A community-driven social marketing approach to policy development

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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 …

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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  • 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?

Transcript

  • 1. A Community-Driven SocialMarketing Approach forPolicy DevelopmentR. Craig Lefebvre, PhDRTI InternationalUniversity of South Florida College of Public HealthWorld Social Marketing Conference, Toronto, Ontario 22 April 13
  • 2. What is Social Marketing?
  • 3. The Shift•From victim-blaming to marketFrom victim-blaming to marketinefficiencies 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 organizationalpractices and policiespractices and policies
  • 4. What is social marketing?Viewing ideas,practices, andsocial causesin the context ofmarkets.
  • 5. Markets Are the Context for Risk– Not People…someone whohas a personalor situationaldisadvantagein themarketplacethat mightcreate negativeoutcomes for theindividual or
  • 6. Market Failures in the HealthMarketplaceValueEvaluationImperfectCompetitionOpportunityCostsNeeds ofDifferentGroupsInformationAsymmetry
  • 7. Community Participation in SocialMarketing (McKee, 1992)• Community understanding of the sources andpotential solutions to health and social puzzles• Freedom from dependence on professionals• Use of local knowledge and expertise• Proposed solutions and their implementation fitlocal needs and are tailored to the local context• Responsibility for the project for both the short andthe long term• Deliver products and services at lower cost• Accomplish more• Increase potential for sustainability
  • 8. A synthesis of advocacy, socialmobilization 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 towardprogram objectives
  • 10. Behaviors to practices and policies
  • 11. Community-Based PreventionMarketing (CBPM; original)Mobilize the communityDevelop communityprofileSelect target behaviors,audiences andinterventionsBuild communitycapacityFormative researchStrategydevelopment fordesigning or tailoringthe interventionProgramdevelopmentProgramimplementationTracking andevaluation
  • 12. CBPM Plan ComponentsActual product What behaviorbehavior will we promote?Priority population Which segments will we give the greatest priority in ourprogram planning?Core product Which benefits will we promise?Position How can we best distinguish our product from thecompetition?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 distributionchannels should we use?Promotion Which spokespersons, information channels, messagedesign guidelines, and activities should we use?
  • 13. Ecological Perspective
  • 14. Integrated Marketing Plan
  • 15. Policy Development Case Study
  • 16. CBPM2 - Flow ChartStep 1:CreateFoundationGet Ready!Get Ready!Select policySelect policyGet Set!Get Set!Develop StrategyDevelop StrategyGo!Go!Implement StrategyImplement StrategyStep 2:ReviewPolicyOptionsStep 3:SelectPolicyStep 4:SelectPriorityAudiencesStep5:ConductResearchStep 6:DevelopStrategyStep 8:AdvocateForPolicyStep 7:MonitorAndEvaluate1.1. 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
  • 19. IOM Report
  • 20. 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
  • 21. CBPMCBPM22Community BasedCommunity BasedPolicy Making and MarketingPolicy Making and MarketingSelect PolicySelect PolicyGET READY!GET READY!ReturnReturn on Investmenton InvestmentHighLowHighLowFeasibilityFeasibilityMidMidCommunity centersJoint useCommunity gardensAccess to health foodsSchool meals
  • 22. GET SET!Step 4: What Audiences Do We GivePriority?Select those most important to influenceBeneficiariesStakeholdersPolicy Makers
  • 23. GET SET!Step 5: How Can We Build CommonGround?Understand each group’s viewpointUse insights to build common ground
  • 24. Formative Research51 neighborhood residentsA group interview with youthSix policy makersSix store ownersFour experts
  • 25. 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
  • 26. 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
  • 27. 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 optimizeperceived value?perceived value?
  • 28. 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 positionedto make it attractive?Policy Plan Components
  • 29. Allies What principles should guide policydesign?Who should design the policy?Who should coordinate the policy?Opponents What activities should the coalitionsponsor to advocate for policyenactment and enforcement?Policy Plan Components
  • 30. Policy Implementation What principles should guidepolicy design?Who should design the policy?Who should coordinate thepolicy?Advocacy Tactics What activities should thecoalition sponsor to advocate forpolicy enactment andenforcement?Measures of Success How will we monitor progress?How will we know we reachedour goal?Policy Plan Components
  • 31. GO!Step 7: How Well Is It Working?Monitor implementationAssess impactModify activities as necessaryShare resultsCelebrate!
  • 32. 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
  • 33. Good Neighbor StoreGood Neighbor Store
  • 34. Certification and BrandingCertification and Branding
  • 35. Better Bites Restaurants
  • 36. Lessons LearnedNot all coalitions are readyEffective coalitions are unstoppableCoalitions can become eventfocusedUniversity partners are essentialTechnical assistanceFocus on model
  • 37. Lessons LearnedROI exercise can be difficultMay need to revisit decisionsProcess is not always rationalFraming is keyMust remain flexible
  • 38. Multiple Streams