Health Communication, Social Marketing & Behavior Change Theories

Health communication

The study and use of communication strategies to inform and influence individual and community decisions that enhance health.

Primary purpose of health communication

To provide/exchange information that improves health outcomes and may influence health-related decisions and behavior.

Roles of health communication

Facilitate access to information, increase awareness, enable informed decisions, encourage healthy behavior, affect demand for services, influence policy agendas, and shape social norms.

Levels of health communication

Individual, group, organization, community, and society.

Health communication message goals

Raise awareness, increase knowledge, change attitudes, reinforce attitudes, and change behavior through adoption or cessation.

Is knowledge alone usually sufficient for behavior change?

No. Awareness and knowledge are important but usually insufficient by themselves to produce behavior change.

When can health communication alone be especially effective?

When the audience is highly motivated, benefits are clear, barriers are low, and the desired action is clear, easy, and affordable.

Social marketing

The application of marketing principles and techniques to influence voluntary behavior for social or public health benefit.

Ultimate goal of commercial marketing

Profit.

Ultimate goal of social marketing

Social good and beneficial behavior change.

Key concepts underlying social marketing

Exchange, self-interest, behavior change, competition, audience orientation/segmentation, the marketing mix, and relationship building.

Exchange

A transaction in which each party gives something and receives something perceived as valuable.

Exchange in social marketing

The target audience must perceive that the benefits of the desired behavior are worth its costs or sacrifices.

Self-interest

The idea that an audience is more likely to adopt a behavior when it perceives that behavior as beneficial to itself.

Competition in social marketing

Existing behaviors, alternative behaviors, products, programs, or priorities that compete with the desired behavior.

The 4 Ps

Product, Price, Place, and Promotion.

The 5th P emphasized in class

Policy.

Product

The bundle of benefits offered to the audience; it may be a physical product, service, behavior, or concept.

Price

Everything the audience must give up or overcome to adopt a behavior, including money, time, effort, inconvenience, embarrassment, and psychological or social costs.

Place

Where and how the audience obtains the product/service or gains the opportunity to perform the behavior; essentially distribution and access.

Promotion

The communication component of marketing, including advertising, earned media, direct marketing, social media, interpersonal communication, and other promotional activities.

Policy as a fifth P

Policies or environmental rules that can facilitate and support the desired behavior.

Four behavioral goals of social marketing

Prevent a negative behavior, stop a negative behavior, start a positive behavior, or reinforce a positive behavior.

Health communication vs. social marketing

Health communication primarily focuses on information and communication; social marketing uses the broader marketing mix to make behavior attractive, valuable, accessible, and feasible.

Relationship between health communication and social marketing

Communication can be part of social marketing through the Promotion component, but social marketing extends beyond communication.

PSI insecticide-treated net case

A social marketing program using subsidized products, private-sector distribution, branding/promotion, and behavior-change communication to increase mosquito-net use and prevent malaria.

Why did PSI sell subsidized nets rather than simply give them away?

To enhance perceived value, encourage use, and provide incentives for commercial wholesalers and retailers to distribute the products.

Media advocacy

The strategic use of news/social media and sometimes paid advertising to support community organizing and advance public policy.

Primary target of media advocacy

Decision-makers and others with power to change policies or environments.

Health communication/social marketing information gap

These approaches often address gaps in information or barriers to individual behavior change.

Media advocacy power gap

Media advocacy addresses differences in power by influencing policymakers and decision-makers who can create structural change.

People and Places Framework

A framework showing that health behavior and health are influenced by characteristics of people as well as characteristics of the environments or places in which they live.

Individual factors in People and Places

Knowledge, beliefs, self-efficacy, affect, skills, motivation, intentions, biological predispositions, and demographics.

Social network factors in People and Places

Network size and connectedness, social support, modeling by family/peers/mentors, and opinion leaders.

Community/population factors in People and Places

Social norms, culture, social cohesion, collective efficacy, social capital, and income disparities.

Place factors in People and Places

Availability of products/services, physical structures, laws and policies, enforcement, and cultural/media messages.

Main lesson of the Nashville diabetes example

Individual behavior is constrained by environmental factors such as food access, transportation, neighborhood safety, and opportunities for physical activity.

Three uses of health behavior theory in communication

Develop assumptions about determinants, test those assumptions with research, and use theory plus research to design approaches and messages.

Why use health behavior theory?

To understand why people behave as they do, identify important determinants, segment audiences, and design appropriate interventions and messages.

Health Belief Model

A theory explaining health behavior using perceived susceptibility, severity, benefits, barriers, cues to action, and self-efficacy.

HBM: perceived susceptibility

A person's belief about their likelihood of experiencing a health problem.

HBM: perceived severity

A person's belief about how serious a health problem and its consequences are.

HBM: perceived benefits

A person's belief that taking the recommended action will provide useful benefits or reduce risk.

HBM: perceived barriers

A person's perception of the costs or obstacles associated with taking action.

HBM: cues to action

Internal or external prompts that trigger health behavior.

HBM: self-efficacy

Confidence in one's ability to successfully perform the recommended behavior.

Stages of Change Model

A model viewing behavior change as a process involving different levels of readiness to change.

Five stages of change

Precontemplation, contemplation, preparation, action, and maintenance.

Precontemplation

No intention of taking action within the next six months.

Best approach for precontemplation

Increase awareness and personalize information about risks and benefits.

Contemplation

Considering taking action within the next six months.

Best approach for contemplation

Increase motivation and encourage development of specific plans.

Preparation

Planning to act within the next 30 days and already taking preliminary steps.

Best approach for preparation

Help develop concrete action plans, goals, and tools.

Action

The behavior has changed but has been maintained for less than six months.

Best approach for action

Provide support, problem-solving, feedback, and relapse prevention.

Maintenance

The behavior has been successfully maintained for more than six months.

Best approach for maintenance

Reinforce benefits and provide strategies to prevent relapse.

Can people relapse in the Stages of Change Model?

Yes. Behavior change is not necessarily linear; people can move backward to earlier stages.

Why is Stages of Change useful for segmentation?

People at different readiness levels require different communication strategies even when their demographics are similar.

Social Cognitive Theory

A theory emphasizing interactions among personal factors, behavior, and the environment.

Reciprocal determinism

The dynamic interaction among the person, behavior, and environment in which each influences the others.

Behavioral capability

Having the knowledge and skills necessary to perform a behavior.

Observational learning/modeling

Learning a behavior by observing credible others and the outcomes of their actions.

Outcome expectations

The outcomes a person expects will result from performing a behavior.

Reinforcement

Responses or rewards that influence whether a behavior is repeated.

Self-efficacy in SCT

Confidence in one's ability to perform a behavior; a central determinant of behavior change.

Audience segmentation

The process of identifying unique groups within a larger population that share similar interests and needs relative to the behavior being promoted.

Why segment audiences?

Because different people pay attention to, process, and respond to different messages; segmentation enables more relevant interventions.

Segmentation

Dividing audience members according to meaningful audience characteristics.

Targeting

Selecting communication channels based on audience characteristics.

Tailoring

Crafting messages to reflect the characteristics of an audience or individual.

Segmentation vs targeting vs tailoring

Segmentation = audience; targeting = channel; tailoring = message.

Characteristics of a useful audience segment

Definable, mutually exclusive, measurable, accessible, mission-relevant, affordable to reach, and sufficiently substantial.

Market segment

A group that is distinct from other groups, internally homogeneous on relevant characteristics, and similarly responsive to marketing strategies.

Major segmentation approaches

Demographic, geographic, psychographic, behavioral, stages of change, diffusion of innovation, and healthstyles.

Demographics

Observable population characteristics such as age, sex, race/ethnicity, income, education, and socioeconomic status.

Psychographics

Beliefs, attitudes, values, worldviews, opinions, and interests.

Demographics vs psychographics

Demographics describe who people are; psychographics describe how they think and what matters to them.

Other segmentation characteristics

Lifestyle/culture, health behaviors, media use/proficiency, and biological, physical, or medical factors.

Factors for selecting a market segment

Segment size, problem incidence, severity, defenselessness, reachability, readiness to change, costs, responsiveness to the marketing mix, and organizational capacity.

Boslaugh et al. study

A study comparing demographic, health-status, psychosocial, and combined approaches to audience segmentation for physical activity.

Main Boslaugh finding

Psychosocial variables produced more meaningful segmentation than demographics or health status alone, while combining variable types performed best.

Boslaugh lesson

Demographic similarity does not necessarily mean people share the beliefs, motivations, or determinants needed for effective communication.

Audience profile

A vivid but concise research-based description of a target audience that guides campaign decisions and maintains an audience-centered focus.

Audience profile contents

Name/persona, demographics and SES, psychographics, behavioral determinants, media habits, barriers, and benefits.

Primary audience

The population whose behavior the intervention primarily seeks to influence.

Secondary audience

People who can influence the primary audience's awareness, knowledge, beliefs, attitudes, motivation, or behavior.

Fresh Empire

An FDA tobacco prevention campaign targeting youth who identify with the Hip-Hop peer crowd.

Fresh Empire targeting lesson

Audiences can be targeted through psychographic identity, values, peer crowd, and media habits rather than demographics alone.

Fresh Empire influencer strategy

Used microinfluencers aligned with Hip-Hop values and local youth influencers to improve authenticity, reach, engagement, and message credibility.

Using theory for segmentation

Theory provides meaningful determinants, such as readiness, perceived barriers, susceptibility, norms, or self-efficacy, that can be used to create audience segments.

Quantitative research

Research using numerical measurement to identify patterns, prevalence, associations, or differences.

Common quantitative formative method

Surveys.

Uses of quantitative research

Measure baseline knowledge, attitudes, beliefs, and behaviors; estimate prevalence; identify patterns; and provide data for evaluation.

Qualitative research

Research used to understand meaning, context, experiences, motivations, beliefs, and the why/how behind behavior.

Why qualitative research matters in public health

Health behavior is often embedded in social meaning, cultural practices, relationships, and contexts that numerical measures alone cannot fully explain.

Qualitative research methods

Participant observation, participatory techniques, photovoice, mapping, free listing, pile sorting, ranking, timelines, projective techniques, interviews, and focus groups.

Free listing

A qualitative technique used to generate a list of items or ideas about a topic researchers know relatively little about.

Pile sorting

A technique used to understand how participants categorize items or concepts.