Elizabeth W. Mitchell, PhD Division of Birth Defects and Developmental Disabilities June 13, 2011...

Elizabeth W. Mitchell, PhD

Division of Birth Defects and Developmental Disabilities

June 13, 2011

Developing a National Social Marketing Plan for Preconception Health and Health Care: Perspectives from the

Consumer Workgroup

National Center on Birth Defects and Developmental Disabilities

Division of Birth Defects and Developmental Disabilities

Presentation Overview

Social marketing- what is it? Phases of a social marketing plan Status of the consumer workgroup’s social

marketing planning by phase Next steps

WHAT IS SOCIAL MARKETING?

Social marketing is:

"The application of commercial marketing technologies to the analysis, planning, execution, and evaluation of programs designed to influence voluntary behavior of target audiences in order to improve their personal welfare and that of society."

* Andreasen, AR. Marketing Social Change: Changing Behavior to Promote Health, Social Development, and the Environment. San Francisco, CA: Jossey-Bass; 1995.

Social Marketing Phases

4

1Problem

Description

2

MarketResearch

6

Implementation

5

Evaluation

Interventions

3

Market Strategy

Source: http://www.orau.gov/cdcynergy/demo/

PUBLIC HEALTH, SOCIAL MARKETING AND CONSUMER WORKGROUP

1

1Problem

Description

Social Marketing Phases

Defining the Issue - Public Health Perspective

Goal: To improve women’s health before pregnancy in order to optimize pregnancy outcomes

Pregnancy intention is associated with improved health behaviors and birth outcomes*

Shah PS, Balkhair T, Ohlsson, A, Scott F, and Frick C. (2009). Systematic Review. Matern Child Health J. Published online: 10 December 2009).

Key Challenges

Half of all pregnancies are not planned* Target audience has a wide age range (18-44)

and is diverse The list of PCH behaviors is long Messaging is challenging (language of PCH ;

time period for promoting behaviors is unclear) Health disparities

Finer LB, Henshaw SK. Disparities in rates of unintended pregnancy in the United States, 1994 and 2001. Perspect Sex Reprod Health2006;38(2):90-6

Defining the Issue- Social Marketing Perspective

The social marketing process involves Identifying an effective marketing mix

• 5 P’s (product, price, promotion , place and partners)o What is the preconception health concept we are

trying to sell to consumers? (product)o What are the costs to consumers ? (price)o How should demand for preconception health and

healthcare (PCH & HC) to consumers be achieved? (promotion)

o Where should PCH & HC messages be promoted? (place)

o How can efforts be supported and sustained? (partners*)

Offering the customer clear and compelling benefits Minimal barriers And advantage over other options (competition)**

*Luca, Nadina Ralulca and Suggs, L. Suzanne (2010) ‘Strategies for the Social Marketing Mix: A systematic Review’, Social Marketing Quarterly, 16: 4, 122-149.

** CE Prue, KL Daniel. Social marketing: planning before conceiving preconception care. Matern Child Health J2006;10(5 Suppl):S79-84.

Defining the Issue- Consumer Workgroup Perspective

Responding to call to action Strategic planning (2010-11)• Revisited overarching goals• Developing an actionable multi-

organizational social marketing plan o Group attributes, gaps, needso Sustainable o Monthly calls among partners to work on

plan

RESEARCH TO INFORM SOCIAL MARKETING STRATEGY

2

2Market

Research

Social Marketing Phases

Market Research Conducted or Underway

Literature review (2009-2010) Materials evaluation (2009) Environmental scanning (2010) Partner assessments (2010 & 2011) Audience segmentation analyses (2009 &

2010) Focus groups (2010) Couple interviews (2010) Secondary data analysis- underway Concept development and testing (2011) Adcept development and testing- underway

Market Research (cont’d)

Literature review Synthesized research on PCH & HC by

audience (women, couples and clinicians) and by 4 P’s to inform formative research plan

Materials evaluation Analysis of consumer PCH materials to

understand what is being communicated, to whom, and with what clinical emphasis

Findings- D. Levis (CON1)

Market Research (cont’d)

Environmental scanning Web based assessments across range of areas

• PCH branding, target audiences, existing materials, tools and campaigns, focus area (preconception, pregnancy, general health etc.)

Among a number of sectors: insurance, media (TV, magazine), foundations, public health, advocacy, web, business

Provided insight into the landscape of PCH, partnership and dissemination opportunities

Market Research- Partner Assessments Two partner assessments conducted

(partner “P”) August 2010 and February 2011

Conducted in order to assess the attributes of the consumer workgroup in order to inform strategic planning, “center” social marketing planning efforts, assess gaps and opportunities

Focused on:• Each organization’s goals• Their audiences• Activities (research, evaluation, education, communication)• Opportunities/barriers• Partnerships• Desired role in a national social marketing plan

Created a partnership database

Market Research- Audience Segmentation Analyses

Purpose Explore how women of childbearing age can be

disaggregated into smaller groups so that effective and appropriate PCH social marketing interventions can be crafted

Market Research- Audience Segmentation Process

Determined byEpidemiology or

stratification data

Entire Population

Target Population Groupsi.e. Women of Childbearing

Age

Kirby Marketing Solutions

Market Research- Audience Segmentation Process

Determined byEpidemiology or

Stratification Data

Determined by Behavioral,

Theoretical, or Multivariate Data

Entire Population

Target Population Groupsi.e. Women of Childbearing

Age

AudienceSegments

Kirby Marketing Solutions

Market Research- Audience Segmentation Process

Determined byEpidemiology or

Stratification Data

Determined by Behavioral,

Theoretical, or Multivariate Data

Entire Population

Target Population Groupsi.e. Women of Childbearing

Age

AudienceSegments

IntendedAudience

Determined by Selection Criteria

Kirby Marketing Solutions

Market Research- Audience Segmentation Analyses

Data Porter Novelli’s HealthStyles survey (2007 & 2009)

Methods Classification and regression tree (C&RT) and Chi- square

automatic interaction detection (CHAID) to define factors most associated with level of pregnancy planning

Results Factors most associated with pregnancy planning**

• timing,* contraception, marital status*, income Insight into segmentation strategies

*Mitchell, E. W., Lewis, MA., Bann, C. et al. Formative Research on Preconception Health for Consumers. Poster presentation at the National Conference on Health Marketing Communication, Marketing and Media, August 11-13th, 2009, Atlanta GA

**Mitchell, EW. , Miracle-McMahill, H, Levis, D. Opportunities for Preconception Health Social Marketing among Women- A U.S. Consumer Perspective. Presented at the First European Congress on Preconception Health, October 2010, Brussels, Belgium

Market Research- Focus Groups

Purpose To learn more about women’s knowledge, attitudes, and beliefs about

PCH behaviors and services (4 P’s)• What do women know, think and believe about PCH & HC?• What does PCH as a term mean?• What are the motivators and barriers ?• How do we communicate with women about PCH & HC?

10 focus groups (N= 65) in Atlanta Segmented by pregnancy planning status (planner, non-planner,

interconception)• By low and middle SES

Findings- L. Squiers (CON1)

Market Research- Couple Interviews

Purpose To understand how couples consider, discuss, and support each other in

the context of PCH and related behaviors (4 P’s)• What do couples know, think and believe about PCH & HC?• What does PCH as a term mean to them?• What are the motivators and barriers for them?• How do we communicate with couples about PCH & HC?

Telephone interviews (N = 58 couples), ~5,000 screened Women 18-44 who were married or in committed relationship with a

partner who was willing to participate in the interview Segmented by pregnancy planning status (planner, non-planner,

interconception)• By low and middle SES

Findings- M. Lewis (CON1)

Market Research- Secondary Data Analysis

Additional data sources triangulated PRAMS (2004-2008) Growth from Knowledge/Mediamark Research and

Intelligence (2009-2010) • GFK/MRI- E. Mitchell (CON1)

Accumulation of data streams used to inform Segmentation recommendations Social marketing plan Dissemination opportunities

AUDIENCE SEGMENTS FOR SOCIAL MARKETING PLAN

Women of Childbearing Age- Planners and Non-Planners

Pregnancy Planners Women who intend to have a child in the next 1-2 years

Non-Pregnancy Planners Women who do not intend to have a child in the next 1-2

years Segmentation based on

Desire to make concepts and messages relevant • Increase attention and engagement in messages

Desire to reach the audience • What channels and why?

Planners are Contemplators

More likely to pay attention to and be receptive to messages about PCH In the “pregnancy mindset” May be starting to mentally prepare to get pregnant or

are actively trying to get pregnant Motivated by messages that focus on

Health of the baby Health of mother during pregnancy and delivery Prospect of enhancing fertility

Desire to be pregnant is a strong motivator to engage in PCH behaviors

Non-Planners are Pre-Contemplators

Lower levels of awareness of PCH Less likely to be receptive to messages

about PCH Pregnancy is not on their radar

Less likely to engage in and be motivated to engage in PCH behaviors (e.g., folic acid) Viewed as irrelevant to their current life More likely to engage in unhealthy lifestyle behaviors

(e.g., smoke) and question need to stop More likely to be receptive to messages

about overall healthy behaviors/lifestyle There is not a trigger event for non-planners to motivate

behavior change

Stages of Change

Prochaska, J. O., & DiClemente, C. C. (1983). Stages and processes of self-change of smoking: Toward an integrative model of change. Journal of Consulting and Clinical Psychology, 51, 390-395.

NON-PLANNERS

Pre-contemplation

Contemplation

Preparation

Action

PLANNERS

Short Term Communication Goals Planners

Increase awareness of PCH behaviors Increase awareness that there is a preconception time

period Increase awareness that what they do before they get

pregnant can affect the health of their baby Increase awareness about where to obtain information

about PCH Non-Planners

Increase awareness about being healthy (PCH) Increase awareness about contraception (RLP) Increase awareness about where to obtain information

about women’s health (PCH)

CREATIVE DEVELOPMENT AND TESTING

Market Research- Concept Development and Testing

Purpose (product “P”) Position PCH & HC (empowering, engaging, memorable) Create an overarching umbrella brand that can be used

by the CDC and partners• Link PCH to consumer values• A relationship between a product, service, or behavior and

its consumers • Creates a set of expectations in the mind of consumers

(brand promise) Create a vehicle for promoting PCH & HC

• One communication channel will reinforce another and increase credibility (among partners, health care providers, media, web etc.)

Market Research- Concept Development and Testing

Positioned PCH and HC A unique time (WOMAN’S WINDOW) An opportunity (CREATE YOUR FUTURE) An invitation (Baby YOURSELF, BABY yourself)

Market Research- Concept Development and Testing

Concept testing completed in May 4 focus groups (N = 32) in Atlanta

• Segmented by planning status (planners vs. non-planners)• Two age groups: 18-30 and 31-44• All low to middle income

Purpose Gauge women’s understanding, impressions and

attitudes toward concepts• Clarity, appeal, motivation (text, images and then PCH

context)

Market Research- Concepts, Adcepts and Testing

Findings Important feedback Creative executions (headline, tagline, images, text box)

• Making revisions to a “Woman’s Window” and “Baby Yourself”

• Developing one new concept “Create Your Future”- dropped

• Instead of inspiring respondents it evoked stress (school, career, financial)

Kaiser Women’s Health Survey (2008):“Approximately a quarter of women report feeling high levels

of stressfrom career (23%), and financial concerns (26%)”.

Market Research- Concepts, Adcepts and Testing

Next steps Analyze transcripts and develop creative

recommendations Develop adcepts (will include logo, more PCH

messaging) Test adcepts via on-line survey

• Nationally representative sample of women 18-44 years of age using a panel with an oversample of African American and Latina women (N=1200)

• Groups: o Non-planners (never intend or intend to have a baby in

more than 2 years)o Planners (intend to have a baby <2 years)

Early Winter 2011

MARKETING MIX AND ACTION PLAN

3

3Market

Strategy

Social Marketing Phases

PRODUCT

Literature review Materials evaluation Environmental scanningPartner assessments Audience segmentation analyses Focus groupsCouple interviewsSecondary data analysisConcept/Adcept testing

5 Ps Data Sources

Product Literature review Materials evaluation CWG input

Environmental scanningFormative researchConcept/adcept testingCWG input

Price Literature review Materials evaluation CWG input

Environmental scanningFormative researchSecondary data analysisConcept/adcept testing

Promotion Literature review Materials evaluation Environmental scanningCWG input

Partner assessmentAudience segmentation analyses Formative researchSecondary data analysis

Place Literature review Environmental scanningCWG inputPartner assessment

Audience segmentation analyses Formative researchSecondary data analysis

Partners Materials evaluation Environmental scanningPartner assessment

CWG input Formative researchSecondary data analysis

Social Marketing Phases

1Problem

Description

2

MarketResearch

Source: http://www.orau.gov/cdcynergy/demo/

Social Marketing Phases

4

1Problem

Description

2

MarketResearch

6

Implementation

5

Evaluation

Interventions

3

Market Strategy

Source: http://www.orau.gov/cdcynergy/demo/

NEXT STEPS

Next Steps

Finalize Marketing strategy, intervention, implementation and

evaluation plan (early 2012) Complete and disseminate PCH & HC social

marketing tools Audience profiles Brand support products (sample materials, logos etc.) Manuscripts and reports

Recruit additional partners

Thank You Project Team

Project teamConsumer WorkgroupCDC : Heidi Miracle-McMahill, MPH, MS;

Denise Levis, MA, PhD, Mindy BarringerRTI : Linda Squiers, PhD; Megan Lewis, PhD;

Molly Lynch, MPH; Karen Isenberg, MPH; Julia Kish-Doto, PhD; Rebecca Munch

AIR : Lori Agin, Mark Cohen, Lynda Bardfield, Jon Stapp,

Tom Hrabal, Martha Mater, Margarita Hurtado, PhD,

Tamika Owens, Allison Fratto

Questions?

On-line social marketing planning tool: http://www.orau.gov/cdcynergy/demo/

1600 Clifton Road NE, Atlanta, GA 30333Telephone, 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348E-mail: cdcinfo@cdc.gov Web: www.cdc.gov

For more information please contact Centers for Disease Control and Prevention1600 Clifton Road NE, Atlanta, GA 30333Telephone, 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348E-mail: cdcinfo@cdc.gov Web: www.cdc.gov

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Thank you

National Center on Birth Defects and Developmental Disabilities

Division of Birth Defects and Developmental Disabilities