Address for correspondence: Dr. Rakesh Kakkar, Department of Community and Family Medicine, All India Institute of Medical Sciences Mangalagiri, Andhra Pradesh, India. E-mail: ni.ude.irigalagnamsmiia@rakkak.hsekar
Received 2019 Jul 1; Revised 2019 Aug 22; Accepted 2019 Aug 31. Copyright : © 2019 Journal of Family Medicine and Primary CareThis is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
Social marketing has expanded its purview in the modern era aiming at a behavioral change of target audience on a large scale. Public health practitioners now admit the value of community-based approaches to social change. Three main patterns of health education materials are social marketing communication material, information and education communication (IEC) material, and behavior change communication (BCC) material. Social marketing is a strategy based on marketing principles of selling products. The communication material suggests that the healthcare option for a particular disease is the best solution, and therefore choice or critical thinking is not necessary. IEC strategy attempts at informing people and increasing their knowledge about a disease, having them use it as a basis for action. BCC strategy promotes individual change leading to healthy community behavior. Social marketing communication material for communities should be creative, innovative, original, with clear messages in English and other local languages, reproducible, acceptable, and reflective. Primary care requires customizing health education material using translatable strategies based on social marketing to change health-care patient behavior for wellbeing. The concept of social marketing should be emphasized in early medical education. In the present times, doctors and medical students should be informed about different communication strategies to transform communication material into program tools to achieve health.
Keywords: Behavior, communication, education, health, primary care, social marketingCommunication in public health is conveying health education messages to people through comprehensive signs, symbols, language, and semiotic rules. Communication material strategies like information and education communication (IEC), behavior change communication (BCC), and social marketing are used for different purposes and audiences. Each of these has different characteristics, although, they can be combined to produce one communication material.
The application of marketing principles and techniques to social issues including public health has emerged as a separate entity known as social marketing.[1] Globally, societies face an escalating array of health challenges, which builds up the importance of social change efforts. This led to the development of new health programs that endorse socially beneficial behavior change only possibly through social marketing, a strategy that has grown in popularity to design and implement these programs.[2] The main objectives of social marketing are to bring attitudinal and behavioral change and develop a helpful environment that reinforces and sustains change within the public health community.[1] Social marketing hastens the acceptance, rejection, modification, neglect, or maintenance of particular behaviors of the target audience—consumers and policymakers.[3] It is a banquet of demand generation, branding, sales promotion, supply chain management, BCC, and much more.[4]
Globally, social marketing is used in immunization, breastfeeding, personal hygiene, blood or organ donation, the prevention of smoking and alcohol consumption, etc. Successful social marketing drives worldwide include Truth campaign against youth smoking in the United States of America, the promotion of insecticide-treated mosquito nets to combat malaria in Nigeria, the safe drinking water campaign to prevent diarrhea in Madagascar, and anti-TB campaign in Peru, etc.[4] In India, condom promotion to prevent HIV/AIDS is a successful model for social marketing.[5]
In the late 1960s, the Indian government started distributing cost-free or subsidized condoms. The policymakers used the principles of social marketing and launched the family planning program to accelerate its population stabilization efforts. This placed India as a pioneer in using social marketing in the public health sector. Though initially confined to family welfare, i.e. the promotion of condoms and contraceptive pills, social marketing has an expanding scope for the application of its principles.[4]
Apart from family welfare, India has promoted immunization, the use of iodized salt, ORS and zinc supplements, sanitary napkins, etc. through social marketing.[4] In 2014, the successful immunization drives of Pulse Polio made India polio-free owing to the tremendous efforts of the Government of India and the World Health Organization and the social marketing strategy. Given the hazards of tobacco and alcohol consumption, India is taking several steps against their usage using social marketing drive. The Swachh Bharat Mission is driving dominant BCC campaigns using social marketing of constructing toilets for individual families and communities to make India open defecation free by October 2019. Counter-marketing, one of the strategies of social marketing, has been widely used in tobacco control. Pictorial warning labels on tobacco packets target changing and stopping tobacco-use behavior. Another strategy is informed decision making that is useful in case of medical uncertainty, for example, HIV testing and treatment.[6]
The social marketing communication material should be creative, innovative, original, with clear messages in English and other local languages, reproducible, acceptable, and reflective. Real actor pictures and their dialogues, political personalities, flags and symbols, personally identifiable information, nude pictures, and content directly copied should be avoided while designing social marketing IEC materials. At large, this aids the public health sector in generating public-oriented health messages.
Three main patterns of health education materials are social marketing communication material, IEC material, and BCC material.[7] Social marketing is a strategy based on marketing principles of selling products. The communication material suggests that the healthcare option for a particular disease is the best solution, and therefore choice or critical thinking is not necessary.[8,9] An example of communication material incorporated in social marketing is “Condoms keep you safe! Freely available at health center! Do not forget to use.” IEC strategy attempts at informing people and increasing their knowledge about a disease, having them use it as a basis for action. “Correct and consistent use of condoms can protect you from sexually transmitted diseases including HIV/AIDS” is an example of IEC-type health education material. BCC strategy promotes individual change leading to healthy community behavior. It facilitates understanding of the disease and promotes change by providing alternatives for unhealthy behavior. An example of BCC-type health education material is “Correct and consistent use of condoms can protect you from sexually transmitted diseases including HIV/AIDS. What will you do?”
Considering the significance of social marketing in public health, the Department of Community and Family Medicine, All India Institute of Medical Sciences, Mangalagiri, Andhra Pradesh studied the health education material received for the promotion of HIV testing from medical students and young public health professionals, via nationwide competition on World AIDS Day 2018, using the principle of social marketing. In a discussion with various stakeholders, including the subject expert, medical expert, and common man using a semi-structured questionnaire, we identified four broad themes in HIV testing communication material. The first theme was the medical jargon in communication material. A participant stated, “It is good but cannot reach the public,” while another participant mentioned, “I do not know what the context is.” The second theme was visual appearance. One participant remarked, “Too dark or too bright.” Another said, “Poor selection of colors,” to one of the studied communication materials. The third theme was ambiguity. Participants described a few communication materials as, “Does not communicate to the public,” “Does not have knowledge about AIDS,” and “Irrelevant communication material.” The fourth theme was acceptability. One of the messages reported under this theme was “Nicely presented, such type of materials will attract the viewers and educate the public.”
Primary care physicians frequently use health education material to share clinical and preventive health care knowledge, facilitating behavior change among patients.[10] Traditionally, health education material is presented as pamphlets, posters, booklets, messages on social media, etc. on common primary care ailment. However, it is often ineffective in bringing behavior change.[11,12] Various health programs provide health education material to promote, change, modify, or stop a behavior toward a healthier lifestyle. Their effectiveness is well documented at the public level but is comparatively limited at individual level.[13,14] Effectiveness could be primarily influenced by the key attributes of the health education materials such as content, format, language, etc. which affect physician practice and patient outcomes. Good design and graphics are at the heart of any educational material. Hence, it is important to understand the patient's psychology for increasing the usability and uptake of health education material. Health education material which uses primary care and social marketing principles to improve knowledge, behavior, and patient outcomes is more preferable.[15] Social marketing of health is important to improve patient's wellbeing. Cultural perception and positive attitude are essential for a good doctor-patient relationship, especially at primary-care level.[16] Therefore, well-conceptualized, simple, reflective, profitable, culture-valuing, and positive health messages are critical for behavior change. They equally play a key role in improving the quality of primary care practice by building trust and confidence toward providers. Using t social marketing, primary care physicians address the determinants of health problems and unmet health-care service requirements. Primary care physicians need to customize health education material using translatable strategies based on social marketing to change patient behavior for wellbeing.
Social marketing has expanded its purview in the modern era aiming behavioral change of target audience on a large scale. Public health practitioners now admit the value of community-based approaches to social change. All medical professionals should be aware of the public's desires and respond to their needs and use in health care to determine how best to solve the problems and recognize their aspirations. Social marketing can reform the public health sector by expediting relationship-building with people and making their lives healthier.
The current world of public health needs to strengthen the capacity of family physicians and medical students to analyze the strengths and weaknesses of existing public health communication materials. Using the wheel of see, feel, and think, the professionals need to build practical skills in developing effective and positive communication materials to prevent common public health problems,[9] thereby transforming communication material into program tools to achieve health. Social marketing is an effective tool for population-based behavior change for a healthy lifestyle. This calls for primary care health facilities and other individual clinical settings to reinforce messages communicated on a population level in a customized format.
There are no conflicts of interest.
Our sincere gratitude to Dr. Mukesh Tripathi Sir, Director, All India Institute of Medical Sciences (AIIMS) Mangalagiri, Andhra Pradesh for providing us support and guidance. We are thankful to the Institute for providing us a conducive environment. We also thank the faculty and staff of the Department of Community and Family Medicine, AIIMS Mangalagiri for their time and consideration. Our special thanks to all the participants of the World AIDS Day Poster and Meme Competition organized by AIIMS Mangalagiri.
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