Little Things Count

When you are creating health messages, small changes can make a big difference. A study by researchers at Penn’s Annenberg School found that slight differences in how the new vaccine for human papillomavirus (HPV) is described influence whether women decide to get the vaccination.

A representative sample of 635 American adults, of whom 49 percent were women, was randomly assigned to read one of three slightly different paragraphs about the vaccine through the Annenberg National Health Communication Survey.

One paragraph addressed how the vaccine protects against cervical cancer, another how the vaccine protects against cervical cancer and sexually transmitted infection and the third how the vaccine protects against cervical cancer, sexually transmitted infection and how it may or may not lead to increased sexual promiscuity among those vaccinated.

The survey was administered to determine the participant’s intentions regarding vaccination.

When women in the survey read that the vaccine protects only against cervical cancer, 63 percent indicated that they were very likely or somewhat likely to get the vaccine compared to 43 percent of women who read that the vaccine protects against cervical cancer and a sexually transmitted infection.

When it’s all about preventing cancer, most of the women wanted the vaccine. But when you introduce the factor of it protecting against a sexually transmitted infection — even while still preventing the Big C — almost a third of the women opted out. Is this because they don’t think it is something that they need (because, after all, THEY would never get an STI), or is it because it stigmatizes the vaccine recipient who wants the cancer protection but does not want people to think she is at risk of an STI?

This has huge implications for how the vaccine is marketed — especially to parents, who will likely make the decision whether their daughters should get it or not (the vaccine is approved for girls as young as 9 years old).

I wrote about marketing this vaccine a while ago in response to a post that Seth Godin wrote about not wanting that marketing gig. Here’s what I suggested should be done (which was endorsed by Seth in the comments!):

We would need to figure out what the key values are of the parents (who would likely make the decision) and appeal to those things that are most important to them — feeling like a good parent, taking care of their daughters’ health, making sure that their daughter will not have reproductive problems in the future. And, God forbid, the worst thing a parent can imagine is their child getting cancer — what wouldn’t they do or pay to prevent that from happening?

Position the vaccine as preventing cervical cancer rather than focusing on anything that might suggest that their daughter would even consider becoming sexually active until she is an adult. Get the CDC to add the vaccine to their recommended immunization schedule so that doctors will provide it as a matter of course with other teen booster shots so that parents won’t feel like the recommendation comes from a negative judgment of them or their daughters. Get insurance companies to cover some of the costs of the vaccination since they will have fewer cases of cervical cancer and STDs to pay for later. The fears about long-term effects may be addressed by comparing the risks of the vaccine to other similar products and showing that the benefits far outweigh the possible risks.

In light of these research results, I stand by my recommendations. Looks like Merck is too.

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Social Marketing Through the Dictionary

The New Oxford American Dictionary announced that the Word of the Year is “Carbon Neutral” (actually, that’s two words, but who am I to quibble with a dictionary?). It will be added to the next update of the dictionary, due in 2007.

According to the press release, “Being carbon neutral involves calculating your total climate-damaging carbon emissions (your “carbon footprint”), reducing them where possible, and then balancing your remaining emissions, often by purchasing a carbon offset: paying to plant new trees or investing in “green” technologies such as solar and wind power.”

Carbon Neutral beat out other potential dictionary inductees with social marketing relevance including (and I’m not making these up):

  • Elbow Bump – a greeting in which two people touch elbows, recommended by the World Health Organization as an alternative to the handshake in order to reduce the spread of germs (Hmmm, wonder why this didn’t catch on. I guess it’s more hygenic than the Eskimo kiss, which the Alaska Health Organization has been promoting.)
  • Ghostriding – the practice of exiting a moving vehicle and dancing either beside it, or on the hood or roof, while the vehicle is in motion
  • Pregaming – consuming alcoholic beverages before attending a sporting event or party, especially one where alcohol may be limited or banned (or likely, before going ghostriding)

Just for fun, I looked up the Word of the Year for the past few years (though it seems to be a recent annual event for the OAD, so I’ve had to go to other sources):
2005 – podcast (Oxford American Dictionary)
2004 – blog (Merriam-Webster Dictionary)
2003 – metrosexual (American Dialect Society)

And just to illustrate how the US and UK are two countries separated by a common language, the 2006 word of the year for the Oxford English Dictionary is “bovvered.” In case you are not familiar with this word either, here’s how the article explained it:

Catherine Tate [a TV comic] catapulted her word into national parlance in November 2005 when at the 77th Royal Variety Performance in Cardiff she asked the Queen: “Is one bothered?” Dictionary compilers say the catchphrase needs little explanation.

A spokesman for the OED said: “Am I bovvered? and it’s follow-up Does my face looked bovvered? had already come to be seen as the perfect expression of a generation of teenagers and their speaking style.

“Now in 2006 ‘bovvered’ has taken over from ‘whatever’ as the signature phrase of teenagers, and to challenge the Little Britain catchphrase ‘yeah-but-no-but’ as the embodiment of couldn’t-care-less adolescence.”

Am I bovvered? Gotta go elbow bump my buds before I do some carbon neutral ghostriding. See ya.

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Preserving the Dignity of Nonprofits

Continuing with the silly mood:

Proud Cystic-Fibrosis Foundation Doesnt Need Your Charity

The Onion

Proud Cystic-Fibrosis Foundation Doesn’t Need Your Charity

AITKIN, MN—A Dream To Breathe Foundation reasserted its status as a “non-profit organization” and expressed embarrassment at unnecessary “handouts.”


Cystic-fibrosis foundation A Dream To Breathe, which has refused to accept more than $250,000 in donations since 2001, announced Monday that it was continuing to make strides in fighting the rare respiratory disorder without any handouts from “self-righteous do-gooders.”

“In the past three months alone, thousands of people from all across the country have come out and asked us to take their money, insisting that we need it more than they do,” said Development Director Joan Vandercamp in an urgent plea to Americans to take their pity elsewhere. “To you and countless others, we can only say: Who do we look like? The Salvation Army?”

“When we need your help wiping this degenerative disorder that affects 30,000 Americans off the face of the earth, we’ll let you know, okay?” she added.

According to Vandercamp, who described her foundation as an independent organization determined to make a difference in the lives of those with cystic fibrosis and not “some pathetic charity case,” A Dream To Breathe is perfectly capable of finding a cure for the deadly genetic disease that strikes the lungs and pancreas without anyone else’s aid.

“Not that it’s any of your concern, but we’ve been raising plenty of awareness on our own, thank you very much, and we’d really like to keep it that way,” said Vandercamp, who added that her foundation already had its hands full identifying the defective protein-producing gene earlier in victims of the disease without others trying to get involved. “We may not be the biggest or the most successful organization of our kind, but we have dignity, and I’ll be damned if we let your patronizing donations change that.”

Read the rest at The Onion

Leading Horses to Water – the Role of Advertising

Clara Jacob asks at the Post Haste blog why advertising alone can’t change behavior:

Is this true? With advertising we can get people to eat candy bars. But we can’t get them to drive the speed limit. Neuter their pets. Stop using meth.

Why is this? We did a direct mail piece recently, which included a coupon for a dollar off a gallon of milk and 5 cents off each gallon of gas. It got a 60 percent response. That’s phenomenal. It changed the behavior of hundreds of people. They went to stores and purchased milk and gas.

Couldn’t “social marketing,” as it’s called in the nonprofit world, change behavior equally well?

Or, as Wiebe asked about 50 years ago, “why can’t you sell brotherhood like you sell soap?” Yes, we can use the same tools, but people do not change their complex health and social behaviors as easily as buying a $3 carton of milk. Advertising is only one piece of what needs to be considered in a social marketing program, and if the other necessary components are not there to back up the advertising, the campaign will not be successful.

Quoting myself from the comments:

The important role that advertising can play is in raising awareness that there is a problem that needs to be addressed, or in helping an individual realize that they are personally at risk if they do not adopt the behavior being promoted. Advertising can create an environment in which the target audience develops a favorable impression of the “product” (ie the behavior) and begins to see it as socially acceptable and desirable.

But for an everyday lifestyle change (e.g., eating in a healthy way) or even an occasional but emotionally difficult behavior (e.g., getting an HIV test), advertising does not always offer enough personal support to lead someone to take action. That usually takes interpersonal communication from an influential person like a doctor, friend, family member or even a knowledgeable and caring person on the other side of a telephone hotline.

Advertising can lead the horse to water, but whether the horse drinks 8 glasses a day is another question.

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Puppet Power

When you think of puppets, do you think about Punch and Judy for kids or those giant freaky paper mache puppets that seem to show up at every anti-globalization rally?  Maybe you should start thinking about social marketing.  The recent edition of the Drum Beat from the Communication Initiative features resources on puppetry for development.  It includes examples of programs around the world that have used puppets to address issues related to intergenerational connections, general and reproductive health, HIV/AIDS, democracy and governance, and human rights.  A particularly good introduction to the topic can be found in UNICEF’s excerpts from Puppets with a Purpose: Using Puppetry for Social Change.

I’m not sure whether in the American culture adults would accept puppets as a way of imparting information or motivation for change outside of Sesame Street.  But it has been quite successful in many other cultures that have a long tradition of puppetry as entertainment or education. 

And what kid doesn’t love puppets?  (Okay, I’ll admit that I didn’t for a long time after I saw an outdoor puppet show when I was very small where a dragon puppet breathed real fire and I ran away screaming, but other than that, you get my point.)  If the age/culture you are addressing is appropriate, consider how you might be able to use puppets to get your message across.

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