Table Of ContentMarketing
Health Behavior
Principles, Techniques, and Applications
Marketing
Health Behavior
Principles, Techniques, and Applications
Edited by
LEE W. FREDERIKSEN
Virginia Polytechnic Institute flnti Strite Uni1lersity
BlflCksburg, Virginia
LAURA]. SOLOMON
Uni1lersity of Vermont
Bur/ington, Vermont
and
KATHLEEN A. BREHONY
Phobia Clinic of Southwest Virginia
ROfInoke, Virginifl
Springer Science+Business Media, LLC
Library of Congress Cataloging in Publication Data
Main entry under title:
Marketing health behavior.
Includes bibliographical references and index.
1. Preventive health services—Marketing. 2. Health education—Marketing. 3. Marketing
—Social aspects. 4. Medicine and psychology. I. Frederiksen, Lee W. II. Solomon, Laura J.
III. Brehony, Kathleen A.
RA427.M295 1984 613 84-3271
ISBN 978-1-4899-0368-6
ISBN 978-1-4899-0368-6 ISBN 978-1-4899-0366-2 (eBook)
DOI 10.1007/978-1-4899-0366-2
© Springer Science+Business Media New York 1984
Originally published by Plenum Press, New York in 1984
Softcover reprint of the hardcover 1st edition 1984
All rights reserved
No part of this book may be reproduced, stored in a retrieval system, or transmitted,
in any form or by any means, electronic, mechanical, photocopying, microfilming,
recording, or otherwise, without written permission from the Publisher
Contributors
Kathleen A. Brehony, Phobia Clinic of Southwest Virginia, Roanoke, Virginia
Lee W. Frederiksen, Department of Psychology, Virginia Polytechnic Institute and
State University, Blacksburg, Virginia
David Garner, Live for Life Program, Johnson & Johnson, New Brunswick, New
Jersey
Philip Kotler, J. L. Kellogg Graduate School of Management, Northwestern Univer-
sity, Evanston, Illinois
John E. Martin, Veterans Administration Medical Center, Jackson, Mississippi
Patrick E. Murphy, Department of Marketing, Marquette University, Milwaukee,
Wisconsin
William D. Novelli, Porter, Novelli & Associates, 3240 Prospect Street, NW,
Washington, D.C.
Donald M. Prue, Veterans Administration Medical Center, Jackson, Mississippi
Douglas S. Solomon, formerly with the Stanford Heart Disease Prevention Program,
Stanford University, Stanford, California; currently with Apple Computer, San Jose,
California
Laura]. Solomon, Department of Psychology, University of Vermont, Burlington,
Vermont
Graham W. Ward, School of Medicine, Tufts University, Boston, Massachusetts
Curtis S. Wilbur, Live for Life Program, Johnson & Johnson, New Brunswick, New
Jersey
v
Preface
This is a book that grew out of frustration. The frustration was rooted in our failed
attempts to help people modify health-related behavior. From a behavioral medicine
perspective, it was readily apparent to us that there were many things people could
do to improve their health. Some of these were preventive behaviors, whereas others
were much more therapeutic or rehabilitative in nature. Put another way, there were
specific well-known behavioral strategies that people could use to maintain or regain
their good health. Yet despite our good intentions, enthusiasm, and considerable
efforts, something was wrong. People dropped out of therapy or failed to follow
behavioral prescriptions. Workshops and clinics were half-empty. If people would
attend workshops or follow therapeutic programs, their health would benefit. Yet in
our experience and in the experience of most of our colleagues, compliance to
treatment programs was a major problem.
Faced with such a situation, it is easy to blame the victim-in this case the
client. It is common to hear therapists talk of poorly motivated clients, complain
that people are just not interested in improving their health, or even speculate about
people's self-destructive tendencies. Although this may be comforting to the thera-
pist, it does very little to solve the problem. What was needed was an approach to
improve adherence to therapeutic programs rather than comforting excuses for their
failure. It is in this context that we became exposed to the area of social marketing.
The notion of marketing seems to be a natural for overcoming the problems
associated with low adherence to behavioral medicine programs. Could we not apply
the same principles used to sell cigarettes, alcohol, and fast foods to the promotion of
regular exercise, smoking cessation, and a healthful diet? The notion that principles
derived from commercial marketing could be successfully applied to the promotion
of desirable behavior had already been developed under the term of social marketing.
To some readers, behavioral medicine and social marketing may seem to be
strange bedfellows. Behavioral medicine is focused largely on the behavior of the
individual and his or her immediate environment. Further, it tends to be clinical in
orientation. Behavioral medicine practitioners see themselves as professional health
care providers.
VII
viii Pre/a.e
On the other hand, social marketing is large scale in focus and methodology. It
deals with populations and market segments, not individuals. Social marketing
practitioners have varied backgrounds, but their roots are often in commercial
marketing. To complicate the integration of social marketing and behavioral medi-
cine further, we have found that for many people within behavioral medicine the
very mention of the word marketing conjures up images of manipulation, huckster-
ism, and fast-talking salesmen in plaid pants.
As formidable as these barriers may seem initially, we have found that the
integration of social marketing and behavioral medicine is a natural one. Both social
marketing and behavioral medicine are fundamentally data-based, systematic ap-
proaches to changing behavior. In each case, the approach is one of experimenta-
tion-finding what works to alter people's actions. There are also many parallels in
the terminology and general approach. In each case for example, one begins with a
well-specified objective and a comprehensive assessment of what really exists.
We also found that the benefits of this integration were many. For example, a
social marketing perspective inspired us to question many unnoticed assumptions of
how programs might be structured, where they might be delivered, and how they
might be promoted. Should all programs be delivered once a week in the health care
provider's office? What about on-site delivery tailored to the participants' schedules?
In short, the marketing perspective emphasizes tailoring the program to the needs of
the people to be reached. It replaces frustration and a search for excuses with a
specific, systematic, and useful approach to solving the problem oflow adherence to
programs.
The purpose of this volume is twofold. Part I focuses on outlining the princi-
ples and techniques relevant to marketing health behavior. Part II explores the
application of these principles to specific health behavior problems.
The first chapter in Part I, which was written by the editors, provides a
framework for the remainder of the volume. It explores the development of behav-
ioral medicine and the need for a marketing perspective. It outlines the components
of the social marketing approach and suggests how they can be applied to the
problems of changing health-related behaviors. Emphasis is placed both on the
underlying similarities of the two fields as well as on the unique contribution of the
social marketing perspective.
Chapter 2 was written by Philip Kotler, a noted social marketing expert. He
describes the roots of social marketing by comparing and contrasting them to those
of the other marketing approaches. He also outlines the social marketing process and
provides illustrations of how it can be applied to health-related behaviors.
Chapter 3 covers one of the key concepts of social marketing, namely, analyzing
markets. It was written by Patrick Murphy, an experienced social marketer and
researcher. This chapter highlights the importance of marketing research and the
related consideration of market segmentation. It details the variables to be consid-
ered in each approach and provides a strategy for relating market research to market
segmentation.
Preface ix
Chapter 4's author is William Novelli, one of the most accomplished social
marketers in this country. Novelli documents the marketing process and takes the
reader through the six critical stages of actually developing marketing programs in
the health area. This chapter is the bridge that links marketing concepts to how-to
practicalities.
In Part II of the volume, the reader explores a series of applications of social
marketing to actual health behavior change projects. These projects range from ones
that are national in scope to those that deal with a specific program in a given
setting. The projects demonstrate that the social marketing principles are applicable
to whatever level one is working at. The chapters in Part II reveal how the principles
and procedures outlined in the first section are applied to the day-to-day develop-
ment and administration of various health programs.
Chapter 5, by Graham Ward, details a multi-million-dollar national program
designed to reduce the prevalence of uncontrolled hypertension. Ward analyzes this
comprehensive project, the National High Blood Pressure Education Program, begin-
ning with initial problem identification. He continues with sections on market
analysis, development of the program, market segmentation, and the results and
implications.
In Chapter 6, Douglas Solomon describes the community health promotion
segment of the Stanford Heart Disease Prevention Program. Although many of the
readers may be familiar with this program from its research aspects, this essay
examines the project from the social marketing perspective. Solomon details the
problem of heart disease and outlines two of the most significant studies performed
within this project. These studies are directed toward impacting health behavior on a
community-wide basis, and they illustrate the integral role of social marketing in
such an effort.
The organization is the locus of intervention in Chapter 7. This chapter is
coauthored by Curtis Wilbur and David Garner, and it outlines the Johnson &
Johnson Live for Life program. This comprehensive health promotion program con-
ducted within an organizational setting was designed to impact on employee health.
The chapter highlights the considerations that went into designing this state-of-the-
art program and even previews some of the early results.
Chapter 8 describes two examples of the use of marketing principles to improve
the impact of health behavior change programs conducted within a single hospital
setting. This chapter, coauthored by John Martin and Donald Prue, is rich with data
evaluating the efforts of their approaches to improve the attendance and impact of a
behavioral medicine program in a general hospital.
The chapters in Part II provide concrete examples of how social marketing
principles can be applied to specific health problem areas. They also show that the
application of these principles can result in programs that are both innovative and
that are likely to be effective. They are programs that people will use.
The development of this volume represents the cooperation and creative efforts
of many people. We gratefully acknowledge the support of our publisher and spon-
x Pre/iKe
soring institutions. Special thanks go to Bridget Simmerman for her unending
patience in manuscript preparation. As we reflect on the individuals who have
contributed most to the development of our ideas, we realize that the authors of th~
chapters of this book are the people who have influenced our thinking most. They
have been the prime movers in making this field come alive for us. It is to the
authors, for their creative efforts and persistence, that our greatest expression of
appreciation must go.
LEE W. FREDERIKSEN
LAURA J. SOLOMON
KATHLEEN A. BREHONY
Contents
PART I: PRINCIPLES AND TECHNIQUES
CHAPTER 1
Marketing Principles and Behavioral Medicine: An Overview . . . . . . . . . . . 3
Kathleen A. Brehony, Lee W. Frederiksen, and Laura j. Solomon
Behavioral Medicine. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Marketing for Health-Related Behaviors ................ . . . . . . . . . 7
Market Research. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Market Segmentation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Consumer Benefit. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Product Personality and the Other Three p's . . . . . . . . . . . . . . . . . . . . . . 15
Product ................................................ 15
Price. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Place. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . 17
Promotion .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Summary................................................. 21
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
CHAPTER 2
Social Marketing of Health Behavior 23
Philip Kotler
Concept of Social Marketing ..... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Four Basic Approaches to Social Change. . . . . . . . . . . . . . . . . . . . . . . 25
The Emergence and Evolution of Social Marketing. . . . . . . . . . . . . . . 25
Who Does Social Marketing? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Distinctions among Types of Social Causes . . . . . . . . . . . . . . . . . . . . . . . 28
Cognitive Change. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
xi
