Social Marketing Research

The traditional health promotion professional conducts research at the beginning of a project to develop an intervention, and again at the end to evaluate the effectiveness of the intervention. In contrast, social marketers utilize research throughout the planning, development, implementation and evaluation phases of the program; social marketing is a process of continuous

development and testing. Many of the tools used to develop social marketing programs--focus groups, consumer marketing databases, intercept surveys--have their origins in the field of commercial market research, and are based on "what works" for gathering various types of needed data. Social marketing relies upon consumer-focused research to learn as much about the target audience as possible by looking at their lives from many different angles--both quantitatively as part of a larger group and qualitatively to investigate individual attitudes, reactions, behaviors and preferences. Social marketing programs use research throughout the life of a project. Research in social marketing is conducted specifically to help make better decisions at key points in the process (Andreasen, 1995). These decisions may include which target audience, messages and media to choose; whether to make changes in program strategy during implementation; and whether to continue the program. Pinpointing the facts needed to make these decisions will help to identify the best methods for subsequently collecting this data. Some types of information may require quantitative data collection methods, such as detecting any measurable differences in knowledge or behaviors once the program has been implemented. Soliciting audience reactions to a selection of program messages, on the other hand, may be best done through qualitative methods. An effective and responsive program requires a combination of research approaches in order to have the data needed for decision making. Professionals who come to social marketing from a traditional health promotion background may have a difficult time in reconciling their notion of "what research is" with some of the methods that social marketers have appropriated from the commercial marketing tool kit. Even those who are committed to using a mix of research methods may encounter institutional resistance to deviating from the quantitative paradigm, particularly when the proposed research will occur in a governmental or academic setting. However, as the field of health promotion evolves from a focus on individual lifestyles and risk factors to a broader concept of social and environmental factors influencing morbidity and mortality, researchers must employ a variety of methods to reflect this new perspective.

Toward an Integrative Social Marketing Research Model

As a useful starting point, Steckler et al. (1992) have delineated four possible models of integrating qualitative and quantitative methods in health education research. In the first approach, qualitative methods contribute to the development of quantitative instruments, such as the use of focus groups in questionnaire construction. The second model consists of a primarily quantitative study that uses qualitative results to help interpret or explain the quantitative findings. In the third approach, quantitative results help interpret predominantly qualitative findings, as when focus group participants are asked to fill out survey questionnaires at the session. In the fourth model, the two methodologies are used equally and in parallel to crossvalidate and build upon each other's results. Social marketers may operate under one or more of these models; the approaches are not mutually exclusive. A social marketing model for integrating methods must include quantitative and qualitative methods at each stage of the process for formative research, process evaluation and outcome evaluation. While each program is unique, the model proposed here can be adapted based on available resources. See Figure 1, Integrative Social Marketing Research Model.

Integrating Formative Research

During the formative research stage, in which the goal is to learn as much as possible about how the target audience thinks and behaves in relation to the issue being addressed, a host of research methods provides many different data "viewpoints" for seeing the big picture. Exploratory research conducted at the beginning of the project reviews previous research involving both quantitative and qualitative data and can include interviews with those who have previously attempted to address the issue. This research will help in the initial development of the project strategy to delineate the parameters of the project, steer the selection of the target audience, specify the potential behaviors to be promoted and identify lessons learned and potential pitfalls. Focus groups conducted for exploration also yield valuable qualitative data regarding the target audience, providing insights into their language, issues and obstacles they identify, and meanings attributed to beliefs and behaviors. Information learned from the initial focus groups can then be used to inform questionnaire construction for a population survey to collect hard numbers for baseline data. The survey will also help to segment the target audience based upon its distribution across the stages of behavior change, as described by the Transtheoretical Model of Behavior Change (Prochaska and DiClemente, 1983), or other characteristics. In addition, commercial marketing databases, while quantitative in nature, provide highly detailed profiles of target audience segments for message development and channel selection. The messages and materials developed based upon the exploratory research should be pretested using both qualitative and quantitative methods so that the results provide depth of understanding as well as generalizability. Focus groups provide a valuable means to pretest messages and materials, for audience members can provide spontaneous reactions and explain their responses. This method, however, can only indicate trends and cannot yield hard quantitative data needed for definitive decision making. If enough focus groups are conducted and participants are considered representative of the target audience, a survey questionnaire may be administered either before or after the focus group to collect numerical data as well. A central-site intercept survey, in which potential audience members are approached in a public area and asked to respond to a quick questionnaire, provides another method of pretesting materials. The fast turnaround nature of this method and high volume of responses makes it ideal for testing draft executions of materials such as print or television ads prior to production and implementation. This method is considered semi-quantitative because respondents are not selected from a random sample, but questions are usually closed-ended and tabulated statistically. Final decisions, such as choosing from among several possible ads, can be made based on the numbers this method yields.

Integrating Process Evaluation

Upon implementation of the program, process evaluation helps to keep the project on track and signals when changes are needed in the program strategy. The most common data collection activity in this phase involves counting--materials distributed, number of people attending activities, broadcasts of the television or radio ads, media coverage of events, phone calls to the organization--to ensure that the project proceeds as intended. Other quantitative tracking mechanisms, such as consumer surveys, identify whether the program's message is reaching the target audience and is getting its attention and motivating action. In an ongoing multi-year project, this may be a repetition of the population survey conducted at the beginning; for a shorter-term project, a survey may target a very specific audience segment.

Qualitative process evaluation methods can include periodic interviews or focus groups with target audience members to assess their progress toward behavior change. Through these activities, participants may inform program administrators of unforeseen barriers or opportunities to adopting the behavior that need to be addressed to increase chances of success. Observations of audience members may also provide clues to needed changes in program strategy or messages in case they are using the product in an unsafe manner or performing the target behavior incorrectly. The quantitative and qualitative process research can be conducted simultaneously to collect and react to data.

Integrating Outcome Evaluation

Both types of research are instructive in identifying the program outcomes. A repeat of the quantitative population survey will provide an indication of whether the program realized its objectives in raising awareness, changing attitudes and initiating behavior change. Related decreases in morbidity and mortality or other major indices will be more difficult to claim without also conducting a matched community intervention study, with the only difference between the communities being the presence of the social marketing program. In the end, the quantitative data emerging from the survey are generally used as the final arbiters of success. However, qualitative research can point out successes that may have occurred on a more human scale through anecdotes about how the social marketing program made a difference in someone's life. Focus groups, interviews and other methods of collecting individual people's stories and responses to the campaign are valuable in learning which components of the program were successful and how the next project can be improved. Both types of research are necessary to assess the full extent of the program's impact upon the target audience.

Conclusion
Integrating quantitative and qualitative research methods lends depth and clarity to social marketing programs. This combination of approaches is necessary because of the wide range of data needed to develop effective communications. However, the potential for problems exists when attempting to combine such divergent research paradigms; one may end up not doing either type of research well. This integrative approach therefore requires a research team with expertise in both types of methods. Using multiple approaches can also be time-consuming, labor-intensive and expensive. Another obstacle, which will likely change as social marketing gains in usage, is that combining multiple methods is still not widely accepted as a viable research strategy--at least in mainstream public health circles. As social marketers demonstrate that such research is necessary to fully understand and address many health-related issues, the research norms and scientific dogma regarding appropriate methods may shift to a new, more integrative paradigm.

References
Andreasen AR (1995). Marketing Social Change. San Francisco: Jossey-Bass Publishers. Prochaska JO, DiClemente CC (1983). "Stages and Processes of Self-Change in Smoking: Toward an Integrative Model of Change." Journal of Consulting Clinical Psychology , 5:390-5.

Steckler A, McLeroy KR, Goodman RM, Bird ST, McCormick L (1992). "Toward Integrating Qualitative and Quantitative Methods: An Introduction." Health Education Quarterly, 19:1-8.
This article originally appeared in the Winter 1996 issue of the Social Marketing Quarterly.

The "Don't Kid Yourself" Campaign

Case Study

Excerpted from Hands-On Social Marketing: A Step-by-Step Guide by Nedra Kline Weinreich (Sage Publications, 1999)

BACKGROUND
The "Don't Kid Yourself" campaign was funded by the U.S. Public Health Service's Title X family planning grant program in a six-state region: Colorado, Montana, North Dakota, South Dakota, Utah and Wyoming. As one element of their initiative to reduce unintended pregnancies in the region, the grant administrators from each state decided in 1995 to pool their resources to develop a social marketing program. Organizers of the project formed a steering committee composed of representatives from each state and the Public Health Service regional office. Although most of the grantees were state health departments, the project was headed up administratively by the Planned Parenthood Association of Utah. The steering committee members first educated themselves by attending a major social marketing conference. Once they determined that they wanted to employ a social marketing campaign, they put together a Request for Proposal (RFP) and sent it to social marketing firms and consultants to solicit bids for the project. After a long proposal review and interview process, they ultimately selected Weinreich Communications to lead the campaign.

PLANNING

Initial Planning
In the "Don't Kid Yourself" campaign to prevent unintended pregnancies, the contract specified a six-month development and pilot-testing phase before extending the campaign to the entire region, so there was no time to waste. The project began with a meeting of the steering committee, the contractor and the subcontractor to refine goals and objectives, as well as to define key parameters of the project. The committee specified the target audience as women between the ages of 18 and 24, with household income of less than 200% of the poverty level. This group was chosen for several reasons: 1) The Title X program is intended to benefit lowerincome women; 2) the 18 to 24 year old group is at the highest risk of experiencing an unintended pregnancy and does so in the greatest numbers; and 3) the committee felt that there were already many programs addressing adolescent pregnancy, but that young adults had been underserved on this issue. The committee selected two pilot sites for the purpose of developing and testing the campaign. After a process of elimination, Salt Lake City, Utah and Butte, Montana were chosen as being representative of the larger and smaller cities in the region. They were also relatively easy to access for travel purposes and had family planning clinics that were eager to participate in the campaign development.

Analysis
For the problem analysis, the contractors first conducted a literature review to learn more about the causes of unintended pregnancies and previous approaches used to address the issue. They also gained some valuable insights by interviewing professionals at a number of organizations that had addressed this issue through the mass media. In both cases, they did not find much information related to their target audience; most of the other programs had focused on teenagers or women in urban populations. The environmental analysis revealed that people in this region tended to be politically conservative and that certain religious groups predominated in the two cities chosen as pilot sites -- Mormons in Salt Lake City and Catholics in Butte. Many of the school systems in the region do not teach about contraception or pregnancy prevention as part of the sex education curriculum. In many of the smaller cities and less populated areas, the Title X-funded family planning clinics are the only organizations addressing the issue of unintended pregnancies in their communities. In addition, the two biggest cities in the region, Salt Lake City and Denver, have a relatively larger number of minority residents than most of the other cities, which comprise very small minority populations. In analyzing the resources available to the project, the contractors determined to do what they could to minimize the costs of research and development. This included using existing resources, such as staff and facilities, whenever possible, as well as enlisting volunteers to assist with various tasks. The focus would also be on using less expensive media options and maximizing the gain from every dollar spent.

Segmenting and Researching the Target Audience

Beyond the characteristics specified at the project kick-off meeting, the contractors decided to narrow the target audience further. The additional segmentation criteria included whether the individual was sexually active and, if so, whether an effective contraceptive method was used every time she had sex. The project would focus its resources on one very specific segment of the population, defined as follows:

Women Ages 18 to 24 Household income of less than 200% of poverty level Sexually active Do not use contraception every time they have sex.

To research this target audience, the contractors conducted focus groups in Salt Lake City and Butte with three different categories of women: those who used contraception consistently, those who did not use contraception consistently and women who had experienced an unintended pregnancy. The focus groups were designed to elucidate the target audience's decision-making process related to contraceptive usage and its thinking about unintended pregnancies. The project recruited participants directly from the family planning clinics; through flyers on college campuses and in county social service offices; and with advertisements in local and campus newspapers. In Butte, the family planning clinic recruited students from the local alternative high school, which served many women who had already had an unintended pregnancy or were at risk of doing so. The key findings from the focus groups were that:

Target audience members experience ambivalence about birth control. They know it's the smart thing to do, but they have many excuses for their failure to use it. Many of the women engage in irrational thinking, such as "It can't happen to me" or "We'll be okay just this once." Target audience members do not learn much about how to prevent pregnancies in school or from their parents. They need basic facts about contraception and a place to receive nonjudgmental information. Women who had babies as a result of an unintended pregnancy said that if they had known how difficult it would be to raise a baby and everything they would have to give up, they would have been more careful about using birth control. The support of male partners and their cooperation in using condoms is needed. Target audience members need help in talking about this issue with their partners.

Strategy
In addition to the primary target audience, the contractors decided to address a secondary audience as well: male sexual partners between the ages of 18 and 24. The key behavioral objectives developed to support the goal of reducing the number of unintended pregnancies throughout the region included that after the campaign's completion: 1) target audience members will use an effective form of contraception every time they have sex; 2) target audience members will seek information on their birth control options; 3) target audience members will initiate a discussion with their sexual partners regarding the use of birth control; and 4) male partners will use condoms every time they have sex. Attainment of the objectives were to be assessed through the detection of statistically significant increases in responses between a pre-campaign and post-campaign survey. Because the research showed that friends were the group most often consulted about sexual issues, peers would model the desired behaviors and help establish social norms. The strategy also included getting target audience members to think about what it would mean for them to become parents at this point in their lives. The campaign would provide basic information about birth control options and where to go for more assistance. Other secondary messages included the notions that men should be responsible and informed about contraception and that these issues should be discussed with one's sexual partners.

MESSAGE AND MATERIALS DEVELOPMENT

Once the "Don't Kid Yourself" campaign developers had decided on the project's target audience and objectives, they were ready to begin thinking about the messages and materials they would use to encourage the regular use of contraception. Based primarily on the information gathered during the focus groups, they selected appropriate channels, developed message concepts and created executions of draft materials.

Channels
Radio was selected as a key element of the campaign for many reasons. First, in the focus groups, nearly all participants said that they listened to the radio regularly. Second, radio allowed the campaign to precisely target women ages 18 to 24 and reach a large percentage of that population. Third, because radio is ever-present in many people's lives, target audience members might hear the messages in situations in which the need for birth control is imminent; the radio spot may serve as a reminder and make it more likely that they use it. The spots could also promote conversations about birth control issues when friends or partners were together. Finally,

older people who might be more likely to be offended by the ads were less likely to be listening to the same stations as the 18 to 24 year olds. The focus group research showed that many of the women read particular types of newspapers or sections of the paper. Newspaper ads were used to reach those who respond better to visual information or who do not hear the radio ads. They also provided the phone number and campaign messages in a form that could be cut out and kept until someone was ready to call. In Salt Lake City, women said they read the alternative and college newspapers geared toward young adults rather than the main newspapers. In Butte, they read certain sections of the main newspaper: Dear Abby, horoscopes, comics, birth announcements and the crime report. Ads would be placed as close to these sections as possible. A set of posters was planned to get the campaign message out through community organizations, including clinics, schools, businesses, government agencies, recreational facilities and local "hangouts." The focus group participants identified a need for information best provided via two brochures. One would help women understand their birth control options, while the other would assist in bringing up the issue of using birth control and condoms with the women's sexual partners. Drink coasters were also chosen to communicate the campaign's message because focus group participants said that bars, clubs and coffeehouses were good places to reach women ages 18 to 24. In Butte in particular, drinking was one of the primary social activities; those under 21 did not have any problem being admitted into bars or purchasing alcohol. In these venues, potential sexual partners or groups of friends drinking together could use the coaster as a method of initiating conversations about birth control.

Messages
The initial message strategy was based on a combination of elements from various theories. From the Health Belief Model, the messages would include information on the risks of having sex without contraception and the consequences of having an unintended pregnancy. The "cue to action" would be a toll-free number included in every communication. From the Theory of Planned Behavior, the campaign would seek to change the perception of social norms. And from the Social Cognitive Learning Theory, the approach would include an emphasis on peer role modeling as well as providing skills to build self-efficacy. From all of these theories, the messages would promote the benefits of the behavior as well as reducing the barriers. The key message concepts the campaign needed to convey were:

You are likely to become pregnant if you do not use birth control consistently. Birth control helps you wait to have a baby until you are financially and emotionally ready. If you are sexually active, get the facts about birth control. Sure, birth control can be a hassle. But what about the alternative? Birth control is something you should talk about with your partner.

A factual and straightforward tone, along with a dose of friendly empathy, would be used to urge the target audience to seek more information through a toll-free number or at a family planning clinic. The campaign would get its messages across through peer testimonials, dramatic vignettes, visualization of consequences and straight facts presented in a nonjudgmental style

using the audience's own words as much as possible. These elements, along with distinctive graphics and typefaces, would project a young, hip image for the campaign.

Executions
Eleven different radio spots were created, using both written scripts and dialogue taken directly from taped interviews with men and women in the target audiences. Each spot had a separate objective and a distinct target audience segment. The campaign created this number of spots in case some needed to be eliminated based on pretesting, and also to have a variety to choose from over the course of the campaign. An artist produced a series of visual concepts to go along with the campaign messages. The project staff designed a variety of draft posters using the artist's drawings and a word processor. A set of four newspaper ads were also designed in several different sizes, along with different versions of the drink coaster. The brochures were laid out using a word processing program to pretest the text before going on to the graphic design. These provided in-depth information and skills-building content at an appropriate reading level, using the target audience's own language.

PRETESTING
Once the messages and materials were drafted for the unintended pregnancy prevention campaign, the project contractor pretested them in several ways. The Salt Lake City and Butte family planning clinics again brought together focus groups, including some with young men, to test the messages, visual concepts, radio spots and brochures. The materials were reviewed by members of the project steering committee who knew the subject matter and were familiar with the target audience. All print materials were also tested for readability using the SMOG formula. Later drafts of the brochures were tested in individual interviews with family planning clinic clients in each state as well. Although the pretesting results were very positive overall, the focus groups and expert reviewers identified areas in many of the materials that required modification. Some examples of the changes made based on the pretesting feedback are:

The "Jason and Miranda" radio spot originally had the soap opera actors behind the camera shift to speaking out of character during a break from filming and commenting on how irresponsible and unsafe their characters were being. The focus group participants found this too confusing, so it was changed to viewers of the soap opera making the comments. This spot also used old-fashioned soap opera music that reminded many in the focus groups of a recent margarine commercial, so new music was created. Another radio spot highlighted the positive effects of oral contraceptives. Though it originally began by stating that the Pill helps prevent cancer of the ovaries and uterus, focus group participants said that some of the other effects were more salient to them, like cutting down on menstrual cramps and PMS. These features were moved to the beginning of the spot. Some of the radio spots that used sound bites from interviews with real people were not totally clear because of problems with enunciation or confusing phrasing. These were retaped using actors when necessary. Out of the six visual concepts for posters, two were eliminated based on feedback from the focus groups. One idea of showing a lottery ball machine with pictures of babies on some

of the balls did not go over well in Utah, where gambling is discouraged and which therefore does not have a state lottery. On the other hand, a concept that visually depicted the statistic that nine out of ten young women will become pregnant in a year if they use no birth control resonated with nearly all of the participants. The focus group participants really liked the brochure on birth control options because of its non-medical nature and use of their own slang words. Based on their suggestions, the contractor added information on the costs of each method and changed some wording to make it more clear.

The campaign tagline, "Don't Kid Yourself," also emerged from the pretesting focus groups. One participant in Salt Lake City, summing up the message in the poster visuals, said "I think it should be something like don't kid yourself.' These aren't accidents, they're excuses." This phrase was a nice double-entendre that concisely stated the campaign's message in both of its meanings. The fact that it came from a target audience member was an added bonus. Once the changes were made based on the pretesting feedback and the final materials were approved by the steering committee, the contractor had the materials printed and radio ads taped and duplicated. The campaign was almost ready to be pilot-tested in Salt Lake City and Butte.

IMPLEMENTATION
Implementation of the "Don't Kid Yourself" campaign in the pilot cities occurred over the course of two months between May and July 1996. The implementation plan helped to identify what needed to be done before the campaign kick-off. The clinics in Butte and Salt Lake City developed dissemination plans for distributing the posters, brochures and coasters throughout the community. The people who answered the phones at each clinic were briefed on the campaign and provided with information on how to respond to community complaints about the campaign. The contractor negotiated and purchased radio advertising time on several stations in each city that focus group participants had indicated were popular with their peers. In most cases, the stations provided free spots as public service announcements for each spot that was purchased for the campaign, or at least lowered their normal rates. The newspaper advertisements were also placed at nonprofit rates in the alternative and college papers in Salt Lake City, in certain sections of Butte's main newspaper, and in its local shopper. In addition to the paid advertising, a press release was sent out to local media outlets announcing the "Don't Kid Yourself" campaign. Prior to the beginning of implementation, several tracking systems were put in place to help assess the effects of the campaign. A caller tracking sheet was developed and used to tally how callers answered the question, "How did you find out about us?" Surveys were distributed to target audience members at the clinics throughout the entire implementation period to assess whether respondents were exposed to elements of the campaign. Blank "diaries" were placed in the clinic waiting rooms with instructions on the cover about the types of comments that were sought, along with a pen attached to each book. A press clipping service was also hired to track any resulting media coverage of the campaign. Implementation ran fairly smoothly over the two-month period. Many local businesses and other organizations were willing to participate in the campaign by putting up posters and using the coasters in the bars and clubs. One of the newspaper ads had to be pulled from the Butte newspaper because a local health official felt it was too explicit and would not provide his approval to run it. Although there were some negative phone calls related to the campaign, many more positive comments were received. The tracking systems were not consistently used by the

receptionists, so the results were somewhat spotty for the caller tracking sheets and clinic surveys; many receptionists found it difficult to add another procedure to their regular routine. Although entries in the clinic diaries did not usually refer directly to the campaign, most of the comments were very positive about the care received in the clinics, and this improved morale among the staff members. In both cities, patients in the target audience provided positive feedback about the campaign when they came to the clinics.

EVALUATION
The evaluation of the "Don't Kid Yourself" campaign included a pilot testing phase and both process and outcome measures for the regionwide campaign.

Pilot Test
The campaign was pilot tested in Butte and Salt Lake City to determine how best to implement it in all six states.

Process Evaluation
The process evaluation in the pilot testing phase provided information on whether the campaign was reaching the target audience and how callers had found out about each clinic. Clinic surveys were filled out by clients when they came in for their appointments to assess their exposure to the campaign. In the Butte clinic, 61% of the target audience members had seen or heard campaign materials. In Salt Lake City, 51% of target audience members coming into the clinics had been exposed. The surveys also revealed that younger teens, outside of the target audience, were also seeing and hearing the campaign. Caller surveys, which asked "How did you find out about us?," revealed that the campaign comprised the third most common method of learning about the clinics in both cities. Based on the process evaluation results, campaign planners felt that they had chosen the right media to reach the target audience. However, the campaign had to be delayed from its original start date because the printing and distribution of the materials took longer than anticipated. In addition, campaign monitoring revealed that clinics received very few community complaints, although an official in the Butte health department had one of the newspaper ads pulled because he felt it was too explicit. Clinic directors found that several community organizations were less enthusiastic about using two of the four posters; they also felt that the size of the posters was too large for the locations they wanted to hang them up, such as bulletin boards and restroom stall doors.

Outcome Evaluation
The outcome evaluation methods varied in each of the two cities, depending on the resources available to each community. A pre-campaign and post-campaign KAB survey was planned for both cities using random telephone sampling of the target audience. In Butte, the state health department was able to provide access to a professional research firm, which conducted the surveys. In Salt Lake City, however, the campaign had to rely on volunteers to serve as interviewers; despite some training, it soon became apparent that respondents were not willing to answer the sensitive questions they were being asked. This may have been because of the more conservative nature of Salt Lake City residents or because of the inexperience of the interviewers. The survey was completed in Butte, but was deemed too inefficient to pursue in Salt Lake City.

The significant differences between the pre- and post-campaign surveys in Butte included a doubling of awareness of the Butte family planning clinic as a place to go to for information, from 21% in the pre-test to 40% in the post-test. Attitudes about responsibility for birth control also changed between the pre-test and post-test surveys in a statistically significant way. More people agreed or agreed more strongly with the statements "Men should take responsibility for birth control during sex" and "Women should take responsibility for birth control during sex." Because one of the radio ads discusses the benefits of the birth control pill, the survey also tested knowledge about the pill. Although respondents were not better able to name benefits of the pill in the post-test, fewer people stated that the pill had no good effects (pre=11%, post=1%). The post-test survey also asked respondents about their exposure to the social marketing campaign. Overall, 51% of the respondents reported that they had seen or heard at least one element of the campaign. Of those who reported exposure to campaign materials in the postcampaign survey, 79% said it made them think about the message, 29% talked about the ads with friends or family, 18% discussed the ads with their partner and 11% used birth control more often because of the campaign. On the less encouraging side, nobody reported calling the phone number featured in the materials and the clinic's records did not show a noticeable change in the number of clinic visits during the period in which the campaign was implemented. Planned Parenthood has a toll-free number that automatically routes callers to the affiliate clinic nearest them; this was the phone number the campaign promoted in Salt Lake City. The Salt Lake City clinics provided phone records showing the numbers of incoming calls to them each month. During the two months of the campaign, the clinics experienced a 72% increase in the number of calls received to the toll-free number. The number of calls declined after the campaign ended. When compared to the same months in previous years, the increase did not appear to be related to seasonal patterns. There was not, however, a noticeable change in the number of clinic visits during the period in which the campaign was implemented. Although the campaign appears to have spurred the adoption of desirable behaviors in Butte, as well as an increase in phone calls to the Salt Lake City clinics, the decision to visit a family planning clinic may not be immediate or even necessary for behavior change to occur.

Regionwide Implementation
To expand the successful pilot campaign to the entire six-state region, several changes and new procedures had to be put in place. Each state's campaign was directed at the state level, with an on-site campaign coordinator at each participating clinic. The materials were customized for each state with its own toll-free phone number. Based on the pilot testing, the contractor knew to leave extra time for printing and dissemination of the materials to make sure they were out in the community at the same time as the radio spots were airing. In addition, the posters were made smaller and only two of the four designs were reprinted. Different sets of the radio spots were used in each state, based on the results of the pilot test and the decision of the state-level coordinator as to which spots were most appropriate for her state. The campaign was implemented in 55 cities throughout the six states for a three-month period. An independent evaluator was hired to assess the effectiveness of the regionwide campaign. The process evaluation consisted of: 1) Qualitative questionnaires completed by the state grant directors, clinic managers in targeted cities and the project director; and 2) Focus groups with clinic staff in three sites. The outcome evaluation provided qualitative and quantitative data from 19 evaluation sites regionwide through: 1) Pre- and post-campaign KAB surveys; 2) Qualitative in-depth interviews with members of the target audience; and 3) Caller tracking sheets from the clinic evaluation sites.

Process Evaluation
The process evaluation identified some areas that required improvement. Despite having begun production of the print materials well in advance, one state delayed printing because it took much longer than expected to receive approval through its bureaucratic channels for a toll-free phone number. In addition, a mix-up by the printer resulted in boxes of coasters being sent to the wrong states. This cut the time available for the state-level coordinators to get the materials out to the local clinics and delayed the start date of the campaign. Although a comprehensive implementation guide was provided to each state-level coordinator to assist clinics in their dissemination efforts, some clinic managers did not always read it or required additional guidance. This resulted in several local clinics not distributing the print materials _ such as posters, brochures and coasters _ in their communities. There were clear differences in the visibility of the campaign in cities with active clinic outreach efforts versus those that relied solely on the radio spots and newspaper ads. The focus groups with clinic staff revealed that some of the clinics actually taped over the tollfree phone numbers on the posters and wrote in their own local numbers. Several participants noted that their clients would feel more secure knowing exactly who they were calling. In addition, staff at participating clinics preferred to use the publicity from the campaign to increase clients at their own clinics versus other competing providers. The low usage of the tollfree numbers also suggested that use of local phone numbers might be preferable. When buying newspaper space, a small number of the media outlets declined to run the ads because their staff felt they were too explicit. This occurred in some of the college newspapers _ particularly the religiously-affiliated schools _ and in community newspapers primarily in South Dakota and Utah. Two major newspapers in South Dakota refused to run the ads, but then both wrote substantial articles about the campaign that included the main messages and toll-free number, with one even including a picture of one of the posters.

Outcome Evaluation
The outcome evaluation produced both good news and bad news. The bad news was that the campaign media had not saturated the markets to the extent hoped for: Based on the postcampaign KAB survey, only 15 percent of the target audience reported being exposed to the "Don't Kid Yourself" campaign. The good news was that those target audience members who were exposed to the campaign responded quite positively. The survey revealed that 92 percent of those exposed to the campaign materials reported that they "liked the message." Nearly 70 percent saw a poster, more than double the exposure of any other campaign medium. Significant attitude changes about the use of birth control were also correlated to the number of campaign media to which the respondent was exposed. Survey respondents who were exposed to the campaign also overwhelmingly took some desirable action. More than three-quarters of those exposed indicated that they "talked with friends, boy/girlfriend, or parents about family planning" as a result of the campaign. Over 55 percent reported that they called for information or an appointment at a doctor's office or family planning clinic as a result of the campaign, but fewer than 5 percent of the respondents called the toll-free phone number advertised in the materials. Despite not calling the toll-free number, about a quarter of the respondents said that they called for an appointment at a family planning clinic as a result of the campaign _ most likely on the clinic's local phone number.

The campaign started its third phase of implementation in Spring 1998. Based on results of the first year of regionwide implementation, the next iteration of the campaign focused on a smaller number of cities in each state to maximize the media exposure that was possible with available resources. The use of toll-free numbers was discontinued in most states, and materials were created for each community using local clinic names and phone numbers. Greater outreach and accountability from local clinics was required as a condition of the inclusion of their community in the campaign.

Nedra Kline Weinreich : President Weinreich Communications

Building Social Marketing into Your Program

First-time social marketers often feel overwhelmed by the rigorous market research processes they see in other large-scale programs. They may hesitate to incorporate social marketing activities into their own programs, unsure whether they have the resources and expertise to undertake such a project. The following ten tips are designed to help those new to the field to understand the basic principles of social marketing, with practical suggestions on how to implement these concepts in any type of program. 1. Talk to your customers. The key to effective social marketing is talking (and listening!) to the people you are trying to reach. Social marketing is a customer-driven process. All aspects of your program must be developed with the wants and needs of the target audience as the central focus. In order to learn what your customers want, you must ask them! A little ingenuity may be necessary to find cheap and easy ways of gathering information. It may be as simple as going to where the people are and talking to them. For example, sit out in the reception area and talk to people waiting to use your services. Go to the local mall to talk to teenagers hanging out there. Go to the laundromat and talk to people as they wait for their clothes. Ask them if they know of your organization and what you offer. See how they talk about experiences they have had with your issue and find out what they need to help them use your services or perform the behavior you're promoting. You'd be surprised at how willing people are to talk about themselves and how delighted they are to be asked for their opinions.

2. Segment your audience. Good marketers know that there is no such thing as selling to the general public. Men and women, adults and teenagers respond differently to particular approaches. To be most effective, you need to segment your target audiences into groups that are as similar to each other as possible and to create messages specifically for each segment. Typical attributes for segmentation include sex, age, geographical location and race/ethnicity. You can also segment your audience by behavior. For example, rather than targeting all teenagers, a smoking prevention program might focus upon African American girls between the ages of 12 and 18 who have never smoked. A smoking prevention program for middle-aged men who are ex-smokers would use a very different approach. Of course, people still vary greatly within these segments, but the more specific you can get, the greater your potential impact. The audience segments targeted may not always be the same people your campaign addresses. If your research shows the people you want to reach are more likely to listen to their family members or doctor, you may have more success with a message to those secondary groups urging them to talk about the issue with the person whose behavior you ultimately want to change. A nonprofit organization may have several audiences it

needs to address: its "customers," its donors, the media, policymakers and the board of directors. Each of these groups requires its own marketing strategy.

3. Position your product. In social marketing, our products are often hard to promote because of their high "price." Products like behaviors and attitudes require longterm commitments and do not sell as easily as a bar of soap or a car. The cost of a social marketing product often includes a person's time and effort (to attend a class or use services), giving up things he likes (high fat food), embarrassment or inconvenience (buying and using condoms), or social disapproval (resisting peer pressure to smoke). To counteract factors working against adoption of the product, we need to acknowledge these potential problems and address them. Your product positioning determines how the people in your target audience think about your product as compared to the competition. Just as various cigarette brands bill themselves as the freshest, the most fun, the most athletic, the least expensive, the classiest, or the most feminine, your product needs to be positioned in relation to the alternatives. Product positioning is usually based on either the benefits of the product (what will it do for me?) or removal of barriers (how difficult is it for me to do?). By talking about your product with the target audience, you can learn the benefits they value most and the barriers they foresee. For example, women may feel that breastfeeding is a way to bond with their babies, is healthier, and makes them better mothers. However, they may also think that breastfeeding doesn't fit into their lives, is difficult to do, and is painful. In this case, a program could either promote and reinforce the positive aspects of breastfeeding or provide ways to get around the barriers, by explaining how to work breastfeeding into a busy schedule and teaching the proper way to do it to avoid discomfort.

4. Know your competition. In the commercial sector, successful companies watch every move their competitors make. They know their selling environment intimately and are ready to react as soon as conditions change. Social marketers also need to be aware of the competing messages pulling on their target audiences. Your product's competition may be another product, such as french fries versus fruit, or it may be nonperformance of the behavior you are promoting; inaction is nearly always easier than adopting a new behavior. Your product must be more attractive than the alternatives to be accepted. Just as Coke creates its marketing strategies based on what Pepsi is doing, we can take advantage of our competitors' tactics to promote our own products. Many successful health campaigns against tobacco and alcohol have parodied the well-known cigarette and beer slogans, creating ads that grab our attention because of their new twist on familiar images. Other environmental factors may also affect people's reactions to your program. Political changes may require new approaches, news events may change the context in which people hear your message, and work done by other organizations in your field may affect how you portray your message. You must be able to monitor these changes in the environment and adjust your program accordingly. 5. Go to where your audience is.

People will not go out of their way to find your message. You will need to put your message in places your target audience will encounter. When you talk to your customers, ask them where they get their news, what radio stations they listen to, where they go in their free time. If you learn that your target audience tends to read the local newspaper, place your ads there and work with that paper's reporters to get coverage of your issue. If the people in your audience are the ones who do the grocery shopping, work with local supermarkets to put information on healthy eating in their stores. If the people you are targeting like a particular type of music, go to rock concerts and pass out your materials. Bring a mobile mammography van to people's worksites. You can research the audience demographics of local media outlets (i.e., television, radio, newspapers) in order to match your target group's characteristics with their favorite media. The only limit to reaching your audience is the extent of your creativity.

6. Utilize a variety of approaches. Social marketing involves much more than television advertising campaigns. The most effective programs use a combination of mass media, community, small group and individual activities. When a simple, clear message is repeated in many places and formats throughout the community, it is more likely to be seen and remembered. A social marketing program might contain television and radio spots, print ads, a community event, a poster contest, giveaways of your products or coupons for your services, a toll-free hotline for individual counseling or referrals, or classes on your topic offered in the community. The variety of approaches you use will depend on your program's budget and what will be most effective with the target audience. No matter what you do in your campaign, try to stick to one main "look" and slogan, or people may not realize all the pieces are from your organization. Consistency and continuity are key to a successful campaign.

7. Use models that work. As with any field, social marketers design programs using the most effective and useful models available to them. In one model that incorporates elements of several well-established health behavior theories ("Stages of Change"), people move through several steps in a continuum before adopting a new behavior. In the first stage, precontemplation, a person may not feel at risk for the condition or think the behavior is relevant to him. People at this stage must first be made aware of the problem and possible risk factors to move to the next stage, contemplation. To move from contemplation to action, messages should promote the benefits of performing the behavior and minimize the perceived costs. In this stage, the behavior should be portrayed as something that many other people do and agree with; skill-building messages and demonstrations of the behavior by others similar to themselves will help them move to action. Once they have tried the behavior, the last and often most difficult stage is maintenance. Motivational and reinforcing messages are necessary to prevent relapse to the contemplation stage. This model provides a useful framework for segmenting the target audience. A program could address people in each stage over a period of time or select just those at a particular stage of the process.

8. Test, test, test. All of the products, promotional materials, and services you develop for your program should be tested with your target audience to gauge their potential effectiveness. Social marketing recognizes that the customers are the experts on what works best for them. Even the best minds on Madison Avenue test their ideas with their consumers (and consequently avoid spending lots of money on concepts that don't work). One of the methods most associated with social marketing is the focus group. This involves bringing together 8 to 12 people with particular characteristics relevant to the program and leading them through a focused discussion on a given topic. Focus groups can be used to learn how people in the target audience think about the issue and why, the language they use to talk about the issue, and their reactions to messages or materials you've developed. Surveys are a more generalizable method to find out people's knowledge, attitudes and behaviors regarding a particular topic. They work best when you have very specific questions that don't require the respondents to explain their answers (e.g., "yes" or "no" questions). These dont have to be very complicated, but do require care in administration and interpretation.

9. Build partnerships with key allies. Just as the power of a choir derives from its union of many voices, a powerful message requires groups throughout the community to come together in a coordinated effort. Organizations concerned with your issue can sing the melody along with you, while other groups--the media, schools, businesses, government agencies--can provide the harmony, complementing your efforts through their involvement. By pooling resources with other organizations working toward the same goal, you can have a greater impact as well as access to new audiences. Build connections with key people and organizations who have the potential to bring attention and credibility to your program. You can develop beneficial relationships with the reporters covering your issue at key media outlets; pitch stories to them with a fresh news angle, provide them with fact sheets or lists of experts they can contact for their stories, and be available when they call for information. Include your local politicians in activities to help them understand and support your issue. Invite businesses to sponsor your projects, exchanging positive corporate publicity for their financial support. Other potential allies include professional associations, local service organizations (e.g., Kiwanis, Rotary Club), religious groups and existing community coalitions.

10. See what you can do better next time. The cornerstone of social marketing is evaluation--determining what you accomplished so you can use that information to improve your program. Evaluation occurs throughout the social marketing process. As you develop your program, you need to test and refine your messages or products with members of the target audience. When the program is implemented, you need to monitor activities to assess whether they are occurring as planned. How many brochures were disseminated? How many media "hits," or mentions of your program, did you achieve? Are the people in your target audience the ones who are using your program? The answers to these questions will let you know whether you need to make adjustments while you have the opportunity to do so.

The big question, though, is: Did you make a difference? There are two ways this can be answered. One way is to see whether members of the target audience engaged in the desired behavior as a result of the program. This can be determined quantitatively through survey research with the people who participated in the program or who were exposed to the message. A second way requires a longer-term perspective, investigating whether performing the behavior induced the desired change (e.g., a reduction in related mortality and/or morbidity). The actual impact of a social marketing program is difficult to assess accurately. Can a public service announcement reduce mortality from heart disease? Probably not, but many such efforts can combine synergistically over time. The only way to establish a cause-and-effect relationship between your social marketing program and changes in behavior and health outcomes is to conduct a community intervention study. At whatever level you perform evaluation, the information gained should be used to improve your program in the future. This article originally appeared in the July 1995 issue of the Social Marketing Quarterly

Okay...here is my list of 101 "interesting" direct mail openings: 1. As a member in good standing... 2. You may now enjoy... 3. How much time and effort do you spend on... 4. Ask 10 people what _____ means to them, and.... 5. I'm writing to tell you about... 6. I know _____ will build your business. 7. Next week is the last week for you to receive... 8. There's one reason for accepting... 9. Would answers to any of these questions... 10. How to fight the high cost of ____ 11. This letter is going to be short and to the point. 12. It's true: _______ helped me... 13. The first time I used ____ I earned (learned, saved, made, enjoyed, ... ) _________ 14. ______ is a proven resource for raising money. 15. This report will update you on.... 16. There are few sights more beautiful than a ... 17. Before you read another word...please take a moment to look at ___________ 18. If you love _____, this is for you: _______ 19. Just like stop signs, fire hydrants, watermelons, cherries, and hearts, this touch of red instantly identifies... 20. I'm pleased to inform you of a very special offer reserved in your name. 21. I'm pleased to inform you of .... 22. If you're like me, you have less time than ever! 23. If you're like me, you have . . . 24. What do you do when you need . . . 25. On Thursday, April 6 an important event will take place. 26. Thank you for placing your trust in us. 27. It is my privilege to invite you to . . . 28. We agree that . . . 29. Your interest in .... reveals something important about you: ________________________ 30. Stop for a moment! 31. Do these situations sound familiar: _____________

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