Marketing Social Strategy by kdh40920


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									    Social Marketing
Strategy/Plan 2010 - 2011

    1. Background and Evidence Base

    2. Local Context
    2.1 Local Targets

    3. Definition

    4. Process
    4.1 Insight and Understanding

    5. Prioritisation

    6. Project Planning / Action Planning

    7. Evaluation

    8. Risks and Constraints
1. Background and Evidence Base

The UK Government 2004 Public Health White Paper ‘Choosing Health’ (DOH. 2004) recommended that social marketing is used to help make
behaviours that can harm health less attractive, and to encourage and support behaviours that can improve health (Department of Health,
2004), this was reinforced in the Health Inequalities report published last year (DOH, 2008b). Social marketing has the potential for being a
powerful approach to strengthen and enhance efforts at national, regional and local levels to improve health and reduce health inequalities.
There is growing evidence that suggests when social marketing is used effectively and appropriately it can achieve real and measurable impacts
on behaviours (NSMC, 2007). However, it is important to recognise that social marketing is not a panacea (ibid) but part of overall strategic

In 2006, in response to Choosing Health, an independent report by the National Consumer Council : It’s Our Health (NSMC, 2006), reviewed
the potential of social marketing to help promote health in the UK. This review is informing the development of a social marketing strategy for
England. Its key recommendations were that the Department of Health nationally and Primary Care Trusts locally need to develop a programme
that puts the consumer at the centre of all of its policy development and delivery work, concentrating resources around delivering key public
health messages through the wider community. The review’s recommendations formed the basis of the Department’s social marketing strategic
framework, and led to the creation of a specialist team, ‘The Social Marketing and Health-related Behaviour Team’. This team sits within the
Department of Health and supports work to integrate a social marketing approach in key work streams. For example:

   •   NHS LifeCheck
   •   Health Trainers
   •   Health Literacy
   •   Alcohol Misuse

Building on demographic and epidemiological data, the main drive of social marketing is to genuinely understand the target audience – their
daily lives and routines in order to gain core ‘actionable insights’ that inform the appropriate selection and implementation of interventions.
Therefore the customer has to be at the heart of any intervention (see figure 1 below). This is important as messages about health are
sometimes inconsistent or uncoordinated and out of step with the way people actually live their lives (NSMC, 2006).
Figure 1 – NSMC (2007)

The Department of Health set out a formal response to the recommendations contained in It’s Our Health (NSMC, 2006) through ‘Ambitions for
Health – a strategic framework for maximising the potential of social marketing and health-related behaviour’ (DOH, 2008a). This new action
plan provides a clear steer on the Departments of Health’s next steps for social marketing in order to ensure that social marketing is utilised and
embedded throughout public health delivery systems. Its also illustrates the practical tools that the Department of Health are developing to
build social marketing competencies and capacity in England to ensure policy development and public health interventions are informed by an
understanding of what motivates people (see appendix 1).

2. Local Context

Data from Primary Care1 suggests that Warrington has a higher prevalence of coronary heart disease, diabetes, chronic obstructive pulmonary
disease and asthma than England. Widely recognised evidence shows that people’s lifestyles (e.g. smoking, physical activity, diet, alcohol
consumption and emotional well being) affect the prevalence of cardiovascular disease, other long term conditions such as diabetes, as well as
mortality rates amongst adults, hospital admissions and prescribing costs. Social marketing is one way (alongside other interventions) of trying

    Data used from NHS Warrington and Warrington Borough Council (2008) Joint Needs Assessment.
to address these issues from an early detection/preventive point.

Evidence has demonstrated that lifestyle factors have a significant impact on life expectancy. Social Marketing can effectively be targeted at the
most disadvantaged areas to engage with them and make it easier for individuals in these communities to make healthier choices. As
acknowledged in the Health Inequalities report published last year (DOH, 2008), the government visualises these initiatives as important in
tackling health inequalities through improving access to health advice, support, and services in disadvantaged communities and therefore will be
addressing health inequalities in Warrington.

Using Social Marketing in this way as a mechanism for encouraging behavioural change moving the focus from mass communication
techniques to more tailored and targeted approach is something that NHS Warrington aims to achieve. Our objective is to develop a culture in
the PCT where everyone adopts a social marketing approach to service delivery and design. Where understanding the audience and their
needs is achieved prior to any service change, promotion or campaign being launched.

Social Marketing is the combination of Social Policy and Marketing. It is the ‘systematic application of marketing, alongside other concepts and
techniques to achieve specific behavioural goals for a social or public good’ (Freren, Blair-Stevens, 2006). It basically uses the marketing
techniques of the commercial sector to challenge problematic areas of society. For NHS Warrington, this could include obesity, smoking, sexual
health and the inappropriate use of services among others. However, Social Marketing is not a new area, nor is it a stand alone magic tool, it is
something that this trust does on a daily basis, in many departments. We are continually looking at ways to better understand the population we
serve, regularly update the information we provide to influence the behaviour of local people and we constantly try to engage our community in
healthcare issues, all of which fall under the umbrella of ‘Social Marketing’.

2.1    Local Targets
For NHS Warrington, social marketing is essential to a number of Key Health Improvement Programmes that link into the PCT 16 key priority
areas. It is also a programme that is in total compliance with the goals of World Class Commissioning in particular competencies 1, 2 and 3. It
also contributes to D13 acting upon a significant public health problem, C22 promote, protect and improve the health of the community and C23
having systemic managed disease prevention programmes. It will contribute to the vital sign VSB02 CVD mortality rate, VSB05 Smoking
Prevalence. LAA Targets in particular 12, 13 and 22.
3.      Definition

The National Social Marketing Centre says…..

(National Social Marketing Centre, 2006:7)

It is important that NHS Warrington have a clear definition of what they, as a Trust, mean and adopt as social marketing. There has been a lot
of work done by the National Social Marketing Centre in terms of producing a benchmark criteria in order to determine whether work fits within
the category of social marketing (see appendix 2). The benchmark criteria is essentially the key elements that should be in place if an
intervention is to accurately describe itself as social marketing. The criteria is not an exhaustive list but includes those elements which are
crucial to social marketing. Other factors that may be important are strategic planning or partnership and stakeholder engagement (to mention a
couple). These are important in there own right, and key to successful interventions, yet their presence (or absence) does not indicate if
something is social marketing or not. The eight criteria included in the benchmark are however, the things that have to be present in order to be
described as consistent with social marketing (NSMC, 2007).

4.      Process

Social marketing, like generic marketing, is not a theory in itself. Rather, it is a framework or structure that draws from many other bodies of
knowledge such as psychology, sociology, anthropology and communications theory to understand how to influence people’s behaviour. Like
generic marketing, social marketing offers a logical planning process involving consumer-oriented research, marketing analysis, market
segmentation, objective setting and the identification of strategies and tactics. It is based on the voluntary exchange of costs and benefits
between two or more parties. However, social marketing is more difficult than generic marketing. It involves changing intractable behaviours, in
complex economic, social and political climates with often very limited resources. It is therefore essential that as an organisation working with
partners we are clear of the process we are taking in terms of social marketing. The process detailed below will be the standard approach to
social marketing for NHS Warrington. All social marketing programmes will be expected to follow this same process.
                          AIMS                                ACTIVITY                           ACTIONED/SUPPORTED BY

PRIORITISE WORK STREAMS   Identification of priority health   Analysis of quantitative data      PCT Knowledge & Intelligence key
                          areas for application of social     - public health intelligence       staff
                          marketing programme                 primary and secondary data         PCT Health Improvement key staff
                                                                                                 Social Marketing steering group
                                                                                                 WBC data intelligence dept.
                                                                                                 Information sharing

EVALUATION DESIGN         Development of appropriate          Setting of achievable/measurable   PCT Knowledge & Intelligence key
                          activity and outcome short,         goals                              staff
                          medium & long-term measures                                            PCT Health Improvement key staff
                          to evidence impact and              Identification of evaluation       Other key staff from PCT & partner
                          efficacy                            methodology                        organisation as identified
                               - does it work?
                               - how well does it work?       Identification of mechanisms
                               - how does it work?            needed to meet reporting
                          Implementation of systems           Review of capacity of existing
                          and procedures to support           data collection & management
                          monitoring and summative            systems to support monitoring
                          evaluation                          and evaluation
SCOPING                   Identification of target            Analysis and review of national    PCT Knowledge & Intelligence key
                          population/area for focus           and local quantitative data        staff
                                                                 - public health intelligence    PCT Health Improvement key staff
                                                                       primary and secondary     Information sharing
                                                                       data                      WBC data intelligence sources
                                                                 - geodemographic &
                                                                       epidemiological data

                                                              Desk research
                                                                 -   review of existing
                                                                     evidence and data
SEGMENTATION              Achieve appropriate focus for      Analysis of:                          PCT Knowledge & Intelligence key
                          specific target group              - geodemographic (people &            staff
                                                             places)                               Key PCT staff as identified
                          Inform physical targeting of       - TGI (where appropriate)             Could Borough Council support
                          developed intervention             - healthy foundations lifestyle       this?
                                                             segmentation model
                                                             - epidemiological data
                                                             - theoretical, literature &
                                                             systematic review

INSIGHT & UNDERSTANDING   In-depth understanding of          Qualitative research                  PCT Knowledge & Intelligence key
                          customer orientation &             - identification of methodology for   staff
                          behaviour                          engagement with participants          WBC and other staff – in terms of
                                                             - identification of participants      conducting insight work
                          Identification of actionable       - recruitment of participants         Community and Voluntary Sector
                          insights to inform selection and   - conducting of research/insight      Participatory Appraisal
                          implementation of intervention     - analysis of findings                Researchers?

                                                             Capacity building/training to
                                                             support insight/research process

DEVELOPMENT/PILOTING      Identification of effective and    Selection of SM intervention and      PCT Health Improvement key staff
                          appropriate methods for            marketing mix                         PCT Knowledge & Intelligence staff
                                                             Piloting of implementation
                          Test selected marketing model
                          and delivery mechanisms –          Review of efficiency of selected
                          service re-design model?           model
IMPLEMENTATION                         Effect desired change in         Delivery of programmes of            PCT Health Improvement key staff
                                       behaviour and lifestyle to       support to encourage health          CSU
                                       improve health outcomes for      improving behaviours                 WBC
                                       target group(s)                                                       CVS
                                                                        Collection of data to inform         Relevant members of the steering
                                       Redesign Services                monitoring and evaluation of         group
                                       Implement tried and tested
                                       marketing model as evidenced
                                       through the pilot?

                                       Reduce health inequalities

EVALUATION                             Assess efficacy and efficiency   Using agreed evaluation design       PCT Knowledge & Intelligence key
                                       of processes and outcomes        model collection and analysis of:    staff
                                       against defined measurables      Quantitative                         PCT Health Improvement key staff
                                                                           - activity data analysis          Key staff from relevant partner
                                       Identify delivery model and         - outcome data analysis           organisations
                                       where necessary review model            (using agreed
                                       and approach                            measurables)

                                       Evidence impact and causal       Qualitative (where appropriate)
                                       connections                         - in depth interviews
                                                                           - focus group

4.1    Insight and understanding
Fundamental to the social marketing process is the need to seek a deeper understanding of attitudes and behaviour to direct service design and
delivery. This insight work will be conducted by key staff within the Research & Intelligence Unit working in partnership with other internal and
external staff to secure the engagement and participation of the target population in research. Analysis of demographic, geo-demographic and
epidemiological data will provide information needed to segment the population and direct the focus of insight work. Insight work will involve the
use of focus groups and individual interviews to develop a better understanding of the factors impacting upon choices and behaviours.
5.     Prioritisation

The JSNA details the need to move resources from ‘fixing people’ to ‘stopping people becoming ill’. The social marketing process aims to
identify and implement approaches which will raise understanding and awareness and promote changes in behaviour which will ‘help people to
stay well’. In light of the health needs of Warrington and the aims and objectives of the Strategic Commissioning Plan, the Social Marketing
Steering Group has identified a number of priority areas for social marketing over the next 12 months. These areas have been identified using
the following prioritisation matrix:

                    PCT                    National/               Links to PCT
                              identifies               Maximises                  Financial
                   Priority                Regional                    Work                   Total
                                health                 Resource                   Benefits
                    Area                   Campaign                Programmes

   Obesity            3           3           3           3             3            2         17
   Alcohol            3           3           3           3             3            2          17
  Smoking             3           3           3           3             3            2          17
                      3           3            2           3            3            3         17
                      3           3            3           3            3             2        17
Breastfeeding         3           3           1            3            3            2         15
Prison Health         2           2           1            3            2            3         13
Mental Health         3           3           1            3            3            3         16

Score 0 to 3
Highest Priority

5.1    Obesity
Obesity is a key priority area within the commissioning strategy and a major issue addressed right across the Local Strategic Partnership.
Obesity has serious economic costs. It has been estimated that the cost of obesity to the NHS is approximately £1billion per year, with an
additional £2.3b - £2.6b per year to the economy as a whole. If the current trend is not halted, Wanless estimated that by 2010 the cost to the
economy alone could be £3.6b per year. The National Audit Office (NAO) has predicted that one million fewer obese people in this country
could lead to around 15,000 fewer people with coronary heart disease, 34,000 fewer people developing type 2 diabetes, and 99,000 fewer
people with high blood pressure – which leads to a significant cost saving2. A literature review carried out by Dr Foster Intelligence on behalf of
NHS Warrington, accompanied by some primary and secondary data analysis, identified a need to explore the views and experiences of
women, from the 20% most deprived areas of Warrington in relation to diet and lifestyle. Focus groups were held and the findings from this
insight work are being examined to inform the development and implementation of interventions aimed at supporting weight management and
promoting health and well-being amongst this group. As finances and resources have already been invested in the first stages of this social
marketing project, the continuation of this programme is considered a priority.

5.2     Alcohol
Warrington’s alcohol-related hospital admission figures are amongst the highest in the country. The Strategic Commissioning Plan estimates the
cost of alcohol misuse to NHS Warrington at £6.5million per year4. In July this year, following analysis of hospital admission data, the PCT, via
the regional alcohol network, commissioned a piece of insight work to explore the behaviours and motivators of a high risk group of the
population namely females who were drinking at harmful levels (30+ units per week). A report has been produced which will inform the
development and implementation of a social marketing programme aimed at effecting behaviour change in this group. The recent NST visit
praised the commitment to use social marketing principles to address the rise in drinking amongst females and recommended that this work be
continued in the next 12 months. Again, as investment in the first stages of this alcohol-related social marketing project has already taken place,
the continuation of this programme is considered a priority.

5.3     Smoking
Smoking remains one of the major public health issues with over 22.3% of the Warrington population being smokers3. Smoking as a lifestyle
factor affects the prevalence of a number of long term conditions such as diabetes and coronary heart disease. Smoking is identifed as the
major risk factor in CVD mortality rates in addition almost all deaths from lung or oesophagal cancer are due to smoking. Smoking is identified
as a key risk factor in Warrington’s Strategic Commissioning Plan which estimates that smoking costs the PCT £5.3million per year4. The recent
NST visit highlighted the need for Warrington to proceed with social marketing work in relation to smoking within the next 12 months An
additional consideration in focusing on smoking is the launch in early 2010 of a national quit smoking campaign which will seek to integrate
national, regional and local communication campaigns to ensure maximum impact and recognition. All the above demonstrate the importance of
smoking being a priority for social marketing work in Warrington.

  Warrington Health Profile (2009)
  NHS Warrington (2009). Strategic Commissioning Plan. Appendix 10: Evidence to support further investment into behaviour change and risk
5.4      Cardio Vascular Disease (CVD) Screening
Warrington has a higher prevalence of CHD than the national average. The key risk factors linked to CVD are tobacco use, high blood pressure
and cholesterol. Findings from the JSNA have found significant correlation between deprivation and cardiovascular disease (CVD) mortality with
nearly half of the variation in mortality (47%) being attributable to underlying deprivation at ward level. The Strategic Commissioning Plan
identifies CVD as a key example of the need to focus resources from ‘fixing’ people to stopping people becoming ill. One of the main aims of
this is to achieve higher levels of efficiency and effectiveness within care pathways by bringing investments, needs and outcomes into line. The
vascular screening programme will be the major initiative to impact on CVD mortality. The PCT is currently involved in the introduction of a CVD
screening programme aimed at identifying and addressing CVD risk related behaviours. By year five, the intention is that at least 75% of the
population aged 40 to 74 will be screened for vascular disease. Social marketing can contribute to the task of raising knowledge and awareness
in order to help individuals understand their CVD risk better, attend for a screening and subsequently adopt preventative measures through
making healthier lifestyle choices. Key staff from the PCT Knowledge and Intelligence team are currently working in partnership with academics
from Sheffield Hallam University on a consortium proposal for evaluation of the CVD screening programme. The social marketing research and
insight work will complement and be informed by the qualitative element of this evaluation. For all the reasons detailed above CVD screening is
considered a main priority for the social marketing programme.

5.5     Unscheduled Care
Reduction in unscheduled care and inappropriate hospital admissions is a national as well as local issue. A detailed analysis undertaken as part
of the unscheduled care review in Warrington found factors that suggest a less than optimal use of resources, such as the high level of
emergency admissions for less than a day, and that between 20% and 40% of unscheduled admissions could be inappropriate. As costs for
emergency admissions are higher than elective admissions, the higher than expected rates have a disproportionate impact on budgets. The
PCT has a target to reduce 250 hospital admissions which would give a cost saving of £0.5million. Within the Warrington Strategic
Commissioning Plan there is a vision to secure a range of integrated hospital and community services to meet the urgent and unscheduled care
needs of the population and to ensure that people access the right level of care to meet their needs. The aim is to reduce patient reliance on
unscheduled and urgent care services where this is not appropriate to their needs, and to enhance access to urgent care where required. The
PCT has set up an unscheduled care board and this work is now led by the PCTs Medical Director. This has led to a much greater focus on
unscheduled care, buy-in from key stakeholders, and the identification of dedicated resource for delivering unscheduled care initiatives. Social
marketing can contribute to the task of developing a knowledge of people’s understanding of the different levels of care and raising knowledge
and awareness in order to help individuals understand and be able to access the right level of care to meet their needs at the time they need it.
         Clear aims and objectives will need to be set at the start of each area of work so an evaluation in terms of the initial aims and objectives can be
         developed. Further requests for social marketing work, and planning of future programmes will be prioritised using the matrix as described
         above, and a plan for future work devised once this planned programme has successfully progressed.

         In addition, it is proposed that throughout the year NHS Warrington will also deliver training to both internal staff and external partners in terms
         of the principles of social marketing and focus group techniques. The purpose of this is to develop both the capability and capacity to be able to
         deliver the above proposed social marketing programme.

         6.      Project Planning and Action Planning

         Social Marketing work will be overseen by the Social Marketing Strategy Group. This group will be made up of a mixture of NHS Staff,
         Warrington Borough Council, CVS, Links, Police, Fire Service and other partner agencies depending on the social marketing priority being
         addressed at that time. The group will be a continuation of time limited task and finish group existing for the life of each piece of discrete social
         marketing work. For example, when the priority for social marketing is around obesity, there will be an obesity social marketing task and finish
         group to go through all the stages of the social marketing process detailed to meet the aim set out around obesity. Below is the overall time-
         line and workplan for social marketing

                 Jan 10    Feb 10    March     April 10   May        June 10    July 10     August     Sept 10    Oct 10     Nov 10      Dec 10     Jan    Feb   March
                                     10                   10                                10                                                      11     11    11
Evaluation                                     Smoking                          Unsched                           CVD
Design                                                                          Care
Scoping                                        Smoking                          Unsched                           CVD
Insight and                                               Smoking    Smoking                Unsched    Unsched               CVD         CVD
Understanding                                                                               Care       Care
Segmentation                                                         Smoking                           Unsched                           CVD
Development/     Alcohol   Alcohol                                              Smoking                           Unsched                           CVD
Piloting         And       and                                                                                    care
                 Obesity   Obesity
Implementation             Alcohol   Alcohol                                                Smoking                          Unsched                       CVD
                           and       and                                                                                     Care
                           Obesity   Obesity
Evaluation                           Alcohol   Alcohol                                                 Smoking                           Unsched                 CVD
                                     and       and                                                                                       Care
                                     Obesity   Obesity
There will also be GANNT charts developed (see below) to detail the process and timescales for each priority area as it is addressed.
Social Marketing
                 DETAILS                                                              March   April   May   June   July   August   Sept   Oct   Nov   Dec   Jan   Feb   March   April   May   June   July   August   Sept   Oct   Nov   Dec

KR               Implementation and Evaluation Plan
TF/FM/KR         Ensure followed DoH
TF/FM/KR         National Social Marketing Centre Research
TF/FM/KR         Existing Dr Foster Research

KR               Produce Proposal - with clear objectives
KR               Include Costing
DB/KR            Proposal to CLT for sign off
TF/FM/KR         Establish Social Marketing Steering Group
TF/FM/KR         Develop Social Marketing Strategy
TF/FM/KR         Consult on Strategy
Exec Team        Sign Off Strategy
                 Look at Capacity to deliver social marketing e.g. focus groups etc
                 Clear priority criteria

                 Quantitative Analysis
Public Health Analysts
FM/Capacity      Qualitative Understanding
FM               Include Segmentation

                 Develop materials
                 Develop alternative service design

                 Implement Campaign
                 Implement Service Re-design
                 Feed back to service users

                 Evaluation and Monitoring
                 Has it been effective
                 Have the outcomes been met
                 Was the process valid
                 Was the process effective

                 Follow Up
                 Did it make a change?
                 Are people now accessing service - 6 months on
                 Have people maintained a behaviour change?

                 TF - Tracy Flute
                 KR - Katie Roberts
                 FM - Frances Mann
                 DB - Dave Bradburm
                 CC - Cate Carmicheal
                 Exec Team - Executive Team


                 Not yet started
                 In progress
                 Comment why overdue
Because of the nature of social marketing it is likely that the work will overlap and co-exist within existing groups on defined topics e.g. Obesity
Strategy Group. This work will be cross-referenced to ensure it is implemented in accordance to evidence and best practice. Appendix 3 and 4
will also be crucial tools to help with project planning and implementation.

7.       Evaluation
Evaluation is crucial in order to evidence and prove the effectiveness of social marketing within the organisation. The evaluation for each of the
priority areas will be determined at the outset of the project and hence is the first stage in the process of social marketing that NHS Warrington is
going to adopt. A useful guide for evaluating social marketing work is detailed below (see figure 3). The evaluation of individual social
marketing projects will depend on the aims and objectives set out at the start of each discrete piece of work – with the evaluation being tailored
to assess and monitor this (appendix 3 and 4 will be useful tools to help with this). It will be important to set short, medium and longer term
indicators which monitor the efficacy of both processes and outcomes for each project. An overall evaluation of all social marketing work will
take place on an annual basis with the social marketing strategy being reviewed a tear after it’s development to be able to determine additional
priority areas.

Figure 3

                                                                                              (NSMC, 2007)
8.       Risks / Constraints
     •   In-house capacity for insight/research work –
     •   Timescales
     •   Demands for social marketing that don’t fit within capacity of developed work plan


DOH (2004) Choosing Health: Making Healthy Choices Easier. London: Department of Health.

DOH (2006) Our Health Our Care Our Say: a new direction for community services. London: Department of Health.

DOH (2008a) Ambitions for health: a strategic framework for maximising the potential of social marketing and health-related behaviour. London:
Department of Health.

DOH (2008b) Health Inequalities: Progress and Next Steps. London: Department of Health.

NSMC (National Social Marketing Centre) (2006) It’s our health! Realising the potential of effective social marketing. London NSMC.

NSMC (2007) Social Marketing – Big Pocket Guide: Second Edition. London: NSMC.

Websites [last accessed 9th March 2009] [last accessed 8th March 2009]
Appendix 1
Appendix 2
Appendix 3

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