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The Role of Research in Social
Marketing
Insight, Development &
Evaluation
Banos Alexandrou, August 2009
Session Outline
• The role of research in Social Marketing
• What research methods to use
• Driving Insight out of data
• Some examples….
• Some problem solving
2
Role of Research in Social Marketing
What is social marketing?
Health-related social marketing is the systematic
application of marketing, alongside other
concepts and techniques, to achieve specific
behavioural goals to improve health and reduce
inequalities
4
A Social Marketing Intervention Should:
• Seek to change specific and measurable behaviours
• Be based on an understanding of target group
experiences
• Be tailored to individual segments
• Incorporate ‘marketing mix’ – the 4 product, price, promotion
and place
• Provide an exchange for behaviour change
• Consider competing influences and seek to remove or
minimise them
Andreason, 1994 – regarded as the definitive definition
5
NSMC breaks the principles down a little further
A Social Marketing Intervention Should:
• Be evaluated
• To ensure the intervention was properly developed
FORMATIVE
• To ensure the intervention was properly implemented
PROCESS
• To ensure the intervention was effective
OUTCOMES
• To ensure that it is sustainable – all of the above
A recent systematic review by Stirling University of social marketing
interventions in the areas of tobacco, drugs and physical activity found
evidence that social marketing can be effective, particularly when
adhering the above principles (Stead et al, 2007)
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The role of Research
Customer Context & Behaviour
Segmentation – ‘what moves
INSIGHT
and motivates’
Intervention pre-testing
DEVELOPMENT Intervention – recommendations
for development
Formative – was it properly
EVALUATION developed
Process – was it properly
implemented
Outcomes – was it effective and
sustainable
7
What research methods should I use
Market & Social Research – Some Basics
• Collection of methodologies that enable us to ‘know’
something about our populations – be they public, patients or
health professionals
• Three broad types
• Secondary Research – using existing research, data and
information to ‘scope’ a problem and identify gaps in knowledge
Primary • Qualitative Research – in-depth interviews, focus groups –
Research responses are ‘textual’
• Quantitative Research – surveys – face-to-face, telephone, postal
etc – responses are pre-set and presented as proportions of a
total group or relevant sub-groups
• Choosing the right methodology is key to any research project
and starts from the brief (more of that later)
9
Secondary Research – what do we already know?
• Using/analysing existing data we can determine our focus of enquiry
– who we speak to, what regions we focus on
• Using existing research (often using a systematic approach to
reviewing literature) we can set up our hypotheses – e.g. mental
health research tells us that childhood resilience is key to mental
health well-being – knowing this we ensure we capture what supports
‘resilience’
• Examining existing interventions (and any information supporting
their development) means we can consider what worked, didn’t work
and explore why in primary research
• Secondary research is often key to a formative evaluation –
examining the development of an intervention – where is the
10 evidence?
Designing the right research approach
• What are the objectives – insight, testing, evaluation
• What can be answered with existing data or research
• What research methodologies are able to answer the specific
questions
• Only at this point should we consider whether we need to
use qualitative or quantitative methodologies
11
Quantitative Research
• Quantitative surveys should be used when we wish to:
• Measure, benchmark or track incidence, awareness, behaviour,
attitudes and expectations – e.g. what are the current awareness
levels of sexual health services amongst young people,
• Key building block to building segmentations where national and
local data is sparse – i.e. what are the characteristics of heavy
drinkers in a region
• Essential when requiring an ‘outcomes’ evaluations – e.g. what %
of people were aware of a communication campaign, changed
their levels of contemplation (to quit smoking for instance)
• Many methods for quantitative surveying
• Face to Face – in home or on the street
• Telephone – using CATI
• On-Line – using bespoke surveys hosted externally or potentially
on a client’s intranet
• Postal
• Using existing Omnibuses – that are variously telephone, on-line
or in-home face to face – e.g. BMRB run a panel
12
When to use – ideally e.g.
Hard to reach populations – strict geography Determining
In-Home alcohol
Need to show visual stimulus
Need to interview whole household consumption
levels amongst
Need to conduct a long interview most deprived
Hard to reach populations – strict geography Measuring
Street Intercept smoking
Need to show visual stimulus
A short questionnaire communications
and
Good for young people (over 14)
service
COST
awareness
Professional population – with contact lists Determine GP
Telephone perspectives on
Broad population - from random dialling
No need to show stimulus practice based
commissioning
Professional population with access to the internet Testing
On-line in the course of their work satisfaction, ease
Broad population – particularly testing web based of use etc of
propositions health prevention
website
Never really ideal – perhaps when you want to
Postal show that you have given the most amount of
people the chance to respond – e.g. consultation
exercises
Ideal for measuring aspects of a national
Omnibus/Panels population of the public or stakeholders
13
Sampling for Quantitative Surveys
• A survey is only as useful as the sample it is based on
• The most common method in achieving a good sample is through
setting quota targets – (something that is not always possible with on-
line or postal methods where you rely on individual self completing
and therefore have no control over numbers coming in)
• For instance, if you wanted to understand levels of awareness of
cancer risks and symptoms across a population you would set sample
quotas on region, age, demographic and gender (primarily) that reflect
existing population profiles (available from census data)
• You can boost certain population samples – and then re-weight back
to population statistics – etc….
• And, if you want to compare measures across groups – a group
should have as a minimum at least 50 respondents in order to drive
out statistically significant differences
• A sample of less than 50 is not really advisable
14
Focus Groups & In-Depth Interviews
• From a methodological point of view people often talk about group
‘synergy’, the ability for members of the group to have their
perspectives challenged – thus promoting participants to think how to
justify their position – hence more information than simply asking
someone what they think
• In-depth interviews are particularly good with professionals whom you
know can wax lyrical on a subject related to their work without being
curtailed too much by challenging other professionals – but groups for
this lot are very effective sometimes (especially when wringing hands
about the public!!!)
• A sample should reflect the target population – e.g. asian male
smokers, and should be drawn from the region of interest – e.g. asian
male smokers in Lewisham – or health professionals who have direct
contact with a target population etc
15
Focus Groups & In-depth Interviews
• Good for driving deep into experiences, behaviours, motivations and
expectations – getting the why?, the ‘reaction’, the nuance – often
deploy enabling and projective techniques – good for devising and
fleshing out a segmentation (adding colour to numbers)
• Sets parameters for an enquiry – e.g. we know these are the factors
that influence a person’s behaviour – but we won’t know the extent to
which these work in the wider population (this we would use
quantitative surveys for)
• Can be used when undertaking a ‘process’ evaluation – e.g.
research amongst participants or stakeholders on whether the process
was good, easy etc
• But NO GOOD for an ‘outcomes’ evaluation – can’t generalise from
focus groups as to awareness of service or incidence of desirable
behaviours, following an intervention
16
The role of Research
Customer Context & Behaviour
Segmentation – ‘what moves
INSIGHT
and motivates’
Intervention pre-testing
DEVELOPMENT Intervention – recommendations
for development
Formative – was it properly
EVALUATION developed
Process – was it properly
implemented
Outcomes – was it effective and
sustainable
17
Some Logistics
Materials….
• Research specification – an outline of objectives and how
those will be met by the proposed research methodology
• Sample Frame – qualitative or quantitative – who we are going
to speak to and in what quantities
• Recruitment Screener – who we select for qualitative research
• Discussion Guide – a guide incorporating the question themes
we want to cover
• Questionnaire – a survey instrument that captures information
on who we are speaking to and their responses to questions
(mostly) with set responses – e.g. yes/no, 3 out of 10 etc
19
The art of recruitment #1
• Whether we are recruiting for focus groups or for the right participant
type in a survey the key task is to specify ‘who’ we are researching
• For focus groups/in-depth interviews we decide this in advance and
draft a ‘recruitment’ screener:
• e.g. recruiting those at risk of diabetes – criteria:
• Aged 35 +
• Smoke and drink alcohol regularly
• Take little exercise
• Have history of diabetes in the family
• For surveys we ensure we collect all the information we need to know
about an individual to ensure we know when we have reached our
sample target – typically age, socio-economic group, region, gender
etc….
• Sometimes we only want to speak to smokers or carers of children –
which means these questions are posed at the front of a survey to
ensure we get the right people
20
The art of recruitment #2
• Best practice to use independent fieldwork or recruitment agencies -
working to Market Research Society Code of Conduct – beware of
telesales companies masquerading as recruiters
• Trying to recruit participants from existing lists that PCTs may have
can be problematic – the usual suspects and hard to find a suitable
date and time when limited to a short list – better to go to into the
population as a whole with a pre-defined and agreed set of criteria
• They have a database of recruiters and interviewers that they deploy
on projects
• Recruitment agencies will typically organise venues and incentives for
participants and provide a host – e.g. when conducting groups in a
local hotel or viewing facility
21
Getting insight out of data
The real challenge!
Analysis of ‘data’
• Should be systematic
• Should be informed by and should test pre-conceived
hypotheses
• Should allow for the unexpected – letting the data speak
for itself
• Should be transparent and reviewable
23
Analysing different types of data….
Quantitative Data Qualitative Data
• Use data tables • Use ‘content analysis’
• Specify tables by deciding • The ‘text’ (interview/group
what ‘groups’ of interest we transcript) is the data
want to compare – this is how • Assign text according to pre-
we build and refine segments Draw determined themes – e.g.
• Use statistical significance Insights service experience, service
testing – this tells us whether needs, service expectations
the difference between one • But consider what themes we
group is likely to be the result may have missed (letting the
of chance or an observable data speak)
difference • We look across different
groups for commonalities or
distinctions across themes –
another we build and refine
segments
24
Example – data tables
25
Example – Analysis Grid
Group 3 Female 25 – 35 ABC Group 4 Female 25‐35 DE (6 respondents) ‐ No screening in
Sample Women 25‐35 ABC ‐ Yes screening (5 respondents) ‐No screening in the past 3 years Women 25‐35 DE ‐ Yes screening the past 3 years
Chelmsford Maldon Braintree Braintree
• All registered with GP – either at Blandford Medical
Centre (4) or Mount Chambers (2)
• Mount Chambers v difficult to get appt especially with
own GP always told to ring back in a couple of days.
Services known; childhood immunisation, baby clinic, Well
•All registered • All registered with GP practices and most have attended recently woman clinic (weds eve but impossible to get appt). No sat
•Very mixed views on how accessible services are. Those not – all have young children, one pregnant appts available. Easy to access but no parking.
working find making appointments easy, those who are, • Difficulty booking appts and frustration at cost of waiting on • Blandford – also tricky getting appt, usually get to see a
much less so automated telephone system • All registered nurse or GP will call back and discuss issue over the phone.
•One GP has recently introduced out of hours services, • At Blackwater appt booking system recently changed and can • Various levels of satisfaction with appt booking Can book in advance for a nurse appt but can only book 2
others not sure about theirs now book appts in advance which is an improvement • General feeling it is much easier to book appts for their days in advance for GP appt. Unsure of services offered at
•General sense that making appointments for children is • Booking appts at Longfield ‘a nightmare’, also Haybridge clinic children than for them new surgery. Hard to get appts outside of working hours,
easier than for themselves never open and doesn’t have nurses meaning respondent has to go • Seeing a nurse is not a problem no sat appts available. Very difficult to access if don’t drive
Access to GP/ health centres •Seeing a nurse is not a problem at any of the practices to a different surgery much further away • Physical access is ok for most (one surgery has moved, – now that its moved – 1 mile walk down main road
‐ represented and all have access to female nurses leaving one participant with a long journey)
• All say have greater knowledge of cervical cancer following media
news re. Jade and knew little before although mention getting
fatigue from all the recent coverage
• Only info seen re. screening are posters and leaflets in GP surgery
and letters from screening programme – now knowledge of any
media campaigns
• Risk factors: age at which become sexually active (cervical), family
history, smoking, diet, obesity
• Being on the pill can help protect against breast cancer
• Knowledge of injection against cervical cancer being given to 12‐
13 yr olds
• Some have been told of procedure by their mothers but talk
amongst friends is limited to the horrors of the procedure rather • 2 had lost their mothers to cancer, brain tumour and
than the real facts of why being screened ovarian, 1 has younger brother that had cancer
• One respondent has encouraged her mother to go for cervical • Cancers that affect women – breast, cervical (although
screening as following the menopause she thought she no longer some say they wouldn’t have known of this before Jade
needed to Gody), Ovarian (due to mother’s illness)
Breast screening • Increased risk – smoking, sunbeds causing skin cancer,
•Relatively high ‐ able to list many different cancers • None aware of when screening begins – one thought service only •Relatively high awareness due to personal experience fatty diety, alcohol, being on the pill? Family history (breast
•Spontaneous mention of basic prevention / screening for those with family history of breast cancer •Spontaneously mention screening as an important aspect and ovarian)
messages ‐ not that these are always adhered to • Aware that mobile units offer breast screening – and know that of prevention • Prevent cancer? – regular check ups and screening, good
•All know (of) someone who has had cancer and there is a lot some of their mothers have been •Feel bombarded by messages about what might cause diet, not smoking
General awareness of cancer of interest in and concern about it cancer
• All aware of smear tests but two not aware what
procedure was checking for pre‐cancerous cells
• Uncertainty at what age screening starts, 25 (but soon to
be reduced to 20), others have had been called for tests in
teens or after they had children or if experienced irregular
•Awareness of screening is high and they all consider it to be bleeding
very important •Awareness of screening is high and they all consider it to • Only one aware of link between age one becomes
• No recollection of public health campaigns ( other than be very important sexually active and no. of partners can increase risk
invitation/reminder letters and, for a couple, leaflets sent • No recollection of public health campaigns ( other than • Before Jade – most knew v. little about cervical cancer
with these letters or at GP) • Aware screening begins at 25 in UK and queries as to why 20 in invitation/reminder letters and, for a couple, leaflets sent • Awareness amongst some (with daughters of appropriate
•Although clinical guidelines have changed since they first Wales and Scotland and not UK with these letters or at GP) age) of immunisation jab against CC but no real
started attending screening, they know the new • Don’t understand why changes from every 3 to every 5 yrs as you •They talk very openly about their experiences (more than understanding of why at that age and why older women
Attitudes towards/awareness of recommendations largely because of cases in media since JG get older if affects older women more any other group) can’t have it
cervical cancer screening (i.e. women under 25 saying they've been turned away from • Important to all procedure carried out by a female •Much concern and confusion that screening now starts at
‐ smear) 25. Majority still believed age to be 18 until JG coverage
Breast cancer
•Mixed awareness
Breast cancer • Several have family / friends with personal experience
•High awareness and for some detailed knowledge as they • Some awareness of campaigns and celebrities who have
have close family/friends with personal experience had BC
•Lots of local and national campaigns • Know they should be self examining and several do
•They all know they should self examine but generally don't Knowledge of screening
do this routinely •Majority know that screening is available and several
Knowledge of screening know it starts around 50 (several have mothers who have
•Levels of knowledge vary. 2 do not know it exists. Others do recently had mammograms)
Attitudes towards/awareness of and think it is important but some have no idea when it •Some have seen local screening van
breast cancer screening starts. About half guess around 50 •Criticism that screening is not offered for younger women
• Had two letters previously which have been ignored but since
recent Jade Goody story has decided to go Cervical screening
• ‘I didn’t have my first smear until I was about 22. I was so scared • One has had couple of letters but not gone for appt as
and worried because you just hear these horror stories don’t you. don’t like procedure
Oh you may bleed and they’re oh God, you’ve got to put your legs • Hear negative stories from others “People do tell you
in the air and all this and everyone, and you think oh no, especially horror stories about stirrups, they put your legs up and
when you’re young’ attack you with this great big metal thing and open you up.
• Less bothered about attending for screening following childbirth People terrified me but when I made my first appt my Dr
• I haven’t had a smear done since my first child so it’s probably, it made me two, one to talk me through what would happen
is probably five and half, six years and it’s for no reason, I can’t say before and then one to have it done which was really
that it’s the traumatic experience or anything like that, it’s just good”
shear laziness, probably, to be quite honest.’ • Partner went on internet and told her how she would be
• ‘I got a letter a couple of weeks ago, so I’ve got to book one but ‘used and abused’
•Yes, all attend regularly. Half have had recalls after I’m too terrified, [unclear] next week. So I haven’t had one in over • Very daunting first time
abnormal cells/unsuccessful screening and several have had three years’. • Do discuss with friends and people try to put you off
some treatment • V good experience of screening conducted at Well Woman clinic saying it hurts
•One attends but delays making appointments following a at uni, nurse showed how to self‐examine breasts • All screened regularly • Some have found reassurance from mothers but others
negative experience in the past • All screenings done at GP surgery carried out by female nurses • Half of the group have had coloscopies ‐ so some haven’t discussed with them
•Majority of their smears have been conducted by female which is preferred screened very regularly • One had had male GP – not happy with this at all “Now
nurses, one by a male GP • Would prefer it is examination rooms had pictures, music, • All are usually screened by female HPs, though several the nurses do it and it’s not so bad”
•Some are indifferent about the gender of the HP conducting TV and more distractions when attending for screening have had male HPs at hospital •Preference for female HPs, • Some feel nurses have a better bedside manner, others
the smear. Others express a preference to see a woman • It would be good to have a second nurse to chat to you and some wouldn't be screened by a male professional have had good experiences with Female GPs
GP/nurse but are willing to be seen by a male HP. A couple and take your mind off procedure "I wouldn’t let a man doctor do it because I’m funny about • Would prefer to have done at separate Well Woman
say that male HPs are likely to be more gentle "It doesn’t • Being offered choice of lying on side instead of back good things like that" clinic – all female health professionals, know that everyone
bother me. I've been examined by men and women, and the – more dignity • One has not had recall or reminder letters is having same procedure, time to explain things to you,
way I see it is to get on with it. It's your job. You're helping • Mention of feeling violated •One is disappointed with the info/explanations she was can have smear done at same time as going
me out" Results given when she had pre‐cancerous cells for FP advice and contraceptives.
•There is little/no sense of embarrassment about having a • Received by letter 2 – 6 weeks after screening •Smears have become less uncomfortable since the move Well Woman clinic now run at GP surgery but hard
smear done among this group especially for those who have – don’t nervously wait most forget about them until they arrive to liquid based cytology to get appt
Cervical cancer screening history had children •Results are taking longer to come through
Cervical cancer screening history 2:
Have not been screened n/a n/a
Breast cancer screening history 1:
Have been screened n/a n/a
26
And the questions to answers are broad
• What will encourage more women to screen for cervical
cancer
• Can we distinguish segments from our target audience of
carers with respect to their propensity to give their children the
2ND MMR jab – e.g. in terms of ‘what moves and motivates’
• Has the awareness of the stop smoking service or
contemplation to give up smoking risen since the inception of
a local mixed media campaign designed to drive people into
stop smoking services
• What proposition/concept is the most compelling in
encouraging overweight carers to seek weight management
help for themselves and their children
• Did GPs involved in a CVD screening pilot believe that the
intervention was properly conceived and deployed
27
Some examples
Customer Insight – How to encourage better up-
take of MMR vaccination in Camden #1
The Issue
• MMR up-take (second jab) low in Camden
• Data systems clearly a problem - reminders not getting through to right people
• But a diverse population and the hypothesis that new migrants and the middle
class were particularly problematic and behaviour could not just be put down to
data
The Research Approach
• Survey with 350 carers – target sample quotas set to ensure sufficient numbers
of new migrants, established BME and affluent carers – compare behaviours,
attitudes, awareness of risk etc….
• In-depth interviews with 35 carers (some of whom with incomplete immunisation
histories) – to determine more in-depth the challenges in achieving full
vaccination for infants and children
• On-line survey of Health Professionals (60) and Workshop with 30 health visitors
(and some GPs) to feedback findings and determine their perspectives on
‘problem’ populations and consider intervention ideas/recommendations
29
Identified segments (i)
Segment Description Profile
Go through with immunisations routinely and Most households from all
have complete trust in the system and backgrounds.
healthcare professionals.
Oops! Unintentionally miss immunisations due to a lack Transient households and
of reminders, or immunisation not a top priority those who do not come into
for parents. much contact with healthcare
professionals (especially when
children get older).
30
Identified segments (ii)
Segment Description Profile
Help! Believe immunisation is essential for a child’s health More likely to be less educated
and would not miss an appointment, but MMR is and/or less affluent and from all
something different, confusing and frightening. Better to backgrounds, although some tight-
delay and wait until the child is older and strong enough knit BME communities are strongly
(or just forget about it). Not likely to go for single jabs present (e.g. Bangladeshi, Somali).
due to the cost.
NO… Reject the three-in-one MMR jab based on an ‘informed’ More likely to be well educated and
decision. Have already had several discussions with more affluent and possibly White
healthcare professionals but are not yet convinced of its British.
safety. Better to have the single jabs (or delay, or not do
at all) because this seems safer and can be afforded.
REJECT Believe in natural medicine and reject all immunisations. Very much the minority and more
IMMS likely to be White British and
reasonably affluent
31
Some Recommendations (from Health Visitors)
• Improve current information and materials – focus on
consequences of disease – and use imagery wherever
possible – not everyone can read or read well.
• Promotion should be sustained – and community
influencers – particularly amongst Somali community
should be leveraged
• Educate at point of contact – provide support workers,
nursery staff wherewithal to educate carers they come in
contact with or at least a reliable referral mechanism
32
So… we found that an intervention should
• Ensure the availability of complete, non-judgmental and easily digestible
information for carers across diverse population
• Seek to develop the level of empathy exhibited by health professionals - whilst
they may know there to be no autism risks from MMR some carers are still
unsure enough to ‘stick their head in the sand’
• Educate and provide information to influencers in schools, nurseries, community
leaders etc….
• Be based on a review of information materials and development and testing of
these
• Incorporate a ‘launch’ (through the line) of a new suite of information ensuring a
consistent message that focuses on the consequences of not being vaccinated
and the availability of ‘empathy’ - advice and guidance - if there is any doubt….
• Ensure that advice and guidance is available when needed!
33
Intervention Pre-Test – How to reduce smoking
amongst the deprived in Greater Manchester
Series of one day Creative Development Workshops
Low income smokers 20
Frontline Staff
participants per workshop
CREATIVE BRIEF
Qualitative Market Testing…low income smokers
On-Going Concept Production
34
35
35
36
36
37
Some Problem Solving
How can we encourage our
population to recognise that they
have a treatable mental health
condition?
How can we encourage our
adolescent population to
recognise sexual health risks and
use services designed to help
them minimise risks of STI’s or
early pregnancy?
The Task
• What questions should we be asking to help us determine our
approach?
• What existing information will help us shape our research
approach?
• Whom should we be speaking to?
• What should we be asking them?
• How should we try and research them?
• What does success look like? Evaluation?
41
THANK YOU
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