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Healthy Lifestyle Promotion: How Brands Work in Public Health Presented by Doug Evans RTI International Presented at Conversations on Social Marketing November 5, 2007 • Washington, DC. 701 13 th Street, NW ■ Suite 750 ■ Washington, DC 20005. Phone 202-728-2058.

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Healthy Lifestyle Promotion: How Brands Work in Public HealthPresented byDoug EvansRTI InternationalPresented atConversations on Social MarketingNovember 5, 2007 • Washington, DC

701 13th Street, NW ■ Suite 750 ■ Washington, DC 20005

Phone 202-728-2058

Fax 202-728-2095

E-mail [email protected]

RTI International is a trade name of Research Triangle Institute


Outline
Outline

  • Lessons from commercial branding

  • Branding in public health

  • Case studies of public health brands

  • Evaluation of public health branding

  • Evidence from branding evaluations

  • Future of branding


What i ll tell you
What I’ll Tell You

  • Brands in the commercial and public health (PH) sectors add value to the relationships between products and consumers

  • PH brands can be differentiated from commercial brands by their purposes (changing health behavior), value exchange between brand and consumer, and outcomes (health behavior change)

  • Brands can apply “upstream” – such as to organizations and government policies – and “downstream” to individual behavior

  • Branding is a global social marketing strategy that has demonstrated evidence of effectiveness across cultures, country settings and topics

  • More research is needed on how public health brands work, and more brands should be developed in the public health sector


Lessons from the commercial sector brands are like reputations
Lessons from the commercial sector:Brands are like reputations

  • Marlboro, BMW, and Virgin Atlantic – Great brands have a clear cut identity and value proposition

  • Marlboro’s identity: “All-American; hardworking/ trustworthy; rugged individual, man’s man (experienced, sure of self, confident, in charge, self-sufficient, down to earth, cool/calm, get the job done); admire his strength.”

  • Desirable, masculine reputation promotes associations with the brand for Marlboro consumers



Basic brand features
Basic Brand Features

  • Relationship between consumer and product or service (marketing focused on the consumer and building the brand-consumer relationship)

  • Value (customer and otherwise defined) added to a product or service

  • Exchange (cost and benefit) between product or service and consumer

  • All brands promise value, great brands consistently deliver it


Brands and brands of brands
Brands and Brands of Brands

  • Organizations can brand themselves – establish reputations that affect all their offerings

  • Virgin’s brand of brands transcends any one product

  • Modern, funny, hip, cool & maybe even “green”

  • Every Virgin brand benefits from the organization’s promise and delivers in its own sector



Persuasive mechanisms
Persuasive Mechanisms

  • Aspiration to an appealing external ideal

  • Modeling of a socially desirable good

  • Association with idealized imagery

  • Successful brands promise an external ideal for consumers, and then deliver (mostly) on the promise



How do brands work
How do brands work?

  • Why does that image work so well? How does it communicate so much when it “says” so little?

  • Positive associations – brand promotes them based on strategic marketing objectives

  • Images inspire aspiration – I want the promised external ideal

  • The individual aspires to close the gap between his or her own self-image, and the external idealized image

  • “Social imagery” (i.e., my perception of the external ideal) can also explain health behaviors


What is public health branding
What is Public Health Branding?

  • Commercial brands are associations that enhance the value of products and services for consumers

  • Branded products or services project socially desirable models & idealized imagery for consumers

  • Public health brands are associations that enhance value of health behaviors for an audience (better life as a nonsmoking, physically active, condom user)

  • Public health brands are about healthy lifestyles


Healthy lifestyle promotion
Healthy Lifestyle Promotion

  • Public health brands offer behavioral alternatives to health risks, promote healthy choices as socially desirable

  • Identify audience motivations & barriers:

    • Example audience motivations:

      • Independence, personal control, social status

    • Example barriers:

      • Competing messages, low self/outcome efficacy

  • Appealing social images (cool kids are physically active) promote aspiration to promoted lifestyle

  • Competition with unhealthy behaviors/marketing


Overarching strategy
Overarching Strategy

  • Brands present a call to action

    • Social Movement against tobacco use or promoting condom use as socially responsible

  • Brand promise

    • Ohio’s stand tobacco countermarketing brand — “Make a difference in the lives of important people around you by Standing Up against tobacco use”

  • Vaccination or inoculation from health risks (condom use as protection from HIV/STDs)

  • Result is a replacement or alternative lifestyle


Theoretical basis
Theoretical Basis

  • Social cognitive theory (Bandura, 1986): Modeling a positive, nonsmoking lifestyle encourages emulation

  • Social images projected by truth® are of coolness and popularity of non-smoking lifestyle (Evans et al., 2005)

  • Evidence for branding effectiveness across most modifiable behaviors (Evans et al., forthcoming)

  • Additional evidence on public health brands:

    • Hornik et al. (2003): ONDCP anti-drug campaign

    • Huhman et al. (2005): VERB physical activity campaign


Branding as mediator
Branding as Mediator

Brand Equity

MessageExposure

Health Behavior (smoking, diet, etc.)

Moderators(other media,demographics,etc.)


Concept of brand equity
Concept of Brand Equity

  • Multi-dimensional scale of attributes & associations

  • Aaker (1996), Keller (1998) developed measures in commercial sector

  • Evans, et al. (2002; 2005) developed brand equity scale for truth campaign, stand campaign (2007)

  • Adapted to nutrition & physical activity (Evans, et al. 2007; forthcoming)



What are the main components of public health brands
What are the Main Components of Public Health Brands?

  • Subject matter (HIV, tobacco)

  • Brand development (use of theory)

  • Marketing execution (channels)

  • Evaluation (design, data, analysis)

  • Outcomes (branding, behavior change)


Example lovelife
Example: LoveLife

  • African condom use promotion campaign

  • Promoted condom use as hip and cool, part of modern lifestyle for young adults

  • Increased positive attitudes toward responsible sex, increased condom use (Stadler & Hlongwa, 2002)


Lovelife message
LoveLife Message


Lovelife strategy
LoveLife Strategy

  • Promote lifestyle choices: value abstinence, delay initiation of sexual activity, reduce sexual partners among sexually active teenagers & condom use

  • Reach a number of audience segments (e.g., pre-contemplating, contemplating, sexually active)

  • Use multiple channels: Mass media, nationwide adolescent-centered reproductive health services, network of youth outreach and support, co-branding


Example truth
Example: truth

  • Launched in February 2000

  • Largest National anti-tobacco campaign (Over $300M)

  • Encouraged emulation of non-smoking lifestyle by tapping adolescent needs for independence, rebellion, control

  • Media tracking, evaluation of branding effort, anti-tobacco industry attitudes

  • High overall brand identification (Evans et al., 2005), reduced smoking associated with brand exposure (Farrelly et al., 2005)



How can public health brands be evaluated
How Can Public Health Brands be Evaluated?

  • Was the audience exposed to message?

  • What were audience message reactions (message perceived as credible, likeable?)

  • What associations were formed by target audience with brand?

  • Is brand exposure associated with positive reactions and associations?

  • Are reactions and associations related to intended behavior change?


Evaluation designs
Evaluation Designs

  • Observational (media tracking studies)

    • CDC’s VERB tracked tween awareness

  • Quasi-experiments (natural variation in exposure)

    • Truth used variation in media buy (Gross Rating Points) as natural control variable

  • Experiments (RCTs of exposed/non-exposed)

    • Chicago’s 54321 Go! being evaluated in randomized trial (Evans, Necheles, et al., 2007)


Evaluation measures
Evaluation Measures

  • Exposure

    • Self-reported (aided & unaided, or confirmed awareness)

      • If prompted, does respondent report message exposure (claimed)

      • If asked to provide description of message, does respondent demonstrate exposure (confirmed)

    • Environmental (Gross Rating Points, measure of population exposure in media market)

      • Nielsen media data on time/market audience size


Example truth media evaluation
Example: truthMedia Evaluation

Truth Campaign Exposure by Media Markets (2000–2002)


Portion of decline in youth smoking attributable to truth

Approximately 22% of total decline in youth smoking attributable to the truth campaign

Represents roughly 300,000 fewer youth smokers as a result of truth

Portion of Decline in Youth Smoking Attributable to truth


Evaluation measures1
Evaluation Measures attributable to the

  • Brand reactions (Elaboration Likelihood Model, Petty & Cacioppo, 1986)

    • Was the branded message credible? Was it likeable?

    • Predicts subsequent attitudes/associations

  • Brand associations

    • Imagery, social norms, attitudes, and behaviors audience associates with brand

    • Are these associations socially desirable?


Branding measures
Branding Measures attributable to the

  • Brand association examples

    • Loyalty (Will you continue with behavior?)

    • Leadership (Is the brand better than competitors?)

    • Personality (Do you perceive the brand characteristics as cool?)

  • Combined associations form brand equity construct (Aaker, 1996; Keller, 1998)

  • Youth with higher brand equity in Ohio’s stand:

    • more likely to sustain non-smoking lifestyle,

    • perceived messages superior to tobacco industry,

    • perceived brand to have socially desirable personality

    • (Evans, Renaud et al., 2007)


Behavioral outcomes
Behavioral Outcomes attributable to the

  • Example self-reported health behaviors

    • Smoking initiation, uptake

    • Time spent in moderate, vigorous exercise

    • Food choice, consumption

    • Condom use

  • Direct effects of branded message exposure on behavior

  • Indirect (mediated) effects of reactions and brand associations on behavior


Example mediated effects of truth on smoking behavior
Example: Mediated Effects of truth attributable to the ® on Smoking Behavior

APEX

Uptake

-.023

.323*

Anti-tobaccoCommitment

.157*

CFI: .941

SRMR: .052

RMSEA: .044

* p <0.01

-.285*

-.305*

Industry Manipulation

.457*

.490*

BrandEquity

SensationSeeking

.143*

Source: Evans, Price, Blahut, 2005.


Evidence from evaluations of public health brands
Evidence from Evaluations of attributable to the Public Health Brands?

  • Social marketing effective, but small effect sizes in 5–9% range (Snyder, et al. 2002)

  • Limited evidence on targeted message strategies, including branded campaigns

  • Most effective branded campaigns found in tobacco, nutrition/physical activity, HIV/STDs (Evans, et al. forthcoming):

    • truth

    • LoveLife (Africa)

    • VERB

    • 5-A-Day

    • Fighting Fat, Fighting Fit (UK)


Evidence of effectiveness
Evidence of Effectiveness attributable to the

  • Farrelly et al. (2005) showed truth campaign was associated with 22% of observed decline in youth smoking prevalence from 1999 to 2002.

  • Siegel and Biener (2000): 12–13 year olds in MA exposed at baseline less likely to progress to established smoking; no effect on 14–15 year olds or exposure to radio or outdoor ads.

  • Sly et al. (2002): teens with anti-tobacco industry attitudes promoted by Florida TRUTH were 4 times less likely to initiate smoking & 13 times less likely to become established smokers.


Review of branding evaluations
Review of Branding Evaluations attributable to the

  • Nearly all branded campaigns in published literature evaluated (Evans, et al. forthcoming)

  • Study sample & sample size generally reported

  • Sample characteristics & response rates usually not described

  • Observational designs most common

  • Descriptive statistics commonly reported; multivariate statistics uncommon

  • Rigorous evaluations relatively rare


Subject areas of published branding efforts
Subject Areas of attributable to the Published Branding Efforts


Role of evaluation in branded health communication programs
Role of Evaluation in Branded Health Communication Programs attributable to the

  • Evaluation is integral part of the Health Communication development cycle shown in Social Marketing Wheel (NCI, 2002)

  • Formative research widely used to developed branded messages

  • Media tracking used to evaluate exposure, message reactions

  • Brand associations and effects on behavior used to evaluate outcomes


Case study brand evaluation in cdc s verb campaign
Case Study: Brand Evaluation in attributable to the CDC’s VERB Campaign

  • Commercial marketing applied to a public health problem with a branding strategy — organizing principle of entire enterprise (Huhman, et al. 2005)

  • Conceived VERB brand as supporting each specific campaign strategy:

    • For example, promoting parks as place to have fun and be active

  • VERB as behavior + idea

  • VERB: Physical Activity = fun


Example verb message
Example attributable to the VERB Message


Evaluating branded campaign spots ohio s debunkify
Evaluating Branded Campaign Spots: attributable to the Ohio’s Debunkify

  • Campaign target: young adults age 18–24

  • Objective: Secondary prevention

  • Paid mass media in markets across state

  • Main messages: Debunk myths around smoking, smokeless tobacco, and tobacco industry marketing of tobacco

  • Evaluated brand associations and changes in social norms about tobacco use (e.g., perceived prevalence)


Measuring associations
Measuring Associations attributable to the

  • (Awareness) When you think “debunkify”, you think: Tobacco companies are lying to me.

  • (Awareness) When you think “debunkify”, you think: breathing secondhand smoke is like smoking cigarettes.

  • (Loyalty) I’d wear or use a “debunkify” T-shirt or other gear.

  • (Leadership) Debunkify is for people like me.

  • (Personality) The people in debunkify don’t get fooled by tobacco companies.


Stand awareness and smoking uptake
stand attributable to the Awareness and Smoking Uptake

  • Longitudinal Survey: Time 1 (Y1) - Time 3 (Y3)

  • Never Smokers at Y1

  • Aware of stand at Y1 - Less likely to try smoking at Time 3

    • 6.5% vs. 9.5% or

    • 44% less uptake


Example ohio debunkify message game show models
Example Ohio Debunkify Message: attributable to the “Game Show Models”

  • Television advertisement

  • Aired shortly after “Debunkify” launch in 2006

  • Purpose:

    • Introduce brand & theme:

      • “Debunk” idea that most people smoke

      • A non-smoking lifestyle is an acceptable choice

    • Create buzz around target audience

    • Drive traffic to debunkify.com website


Example ohio debunkify message game show models1
Example Ohio Debunkify Message: attributable to the “Game Show Models”


Example ohio debunkify message secondhand snakes
Example Ohio Debunkify Message: “Secondhand Snakes” attributable to the

  • Television advertisement

  • Aired shortly after “Debunkify” launch in 2006

  • Purpose:

    • Introduce brand & theme:

      • “Debunk” idea that secondhand smoke isn’t deadly

      • Understand reasons for promoting and supporting smoke-free establishments

    • Create buzz around target audience

    • Drive traffic to debunkify.com website



Future of public health branding
Future of public health branding attributable to the

  • Big issue: Commercial marketers will always have bigger budgets, 24/7 exposure – PH never will

  • How can PH beat that kind of competition?

  • How can brands be used strategically to magnify the effects of commercial marketing?

  • Cooler, hipper, more audience-focused brands

  • Utilize social trends (e.g., green movement, distrust of authority)


Example healthy media use
Example: Healthy Media Use attributable to the

  • Children’s media use is over 8 hours per day (with multi-tasking) and associated with negative health outcomes (e.g. obesity)

  • Develop branded campaign targeting parents of pre-school (aged 2-5) and elementary (6-11) children

  • Modify norms about media use, promote parent involvement

  • Complementary adolescent campaign to promote “smart” media use as socially desirable

  • Brand interpersonal social engagement as cool (maybe: “virtual dating isn’t even fooling around” – get it?)


Innovative strategies
Innovative Strategies attributable to the

  • Co-branding: Social marketers can link their branded messages to other trusted brands (e.g., co-brand a nutrition social marketing message with the Sesame Workshop)

  • Technology: Internet, handhelds, other media offer opportunities to compete with industry using “viral marketing” and potentially with lower advertising costs, reach youth audiences

  • Social networking: Place messages in media used by children and adolescents to network, take advantage of potential social diffusion effects (e.g., through MySpace, Facebook, iPods)


Future research
Future Research attributable to the

  • To what extent, and under what conditions, do PH brand equity effects increase over time?

  • How does the relationship between PH brands and audience change over time?

  • Can PH brands withstand fluctuating media buys, low exposure?

  • What effects do changes in social norms and other moderators such as the media and marketing environment have on brand equity and its mediating effects?

  • How can social marketers improve the effectiveness of brands in maintaining health behavior change over time?


Discussion
Discussion attributable to the


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