Social Marketing

WORLD HEALTH COMMUNICATION ASSOCIATES

Campaign Development Workshop

Izhevsk 22-24 SEPTEMBER 2009

Background Paper and Planning Template Franklin Apfel

World Health Communication Associates Ltd

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Background Coordinators and key stakeholders from Cherepovets, Dimitrovgrad, Izhevsk and Stavropol are being were convened in this third training session of the We Choose Life Youth Against HIV AIDS Project to explore ways in which they can develop campaigns that will address identified needs and gaps in current HIV /AIDS communications, enhance HIV/AIDS literacy amongst key target groups, especially youth; “engage the unengaged”; overcome obstacles and strengthen the reach and impact of current prevention and treatment services. This campaign development workshop builds on the Stakeholder and Youth Volunteer Network activities to date; in particular the youth behavioural surveys. The workshop will serve to help each of the cities finalise campaign plans and will utilize data collected by each city prior to the meeting see campaign development planning questions below. The three day workshop will be include sessions on communications as a determinant of health, formative communication research, issue framing, an advocacy framework , practical campaign planning exercises, issues related to social marketing, working with media, media advocacy, and campaign evaluation. There will be both lectures, group work and discussion sessions. Workshop Objectives The overall aim of the project is to reduce the disease burden related to HIV/AIDS amongst youth in participating cities. The key objective of the workshop is to assist each city stakeholder team to agree and finalise plans for a youth focused HIV/AIDS communication campaign that will raise awareness and stimulate healthy behaviors, choices and policies. As a secondary benefit of this process the workshop aims to enhance participants’ capacities in health communications, communication related research, advocacy, social marketing as well as working with media. It is further anticipated that the skills developed for this specific project should be generalisable to other key public health communication challenges. Pre-workshop activities- Some questions to answer Each city is asked to carry out a series of tasks that is aimed at collecting data needed for effective campaign planning. Reach city will customize their own campaign plans aimed at enhancing HIV/AIDS prevention and treatment information, education and public awareness (and supportive policies) by stimulating demand for information and engaging and strengthening the capacity of health leaders, people living with HIV/AIDS (PLWHA) and information mediators, e.g. health professionals, media, policy spokespeople, NGO advocates, and private sector advertisers, to respond effectively.

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The reason communications is being emphasized relates to the facts that:

• HIV/AIDS remains a major health threat in all cities. • Current uptake of available prevention and treatment services is poor. • Communication issues have been identified as a major obstacle to HIV/AIDS

progress. • Cities have all reported that they have had difficulties “engaging” media in their

prevention activities. • Cities are uniquely placed and committed to address the multi-sectoral, inter-

agency reality of this scourge. • Capacities, networks and infrastructures developed around this “priority

disease” issue can be utilised to address other public health challenges, eg avian flu, etc.

Campaign planning template- 6 steps Step 1- City communication resources- Asset Mapping Exercise 1 This communication campaign is not about starting new projects but enhancing the effectiveness of existing initiatives. Before planning it is important to know what are your assets and to build on your successes and learn from your less successful campaigns. Questions to answer What are your city and extended stakeholder group communication capacities?

1. Does the city and/ or partner agencies have a strategic communication policies and plans? Is HIV/AIDS and or Youth Behavior related communication part of these plans. Specify.

2. Do you have a press department? How active is it( How many press releases in a year?how many press conferences?

3. Do you have spokespeople? 4. Do you have press contact lists ? Are they current? 5. Do you have your own newsletters, TV/Radio time or Print/Internet based

publication space? 6. Do you have regular access to local TV, Radio, Print or Internet based media? 7. What kind of HIV/AIDS communication campaigns have you run in past? a Please select a successful and less successful campaign and fill in the attached case study sheet( see annex 1)

Step 2 Make a list of all major media outlets( Print, Television, Radio, Internet based blogs etc.) in your city and identify a contact person for HIV/AIDS and Youth Behaviour information. Asset Mapping Exercise 2

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Step 3 Identifying who are the HIV/AIDS communicators in your information marketplace? Asset Mapping Exercise 2 Communication audits and surveys can provide up-to-date information on capacities, activities, attitudes, strengths and weaknesses of health communication actors, including broadcast media, newspapers, ministries, educators/professionals, NGOs and the private sector. They provide baseline data for planning and evaluation. We suggest you select 3 key print media ( newspapers or magazines) and review all articles printed on HIV/AIDS and Youth behaviors over a 3 month period in 2009 and use this data to answer the media audit questions below to your findings. Media Audit Questions to answer

1. Are HIV/AIDS Health issues being covered in the news? By whom? In which channels?

2. What are the main themes and arguments presented on various sides of the issue?

3. What’s missing from the news coverage? 4. How are issues being framed (see below)? 5. Who is reporting, campaigning, advertising on HIV/AIDS stories/products related

to it? 6. Who are appearing as spokespeople? 7. Who is writing op-ed pieces or letters to the editor? 8. What solutions are being proposed? By whom? 9. Who is named or implied as having responsibility for solving the problem? 10. What stories, facts, or perspectives could help improve the case for this

campaign? Step 4- Selecting your campaign issue Once you have assessed your assets you are ready to select an issue or problem you want to tackle. In looking at various options, you should consider applying a set of criteria to issues that concern you. The fact that something is a big problem is not sufficient to make it a good candidate for campaign action. A variety of contextual factors will affect topic choice; for example, knowledge of a reasonable solution for the problem. Developing a set of selection criteria is often helpful . Your choice should honestly reflect the reality of your policy environment, resources, time, potential allies and opponents and level of working.

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Questions to answer- Selecting an issue Criteria for selecting a particular issue might include the following:

1.Will a solution to this problem or issue result in a real improvement in people’s lives?

2. Is this an issue or problem we think we can resolve? 3. Is this an issue or problem which is fairly easily understood? 4. Can we tackle this issue or problem with the resources available to us? 5. Is this an issue that will attract support or divide us?

(ICASO 1999, reprinted 2002)

Step 5: Targeting Primary and secondary target audiences There may be different (primary and secondary) target audiences for each campaign objective. Primary targets are individuals and/or institutions with decision-making authority. Secondary targets are individuals and institutions that can influence decision makers. Understanding these target groups—knowing how they function, what media influence them, their weak spots, etc—will help advocates to develop their messages and select appropriate channels of communication. Here you will need to decide whether you will be focusing on individual behaviour or system level policy change or both. If its policy change then specific policy makers with the authority to create needed legislation or regulations will be your primary target group; e.g, hospital administrators who can establish clinics; regional or national lawmakers that can make funds available for anti-retrovirals -, etc. If its individual behaviour change then your primary target group will those persons whose behaviours you want to change;e.g., health professional attitudes towards HIV positive patients; Young people’s attitudes towards using condoms, eytc. The most effective information intermediaries will be those people/media channels which are read/viewed/accessed and trusted by large numbers of the target audience group. For example, public opinion polls repeatedly show that in public health policy area NGOs are most trusted, industry least, and doctors and scientists somewhere in between. Five key information intermediaries are media/journalists, NGO advocates, scientists/health professionals, government public information officers, and industry-based PR, advertising and risk communicators. Questions to answer?

1. Who will be the primary and secondary target groups? 2. What channels will you use to reach them? 3. What intermediaries will you use?

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Step 6: Knowing your target audience- developing your messages - Formative research In developing messages, campaigns need to draw on advertising and social marketing principles. Key to developing successful messages( see box 1) is knowing your audience thoroughly and then tailoring simple, concise messages to their interests. Formative research is a primary tool that campaign organisers can use to identify and address the needs of specific target audiences.

Box 1 Message development 1. Keep it simple and concise—there should ideally be only one main point

communicated or, if that is not possible, two or three at the most. It is better to leave people with a clear idea of one message than to confuse or overwhelm them with too many.

2. Use appropriate language—messages should always be pre-tested with representatives of the target audience to ensure that the message sent is the one received.

3. Content should be consistent with format and be delivered by a credible messenger. 4. Tone and language should be consistent with the message. 5. Give people something to do—the message should not only persuade through valid

data and sound logic, but it should also describe the action the audience is being encouraged to take.

Stop TB partnership 2007, p20 .There are a variety of approaches to formative research. Small (‘focus’) groups, selected in such a way as to be representative of the target audience, can be convened to elicit feedback about programme planning, provide ideas about strategy and/or gather reactions to specific messages. Campaign organisers can then make modifications to plans, strategies and content based on the feedback from these focus groups. The general approach to pre-testing concepts is to share them with members of the target audience and learn from their reactions. Literature reviews, in-depth and/or ‘intercept’ interviews ( e.g. catching people in the hallway) and the use of internet- based panels of respondents are other examples of formative research tools that can be used to help determine if one concept is more salient to an audience segment than another, and which concepts should eventually be developed into specific messages.

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Other uses of formative research include analysis of target audiences by age, gender, income, etc. (called segmentation), analysis of media habits of the target population so that messages can be placed in the appropriate media at an appropriate moment, and an assessment of pre-existing knowledge and attitudes (baseline data) so that change can be documented over the time of interventions. Formative research, when done properly, can reduce some of the uncertainty associated with campaigns and enhance the potential validity and reliability of methodological approaches. Testing possible campaign slogans, for example, can ensure that such slogans are culturally sensitive and likely to be interpreted in the way advocates intended (Wallack et al 1993). Such formative research (pre-testing) helps determine whether the messages and formats are appropriate, understandable, clear, attention-grabbing, credible, relevant, and have the desired effect (e.g. to raise awareness about an issue). Questions- Formative research For your selected target audience- convene a small focus group (8-10 representative persons) Identify:

1 What is their current knowledge, attitudes, and behaviour related to the subject? 2.Whether and what kind of new information is needed? 3. Myths and misconceptions about the topic?

When messages are developed test these with the group 4. To assure appeal, appropriateness, understanding, clarity, and personal relevance of materials 5. To check for comprehension and cultural appropriateness

Step 7- Framing In many cases, in spite of the availability of and resources for treatment, it is not taken up due to prejudice, misinformation, unwillingness to take up treatment, stigma and discrimination. In other words, access is not only a matter of resources or money but also a matter of how it is perceived and “framed”1 by providers and patients and people in general. How HIV/AIDS and HIV/AIDS patients are perceived will need to be changed if treatment uptake is to be successful. There is a need to move away from

1 “Framing” relates to the “spin”, the way perceptions related to an issue are managed/manipulated. Frames create the context within which policy debate takes place. Simply put, if you get people asking the wrong questions the answers do not matter. For example, marketing people hired by the tobacco industry have been very successful in framing tobacco issues around freedom, autonomy and choice as opposed to public health. Key to the success of the Framework Convention on Tobacco Control was the ability of public health advocates to reframe the issue around public health concerns, e.g. Tobacco Kills Don’t be Duped.

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frames which deny care to IDU, based on “if you play, you pay” or “if that’s your choice, well good luck” or “choose drugs and die” frames to ones which will engage relevant players more positively and effectively, such as the right to treatment, the need for harm reduction, the relationship to social and economic development, the opportunity to transform health systems and the need to protect the general population. Question- Framing

1. What is the dominant framing of HIV/AIDS issues in your marketplace? 2. What opportunities exist for re-framing?

Step 8- Stakeholder analysis Know your supporters and opponents (and their arguments) Effective planning for any campaign requires knowledge and understanding of both supporters and opponents. Stakeholder analysis is one method of gleaning this information (see box 2). Knowing how to address ‘the other side of the story’ or counter what your opponents are saying is often critical to success. Campaigners need to anticipate the reaction of adversaries and continuously improve and reformulate arguments and counterarguments about their particular issue to account for new developments (Wallack et al 1993).

Box 2—Stakeholder analysis Stakeholder analysis is the technique used to identify the key people and organisations that have an interest or activity relevant to your issue. The first step in stakeholder analysis is to identify who these stakeholders are. The next step is to work out their power, influence and interest. The final step is to develop a good understanding of the most important stakeholders so that you know how they are likely to respond, and so that you can work out how to win their support or counter their opposition. Many people develop a stakeholder map to keep track of the various players and changes over time.

(Mindtools n.d.)

A crucial challenge for campaigners is to avoid merely aiming messages at people—telling them what to do or what not to do—and concentrate more on engaging people in being agents of their own change. In short, campaigners must seek to catalyse debate between citizens and between people and policy makers (Wallack 2001). Good communication and interpersonal skills, time, and knowing who are the key stakeholders are the keys to successfully encouraging people to work towards a common goal. Developing networks and alliances is often helpful.

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Campaigners should support the principles of participation and empowerment and should seek to encourage young people and people living with HIV/AIDS to undertake advocacy themselves and become agents of change in their own areas of concern. Public perceptions of the validity and legitimacy of a campaign are enhanced if those most directly affected by the problem or issue (key stakeholders) are seen to be actively involved ( see Box 3). However, health constraints, risk factors, or lack of skills, knowledge and confidence may prevent the involvement of key stakeholders in the initial stages of a campaign. Those who advocate on behalf of others need to ensure that they represent opinions and interests fairly. This requires close contact with those affected by the problem or issue, a deep understanding of the issue, and permission from those affected to represent them.

Box 3—Advocacy legitimacy

Why it is important to involve those directly affected by the advocacy issue, from early in the planning process

• They will have expert knowledge of the issue or problem. • They can suggest workable solutions based on direct experience of the

problem. • They can view a problem from a different perspective. • They are often highly motivated, because they are directly affected by the

issue. • Affected individuals and groups will gain more skills and confidence. It is a

good opportunity to reduce stigma, e.g. against people affected by HIV/AIDS.

Problems caused by lack of legitimacy Involving those affected by the problem or issue late, superficially (‘tokenism’) or not at all can result in:

• identifying irrelevant issues • suggesting solutions which do not solve the problem, or make the problem

worse • public disagreement • loss of credibility for the organisations and individuals involved in advocacy • increased stigma and legitimised exclusion and non-involvement of those

affected by the problem or issue • disempowerment of those affected, so they are less in control of their own

situations. (International AIDS Alliance 2003, p62)

Questions- Stakeholders- Develop a stakeholder Map

1. Who are key stakeholders? 2. Who are supporters and who are against you? 3. What is their power? 4. How can you win their support or counter their opposition?

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Step 9: Strategic campaign plans The objective with campaign is not merely to place concerns in the public arena and then wait for the process to unfold. Once an objective has been set, advocates must seek to maximise support with a strategic plan which incorporates ways to argue the case, engage key stakeholders and put pressure on decision makers for a favourable outcome. Campaign objectives should be SMART:

• Specific (specifying what they want to achieve); • Measurable (showing if the objectives are being met); • Achievable (attainable); • Realistic (achievable with the resources you have); • Timed (achieved within a set timescale/deadline).

Box 4—Strategic objectives

Campaigns objectives can include: New behaviours New laws and regulations Enforcement of existing laws and regulations, including stronger penalties More funding for programmes Tax rises or reductions on products to depress or increase demand Changing clinical or institutional practices Having other sectors direct energy at health issues Explicit objectives can also be set for the process of advocacy itself. These can include: Ensuring that an issue is discussed publicly and politically where it is being suboptimally discussed Having an issue discussed differently in ways that are more conducive to the advance of policy and funding (‘reframing‘ issues that are being discussed,

but in ways that are helpful to public health) Discrediting the opponents of public health objectives Bringing important, different voices into debates Introducing new key facts and perspectives calculated to change the focus of a debate

(Chapman 2007, p25)

Questions – Strategic Plans

1,What are your campaigns objectives? 2. How will you measure whether you accomplish them?

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Step 10- Addressing obstacles and taking advantage of opportunities One of the main barriers to treatment uptake is stigma and discrimination. People in need of testing and treatment may not come forward because of the stigma attached to HIV/AIDS. In many people’s minds, getting infected with HIV/AIDS is the result of either ‘stupidity’ (drug use, unsafe sex) or socially unacceptable behaviour (promiscuity, men having sex with men, prostitution). This is a major barrier which also stands in the way of effective NGO work. In addition, it needs to be kept in mind that for some behaviours (such as drug use) there is a risk of legal prosecution, which makes it difficult for people to come forward. Stigma not only affects people with HIV/AIDS, but is relevant to health professionals and policy makers as well. The closer health professionals work with people with HIV/AIDS, the more stigma seems to exist. Toolkits for working with HIV/AIDS exist for nurses, but these have been designed without the input of patients. This needs to be changed. Continued education for health professionals in this domain is crucial, not least in the area of communication skills: this is often lacking, while communication in building relationships with patients is crucial in order to facilitate access to testing and treatment and the provision of other forms of support. Unethical behaviours of health professionals are also cited in relation to violating confidentiality and unequal standards of human rights regarding free and anonymous counseling and testing, access to harm reducing interventions (sexual and IDU) and free and voluntary inclusion in clinical trials. Training in medical ethics is also of paramount importance. Advocates use or create events to attract media attention or illustrate a problem. Sometimes this is planned, but often it is not. Advocates need to be opportunistic and take advantage of a wide range of events. They must be ready to respond to breaking news that presents an opportunity for media access, and learn to interpret that news from the perspective of their policy goals. It should be day-to-day practice of advocates to regard almost any news event as a potential opportunity, or ‘teachable moment’, to bring attention to a health issue. A delegate to an American Public Health Association meeting in the early 1990s was accidentally shot in the hand at a restaurant when someone at the next table dropped a purse with a gun in it. Advocates at the meeting immediately used this headline story to introduce arguments for gun control.

Advocacy Tip 10—Opportunism Advocacy communications can usefully be timed to take place: before an election/just after an election when something happens to bring the issue to public attention before the issue goes public before the issue gets to Parliament when legislation is being changed on quiet news days

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when you have information/expertise relevant to the issue when the target audience are potentially interested in the issue

Sida 2005, p8

Questions- Obstacles- opportunities

1. What are obstackles to your actions? 2. How do you plan to overcome them? 3. What opportunities exist that could strengthen timing or impact of your

campaign? Step 11 : Evaluation2

Monitoring and Evaluation Public health information campaigns require investment in scarce human and financial resources. It is important to measure the value of such investment, in terms of money, time and effort. Measures for evaluating the effectiveness of advocacy campaigns have become more and more sophisticated, but some techniques are more sensible than others. Simply measuring the number of column centimetres devoted to your campaign in print (quantitative analysis) may provide impressive figures, but they mean very little if you do not know what type of publications were measured. What is their circulation area? What are their circulation figures? Who are their target audiences? Which ones are read by the people you want to contact? Nowadays, when so much communication is web-based, it may more appropriate to measure the number of ‘hits’ on a story, but such figures may be restricted because they may be regarded as commercially sensitive information. To discover whether your investment has been wise and effective, the results need to be measured against clearly defined objectives determined at the outset. The best advice in evaluation exercises is: keep it simple, and keep it common sense. Some of the issues you might consider in doing a campaign evaluation are listed in Box 5.

Box 5—Advocacy campaign evaluation

How much did you spend? Look at the budget and itemise everything, including staff hours. Keep an eye on hidden costs, such as the extra telephone time, travel or reprinting costs needed to respond when you get enquiries—these can continue for a long time after a campaign launch. Do not look only at external factors when you evaluate. Bring the campaign team together for a debriefing. Talk about the efforts they put in. Did people have to work late to get the materials ready? Were there extra costs which you did

2 Much of the material in this section is drawn from the World Health Communication Associates publication, Working with the Media, 2005 written by Mike Jempson.

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not expect? Did telephone inquiries increase so quickly that you did not have enough staff, or enough telephone lines? Write up a short report based on the information you gather and use it to inform the planning stage of your next campaign. Measure public awareness of the issues before and after a campaign. This can be both complicated and expensive. Partnership with academic, public opinion, media or market research organisations can help. Persuade a newspaper to run a reader poll about your main message; give them some exclusive part of your campaign, and get them to run the poll again in the days after a launch. Or try to get a polling agency to add some questions to one of its regular public opinion polls—this ‘piggy-backing’ can be cost- effective if you have invested a lot in a campaign. Proxy variables such as increased requests for HIV testing, increased sales of condoms, etc., may also provide some useful data here. Have you succeeded in shifting the focus of debate? If you have been aiming at ‘reframing’ your issue, are policy-makers now debating on your terms, and asking relevant health and environment impact questions? Were you able to implement your ‘follow-up’ strategy? If someone saw an article or TV show, or heard a radio programme about the campaign, and made contact with you—were you able to answer their questions and provide them with accessible information, or refer them to appropriate authorities? Did you log these enquiries and ask these people if they would like to stay on a mailing list? Have you found out what your target groups thought about the campaign and your information packs? Follow up with the people who called you for information a few weeks later: ask them what made them call you and what they thought of the information you sent them. What positive action have they taken as a result? Make a note of their replies and use them in future campaigns, or to inform your planning. Get a ‘focus group’ of people to give you feedback— not only on what they thought of the look of the materials and the messages in them, but whether they found materials useful.

(Jempson 2005)

Step 12 : Advocacy is about taking a developmental approach Whatever the focus of an advocacy action, the process of identifying the issue, analysing the political context, mapping the information marketplace, engaging others, developing, implementing and evaluating a strategic approach provides a critically important opportunity for personal and professional development. The process of articulating priorities, interests and rights through planning advocacy can be as important as the act of claiming them through political organising. Acquiring and practising advocacy competencies, such as strategic planning, networking, communication, etc., will strengthen all participants’ capacities to help their institutions, communities and systems to have a more sustainable positive impact on the health of current and, importantly, future generations.

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SUMMARY The personal, political, social and economic commitment and will to circumscribe, prevent, and treat HIV/AIDS depends greatly on strengthening public health communication capacity. Effective public health communication must be evidence-based, ethical and credible. It must be able to package accurate, relevant and impartial information in ways that inform and stimulate healthy behaviour and policy action. But information alone is not enough. It also calls for a health communication platform that can support people’s understanding of the relevance of information and how to use that information to advantage: in essence, how to turn information into knowledge. “Knowledge is information that is embedded in a context, has a purpose and leads one to seek further information in order to better understand something about the world.”(Zalinski, 2000) This health campaign, therefore, is also about understanding the context in which health and ill health occur and the social and political forces which drive it. So our challenge here is not just about “aiming messages at people – telling people what to do and what not to do. Instead, it is much more about stimulating demand for accessible information and helping information mediators to support the public to understand, debate and come to its own conclusions ... to consider the public not as objects of change, but as agents of their own change.”(Wallack et al, 1999)

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Annex 1-Social Marketing Social marketers generally believe they address key shortcomings of ‘traditional’ public health communication campaigns in which target audiences have little input into message development. The major contribution of social marketing approaches has been the strong focus on consumer needs. Consumer orientation means identifying and responding to the needs of the target audience. A primary tool to tailor public communication efforts to specific audiences is formative research (see previous discussion of Formative Research).

In general, social marketing provides a framework to integrate marketing principles with socio- psychological theories to develop programmes better able to accomplish behavioural change goals. It takes the planning variables from marketing (product, price, promotion and place) and reinterprets them for health issues. A key concept is that it seeks to reduce the psychological, social, economic and practical distance between consumer and the behaviour.

Advocacy Tip 18—The ‘four Ps’ of social marketing

“Product refers to something the consumer must accept: an item, a behaviour, or an idea. In some cases, the product is an item like a condom, and in other cases it is a behaviour such as not drinking and driving. Price refers to psychological, social, economic, or convenience costs associated with message compliance. For example, the act of not drinking in a group can have psychological costs of anxiety and social costs of loss of status. Promotion pertains to how the behaviour is packaged to compensate for costs—what are the benefits of adopting this behaviour and what is the best way to communicate the message promoting it. This could include better health, increased status, higher self esteem or freedom from inconvenience. Finally, place refers to the availability of the product or behaviour. If the intervention is promoting condom use, it is essential that condoms be widely available. Equally important to physical availability, however, is social availability. Condoms are more likely to be used when such use is supported and reinforced by peer groups and the community at large.”

( Wallack et al 1993, p22)

The NSMC3 has identified the following six features and concepts as key to understanding social marketing:

• Customer or consumer or client orientation: A strong ‘customer’ orientation with importance attached to understanding where the customer is starting from, their knowledge, attitudes and beliefs, along with the social context in which they live and work.

3 The National Social Marketing Centre (UK) has elaborated 8 benchmarks of social marketing, as follows:

1. Sets behavioural goals 2. Uses consumer research and pre-testing 3. Makes judicious use of theory 4. Is insight driven 5. Applies the principles of segmentation and targeting 6. Thinks beyond communication 7. Creates attractive motivational exchanges for the target group 8. Pays careful attention to the competition faced by the desired behaviour

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• Behaviour and behavioural goals: Clear focus on understanding existing behaviour and key influences on it, alongside developing clear behavioural goals, which can be divided into actionable and measurable steps or stages, phased over time.

• ‘Intervention mix’ and ‘marketing mix’: Using a range (or ‘mix’) of different interventions or methods to achieve a particular behavioural goal. When used at the strategic level this is commonly referred to as the ‘intervention mix’, and when used operationally it is described as the ‘marketing mix’ or ‘social marketing mix’.

• Audience segmentation: Clarity of audience focus using ‘audience segmentation’ to target effectively.

• ‘Exchange’: Use and application of the ‘exchange’ concept—understanding what is being expected of ‘the customer’, the ‘real cost to them’.

• ‘Competition’: Use and application of the ‘competition’ concept—understanding factors that impact on the customer and that compete for their attention and time.

Social marketing assumes that power over health status evolves from gaining greater control over individual health behaviours.4 It provides people with accurate information so they can better participate in improving their own health. Media advocacy assumes that improved health status evolves from greater control over the social and political environment in which decisions that affect health are made. It provides people with skills and information to participate better in changing the environments that create the context for individual health decisions. Both approaches, used in balance, have an important role to play in making mass media more responsive to health issues. (Wallack et al 1993, p24)

4 Some social marketers do include policy-level interventions by focusing their advocacy efforts on changing the behaviors of policy makers (NSMC 2007a).

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Annex 2 Media advocacy In its simplest application, media advocacy asks five key questions (see Advocacy Tip 19), the answers to which guide subsequent actions.

Advocacy Tip 19—Five key ‘media advocacy’ questions (adapted from Wallack et al 1999)

1. What is the problem?

2. What can be done about it?

3. Who has the authority to do this?

4. Who can influence this authority?

5. What ‘mediated’ messages will make these influential people act?

The key element here is the identification of the policy-level authority. This is the ‘end target’ of the media advocacy effort. It is these people with power that advocates want to influence. Media advocates design media campaigns around delivering messages to those (secondary targets) who can influence these people with the power (primary targets). Advocates want these influencers to act and communicate their messages to the authorities. For example, campaigners concerned about traffic accidents around schools may have identified the school’s board of governors as having the power to require traffic-slowing measures to be implemented around the school. They might usefully focus on helping parents, teachers, and students ‘find their voice’ and deliver messages to those in power. Such action by parents and children may further attract local media and thus serve to influence action by local politicians to introduce traffic restrictions. In some cases information alone will be enough to provoke change. In most instances, however, changes will be contested. Media advocates then work with the potential influencers on identifying and strengthening their capacities to deliver more effective messages than their opponents. Delivering messages requires an understanding of how different media ‘channels’ work and how best to access them. Media access strategies Common media channels include newspapers, radio, television, billboards, newsletters, web pages, blogs, email list serves, etc. Each media channel/outlet contains within it several possibilities for coverage. For example, a campaign issue may be covered as a front page story, or in sports, life styles, paid advertising, arts, comics, financial, op-ed (opinion–editorial), editorial, special feature, or letter to the editor pages of a newspaper. One example from the west of England was the threatened closure of a popular, nationally-known local factory. The local newspaper decided to support the campaign against closure and distributed banners which included their masthead, and published photographs of the workers carrying them. Later these appeared on huge advertising hoardings promoting the local credentials of the newspaper—and expanding awareness of the campaign.

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Being aware of all the possibilities is fundamental to taking full advantage of available resources. Media advocates are most interested in knowing what channels/outlets are most frequently used by their target group of influencers and policy-makers. There are three basic strategies for gaining access to the media: paying for it, earning it and asking for it. Asking for it usually relates to public service air or print space, often required of media by law as part of licensing requirements. This time and space are free but advocates have little control over when and where their stories will be aired or included. Many are played at less advantageous times (like the middle of the night) or placed in sections less likely to be read. Nonetheless, this does provide some exposure and it is free! Paid-for placements are the surest way to see that a message reaches its chosen target. It is the only way to fully control the placement and content of a message, the audience it will reach, and the timing of its dissemination. Canadians for Non-Smokers’ Rights5, used a full-page print advertisement to speak directly to legislators at a critical point in the development of public policy. It included a picture of the then prime minister and his close friend, who had just been appointed President of the Canadian Tobacco Manufacturers Council, beneath a headline that asked, “How many thousands of Canadians will die from Tobacco Industry Products may be in the hands of these two men.” The text of the advertisement explained the importance of the legislation and highlighted the relationship of the two men, ending with an appeal to the Prime Minister to act in the interest of future generations. The advertisement devastated the tobacco lobbying influence by personalising the issue and making whatever success they could have damaging to the political career of the Prime Minister. The legislation passed without a problem! Earned, as opposed to paid-for, media coverage, however, is the bread and butter of media advocacy. Here the aim is to be proactive. When the media calls for a comment, the reporter usually already has an angle or ‘frame’, marginalizing health behind economic and political interests. Proactive strategies require cultivating relationships with members of the local media. Journalists need information and ideas for stories that have importance to the local community. Advocates should think of themselves as resources who can make it easier for journalists to do a good job (see Working with the Media, above). Useful accurate data, examples of local activities, a summary of key issues and names of potential sources can serve this purpose. A second way to draw news attention is to create it. Opportunities to create news happen everyday. The release of a new report or a community demonstration can be turned into engaging news stories. A third way is to ‘piggy back’ onto the breaking news by finding links with current ‘hot’ news items and inserting the campaign’s perspective. Tobacco activists6 in the US jumped on a story

5 Wallack et al (1993, p89) gives the example of Gar Mahood, of Canadian for Nonsmokers’ Rights 6 Wallack et al (1993) gives this example from USA.

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about the halting of Chilean fruit imports because of worrisome levels of cyanide to point out that the amount of cyanide in one cigarette exceeded the amount in a bushel of grapes! Other coverage includes letters to the editor, ‘op-eds’ (comment columns that appear near a newspaper’s editorial opinion), talk show appearances, etc. Meetings with editorial boards can be very useful. Shrewd campaigners will be also sensitive to public figures who are espousing important causes. A campaign stands a better chance of publicity if it is supported by a local celebrity (musician, actor, sportsperson); if that person is committed, they will be willing to take part in events that will attract publicity and could even be the best advocate to encourage journalists to take up the issue. Indeed, a rolling programme of publicity can be achieved by releasing details of new celebrity supporters, whose agents may even encourage them to jump on a popular bandwagon.