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Policies and Laws. Social Gradients. Income. Living Conditions. Transportation. Culture. Upstream Social Marketing. Discrimination. Social Capital. Education. Social Networks. Social Support. Violence. ASU Wellness and Health Promotion May 13, 2008

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upstream social marketing

Policies and Laws

Social Gradients


Living Conditions



Upstream Social Marketing


Social Capital


Social Networks

Social Support


ASU Wellness and Health Promotion

May 13, 2008

Karen Moses, MS, RD, CHES and Jim Grizzell, MBA, MA, CHES, HFI

Individual and Community Health

learning objectives
Learning Objectives
  • Explain importance of moving upstream
    • Social determinants of health
      • Policy makers, decision makers, implementers, regulators, funders, police, other influencers
  • Describe upstream social marketing approaches
  • Apply upstream social marketing to ASU health problems
why move upstream
Why Move Upstream
  • It is unfair to expect individuals to use healthy behaviors
    • Even if motivated because barriers make it difficult
  • Social environment in which we live has a marked impact on our choices
  • Our behavior is only partially under our own control
why use upstream social marketing
Why Use Upstream Social Marketing
  • A social determinant may seem
    • Too big to tackle
    • Out of bounds because it is not specifically health-related
  • Can’t understand many health problems without acknowledging predisposing causal factors
why use upstream social marketing5
Why Use Upstream Social Marketing
  • Social marketing is appropriate
    • whenever you have a behavior to influence
    • for motivating a bureaucrat to implement new or existing laws or regulations that would contribute to increase social welfare
  • Customer orientation
  • Behavior
  • Theory
  • Insight
  • Exchanges
  • Competition
  • Audience segmentation and targeting
  • Marketing mix
    • Continuous and strategic formative & process research, monitoring and evaluating

Green text are common tasks left out of social marketing programs.

alan andreasen s approach
Alan Andreasen’s Approach
  • Process
    • Listening
    • Planning
    • Pretesting
    • Implementing
    • Monitoring
    • Revising
  • Concepts and tools
    • Stages of change
    • BCOS
      • Benefits, Costs, Others, Self-assurance
    • Competition
  • Others concepts
    • Segmentation, 4Ps, Branding
cdcynergy social marketing edition
CDCynergy's Competitive Advantage

Extremely pre/post tested

Distills comprehensive best practices

Vetted by major players in social marketing

Over 700 resources

CDC originated

Use CDCynergy for funding requests

Looked on very favorably!!

Recognized nationally and internationally


Problem description

Market research

Market strategy




CDCynergy Social Marketing Edition

Green text are common tasks left out of social marketing programs.

phase 1 problem description
Phase 1: Problem Description
  • Write a problem statement
  • List and map the causes of the health problem
  • Identify potential audiences*
  • Identify the models of behavior change and best practices*
  • Form your strategy team
  • Conduct a SWOT analysis

* These are Logic Model items

phase 2 market research
Phase 2: Market Research
  • Define your research questions
  • Develop a market research plan
  • Conduct and analyze market research
  • Summarize research results
phase 3 market strategy
Phase 3: Market Strategy
  • Select your target audience segments*
  • Define current and desired behaviors for each audience segment*
  • Describe the benefits you will offer*
  • Write your behavior change goal(s)*
  • Select the intervention(s) you will develop for your program
  • Write the goal for each intervention
phase 4 interventions
Phase 4: Interventions
  • Select members and assign roles for your planning team
  • Write specific, measurable objectives for each intervention activity*
  • Write a program plan, including timeline and budget, for each intervention
  • Pretest, pilot test, and revise as needed
  • Summarize your program plan and review the factors that can affect it
  • Confirm plans with stakeholders
phase 5 evaluation
Phase 5: Evaluation
  • Identify program elements to monitor
  • Select the key evaluation questions
  • Determine how the information will be gathered
  • Develop a data analysis and reporting plan
phase 6 implementation
Phase 6: Implementation
  • Prepare for launch
  • Execute and manage intervention components
  • Execute and manage the monitoring and evaluation plans
  • Modify intervention activities, as feedback indicates
learning objectives16
Learning Objectives
  • Explain importance of moving upstream
    • Social determinants of health
      • Policy makers, decision makers, implementers, regulators, funders, other influencers
  • Describe upstream social marketing approaches
  • Apply upstream social marketing to ASU health problems
processes of change
Processes of Change

Positive outcomes and ROI

Reduced utilization

Reinforcement Management: Finding intrinsic and extrinsic rewards for new ways of working;

Environmental Reevaluation: Appreciating that the change will have a positive impact on the social and work environment;

Self-Liberation: Believing that a change can succeed and making a firm commitment to the change

Self-Reevaluation: Appreciating that the change is important to one’s identity, happiness, and success

Dramatic Relief: Emotional arousal, such as fear about failures to

change and inspiration for successful change

Consciousness Raising: Becoming more aware of a problem and potential solutions

Moving to a Health Agenda

customer orientation
Customer Orientation
  • Customer in the round’ Develops a robust understanding of the audience, based on good market and consumer research, combining data from different sources
    • A broad and robust understanding of the customer is developed, which focuses on understanding their lives in the round, avoiding potential to only focus on a single aspect or features
    • Formative consumer / market research used to identify audience characteristics and needs, incorporating key stakeholder understanding
    • Range of different research analysis, combining data (using synthesis and fusion approaches) and where possible drawing from public and commercial sector sources, to inform understanding of people’s everyday lives
  • Based on developing a deeper ‘insight’ approach – focusing on what ‘moves and motivates’
    • Focus is clearly on gaining a deep understanding and insight into what moves and motivates the customer
    • Drills down from a wider understanding of the customer to focus on identifying key factors and issues relevant to positively influencing particular behaviour
    • Approach based on identifying and developing ‘actionable insights’ using considered judgement, rather than just generating data and intelligence
health in higher education
Health in Higher Education
  • Health in higher education supports 18 million students in 4,200 IHEs
  • Many college and university professionals work in higher education to promote health
    • 250 professionally prepared ACHA HEs - 1:72,000*
    • 19,000 faculty and staff – 1:947
  • Health problems
    • Campus wide
    • Specific to college or major
  • Influences quality and productivity

* See notes section

traditional health programs
Traditional Health Programs
  • Use the Medical Model
    • Health services has primary responsibility
    • Staff trained in clinical practice
  • Health care agenda focus is on the physical
    • Healing sickness/injury
    • Wellness for physical health
  • Methods focus on the individual
    • Awareness activities, written information, didactic presentations
the traditional approach
The Traditional Approach
  • Limits our understanding of health
    • Physical health is what counts most
    • Ignores role of environment/community on health
    • Lacks prevention focus
  • Financially costly and ineffective
    • Lacks cost-effectiveness, positive ROI, reach, impact
  • Removes responsibility for health outcomes by non-health entities
    • Gives medical systems a lot of power
traditional health programs26
Traditional Health Programs
  • Based on tradition, convention, belief, anecdotal evidence
  • Pressure to be seen as acting
  • Desire to help
  • Poorly developed skills and understanding of population behaviour change
  • Short term policy planning, budgeting and review
evolution of college wellness health
Evolution of College Wellness & Health

1850s 1970s 1980s ~1995 2010

1st Generation 2nd Generation 3rd Generation




Instruction, Treatment, ExerciseHealth Education/Promotion EB/CE-HP*

* Evidence-based / Cost Effective Health Promotion

evolution of college wellness health28
Evolution of College Wellness & Health

Traditional Medical Model and Health Education

Traditional Medical and Health Promotion

Evidence-Based & Cost-Effective Health Promotion

Name of Model

Fun activity focus

No risk reduction

No high risk focus

Not HCM* oriented

All voluntary

Site-based only

No personalization

Minimal incentives

No sig. others served

No assessment/eval

Mostly health focus

Some risk reduction

Little risk reduction

Limited HCM oriented

All voluntary

Site-based only

Weak personalization

Modest incentives

Few sig. others served

Weak assess/eval

Focus on student learning

Strong risk reduction

Strong high risk focus

Some required activity

Site and virtual

Environmental changes

Strongly personal

Major incentives

Sig. others served

Rigorous assess/eval

Main Features

Morale Oriented

Activity Oriented

Results / Outcome Oriented

Primary Focus

Moving to a Health Agenda

* Health Cost Management

social marketing commercial vs social
Social MarketingCommercial vs. Social
  • Marketing is about behavior change
    • The bottom line
    • ROI and CEA
  • If your intervention won’t change behavior
    • Don’t do it!!!!
  • Theory
    • Distillation of previous work
    • Simplify complex phenomena
some questions to guide theory selection
Some Questions to Guide Theory Selection
  • Where are people in relation to a particular behavior?
  • What factors cause this position?
  • How can they be moved in the desired direction?
keys to effective use of the ecological perspective
Keys to Effective Use of the Ecological Perspective
  • Expand the focus beyond health information and programming
  • Integrate responsibility for health across student affairs and academic units
  • Provide supportive environments and reduce barriers to optimal outcomes
  • Promote leadership and involvement by multiple partners
intervention pyramid
Intervention Pyramid







Primary Care

Activities no feedback

Health Systems

Activities w/ Health Education

Community &

Neighborhood Collaboration

Health Communication, Social

Ecological Model & Social Marketing




continuum of services
Continuum of Services

For students at highest risk of engaging in high behaviors or already having a health problem

For students at risk of engaging in high behaviors or already having the health problem


For all students, regardless of risk to delay or prevent health problems

Early Intervention

Universal Prevention

From Dept of Education Safe Schools / Healthy Students Grant Guidelines

health in higher education35
Health in Higher Education

Karen S. Moses, MS, RD, CHES*

Director, Wellness and Health Promotion

Arizona State University

Chair, NASPA Health in Higher Education Knowledge Community

Member at Large, ACHA Board of Directors

Deputy Coordinator, Coalition of National Health Education Organizations

* Certified Health Education Specialist

the ecological perspective
The Ecological Perspective

The science and art of helping people change their lifestyle to move toward a state of optimal health….Lifestyle change can be facilitated through a combination of efforts to enhance awareness, change behavior, and create environments that support good health practices. Of the three, supportive environments will probably have the greatest impact in producing lasting changes.

  • M. P. O’Donnell, American Journal of Health Promotion (1986)
a new paradigm the ecological approach to campus health
A New Paradigm: The Ecological Approach to Campus Health
  • Views the connections among health, learning, and the campus structure
  • Explores relationships between and among individuals and the learning communities that comprise the campus environment
using the ecological perspective on campus
Using the Ecological Perspective on Campus
  • Establish a Working Group
  • Identify Campus Values
  • Assess Student Health Data
  • Analyze Campus Health Concerns Through an Ecological Lens
      • Environmental influences
      • Individual influences
  • Develop a Plan
influencing factors
Influencing Factors

Characteristics of the:






environmental influences
Environmental Influences



The location of the campus

The weather

The constructed designs


Behavior settings: Rituals,

student organizations

Cultural Influences: Customs,

traditions, values

Economic Forces: Student

financial stability, budget

Inhabitants: Diversity, Athletics,

Greek, campus communities, etc.

Organizational Structure


Organizational Climate



Political Climate


Pro education?

Reinforcement and Rewards

For healthy org & indiv behaviors

stress environmental influences
Stress: Environmental Influences

Warm climate

Lack of parking

High traffic

Campus size—distances

Crowding—long lines



Financial concerns

ISO – global troubles

Relationships w/friends

Lack of friends/commuters

Irresponsible drinkers

Uninvolved students

Services--lack of info

Depts disconnected

Too many steps

Weak policy enforcement

Inconsistent messages


State budget crisis

Increase in tuition/fees

Rewards for over


Culture of stress



Social Marketing Social Marketing Social Marketing



Primary Care

Activities no feedback

Health Systems

Activities w/ Health Education

Community &

Neighborhood Collaboration

Health Communication,

Ecological / Environmental Approach


Social Marketing’s FitIntervention Pyramid

Social Marketing in Health Promotion

historical snapshot think health agenda business case corporate college health wellness
Historical Snapshot: Think Health Agenda & Business Case Corporate & College Health & Wellness

1st Generation 2nd Generation 3rd Generation 4th Generation

RecreationFitnessHealth Education > Promotion HPM*

1850s 1970s 1980s ~1995 2010

1st Generation 2nd Generation 3rd Generation

Instruction, Treatment, ExerciseHealth Education > Promotion HAPM*

* Health & Productivity Management, Health & Academic Performance Management

Moving to a Health Agenda