Everyone remembers those iconic public health adverts – the ‘fatty cigarette’ or HIV tombstone TV ads for example. But there is a lot more to health marketing than memorable and creative ideas – did you know that smokers have ordered over 2.3 million Quit Kits since they launched? Or that Change4Life’s Meal Mixer app has been downloaded by over 833,000 people as part of their Healthy Eating programme?
One of Health and Wellbeing’s roles is to design and deliver national social marketing programmes. It’s a high profile area and we are fortunate to have a great team under Sheila Mitchell working on it. In this post I want to talk about why it is a critical part of our offer, the science behind health marketing and what’s on the horizon.
Today, no professional health marketer would argue that education – or even exhortation – alone will change people’s behaviour. Changing ingrained daily habits or, in some cases, overcoming dependency is extremely challenging and requires much more than good intentions on the part of the individual. It is not enough to know you should change, or even want to change if that something is harder, more expensive or less pleasurable than your current behaviour. But just as we accept that education alone is insufficient, we should also acknowledge that significant and sustained change can rarely be accomplished without large-scale citizen engagement.
There is plenty of evidence that marketing can be effective, but also plenty to show that it isn't necessarily effective. To maximise the impact of PHE’s work our approach is increasingly to create big, multi-dimensional campaigning platforms that work within the wider policy context and complement other levers such as taxation or legislation. In each case, we don’t simply broadcast messages: there is a full customer journey with a programme of support, including evidence based interventions like SMS support programmes, drinks tracker apps and financial incentives (funded by the commercial sector) to make change easier, cheaper and more rewarding. Our programmes are also built to support our local partners - allowing local authorities, the NHS, schools, third sector providers and others to showcase the on-the-ground support (local stop smoking services, exercise classes, cooking programmes etc.) that they provide.
Our approach is gaining in sophistication and we increasingly deploy insights and techniques from the behavioural sciences to boost effectiveness. For example, Stoptober ‘chunks’ the process of quitting – stopping for a month is less intimidating than stopping forever – and once you've made it to a month your odds of carrying that on are very good. It gives daily evidence based support to participants and creates a social network of people who are stopping together and supporting each other along the way. We know it’s popular as 275,000 people signed up and we know it’s effective – participants are four-and-a-half times more likely to make it to 28 days than those who go cold turkey! The Stoptober team have also embraced the live testing used so effectively by commercial organisations like Amazon. They are testing 24 variants of the Stoptober sign-up page in the first phase of launch and will pick the most effective to increase overall sign up rates.
So what’s on the horizon for marketing? I’m really excited about building on our great results in areas such as early diagnosis and tobacco control and applying the creativity, energy and dynamism of marketing in new areas such as Health Checks and mental health. I can also see a huge potential opportunity to enhance our programmes that smartly applied technology presents. For example, over two million people have signed up to our marketing programmes already, and using that data more effectively presents an amazing opportunity. Change4Life already had three top 10 health apps with over a million downloads – how do we build on that?
We’re currently starting to develop our marketing plan for the next two years, and PHE needs to make sure we go from good to great. If you’d like to be part of the development process, do let me know. I’d like to finish with our top 10 principles for health marketing – what would you add to the list?
10 principles for great health marketing
- Make it easy, fun and popular – this is the most important one!
- Embrace popular culture, don’t ignore it. Do you know what your audience watches, buys and feels? If not then why not? The most popular media channel for young people is YouTube so that’s where we focus our national investment.
- Have behavioural objectives, not ‘awareness’ objectives. Awareness isn’t a goal in itself - just because people know something doesn’t mean they will do something.
- Have deep insight into the way the target audience lives their lives – if people buy their food daily on offer from low-cost supermarkets then do we reflect that in the recipes we provide to them?
- Focus on the benefits of a product (more time with your grandchildren) not the features (a healthcheck)
- Be evidence based, and make sure your work is contributing to the evidence base – test, test, test.
- Be obsessed with User Experience –we know that context and heuristics matter disproportionately - make it as easy as possible to get involved and stay involved
- Use behavioural science as a foundation when you’re building programmes - we know that rational linear theories of change such as Prochaska don’t work, don’t use them!
- Think big about the potential of technology – why can’t change4life give every primary school child an accelerometer based tool and promote a mass intervention. Why can’t we take the pulse of millions via a mobile phone app and help if some have arrhythmia?
- Integrate with other policy levers and partners for bigger impact
Comment by Noel McDermott posted on
Interesting and I agree, could your blogs have images on them, makes them more interesting to post to LinkedIn etc regards Noel
Comment by P Badrinath posted on
Very heartening to see PHE adopting the modern technology and evidence based approach to helping people to change for the better. I would add that all marketing strategies should contain why one should change - the benefits of changing including positive messages. Celebrity role models won't hurt either.
Comment by Lisa Cohen posted on
Please can you clarify why you believe why the Prochaska model shouldn't be used for great health marketing. I agree that the theory of change is linear and the reality is that people may go back and forward along the steps but why not use at all?
Comment by Kate Houghton posted on
Social Sense has long propounded this approach and indeed have the proof of the pudding in the many and measurable successes delivered by our programme RUDifferent? (www.rudifferent.co.uk)
Nobody likes to be told off, and nobody ever applies the ‘it could happen to me’ thinking unless they’re buying a lottery ticket.
By using social norms research, and presenting positive messages about peer group behaviours to young people, we have proven that you can change behaviour and encourage smarter decision making.
Delighted to see that Public Health England is demonstrating such well considered thinking too.
Comment by C Fenton posted on
would be great to see a new campaign focussing on cervical screening particularly among young women.
Comment by Dan Metcalfe posted on
Lisa - hi - I work in the PHE marketing team. The issue with Prochaska is that it is too linear. Although past marketing activity, especially in smoking cessation, has drawn from the Prochaska Stages of Change Model to inform the targeting and the nature and timing of content , we now have serious reservations about an over focus on this way of thinking. For example, with specific regard to smoking:
-the definition of the stages is arbitrary with no real supporting evidence of why each stage starts and finishes when it does
-academic studies have suggested that up to 50% of quit attempts involve no forethought or planning
-the model assumes that behaviour change is conscious
Much of this thinking is detailed in the 2008-11 marketing strategy for tobacco cessation.
Further, NICE is currently updating its guidance. The draft of the new guidance is out for consultation and includes the following paragraph:
"The Programme Development Group was concerned that training programmes still describe the stages of change model (also known as the transtheoretical model) as a theoretical basis for behaviour-change interventions. The PDG wanted to highlight that, although it may help practitioners to understand their client’s experience of behaviour change, it is not a theory that explains and predicts such change. It noted that the evidence indicates that interventions based on this model alone are not effective"
I hope that's helpful - let me know if you'd like to discuss further.
Comment by Christiane johnson posted on
Have just come across this and wanted to point out that in my experience as a PH trainer(20+ years) Prochaska is a very useful model to help practitioners think through the approaches (Motivational Interviewing, solution focussed, etc) that are helpful when working with individuals. No-one I know in training would use it in isolation, nor in a linear way...As such, I don't feel it's fair to suggest it's 'a linear model that doesn't work'. Context is all!
Comment by jack cruso posted on
The benefits of integrating social media into healthcare marketing efforts are priceless. Firstly, during social marketing campaigns, such as anti smoking campaigns, practitioners should reinforce media messages through brief counseling. Secondly, practitioners can make a valuable contribution by providing another communication channel to reach the target audience. Finally, because practitioners are a trusted source of health information, their reinforcement of social marketing messages adds value beyond the effects of mass communication.
Comment by Michael Bian posted on
"Make it easy, fun and popular – this is the most important one!" I completely agree on that, should have to be really creative by doing such.
Comment by Abi Brown posted on
How refreshing to see recognition of the 'creativity, energy and dynamism' of the marketing discipline in a public health context. For too long the debate has been 'either' social marketing 'or' public health. There's no reason why health marketing can't add to the evidence base. Let's find more innovative and level ways to open up health data and ways to work together in partnership across NGO, public and private sector.
Comment by Bren posted on
I think the social marketing approach needs to be tested with seldom heard people and communities that may not respond in a way other groups may. In other words, specific targeting within a generic programme. I also think it needs to be looked at in the context of community groups who are often adopting a wrap around service approach with people across the life course need. Bren.