Marketing Behavioral Change Bill Reger-Nash, EdD Professor, Department of Community Medicine West Virginia University School of Medicine wreger@hsc.wvu.edu; 304-293-0763 Bill Mercer, MD, Ken Simon, EdD, Elizabeth Earley, BS, Crystal Toth
OBJECTIVES As a result of this presentation, participants will be able to: • Identify Five Wheeling Walks Social Marketing strategies • Describe the role of Participatory Planning • Explain how mass media can effect communitywide physical activity changes Bill Reger-Nash, EdD, WVU Community Medicine
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“We don’t know everything, but we know enough to act.” M. McGuiness
Bill Reger-Nash, EdD, WVU Community Medicine
Target Population 78% of 55-64 year olds were insufficiently active BRFSS 2001 Bill Reger-Nash, Ed.D. WVU Community Medicine
DHHS 2008, ACSM, and AHA recommend: At least 150 minutes of moderate-intensity PA/week Preferably 300 minutes Bill Reger-Nash, Ed.D. WVU Community Medicine
METHODOLOGY : • Participatory Planning • Hierarchy of Effects • Theory of Planned Behavior (Attitude, Social Norm , Control Beliefs, Intention) • Social Marketing Bill Reger-Nash, Ed.D. WVU Community Medicine
Social Marketing can: • Promote awareness and behavior change • Set Agenda for change • Reduce barriers to make walking more accessible • Change policies--local and statewide • Develop social capital Bill Reger-Nash, Ed.D. WVU Community Medicine
WORLD HEALTH ORGANIZATION 1 st International Conference on Health Promotion November 21, 1986 Ottawa, CANADA OTTAWA CHARTER FOR HEALTH PROMOTION “Health promotion is the process of enabling people to increase control over, and to improve, their health…People cannot achieve their fullest health potential unless they are able to take control of those things which determine their health .” Bill Reger-Nash, Ed.D. WVU Community Medicine
Participatory Planning • The more ownership within a community, the more likely a program will be effective. Richardson and Bensley, 1991; Glasglow, et al., 1993; Purdey, Adhikari, Robinson, and Cox, 1994.
This FIRSTHAND experience is achieved through participants’ simultaneous involvement in three types of structured experiences over a 10-12 week period: INFORMATIONAL EXPERIENTIAL ACTION / TASK FORCES
SOCIAL MARKETING Campaigns using mass media that are structured, co-ordinated, & multi-faceted community Multi-strategy campaign interventions & community Mass development Legislative Media & Regulatory health profession paid unpaid education Bill Reger-Nash, Ed.D. WVU Community Medicine
C ascade of three sequential stages in the message delivery: RECEPTION Exposure to and awareness of message PROCESSING Receive, comprehend, and think about message RESPONSE Current beliefs altered, new ones remembered, and behavior changed Bill Reger-Nash, Ed.D. WVU Community Medicine
Apply marketing strategies like McDONALDS Ford Motors Bill Reger-Nash, Ed.D. WVU Community Medicine
Our research indicated that our most effective message needed to focus on: TIME ENERGY Bill Reger-Nash, Ed.D. WVU Community Medicine
Bill Reger-Nash, Ed.D. WVU Community Medicine
campaign aign ts — compon onen ents PAID ADVERTISING • MEDIA RELATIONS Events • COMMUNITY ACTIVITIES • POLICY • ENVIRONMENT • Bill Reger-Nash, Ed.D. WVU Community Medicine
PAID ADVERTISING • Two 30-second television ads that ran PRIME TIME 683 times / 5,104 GRP (average 12 a day) • Two 60-second radio ads that ran PRIME TIME 1,988 times / 3,461 GRP • Two 1/8-page newspaper ads that ran 28 times (twice a week) Bill Reger-Nash, Ed.D. WVU Community Medicine
MEDIA RELATIONS Events included: WEEK 1: KICK-OFF Press Conference WEEK 3: Physicians Press Conference WEEK 4: Mid-campaign Press Event WEEK 6: Mayor’s Walking Fitness Cup WEEK 7: Intergenerational Walk WEEK 8: Campaign Finale Press Conference Bill Reger-Nash, Ed.D. WVU Community Medicine
EXAMPLE: Earned media of KICK OFF Press Conference Bill Reger-Nash, Ed.D. WVU Community Medicine
COMMUNITY ACTIVITIES • Campaign Website • Worksite programs and challenges • Physicians’ “Prescription for WALKING” • United Way-type thermometer • Faith-based program • Weekly newspaper column Bill Reger-Nash, Ed.D. WVU Community Medicine
Bill Reger-Nash, Ed.D. WVU Community Medicine
EVALUATION A Telephone Survey Questionnaire Social Capital Assessment Process Policymaker Assessment Bill Reger-Nash, Ed.D. WVU Community Medicine
RESULTS — measured by self-report TELEPHONE QUESTIONNAIRES 14% difference Percent Increase 40% 32% 30% 18% 20% 10% 0% WHEELING Comparison Bill Reger-Nash, Ed.D. WVU Community Medicine
Wheeling Walks 100 Least Active at Baseline Weekly walking time-in median minutes 90 80 70 60 50 40 30 20 10 0 Group A= Baseline daily walking minutes <=10 minutes 0 3 6 9 12 Months from baseline Bill Reger-Nash, Ed.D. WVU Community Medicine
EXAMPLE: unanticipated spin-off Earned Media USA TODAY Bill Reger-Nash, Ed.D. WVU Community Medicine
RESULTS — TELEPHONE QUESTIONNAIRES 8-week campaign vs booster Self-report Immed 12-mos Post Post Knew about campaign 90% 89% Saw TV ads 77% 93% Heard Radio ads 33% 36% Saw or heard news stories 81% 83% Heard about campaign: at worksite 5% 5% via faith-based programs 4% 4% via speakers 4% 5% Bill Reger-Nash, Ed.D. WVU Community Medicine
Accomplished: • massive dose of paid and earned media • real excitement and enthusiasm generated • 12-14% increase in walking among the most sedentary • “walking 30+ minutes a day” NOW, WHAT HAPPENS? • IF NOT SUSTAINED, IS IT BENEFICIAL? • HOW SUSTAIN THE BEHAVIOR? Bill Reger-Nash, Ed.D. WVU Community Medicine
While Social Marketing can JUMP START change, it cannot ALONE do the job: 1. Physicians’ role 2. ENVIRONMENT in which we live 3. PUBLIC POLICIES Bill Reger-Nash, Ed.D. WVU Community Medicine
PHASE IV – POLICY and ENVIRONMENT Process Outcomes: • Mayor designated Walkable Wheeling Task Force • Meet regularly since 2002 • Trails Master Plan approved by City Council 03/06 • Develop walking opportunities in the community o Upgrade and connect trails (DOT added trails, city exercised eminent domain in December 2005) o Added rest rooms and telephones o Improve overall safety & aesthetics • Engaged city, county, and state agencies: streets, highways, recreation department, schools, parks, planning. • Annual Ogden Distance Race, Wheeling Heritage Trail Tour May 2010 Bill Reger-Nash, Ed.D. WVU Community Medicine
Assessment of SOCIAL CAPITAL Walkable Wheeling Task Force members Nov 99 Feb 01 Feb 02 (n=32) (n=33) (n=29) Mean [sd] Mean [sd] Mean [sd] Commitment 4.10 [0.75] 4.27 [0.78] 4.66 [0.48] * # Enjoyment 4.47 [0.73] 4.38 [0.75] 4.66 [0.55] Confidence 4.16 [0.79] 4.36 [0.90] 4.66 [0.55] * Shared Purpose 4.25 [0.72] 4.44 [0.62] 4.69 [0.54] * Contribution Valued 4.20 [0.85] 4.52 [0.57] 4 55 [0.78] Trust 4.28 [0.58] 4.45 [0.79] 4.72 [0.45] * Data were analyzed as pairwise independent comparisons of means; significance was set at p<0.01 due to multiple testing. *p<0.01 comparing 1999 to 2002 # p<0.01 “Commitment” comparing 2001 to 2002 Bill Reger-Nash, Ed.D. WVU Community Medicine
Assessment of Policymakers Mail survey to assess whether WV Walks intervention also • affect policymakers M unicipal elected officials, appointed heads of departments, • and all individuals appointed to serve on government boards/commissions (133 in Morgantown and 120 in Huntington ) Response rates • PRE POST Morgantown n=76 57.1% n=58 43.4% Huntington n-38 31.7% n=34 29.3% Bill Reger-Nash, Ed.D. WVU Community Medicine
Walking Issues • Morgantown o Baseline: Ranked 4th o Post Campaign: Ranked 1 st P < 0.05 (t-test for differences in proportion means) • • Huntington o Not mentioned Bill Reger-Nash, Ed.D. WVU Community Medicine
Community Problem Issues Morgantown • Lack of Pedestrian Walkways, Crosswalks and Sidewalks • Poorly Planned Development and Sprawl • Traffic Congestion Huntington • Underage Drinking • Drug and Alcohol Abuse • Crime Bill Reger-Nash, Ed.D. WVU Community Medicine
Low income & low literacy population • Typical programs impact higher income and better educated populations • Social Marketing is equally effective for all income and educational levels Bill Reger-Nash, Ed.D. WVU Community Medicine
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