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When selecting marketing and communication techniques, health care organizations must carefully examine their consumer populations, as not all techniques are effective for all consumers. Depending on the product, organizations might even choose two or three different techniques in an effort to reach multiple consumer segments. For this Assignment, you examine the consumer populations of your organization and create an advertisement using marketing and communication techniques appropriate for your consumers.To prepare:Select a health care product to market within your organization. Identify the consumer population of your organization, including general and business consumer.Consider traditional and/or contemporary marketing techniques that may be appropriate for your consumer population (i.e., brochure, flyer, video commercial, audio commercial, billboard, social media, etc.). Reflect on why you might select this technique and how you might use it to market the product.With the marketing technique you select in mind, consider how you might create an advertisement to market the health care product and what communication techniques might be appropriate for your population.The AssignmentWrite a 2-page brief that addresses the following:Describe the health care product you selected.Analyze the consumer population of your health care organization.Recommend a marketing technique that is appropriate for your consumer population (i.e., brochure, flyer, video commercial, audio commercial, billboard, social media, etc.). Include why you selected this technique and how you will use it to market the product you selected.Recommend one or two communication techniques that are appropriate for the consumer population.Then, create an advertisement using the marketing technique you selected. Be sure to utilize communication techniques that would be appropriate for the consumer population you identified.Note: Your Assignment must be written in standard edited English. Be sure to support your work with at least five high-quality references, including two from peer-reviewed journals. See the Week 8 Assignment rubric for additional requirements related to research and scholarly writing. theory_and_model_use_in_social_marketing_health_interventions..pdf new_media_but_same_old_tricks__food_marketing_to_children.pdf one_ceo_attacks_bait_and_switc.pdf incorporating_patients____preferences_into_medical_decision_making.pdf addressing_vaccine_hesitancy_.pdf Unformatted Attachment Preview Journal of Health Communication, 18:20–40, 2013 Copyright # Taylor & Francis Group, LLC ISSN: 1081-0730 print=1087-0415 online DOI: 10.1080/10810730.2012.688243 Theory and Model Use in Social Marketing Health Interventions NADINA RALUCA LUCA Nottingham University Business School, Nottingham, United Kingdom L. SUZANNE SUGGS Institute of Public Communication and Education, Faculty of Communication Sciences, University of Lugano, Lugano, Switzerland The existing literature suggests that theories and models can serve as valuable frameworks for the design and evaluation of health interventions. However, evidence on the use of theories and models in social marketing interventions is sparse. The purpose of this systematic review is to identify to what extent papers about social marketing health interventions report using theory, which theories are most commonly used, and how theory was used. A systematic search was conducted for articles that reported social marketing interventions for the prevention or management of cancer, diabetes, heart disease, HIV, STDs, and tobacco use, and behaviors related to reproductive health, physical activity, nutrition, and smoking cessation. Articles were published in English, after 1990, reported an evaluation, and met the 6 social marketing benchmarks criteria (behavior change, consumer research, segmentation and targeting, exchange, competition and marketing mix). Twenty-four articles, describing 17 interventions, met the inclusion criteria. Of these 17 interventions, 8 reported using theory and 7 stated how it was used. The transtheoretical model=stages of change was used more often than other theories. Findings highlight an ongoing lack of use or underreporting of the use of theory in social marketing campaigns and reinforce the call to action for applying and reporting theory to guide and evaluate interventions. Social and behavioral research on the role of theory in health campaigns suggests that it provides valuable frameworks to design and evaluate interventions (Glanz & Rimer, 2005; Hastings, 2007) and that effective campaigns tend to use theory (Lombardo & Léger, 2007; Thackeray & Neiger, 2000; Weinreich, 1999). ‘‘Theory’’ was added to the Social Marketing Benchmark Criteria in 2006, a set of best practice guidelines for social marketing (French & Blair-Stevens, 2006). To date, reviews of social marketing initiatives have not addressed how or the extent to which theory is used in developing or evaluating social marketing campaigns (Evans, Blitstein, Hersey, Renaud, & Yaroch, 2008; Grilli, Ramsay, & Minozzi, 2002; Snyder et al., 2004; Stead, Gordon, Angus, & McDermott, 2007). Evidence on theory and model use in social marketing interventions is sparse (Lefebvre, 2000). Address correspondence to Nadina Raluca Luca, Nottingham University Business School, Jubilee Campus, Nottingham, United Kingdom NG8 1BB. E-mail: nadina_luca@ yahoo.com 20 Social Marketing Theory 21 Background Social marketing is an approach to developing health, environment, and social change campaigns that aim to influence target audiences to voluntarily accept, reject, modify, or abandon a behavior for the benefit of individuals, groups, or society (Andreasen, 1995; Kotler & Lee, 2008). The social marketing process includes formative research, audience segmentation, development of a marketing mix (product, price, place, promotion), and an evaluation (Pirani & Reizes, 2005). The marketing mix is a key component that differentiates social marketing from other planning models and frameworks for health communication, education, or promotion initiatives aimed to facilitate change. The social marketing approach also relies on the appropriate use of behavioral theory to provide frameworks for developing initiatives by specifying the determinants of health behavior. By understanding these factors, intervention strategies can be developed that specifically address important theoretical constructs. One of the fundamental theories required in social marketing initiatives is the economic exchange theory. It postulates that human relationships are formed by the use of a subjective cost-benefit analysis and the comparison of alternatives. It is considered a core component in social marketing, is included in both published versions of the social marketing benchmark criteria (Andreasen, 2002; French & Blair-Stevens, 2006), and has considerable importance in developing the price and the product mix components (Hastings, 2007; Kotler & Lee, 2008). Exchange theory suggests that social marketers provide strong incentives emphasizing that the benefits of the product outweigh the costs (Kotler & Lee, 2008). Although it is fundamental in social marketing, a cost-benefit analysis alone does not create behavior change. Thus, social marketing also relies on the use of health behavior theory. In the most recent publication about the use of theory in social marketing, the most frequently cited include diffusion theory, the stages of change=transtheoretical model, social cognitive theory, theory of reasoned action, theory of planned behavior, health belief model, and protection and motivation theory (Lefebvre, 2000). Researchers have commonly reported using theory to develop the ‘‘promotion’’ element of the marketing mix, although theory and models can provide useful insight to other elements of the social marketing mix with implications on the intervention design and measuring outcomes (Winett, 1995). The use of theory in social marketing health interventions should help social marketers identify whether a particular behavior is determined primarily by attitudinal, normative, self-efficacy, environmental or other social considerations, or a combination of these (Fishbein & Yzer, 2003) and then to design the marketing mix to address these determinants. Lefebvre’s (2000) chapter published over a decade ago called for better reporting of the use of theory in social marketing activities. This systematic review seeks to learn if social marketers have answered that call by reporting the use of theories and models in social marketing health interventions. Thus, the purpose of this study is to review social marketing interventions aimed to change behaviors related to nutrition, physical activity, smoking, STDs=HIV=AIDS, heart disease, diabetes, and cancer, examining whether theses interventions reported the use of theory, which theory or theories they used, and how they used theory to design or evaluate the campaign. 22 N. R. Luca and L. S. Suggs Method Data Source and Search Strategy We conducted a systematic search of peer-reviewed articles from March 1, 2009, to April 30, 2009. Bibliographic databases included the following: Cochrane Library; Wiley Interscience; Science Direct; PsycINFO; PubMed; Psychology and Behavioral Sciences Collection; Communication & Mass Media Complete; Library, Information Science & Technology Abstracts Publications; Communication Studies: A SAGE Full-Text Collection; Social Services Abstracts; Sociological Abstracts; ABI=Inform; Emerald Management Xtra; JSTOR. Search terms included the following: social marketing, systematic review, metaanalysis, intervention, strategy, marketing mix, campaign, theory, health communication, health promotion, model, nutrition, physical activity, reproductive health, STDs, tobacco, cancer, diabetes, heart disease, smoking, HIV, and AIDS. Inclusion/Exclusion Criteria Included articles were peer-reviewed English-language articles published between 1990 and 2009 that described social marketing health interventions for the prevention or management of cancer, diabetes, heart disease, HIV, STDs and tobacco use, behaviors related to reproductive health, physical activity, nutrition, and smoking cessation. Included interventions met the 2002 social marketing benchmark criteria: behavior change, consumer research, segmentation and targeting, exchange, competition, and marketing mix (Andreasen, 2002). The studies reported at least three of the marketing mix components, or made them possible to clearly identify, and reported an evaluation. Two reviewers evaluated each article and coded them independently. Agreement of 100\% was established before analyzing the data. Outcome Measures To synthesize the findings, the health issue addressed, setting, target audience, theory= model used, how theory was used, and reported outcomes for each initiative were coded. Characteristics of interventions and the use of theory are summarized and discussed. Results We initially retrieved 271 articles. After we removed ineligible and duplicate articles for this review, we identified 24 qualifying studies reporting 17 interventions (see Table 1). Health Topics and Target Audiences The most common behavioral focus of the 17 initiatives was nutrition (n ¼ 4), followed by diabetes (n ¼ 3) and STDs (n ¼ 3). Two initiatives focused on physical activity, two on HIV testing and prevention, and two on smoking behavior (one prevention and one cessation). One campaign focused on heart disease prevention. Nutrition interventions targeted community college students who were 24–32 years old (Shive & Neyman Morris, 2006), school board members (McDermott et al., 2005), low-income students of public elementary schools (Wechsler, Basch, Social Marketing Theory 23 Table 1. Interventions ID Intervention Health topic 1 Energize Your Life! Nutrition 2 3 Nutrition Nutrition 4 LEAN Intervention to promote low-fat milk selection in schools Food Friends 5 VERB Physical activity 6 Get Up and Do Something 7 12 Control Your Diabetes. For Life Thunder and Lightning and Rain Move More Diabetes Heart Truth Style: Doing the Right Thing The Healthy Talk Physical activity Diabetes 13 The Healthy Penis 14 15 16 HIV. Live With It. Get Tested! Think Again Listening to Reason 17 I Am the Owner of Me 8 9 10 11 Nutrition Diabetes Diabetes Heart disease STDs STDs=family planning STDs Articles Shive and Neyman Morris (2006) McDermott et al. (2005) Wechsler et al. (1998) Young et al. (2004) Johnson et al. (2007) Wong et al. (2004) Huhman et al. (2007) Berkowitz et al. (2008) Berkowitz, Huhman, and Nolin (2008) Price et al. (2008) Heitzler et al. (2008) Peterson, Abraham, and Waterfield (2005) Gallivan et al. (2007) Almendarez, Boysun, and Clark (2004) Richert et al. (2007) Long et al. (2008) Wackett (1998) Cho et al. (2004) HIV=AIDS Montoya et al. (2005) Ahrens et al. (2006) Futterman et al. (2001) HIV=AIDS Smoking cessation Smoking prevention Lombardo and Léger (2007) De Gruchy and Coppel (2008) Schmidt, Kiss, and Lokanc-Diluzio (2009) Zyber, & Shea, 1998), and preschool children 3 to 5 years of age and their parents (Johnson, Bellows, Beckstrom, & Anderson, 2007; Young, Anderson, Beckstrom, Bellows, & Johnson, 2004). Diabetes initiatives targeted people with type 2 diabetes (Richert, Webb, Morse, O’Toole, & Brownson, 2007), older Latino=Hispanic men and women with uncontrolled diabetes (Almendarez, Boysun, & Clark, 2004), and adults with diabetes (Gallivan, Lising, Ammary, & Greenberg, 2007). STD 24 N. R. Luca and L. S. Suggs interventions targeted toward 15–29-year-olds (Wackett, 1998), young Hispanic adults (Cho, Oehlkers, Mandelbaum, Edlund, & Zurek, 2004), and gay and bisexual individuals (Ahrens et al., 2006; Montoya et al., 2005). The two physical activity programs targeted children 9 to 13 years of age, parents, teachers, youth program leaders (Berkowitz et al., 2008; Berkowitz, Huhman, & Nolin, 2008; Heitzler, Asbury, & Kusner, 2008; Huhman et al., 2007; Price, Huhman, & Potter, 2008; Wong et al., 2004) and young adults 18–30 years of age (Peterson, Abraham, & Waterfield, 2005). HIV=AIDS prevention and=or testing programs targeted HIV-positive and HIV-negative gay men who engage in unsafe sex practices (Lombardo & Léger, 2007) and youth of color in high seroprevalence communities (Futterman et al., 2001). The smoking prevention intervention targeted youth 12–18 years of age (Schmidt, Kiss, & Lokanc-Diluzio, 2009) and the smoking cessation intervention targeted adults older than 40 years of age (De Gruchy & Coppel, 2008). The heart disease campaign targeted women 40–60 years of age with special focus on African American and Hispanic women (Long, Taubenheim, Wayman, Temple, & Ruoff, 2008). Theories and Models Eight initiatives mentioned using 10 theories and models (Berkowitz et al., 2008; Berkowitz, Huhman, & Nolin, 2008; De Gruchy & Coppel, 2008; Gallivan et al., 2007; Heitzler et al., 2008; Huhman et al., 2007; Johnson et al., 2007; Long et al., 2008; Peterson et al., 2005; Price et al., 2008; Richert et al., 2007; Wackett, 1998; Wong et al., 2004; Young et al., 2004; see Table 2). Some initiatives used more than one theory and some were not clear about how theory was used. For example, the heart disease awareness campaign (Long et al., 2008) reported using seven theories and models with no specifications on how they guided, informed, or were used to design and evaluate the campaign. The most frequently mentioned theories and models were stages of change (n ¼ 4) and the theory of planned behavior (n ¼ 3). The stages of change model was used for segmentation (Gallivan et al., 2007; Richert et al., 2007), evaluation (De Gruchy & Coppel, 2008), and message design (Gallivan et al., 2007), and reported as the transtheoretical model used to guide intervention development in two campaigns (Long et al., 2008; Richert et al., 2007). The theory of reasoned action and theory of planned behavior were reported together as guiding the design of physical activity and heart disease interventions (Long et al., 2008; Peterson et al., 2005). The theory of planned behavior, information processing theory, and social cognitive theory were reported to have guided the development and evaluation of VERB, a physical activity for youth, campaign (Berkowitz et al., 2008; Huhman et al., 2007; Price et al., 2008; Wong et al., 2004). Social network theory was used for promotion in a STD campaign (Wackett, 1998) and mentioned as basis for the heart disease intervention (Long et al., 2008). The health belief model was used for message design in a diabetes initiative (Gallivan et al., 2007) and as a basis for the heart disease awareness campaign (Long et al., 2008). Social learning theory was mentioned as basis for the message design in a nutrition intervention (Johnson et al., 2007; Young et al., 2004) and for guiding the intervention development in the heart disease initiative (Long et al., 2008). Information motivation and behavioral skills model was used in the development of promotion and message design in one STD intervention (Wackett, 1998). The use of diffusion of innovations theory was reported in the heart disease intervention (Long et al., 2008). 25 2 2 1 1 1 1 Social network theory Social learning theory Social cognitive theory Diffusion of innovations Information motivation and behavioral skills model Information processing theory 2 Theory of reasoned action 2 3 Theory of planned behavior Health belief model 4 Number of interventions Stages of change model= transtheoretical model Theory or model Table 2. Frequency of theory=model use 5: VERB (physical activity) 11: Style: Do the Right Thing (sexually transmitted diseases) 10: Heart Truth (heart disease) 5: VERB (physical activity) 4: Food Friends (nutrition) 10: Heart Truth (heart disease) 11: Style: Do the Right Thing (sexually transmitted diseases) 10: Heart Truth (heart disease) 7: Control Your Diabetes for Life (diabetes) 10: Heart Truth (heart disease) 6: Get Up and Do Something (physical activity) 10: Heart Truth (heart disease) 5: VERB (physical activity) 6: Get Up and Do Something (physical activity) 10: Heart Truth (heart disease) 16: Listening to Reason (smoking cessation) 7: Control Your Diabetes for Life (diabetes) 9: Move More Diabetes (diabetes) 10: Heart Truth (heart disease) Intervention Campaign design; evaluation Promotion, message, campaign design Campaign design Campaign design; segmentation evaluation Promotion, message design Campaign design Promotion Campaign design Message design Campaign design Campaign design; evaluation Campaign design Campaign design; segmentation, evaluation Campaign design; evaluation Campaign design Segmentation and evaluation Campaign design, segmentation and messages Segmentation Campaign design How used 26 N. R. Luca and L. S. Suggs Outcomes Interventions used a variety of study designs and outcome measures (see Table 3). Campaign awareness was high (more than 50\%) for the majority of interventions with some exceptions: 11\% for a diabetes program (Richert et al., 2007) and 23.2\% for a smoking cessation program (De Gruchy & Coppel, 2008). Nutrition interventions reported positive outcomes including a statistically significant improvement of school board members’ support for four of seven proposed nutrition policy options (12\%, 14.2\%, 14.7\%, 11.8\%, p < .5; McDermott et al., 2005), and a significant change from pre- to postintervention in typical fruit intake (t ¼
3.4, p < .01; Shive & Neyman Morris, 2006). Another found a significant change in low-fat milk consumption of inner-city elementary students in the intervention group (25\% preintervention vs. 57\% postintervention; F(1) ¼ 48.02, p < .01; Wechsler et al., 1998). A nutrition program based on social learning theory found a significant decrease in preschool-aged children’s dislike of new foods from preintervention to postintervention (p < .08) in the intervention group, whereas the control group showed statistically significant increase in their dislike of new foods at follow-up (p < .10; Johnson et al., 2007). The outcomes reported by diabetes interventions indicate positive changes, although none were statistically significant. One intervention that used the transtheoretical model and health belief model showed an increase of blood glucose tests from 39\% at baseline to 55\% postintervention (Gallivan et al., 2007). One program that did not mention using theory suggested that 27\% of those who saw the campaign reported having taken some type of action to control their diabetes and that 54 of 750 targeted Latinos with uncontrolled diabetes made calls to a toll-free line (Almendarez et al., 2004). The third diabetes program, which used stages of change for segmentation purposes, reported making contact with 750 people living with diabetes and 176 referrals to diabetes self-management services (Richert et al., 2007). The heart disease intervention, based on seven theories and models (Long et al., 2008), found that 45\% would talk to their doctor and=or get a check-up, but did not measure behavior change. The Get Up and Do Something physical activity intervention (Peterson et al., 2005) discussed that although they did not measure behavior change, they did evaluate the effect of the campaign on attitudes, perceptions, and intention to be more active. Attitudes and intention, both constructs in the theory of planned behavior and theory of reasoned action, were claimed to be positive (27.7\% intended to be more active). However, no data regarding attitudes were reported nor were preintervention intention data reported. The VERB campaign reported a statistically significant dose-response effect of tweens exposure to VERB (c ¼ 0.19, CI [0.11, 0.26]; d ¼ 15.4, CI [8.1, 22.8], p < .05) regarding physical activity (Huhman et al., 2007). The tobacco control intervention, Listening to Reason, used stages of change for segmentation and evaluation and indicated no significant behavior change (De Gruchy & Coppel, 2008). The smoking prevention campaign, I Am the Owner of Me, did not report having used theory and reported no significant behavior change (Schmidt, Kiss, & Lokanc-Diluzio, 2009). A statistically significant decrease in knowledge about condoms being a preventive action again ... Purchase answer to see full attachment