This presentation at the World Social Marketing Conference presents a rationale for expanding the scope of social marketing to change markets through policy change to improve health. The original community-based prevention model has been re-imagined as a process to guide community coalitions in the selection and marketing of policy options. The presentation highlights the basics of this approach, and describes its implementation in Lousiville, KY by a coalition tackling childhood obesity. What began as an idea to focus on schools became a much larger environmental and policy initiative as the coalition used the revised CBPM process to arrive at innovative approaches for addressing food deserts and dual use of school facilities.
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Community-Driven Social Marketing Approach Policy Development
1. A Community-Driven Social
Marketing Approach for
Policy Development
R. Craig Lefebvre, PhD
RTI International
University of South Florida College of Public Health
World Social Marketing Conference, Toronto, Ontario 22 April 13
3. The Shift
•From victim-blaming to marketFrom victim-blaming to market
inefficiencies and failuresinefficiencies and failures
•From individuals to communitiesFrom individuals to communities
•From producer focused to co-From producer focused to co-
creationcreation
•From behaviors to organizationalFrom behaviors to organizational
practices and policiespractices and policies
4. What is social marketing?
Viewing ideas,
practices, and
social causes
in the context of
markets.
5. Markets Are the Context for Risk
– Not People
…someone who
has a personal
or situational
disadvantage
in the
marketplace
that might
create negative
outcomes for the
individual or
6. Market Failures in the Health
Marketplace
Value
Evaluation
Imperfect
Competition
Opportunity
Costs
Needs of
Different
Groups
Information
Asymmetry
7. Community Participation in Social
Marketing (McKee, 1992)
• Community understanding of the sources and
potential solutions to health and social puzzles
• Freedom from dependence on professionals
• Use of local knowledge and expertise
• Proposed solutions and their implementation fit
local needs and are tailored to the local context
• Responsibility for the project for both the short and
the long term
• Deliver products and services at lower cost
• Accomplish more
• Increase potential for sustainability
8. A synthesis of advocacy, social
mobilization and social marketing
9. Co-creation in Social Marketing
Identifying problems
Setting objectives
Conducting research
Mobilizing resources
Planning and implementing strategies
Tracking and evaluating progress toward
program objectives
11. Community-Based Prevention
Marketing (CBPM; original)
Mobilize the community
Develop community
profile
Select target behaviors,
audiences and
interventions
Build community
capacity
Formative research
Strategy
development for
designing or tailoring
the intervention
Program
development
Program
implementation
Tracking and
evaluation
12. CBPM Plan Components
Actual product What behaviorbehavior will we promote?
Priority population Which segments will we give the greatest priority in our
program planning?
Core product Which benefits will we promise?
Position How can we best distinguish our product from the
competition?
Augmented product Goods and services to enhance adoption?
Price How can we lower costs and other key barriers ?
Placement Which partners should we mobilize? Which distribution
channels should we use?
Promotion Which spokespersons, information channels, message
design guidelines, and activities should we use?
16. CBPM2 - Flow Chart
Step 1:
Create
Foundation
Get Ready!Get Ready!
Select policySelect policy
Get Set!Get Set!
Develop StrategyDevelop Strategy
Go!Go!
Implement StrategyImplement Strategy
Step 2:
Review
Policy
Options
Step 3:
Select
Policy
Step 4:
Select
Priority
Audiences
Step5:
Conduct
Research
Step 6:
Develop
Strategy
Step 8:
Advocate
For
Policy
Step 7:
Monitor
And
Evaluate
1.1. What do we need for success?What do we need for success?
4. Whose support do we need?4. Whose support do we need?
2. How do we change it?2. How do we change it?
3. Which policy should we promote?3. Which policy should we promote?
5. How do we get their support?5. How do we get their support?
6. How should we promote the policy?6. How should we promote the policy?
7. Are we following the plan?7. Are we following the plan?
8. How is it working?8. How is it working?
17. GET READY!
Step 1: Building a Strong Foundation
Overview
Roles and responsibilities
18. GET READY!
Step 2: What Should We Change?
Review evidence-based policies
Reduce set of options
23. GET READY!
Step 3: What Policy Should We Promote?
Goal: Select one or two policies to promote
Process: find best return on investment
impact
political feasibility
24. CBPMCBPM22
Community BasedCommunity Based
Policy Making and MarketingPolicy Making and Marketing
Select PolicySelect Policy
GET READY!GET READY!
ReturnReturn on Investmenton Investment
High
Low
HighLow
FeasibilityFeasibility
Mid
Mid
Community centers
Joint use
Community gardens
Access to health foods
School meals
25. GET SET!
Step 4: What Audiences Do We Give
Priority?
Select those most important to influence
Beneficiaries
Stakeholders
Policy Makers
26. GET SET!
Step 5: How Can We Build Common
Ground?
Understand each group’s viewpoint
Use insights to build common ground
28. GET SET!
Step 6: How Can We Make It Happen?
Create systematic plan
Frame or position policy
Strategies to promote to key audiences
Agenda-setting tactics
Communication guidelines
Other advocacy activities
29.
30. Motivating Factors
• Creating a more equitable communityCreating a more equitable community
• Creating a safer communityCreating a safer community
• Streamlining governmentStreamlining government
• Quick winQuick win
• Making community healthierMaking community healthier
• Preserving downtownPreserving downtown
• Serving districtServing district
31. Marketing Questions
• Which benefits should we offer?Which benefits should we offer?
• How can we frame these policies to optimizeHow can we frame these policies to optimize
perceived value?perceived value?
32. Policy Goals What is the desired outcome?
Policy Targets Whose behavior must change?
What do we want them to do?
Target Values and Concerns What do they value?
What are their major concerns?
Causal model What factors motivate them?
What factors deter them?
Advocacy Frame How should this policy be positioned
to make it attractive?
Policy Plan Components
33. Allies What principles should guide policy
design?
Who should design the policy?
Who should coordinate the policy?
Opponents What activities should the coalition
sponsor to advocate for policy
enactment and enforcement?
Policy Plan Components
34. Policy Implementation What principles should guide
policy design?
Who should design the policy?
Who should coordinate the
policy?
Advocacy Tactics What activities should the
coalition sponsor to advocate for
policy enactment and
enforcement?
Measures of Success How will we monitor progress?
How will we know we reached
our goal?
Policy Plan Components
35. GO!
Step 7: How Well Is It Working?
Monitor implementation
Assess impact
Modify activities as necessary
Share results
Celebrate!
36. GO!
Step 8: Are We Following the Plan?
Follow blueprint
Advocacy skills
Agenda setting
Letters to the editor and op-ed
Elevator speeches
Policy briefs
Rapid response mechanism
41. Lessons Learned
Not all coalitions are ready
Effective coalitions are unstoppable
Coalitions can become event
focused
University partners are essential
Technical assistance
Focus on model
42. Lessons Learned
ROI exercise can be difficult
May need to revisit decisions
Process is not always rational
Framing is key
Must remain flexible
Thank you for inviting me to discuss our current work at the FPRC.
The final market asymmetry I will talk about is that of value expectation ; that is, how does the consumer expect to benefit from health information and how is that satisfaction or dissatisfaction related to producer and mediator engagement, response, feedback, and outcomes? Clearly one source of market failure can be that different consumers have different expectations for the benefits they will receive from certain types of health information, ranging from consumers who are totally disinterested to those who immerse themselves in gathering the latest information to achieve better health or longevity. For example, different types of consumers have been found to have very different preferences and motivations for having nutrition information on food packages. And we could anticipate that these different value expectations will color their response to the nutrition information they find on food labels as well as the level of feedback and engagement they have with the information source.
First ingredient acknowledges that change is influenced by individual, interpersonal, community and societal factors. Most social marketers focus on the individual and interpersonal levels But a leader in the field Bill Novelli has taught us that most of the problems we face today are big and complex: big enough to bite back. To conquer them before they conquer us, we need to recognize the intricate interplay between people and their environments and be prepared to intervene at multiple levels. The social ecology model or ecological view of these problems reminds us that In keeping with a social ecological perspective, we have learned to look outside the individual to understand how the physical, social and policy environments influence their behavioral patterns. As a result, interventions are directed at all levels: individual, social ,community, and in some cases that I will mention later, even the broader policy level.
Finally, we teach them to use community based participatory research results to develop an integrated marketing strategy
I would like to illustrate the synergy of community, prevention, and marketing with a case study This started in 2003 in KY. Our first step was to mobilize the community. We invited representatives from a wide variety of organizations with a stake in the community ’s health to join an obesity prevention coalition. Seen here are members of over 50 organizations - parks and recreation sector, YMCA, schools, faith based organizations, businesses, concerned citizens, and of course the public health department
Although the coalition is working with us to co-create the process, here are the steps as we envisioned them at the outset. Let ’s look at each one a bit more closely, using our first pilot project to illustrate the tasks completed in each step.
We began the project with an overview of the CBPM2 process and an invitation to work together. When the coalition in Lexington accepted, we identified the roles they would play in process, noting that the coalition members would make all of the key decisions, while university faculty would provide technical assistance, especially in conducting literature reviews and conducting research. Although we hoped coalition members would participate in all activities, we recognized that their interests, time, and expertise varied.
In this step, the coalition reviewed a compilation of 108 evidence-based obesity prevention policies recommended by IOM and/or other organizations.
We provided the coalition members with a report summarizing 108 the evidence-based policies identified by the Institute of Medicine.
In the coalition meeting devoted to Step 2, members nominated policies described in the document, giving a brief rationale for why they felt the coalition should promote it. Each of the nominated policies was written on a large post-it-note and placed on the wall.
Members were given six stickers with which to vote.
At the end of this step, the coalition had winnowed the set of options to seven policies, making it manageable to evaluate them more thoroughly in the next step.
The next task was to select one or possibly two policies to promote using CBPM2. In this step, the coalition assessed the potential “return on investment” of each policy by comparing whatever evidence we could find about the policies’ relative impact and likelihood of adoption.
This matrix demonstrates how the concept of ROI is used to identify policies that have both a significant impact on the problem and a strong likelihood of being adopted in the near future. The PRC staff provided a summary of the evidence on each of the seven policies under consideration and members used this to assess each policy. Based on this information, each member was asked to place a mark on the matrix for each policy. Although disappointment by some members, they did reach a clear decision – food access in food desserts. Most members, even those who preferred working on another policy, placed their mark in the upper right hand quadrant, indicating a good ROI. While this policy became the focal point for the CBPM2 project, the coalition formed subcommittees to pursue other policy initiatives that members felt were also promising
The next step was to identify and prioritize the audiences that we needed to reach. This included groups and individuals directly affected by the policy ( beneficiaries), have a stake in its outcome (stakeholders), or decide if it is enacted (policy makers). We planned to use the concept of “return on investment” again, but it wasn’t necessary. The people they needed to reach in each of these broad categories were rather obvious, so rather than prioritize them, the coalition spent time listing the specific people and organizations that are most likely to support or oppose the proposed policy, and those they would try to recruit for data collection purposes during the next step.
The fifth step is designed to generate insights needed to understand how priority audiences view the policy issue and find opportunities to build common ground among beneficiaries, key stakeholders, and decision makers .
Nine coalition members joined the academic partners in collecting data. Over a six month period, we interviewed Interviews with 51 neighborhood residents A group interview with youth in the East End Six Key informant interviews with Lexington Fayette Urban County Government (LFUCG) Council Members Six Interviews with neighborhood store owners Phone conversations and email communications with 4 colleagues in Louisville, Baltimore, and Philadelphia who have coordinated successful corner store initiatives
The results of the formative research are then used to create a systematic marketing plan for promoting the policy change. PRC faculty and staff create a workbook summarizing formative research results and facilitate a meeting in which members use these results to answer a series of marketing questions. By the end of this step, the coalition has: created a positioning statement or frame for the policy; identified the core benefits that the policy should offer priority audiences; identified ways to lower costs and barriers to supporting the policy; identified spokespersons and partners to engage decision makers and advocate for the policy; identified agenda-setting tactics and communication guidelines; identified information channels for communicating with priority audiences; and, identified other promotional activities for obtaining support.
In preparation, we gave coalition members a strategy workbook that summarized key findings for each audience organized around the marketing questions they needed to answer.
We then facilitated a meeting in which we reviewed key findings, such as this list of motivating factors that council members shared with us during our personal interviews
Followed by a discussion in which we answered the marketing questions needed to create an
But when promoting a policy, we have modified this framework so that we use data to systematically make these decisions. Those familiar with social marketing will recognize their counterparts. The actual product is stated as policy goals – which policy should we promote or what do we want to active i This plan includes: Policy targets refer to the priority populations – who we need to change Values and concerns refer to benefits and barriers or product and price Causal model encompasses any other predictors of change Advocacy frame refers to how the policy should be positioned
But when promoting a policy, we have modified this framework so that we use data to systematically make these decisions. Those familiar with social marketing will recognize their counterparts. The actual product is stated as policy goals – which policy should we promote or what do we want to active i This plan includes: Policy targets refer to the priority populations – who we need to change Values and concerns refer to benefits and barriers or product and price Causal model encompasses any other predictors of change Advocacy frame refers to how the policy should be positioned
But when promoting a policy, we have modified this framework so that we use data to systematically make these decisions. Those familiar with social marketing will recognize their counterparts. The actual product is stated as policy goals – which policy should we promote or what do we want to active i This plan includes: Policy targets refer to the priority populations – who we need to change Values and concerns refer to benefits and barriers or product and price Causal model encompasses any other predictors of change Advocacy frame refers to how the policy should be positioned
In the final step, the coalition develops a plan for how they will monitor policy implementation and assess impact. Coalition members use this plan to monitor how the policy is implemented, and use results to identify the need for midcourse activities to ensure fidelity with the original policy goals.
During this step, the marketing plan served as a blueprint for the coalition ’s advocacy activities. Currently, the Lexington coalition is engaged in this step. Depending on individual members ’ level of interest and abilities, they may: lobby or advocate (e.g., create an “elevator speech,” meet with decision makers); prepare op-ed articles, letters to the editor, and policy briefs; deal with the media (e.g., talking points to shape the conversation and provide a consistent message; handle reporters’ questions); develop media strategy for getting the issue on the agenda; and create community support for policy change. The coalition also has developed a rapid response plan to enable its members to share breaking news, monitor the political context, and make mid-course adjustments as needed. This step continues until the policy is enacted; however, incremental successes (e.g., media coverage, sponsorship by key stakeholders) will be celebrated along the way, and as noted above, advocacy strategies may be adjusted to fit the changing political landscape.
While we expect to learn a great deal more as the Lexington coalition completes steps 7 and 8, we do have a few lessons to share at this time. First, it is important at the outset to clarify what we mean by policy and how it differs from program development. In addition to state or local laws and regulations, the coalition may want to include policies with a small “p”, such as changes in rules governing food sales in local schools, Parks and Recreational venues. Second, to work well, the ROI exercises depends on good data about the potential impact and political feasibility for each policy considered. We were fortunate that this data was available for the obesity policies considered. But it may not always be easy to obtain, in which case, coalitions appear to be overly optimistic in how they assess these measures. Third, not all coalition members want to pursue the same policy goals. By forming subcommittees to work on multiple policies, it is possible to accommodate varied interests and engage everyone, even if one policy gets the highest priority. Finally, as noted before, not every coalition is ready to use the CBPM2 framework. The Lexington coalition had a strong leader, good working relationships, and a topic appropriate for tackling with our model.
Any questions or comments about how CBPM or its ingredients can be applied in your own work?