Monday, May 10, 2010

Social Behavioral Theory and Marketing Fundamentals Missing from GE’s healthymagination Campaign – Cristina Cruz

This paper will analyze the fundamental components of a public health campaign that are missing within GE’s healthymagination initiative, specifically a tailored message, target audience and relatable messenger. Through an analysis of socio-behavioral theories utilized to formulate public health initiatives and referencing studies on successful public health interventions, this paper will pinpoint where GE went wrong. By highlighting the benefits of a social ecological approach and market research as exemplified in the SISTA and truth campaign, this paper will show how these three fundamentals can improve GE’s health initiative.
Healthymagination’s Mission and Implementation

General Electric’s (GE’s) recent, web-based public health initiative, healthymagination, was released in conjunction with the 2010 Winter Olympics in Vancouver (1). In the initiative’s mission statement, GE hopes to help people “become healthier through the sharing of imaginative ideas and proven solutions” (1). This involves making health information more comprehensive, accessible and approachable for site visitors. Healthymagination’s site is composed of multiple projects. The “Better Health Study,” conducted with the Cleveland Clinic and Oschner Health System, reveals the way people perceive their health and how they relate to their doctors. The “Better Healthy Conversations” project, formed in partnership with WebMD, allows patients to prepare a customized list of questions for their next doctor visit. The “Howcast” page is composed of “Healthy-How-to” informational youtube videos geared toward adolescents and college-aged students, presenting pseudo-health information guised in a comical skit. The site also acts as a forum for health discussion by posting the latest in health news through the “Sharing Healthy Ideas” portion of the site. Visualizing Data uses colorful graphs and interactive charts to take complicated health statistics and make them more comprehensive for the general public.
A Lack of Theoretical Application: No Target Audience, No Message

When browsing through the site, it becomes evident that GE has some of the best marketing and communications experts designing and facilitating the site. With a closer look, one can see that healthymagination is a public health campaign that focuses more on presentation than substance. Fundamental elements of social behavioral theory and marketing theory are absent in the initiative’s execution. The root flaw is the lack of a defined audience. With no audience, the minds behind healthymagination cannot tailor their message to their audience’s “core values” (5). To properly “frame” the message of the desired behavior and make the initiative successful, campaigners must appeal to core values in the community (5). These values can include rebellion against authority (an ideal often appealed to in campaigns designed for adolescents (3)) or “fairness” and “justice” (5).

Without a properly framed message, healthymagination isn’t showing why having access to better health is important. This framed message will not only “fulfill important core values,” but it will also show how “maintaining the [targeted] behavior is actually conflicting with these values” (11). Thus, GE isn’t showing that there’s any consequence to not being healthy. Without the proper “packaging and positioning [of] the product-” health- there is nothing special about the information GE provides. Despite its high-quality graphics and videos, the healthymagination site does not effectively promote healthy behavior purely by providing health information.

Health Education: GE’s Implementation of the Health Belief Model
In the healthymagination mission statement, GE claims that “almost everyone wants to make healthier choices, but they don’t know how.” (1)
GE’s belief that better knowledge can lead to better health behaviors is rooted in the Health Belief Model (HBM). This model assumes that a person will change their health behaviors once he/she realizes that he/she is susceptible to a severe disease after weighing the pros and cons of changing his/her health behavior with a new health behavior. Once this person decides the best course of action, he/she will then adopt a new, better health behavior into his/her lifestyle (2).

The first problem in utilizing this model as the foundation for the healthymagination initiative is assuming that people always decisions in a systematic manner. One critique of the HBM is that it “assumes an internal, rational process” that should lead to one conclusion and that all persons have “equal access to, and an equivalent level of, information from which to make the rational calculation” (2). Therefore, the minds behind this project presented health facts and statistics through several forms of multi-media to supplement these rational thought processes. However, much of this information is referenced from other websites in a feedback, user-based platform. Essentially, this is common health information people could easily access elsewhere. In a study on the effects of national anti-drug campaigns, researchers found that the “My Anti-Drug” campaign was ineffective because adolescents had been saturated with information from previous advertisements that repeatedly alerted them to the dangers of smoking (3). In this case, more information did not lead to target behavior deterrence because the campaign’s “implicit message” was not novel and “incremental exposure was small.” Healthymagination’s delivery has a similar issue in that it is not presenting a unique message about health and through so much information, there is little direct impact.

The issue with using the Health Belief Model as the basis for this campaign is that the HBM ignores the effects of social and environmental circumstances on a person’s decisions and assumes that everyone has equal access to the same, pertinent information (2). GE’s concerted efforts in providing instantaneous information through videos, blogs, iPhone applications and online news articles show that they assume all people viewing this information will understand these statistics through multi-media. However, this assumption neglects a very critical population. The nearly 56 million people on Medicaid not only have limited funds for health care, but they also “face serious communication barriers related to limited literacy, language, culture and disability” (10). GE’s utilization of the HBM and presentation does not really take into account the low-income groups who need more tailored information to learn how to make healthy decisions in their daily lives.

Healthymagination’s Non-existent Messenger

The premise of healthymagination’s “Sharing Healthy Ideas” project is “when one person inspires a healthy idea, good health catches on…Let’s make Healthy decisions together” (1).

The “Sharing Healthy Ideas” project is a forum of continuously updated health topics prevalent in the media, healthcare industry and among medical specialists. Popular topics include autism, Alzheimer’s, nutrition, physical fitness and cancer risks. Users are provided multiple social networking sites to peruse these topics. Some are news media outlets, such as the New York Times. Others are trendier, facilitated through users’ contributions, such as iVillage. And, naturally, the minds behind healthymagination maintain their own blog.

The issue with this presentation is that there is no face to the voice providing this information. Studies have shown that audiences respond better to information from someone who is similar to themselves (4). This hearkens to the idea of Albert Bandura’s Social Learning Theory, whereby “individuals observe other people’s actions and. . . adopt those patters of action as personal modes of response to problems, conditions, or events in their own lives” (12). Having a person similar to the audience deliver a message about health is more compelling because that messenger lives by similar norms that exist in the audience’s community. This is how socialization occurs, by learning from others in the community (12). These similarities could be exhibited through a person’s race or ethnicity, level of education, housing situation and family life or simply similar tastes.

In a study on compliance, researchers found that “similarity increases the positive force toward compliance by increasing liking” and it “also increases the communicator’s credibility” (4). Healthymagination’s advisory board is comprised of high-profile politicians and other leaders within the medical industry. They compose a demographic that is not highly affected by the nation’s most pressing health issues. These are the consistent faces of the initiative that don’t appear to have much in common with the female African-American population that suffers from high HIV infection rates (8) or the adolescents that rebel through smoking (13). Utilizing similar messengers is particularly important when targeting adolescent populations who often feel threatened by authoritative figures who are trying to tell them what to do (13). When the truth campaign used young actors to promote their message, they were able to deliver a message that effectively reduced youth smoking by appealing to adolescents’ core value of rebellion with a tone that was not authoritative and helped them see how the smoking industry was controlling their lives through an addiction to smoking (13).

The absence of a relatable messenger is best exemplified by the “Visualizing Data” portion of the site. This project is solely comprised of graphics that condense statistical data into a more colorful, engaging chart. Some issues discussed include: stress at the workplace, the cost of medical treatment for different age groups, and the main causes of death in the nation per ethnic group. The “Causes of Death info-graphic” is summed up as “a reminder to make choices that will keep you healthy” (1). The nation’s various ethnicities and races are boiled down to percentages in relation to age and health problems. According to the social learning theory, these charts are not utilizing a “model” with whom site visitors can identify and learn “functional” behaviors, that “will bring about some desired result if [they are] imitated” (12).

The secondary problem with not using a person to relay this information is that GE assumes anyone can interpret these graphs. A study that addressed patients with limited health literacy (LHL) noted that clinicians often “overwhelm the patient with too much information, using jargon and technical terminology, relying on words alone, and failing to assess patient understanding” (9.) These graphs are taking a similar approach to relaying health information: facts and figures, but little verification of comprehension. This is problematic when “approximately half of the U.S. adult population has LHL” (9). Presenting data in a more interactive manner would allow patients to better absorb the information, particularly those with LHL who “often rely solely on verbal communication” (9).

A Reconstruction of Healthymagination using the Social Ecological Model
A New Approach: Creating Multiple Messages for the Nation’s Audience
By lacking a message, GE is lacking an audience to be receptive to its better health goal. One of the first rules of marketing for public health involves identifying the audience’s core values (5). With these core values, one can then develop a campaign that delivers a compelling message about health that coincides with these values. Healthymagination appears to have identified better access to health information as its audience’s core values. Since the site itself has merit in its design and use of graphics, GE could build upon the healthymagination mission by showing site visitors what current health issues look like by focusing on different topics through a variety of communities in the nation. Using real stories to show a health intervention applied to a community would create a “model” for the visitor to relate to and, subsequently, create an audience by profiling different demographics with whom visitors can relate. Ultimately, by focusing on specific health issues in certain communities, GE’s healthymagination campaigners can create framed messages that will apply to those populations, giving their health information more pertinence in the site visitors’ daily lives.

Using a Broader Approach: The Social Ecological Model
The first thing that could be done to make Healthymagination a more effective public health intervention would be to break away from the simplistic approach of the HBM and create an intervention for the nation’s health from a holistic approach. Implementing change that will stay has to occur on all levels and not through a program that is “oriented solely toward modifying individuals’ behavior” (6.) This means turning away from the individualistic approach touted by the Health Belief Model to put more emphasis on the environmental, social and cultural circumstances that influence a person’s health behaviors. Thus, healthymagination should adopt the Social Ecological Model, which places an emphasis on “creating an environment conducive to facilitate adoption of healthy behaviors.” (6) Providing information to separate individuals does not create the kind of change within the community to see that those health behaviors last.

As more public health campaigns have turned to adopting a marketing approach, multiple studies have shown that targeting a health issue from a group-level has been most effective (8). Healthymagination can use a group-level approach with the social ecological model by placing multiple interventions within different communities across the nation. With a specific demographic represented through each project, the proper marketing research can be performed to determine an effective “message design” implemented through “channels widely viewed by the target audience” (7). Each project can then address different issue areas in their assigned location (i.e., nutrition in Mississippi; physical activity in New York City’s urban population; preventive care in Montana’s rural communities). This approach would separate the nation into “subgroups based on important characteristics” addressing “demographic variable’s [and] risk characteristics” (7).

Utilizing a social behavioral theory that emphasizes the use of models and the role of social factors is essential to developing an effective public health campaign. A 1996 study by Wingood and DiClemente showed that in order to develop the most effective HIV prevention program for African American women the initiative would need: to be driven by a public health theory, target a specific group (in their study, women were the target audience), be “peer led,” focus on the external, everyday factors that influence women’s sexual health practices, and “require multiple sessions” to establish follow-up (8). Wingood and DiClemente’s HIV intervention, SISTA (Sisters Informing Sisters About Topics on AIDS), targeted toward African American women was based on these tenets and showed remarkable success for its “social skills intervention” when compared to the “control condition” it tested against (8).
While still using its current tools of video, engaging graphics and user feedback, GE will have a stronger impact on viewers once they see the anecdotes of people similar to them dealing with prevalent health issues in their community. Giving the messenger (each project’s target community) a sense of place (thereby identifying environmental factors and social norms) appeals to the social skills and needs as exemplified in the SISTA project (8). Multiple sessions of the intervention could be recorded in a video series for each community. By utilizing discussion boards and hosting podcasts with intervention participants, healthymagination could re-enforce its message through follow-up to see how the interventions’ behaviors were incorporated to the community’s daily lifestyle.

By using a person’s life story to convey what it’s like to live with AIDS or to battle with weight loss in the “Better Health Study” project, site visitors can develop an understanding of how to apply the advice from the “Sharing Healthy Ideas” articles. Each location investigated in the “Better Health Study” could have a central topic covered by a video. This video’s web page could have links to the related articles already posted on healthymagination’s site in the “Sharing Healthy Ideas” portion of the site.

Addressing Limited Health Literacy: A Multi-lingual Site
To make their health information most accessible, Healthymagination needs to address the English-language barriers among immigrant populations who frequently have limited health literacy (9). The site’s designers could best explore this avenue by implementing a drop-down menu that could change the language preference of the entire site that pops up when initially connecting to the home page. This could include placing subtitles on all of the videos in the desired language (when specified) and links to verbal translations of podcast scripts in multiple languages. If implemented properly, this could bridge the gap between Western physicians and their non-native patients.

When teaching a new health behavior, especially to patients with LHL, it is best to follow through with a “confirmation of understanding” (9). This could best be done in a web-based format through summary points presented at the end of each video to re-affirm the main message (healthy eating habits, reasons for getting a breast cancer screening, etc.). These final points would automatically be formatted in the selected language the site visitor chose when he or she first entered the site.

Branding the Healthymagination Initiative
After covering the bases of creating an audience through regional health stories and addressing the community’s core values by teaching these communities how to apply healthy behaviors to their everyday life, healthymagination can brand itself. A brand is used to convey the “personality of a program or policy” (5). For Healthymagination, this could involve creating a logo that symbolizes the act of sharing to coincide with its mission of people coming together to make “better health for more people” (1). This symbol could be placed on t-shirts, bumper stickers, pins or any other paraphernalia to give a look to healthymagination’s purpose. This brand would be placed throughout the Healthymagination site, giving new visitors something to identify with when returning to the site.

Both the truth and SISTA campaigns capitalized on the branding technique. When deciding to make a brand for the truth campaign, Jeffrey Hicks and his colleagues recognized that brands “serve as a shorthand way for youth to identify themselves to the world” (14). By visiting the truth website, one can see how the truth campaign (in its apparel, games and videos) identifies itself with rebelling against the tobacco companies, emphasizing the autonomy adolescents crave (14, 3). The SISTA campaign utilized the acronym SISTA in its “project motto” in a “culturally appropriate” way that appealed to young African America women’s values (8). “SISTA love is strong. SISTA love is safe. SISTA love is surviving” speaks to the intervention’s goal of promoting safer sex, re-affirms the women’s ability to be a decision-maker in their relationships by emphasizing strength, and appeals to the African American history of overcoming oppression by ending the motto with the note of survival (8). By making these interventions a part of the target audience’s daily lives, through clothing or by appealing to the audience’s culture, these brands make the intervention more accessible and relatable (5).

A Tailored Approach to a Broad Mission

By properly applying social behavioral theory to its healthymagination initiative, GE can create more compelling messages to which multiple site visitors can relate through a variety of messengers with similar social and environmental circumstances. Research has shown that health interventions have been most successful with a message tailored to the defined audience’s needs and core values that is delivered by a messenger similar to the audience. Since GE’s healthymagination’s site utilizes engaging graphics and popular social media tools, applying these standards to their current broad-based mission would allow greater impact on multiple, diverse communities.

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