This chapter first outlines the fundamental communication principles social marketers have to consider when approaching the issue of childhood obesity and then explains the marketing principles on which their decisions are based when designing a social marketing campaign to address the issue. The innovative French EPODE program is used as a case study throughout this chapter to illustrate principles and process (Box 28.1).

The term “social marketing” was first used by Kotler and Zaltman¹ to refer to the application of commercial marketing principles in the context of socially desirable goals. Andreasen² defined social marketing as: “the application of commercial marketing technologies to the analysis, planning, execution, and evaluation of programs designed to influence the voluntary behaviour of target audiences in order to improve their personal welfare and that of their society” (p.7). Donovan and Henley³ modified this definition to include involuntary behaviors as there are many instances of social marketing where the individual’s voluntary behavior is constrained, for example, under threat of legal sanction (drink driving) or other regulations (smoke-free venues), or where the individual’s choices are restricted (e.g. government restrictions on trans-fatty acids in processed foods).

Until recently, social marketing focused primarily on persuading the individual to adopt recommended behaviors (often referred to as the “downstream” approach). However, current thinking has extended the definition of social marketing to include achieving change in the social determinants of health and safety (referred to as the “upstream” approach).^3–7 Upstream approaches attempt to bring about desired individual behavior, often without the individual’s conscious cooperation.

In the present context of childhood obesity, the “upstream” advocacy role extends to working to ensure individuals have access to healthy foods (such as children’s school meals) and information about nutritional value of foods (as in food labels), as well as advocacy for public facilities to encourage physical activity (such as cycle paths and parks). Other possibilities include taxes on unhealthy foods or products, subsidies for healthy foods or products, regulating advertising to children,⁸ making unhealthy foods less visible, more expensive and harder to access.⁹

It is appropriate to include advocacy elements in a social marketing strategy. Indeed, some would say that social marketers should consider environmental change first¹⁰ and we should only attempt to persuade individuals to change their behavior when all possible environmental changes have been put in place that will make it easier for them to change. Targeting local champions is also a key social marketing strategy because they can significantly influence opinions and mobilize resources (Box 28.2).

Other chapters in this book go into more detail on strategies to change the environment so the rest of this chapter will focus on the more conventional, downstream social marketing activities involved when trying to persuade individuals to change their behavior. Some well-accepted marketing principles are discussed later and shown how they were used in the EPODE context: “getting the right message” and “getting the message right” for different target markets; and the marketing mix. But first, we identify a number of fundamental communication principles to be considered when designing a social marketing campaign:¹¹

• The receiver is an active processor of incoming information: A message will be received differently by different people; pre-existing beliefs, attitudes, experiences and knowledge affect the way an individual attends to, interprets and accepts a message.
  
• Different target audiences may respond to different messages differently: Target audiences must be segmented by beliefs and attitudes before the development of targeted messages.
  
• Formative research, including message pre-testing is essential: Formative research (focus groups/interviews) is conducted with the target audience to understand their different beliefs and attitudes. Messages are then pre-tested with the target audience to ensure understanding, and with secondary audiences, to ensure there are no unintended negative effects.
  
• A theoretical framework increases the likelihood of success: Campaigns guided by theoretical frameworks are more likely to be successful than those that are not. Some of the important models of attitude and behavior change include the Health Belief Model, Protection Motivation Theory, Theory of Reasoned Action and the Theory of Trying (for a summary, see Andreasen).³
  
• Comprehensive, coordinated interventions are most successful: Successful campaigns are comprehensive and coordinated with other environmental and on-the-ground strategies to ensure attitudinal and behavioral success.
  
• Multiple delivery channels and multiple sources increase the likelihood of success: Communication campaigns involving a number of message delivery channels and more than one source appear to be more successful than those that do not.¹²
  
• Campaigns must be sustained to be effective: Communication campaigns must be sustained over time to achieve and maintain success.

These seven overarching communication principles are fundamental to social marketing campaign decisions. The rest of this chapter discusses some of the basic social marketing principles that guide the development of successful campaigns.

“Getting the right message” for different target markets

Creating effective communication messages involves a two-step process: “getting the right message” and “getting the message right”.¹³ The first step involves reference to three types of research:

1. Epidemiological research (using population-based statistical evidence to identify risk and protective factors in health issues), for example: What does the epidemiological evidence say about preventing obesity (e.g., 30 minutes of physical activity on most days a week has a significant effect on some indicators of adult health such as reducing cardiovascular diseases outcomes, but the evidence on the amount needed to prevent unhealthy weight gain in children is less certain and may be up to 60 minutes a day)?

2. Formative research (using qualitative methodologies such as focus groups, in-depth interviews): What do people say will motivate them to try to change behavior (e.g., to eat more fruit and vegetables) through changing attitudes and beliefs?

3. Evidence-based research (referring to available evaluations of previous strategies): What has been done before and deemed to be effective, having been rigorously evaluated against established benchmarks (e.g., which previous messages around healthy food choices resulted in measurable dietary changes)?

When trying to change behaviors relating to childhood obesity, we first have to decide what is the right message to communicate. When targeting children, we can decide on the basis of formative research with children which of the following we should be recommending: eat healthy, eat more fruit and vegetables, eat less fat, avoid soft drinks, be more physically active, be less sedentary, play outside more, sit inside watching tv/playing computer games less, watch no more than a certain number of hours on TV, and so on. Within the target market of “children”, there will be subsections. The US physical activity VERB™ campaign found that their messages around fun were more appealing to younger children and their messages around peers, competition and mastery appealed more to older children.¹⁴

When targeting parents, it is worth bearing in mind that parents have three roles¹⁵ that can influence a child’s nutrition and physical activity levels: they provide specific foods and physical activity options for the child; they model food consumption and activity levels; and they control (at least to some extent) the child’s environment, determining the quality and diversity of experiences at mealtimes and activity times. We can decide on the basis of formative research with parents, whether it is best to recommend that mother or father or both: buy healthier food, withhold soft drinks, provide a certain number of serves of fruit and vegetables, offer smaller portions, allow fewer snacks, eat without distractions (e.g. television), persuade children to go outside to play, try different activities, accompany them on a walk to school, and so on. Within the target market of “parents”, there will be subsections: different messages will be appropriate for mothers and fathers, grandparents or other carers (Box 28.3).