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DEVELOPING EFFECTIVE SOCIAL
MARKETING PROGRAMS FOR ABORIGINAL
PEOPLE: REVIEWING
BEST PRACTICE
J U D I T H J . M A D I L L , P R O F E S S O R A N D H O L D E R O F T H E D E S M A R A I S P R O F E S S O R S H I P I N M A R K E T I N G , U N I V E R S I T Y O F O T T A W A , E - M A I L : M A D I L L @ T E L F E R . U O T T A W A . C A
L I B B I E W A L L A C E , S E N I O R M A R K E T I N G A D V I S O R , H E A L T H C A N A D A , L I B B I E . W A L L A C E @ H C - S C . G C . C A
K A R I N E G O N E A U - L E S S A R D , C H I E F O F M A R K E T I N G , H E A L T H C A N A D A , K A R I N E . G O N E A U - L E S S A R D @ H C - S C . G C . C A .
C E L I N E N D I O N , M A R K E T I N G O F F I C E R , H E A L T H C A N A D A , C E L I N E . N . D I O N @ H C - S C . G C . C A
R O B B M A C D O N A L D , S E N I O R C O N S U L T A N T , M A C C O M M S O C I A L M A R K E T I N G , R O B B @ M A C C O M M . C A
HOW DID THIS COLLABORATION AND PAPER COME
TO BE…
Health Canada:
Has the mandate to address and improve the health of Aboriginal people living in Canada
Commissioned an environmental scan of the literature focused on social marketing programs that targeted Aboriginal and Indigenous audiences
findings are being used to inform the development of Health Canada’s social marketing campaigns.
THE ACADEMIC HEALTH CANADA MIX
We have begun our research partnership examining
social marketing best practices for Aboriginal groups –
thinking we can add to each other’s worlds!
How we have approached this will be described in the
presentation.
WHY THIS TOPIC?
Important Yet Under Researched Field
Much evidence showing significant disparity between the
health of Aboriginal people (including Inuit, First Nations
and Métis) and that of non aboriginal populations in
Canada (cf. Jenkins et al. 2003; Public Health Agency of
Canada, 2011; Smylie, 2000), the US (Parker et. al. 2011),
Australia (Ipsos-Eureka 2010).
FAILURE OF INTERVENTIONS INTERNATIONALLY
Literature notes failure to show significant
impact – Why?
Many reasons:
Insufficient formative research, lack of incorporating
local concepts and values, failure to evaluate and
document impact (Parker et al 2011; Ho et al 2006;
Smylie et al 2004; 2009).
ABORIGINAL AUDIENCES ARE AN IMPORTANT GROUP FOR
REALIZING HEALTH CHANGES
We could locate no overall literature review
that could help influence social marketing
development for this audience…
Definitely are excellent points made and
supported in the research, but no published
attempt to pull this knowledge together
PURPOSE OF TODAY’S PRESENTATION
To identify and review research literature on social
marketing to Aboriginal populations;
To provide conclusions and highlight key avenues for
future research in order to improve social marketing
campaigns targeting Aboriginal peoples;
To present a model developed from the literature
outlining effective social marketing in Aboriginal
groups;
IN ORDER TO IDENTIFY AND REVIEW LITERATURE…
Needed to identify the benchmarks of social marketing campaigns and approaches
Not the first to face this problem (Stead et. al. 2006; Madill and Abel 2007)
Most common approach is to go back to Andreasen (2002) who developed key benchmarks for identifying an approach that could legitimately be called social marketing:
voluntary behavior – change being the goal,
consumer research forms the foundation,
segmenting and targeting are done,
crafting strategies to create exchanges with selected target audiences,
developing strategy utilizing the 4 P’s while paying attention to one’s competitors.
FOR INCLUSION IN THIS LITERATURE REVIEW
Campaigns don’t have to exhibit all the characteristics , but can’t
just be communications campaigns.
OUR METHODOLOGY Conducted literature search and review at two different times – literature
summarized here is from both
Time A: 2011 (Environmental Scan and Evidence Review) (Commissioned by Health Canada)
Identified 120 possible sources in literature review related to social marketing programs target to Aboriginal and Indigenous audiences in Canada, the US, Australia and New Zealand.
Dates 2004-2012
Filtered and selected 28 citations
Summarized each citation and noted key findings
Time B: Winter 2013 (Literature Review)
U of Ottawa Databases on Scholars Portal using “social marketing” and “aboriginal’ as well as ‘social marketing’ and’ indigenous’ (conducted by Madill)
Dates 2008-2013 – five years.
Examined each citation to determine if it met the criteria of research involved in social marketing campaigns.
Duplications from Time A were eliminated
Noted a number of other research papers targeted to aboriginal audiences
FINDINGS: IDENTIFICATION AND REVIEW OF
RESEARCH LITERATURE ON SOCIAL MARKETING FOR
ABORIGINAL POPULATIONS
Challenge of reporting literature – lots of words!
Approach – show summaries on PP
Will not go through in huge detail, but enough to
give flavour!
Will draw conclusions
Will then present model developed from this
review.
Wrap-up with conclusions and suggestions for
future research
LITERATURE OVERVIEW
Author/
Date
Source Methods Focus Subjects Findings
Parker et al.
2011
J of Nut Ed. &
Beh.
Refereed
Qualitative
FGs = 8
Ints n=8
Total n = 42
Diabetes Native
Am Women
US
Prefer:
Family based
Prominent role by
elders
Tribe sites at times
conducive to work
schedules
Ho et al.
2006
Health Prom.
Int.
Refereed
Qualitative
Ints = 78
Oberv. =6
Demons = 13
Quant
Survey = 72
Diabetes Canada
First
Nations on
3 Ontario
reserves
Variations in health
beliefs, attitudes
and environs
required tailoring
of programs to
each reserve
Importance of
formative research
LITERATURE OVERVIEW
Author
/Date
Source Methods Focus Subjects Findings
Ipsos-
Eureka
2010 (a)
Non
Refereed
Consulting
Research
Report
Qualitative
FGs = 37
(Indigenous)
Depth Int =
30
(Health
Pros)
Behaviour
and
awareness
of health
services
and how
they can be
accessed
Australian
Indigenous
and Health
Pros
Belief – chronic diseases
unavoidable part of
contemporary life
Low motivation re why
take action and how take
action now
Negative health
behaviours often shared
activities – important for
social cohesion
Shyness re exercise but
positive view of sport and
walking culturally
appropriate
FINDINGS IPSOS-EUREKA 2010 (a) CONT’D
Healthy food perceived costly. Low levels of understanding about healthy food, cooking and food budgeting skills
Fear of unknown concerning health services - lack of information about the nature of local services and personnel
Preference for holistic health services, perception that health services geared to acute health issues not health promotion/prevention
Costs barrier to accessing preventative health services
Benefits for children and family important
Awareness of past SM campaigns
Term ‘chronic disease’ not commonly used
Preference for visual communications, conversational storytelling approaches
Internet suitable for younger
Social gatherings – information hubs
Little support for gender segmentation
Remote areas have unique needs – English often second or third language
LITERATURE OVERVIEW
Author Source Methods Focus Subjects Findings
Ipsos-
Eureka,
2010 (b)
Research
Consulting
Report
Non-
Refereed
Qualitative
(large-scale)
37 FGs by
age and
smoking
status
(n=220)
Depth
Interviews =
37 (health
pros)
Inform
development
of anti-
smoking
campaigns
Australian
Indigenous
and health
pros in
metro and
remote
Nation wide
Superficial awareness
of negative smoking
health effects –
conscious re effects on
children
Some interest in
cessation
Barriers – social
normalization of
smoking, cost
Motivators – family and
kin, decreased fitness
and sports
performance
Moderate awareness
of mainstream
campaigns
FINDINGS IPSOS-EUREKA 2010 (b) CONT’D
Positive – feature Indigenous faces, voices, cultural
imagery, tied to holistic approach to health
Conversational approach – storytelling
Television popular – radio, poster, billboards
LITERATURE OVERVIEW
Author
/Date
Source Methods Focus Subjects Findings
McShane
et al
2006
Cdn J of
Pub
Health
Refereed
Qualitative
KI
Interviews
FGs
Understand
Health
information
Sources/
Dissemination
Urban Inuit
Canada
Importance of visual
learning, community
elders, community
cohesion, Inuit-non-Inuit
distinction
Core sources – family,
within Inuit community
Prefer direct
communication, one on
one or small groups
Smylie et
al 2009
Health
Promo
Pract.
Refereed
Qualitative
Community
Case
Studies (3)
FGs
KI
interviews
Documents
Understand
Health
information
Sources/
Dissemination
Ontario,
Canada
1 urban
Metis, 1
urban Inuit,
1 semirural
First
Nations
Community
Hypothesis supported
– understanding local
Indigenous processes is
pre-req to effective
knowledge translation
Distinct differences in
each community as well
as commonalities
Theoretical FW –
Decolonization.
FINDINGS CONT’D
Common Themes:
Valuing experiential knowledge – shared
Influence of community structure on health
information dissemination – i.e. WOM in cohesive
community, but challenge in socially fragmented
Preference for within community messages
Local effects of colonization – replacement of
traditional systems
LITERATURE OVERVIEW
Author/
Date
Source Methods Focus Subjects Findings
Consultancy
for Alternative
Education
2010
Non-
Refereed 9
page report
Description of
programs,
services and
practices
Tobacco
reduction
Opinion piece
on practices
most relevant
for Inuit
communities
Didn’t include here
as not research
based
National
Social
Marketing
Centre
Research
Team 2011
Case Study
Non-
Refereed
SMQ
Description of 3-
phase program,
2007-13
Qualitative
In-depth
interviews,
paired
interviews, FGs
with TM, 58
telephone with
Health Pros
Increase
cervical
screening
New
Zealand’s
Maori and
Pacific women
Embarrassment
Lack of awareness
discussion and
ways of talking
about issue
Perception - clinics
difficult to access
and inconvenient
Worry about painful
procedures, costs
Competition for
time
Differences
between groups
LITERATURE OVERVIEW
Author/
Date
Source Methods Focus Subjects Findings
McDonald, et
al. 2011
Global
Health
Promotion
Non-
refereed
Secondary
Literature
reviews
informed the
design
Promote
hand-
washing
with soap
Remote
Australian
Aboriginal
communities –
children
Pre and post
surveys
Found use of
literature evidence
helpful in
increasing success
of campaign
Majid and
Grier, 2010
SMQ
Non-
refereed
Qualitative
Case
description
Interviews
Food Mail
Program –
subsidsize
cost of
shipping
food to
isolated
northern
Canadian
communities
Stakeholders
– customers,
Retailers,
airlines,
government
officials
Outcomes mixed –
growth in past 5
years, yet, rate of
obesity and dietary
related illness is
increasing
Challenges faced
in changing
established food
consumption
behaviours
LITERATURE OVERVIEW
Author/
Date
Source Methods Focus Subjects Findings
Filiault and
Drummond
2009
Refereed
Critical
Public
Health
Literature
review
Health
Call
Centres
Use
Australian
Men –
including
aboriginal
Indigenous men more likely
to use health call centres.
Knowledge determines use
SM that takes into account
vocies and concerns may
enhance use
Adams et
al
2011
Refereed
Australian
Social Work
Quantitative
Survey
N=82
(Online and
Postal)
Nutrition
Physical
Activity
Tobacco
Urbanized
Indigenous
Australians
Respondents more likely to
change behaviours related to
nutrition and physical activity
– less ready to cease
smoking
Peer support preferences
were for face-to face or
group support for physical
activity and smoking and
assistance with food costs
for nutrition.
SUMMARY: RESEARCH SUBJECTS AND COUNTRY
VENUES
Very little published research (N = 12)
US Women – 1 Study
Canada (6 total) General north – 1
First Nations – 2
Inuit – 2
Metis – 1
Australia – 4
New Zealand – 1
Implications….
SUMMARY: FOCUS OF RESEARCH
Physical Activity – 3
Nutrition, food, diabetes – 4
Accessing health services – 4
Tobacco – 2
Cervical Screening – 1
Hand Washing – 1
Implications…..
KEY OBSERVATIONS: OTHER LITERATURE
Tangential literature available that might help build
understanding of Aboriginal populations and health
behaviours, BUT not specifically SM oriented
For example, France et. al. (2010) in Substance Use
& Misuse – qualitative study in West Australia to
identify barriers that health professionals encounter
when addressing alcohol used with Aboriginal
pregnant women
KEY OBSERVATIONS: OTHER LITERATURE
Literature available on socially disadvantaged
groups more generally that might help, but not
focused on Aboriginal or Indigenous populations
specifically
For example, Guillaumier et al, 2012 in Drug and
Alcohol Review, focused a systematic review of
the effectiveness of anti-tobacco mass media
campaigns and socially disadvantaged groups
Found weak study designs and recommends
improved methodological rigour
CONCLUSIONS FROM
LITERATURE REVIEW
Theory:
Reviewed only one paper that utilized decolonization theory as theoretical frameork for the paper (Smylie et al 2009).
From 1996 Canadian Royal Commission on Aboriginal Peoples.
Implications: Research weak theoretically
SUMMARY/CONCLUSIONS FROM
LITERATURE REVIEW
Methodologies: Research is often/always formative concerning the
development of specific campaigns
Research most always qualitative (focus groups and interviews)
Support of use of focus group methodology (in keeping with storytelling tradition, Parker et. al. 2011)
Support for use of moderators with indigenous connections.
Subjects include target markets as well as health professionals involved with the target markets (focus groups often had n of 1 or 2).
Conclusions
Predominance of qualitative research
Limited generalizability based on type of methodologies used, yet considerable convergence of findings
Considerable support for using focus groups, but noted recruitment difficult and very small n’s.
Limited research overall – half refereed, half (6) was not.
CONCLUSIONS
Given the paucity of research - especially peer reviewed findings, the limitations of study designs, practitioners advised to be cautious and recognize that much needs to be learned.
Many recommendations are presented in each report, for example: Not limited to print – provide opportunities to come together Role of elders – influential and valued Family based and tribe specific
The recommendations are very diverse – developed model which tries to pull the most important together….
SUGGESTIONS FOR FUTURE RESEARCH
Given importance of Aboriginal/Indigenous peoples health
problems, critical to continue efforts to improve health
outcomes
Critical to pull research together in a literature review
concerning what is known – we intend to move our paper
forward with this intention
Have proposed model and useful next step would be to test
empirically in a variety of settings, countries and health issues
and report upon its effectiveness – we intend to do this and
hope others will as well.
Social Marketing Approach for First
Nations and Inuit in Canada
April, 2013
32
Lessons Learned
Individual
Family
Community
APPROPRIATE • Segment
• Relevant
• Culture
• Oral, story-telling
• Visual
MOTIVATION &
BARRIERS • Knowledge, attitude, belief
• Emotional
• Practical
Considerations
COMPELLING • Community-based, participatory
• Balanced
• Emotional, personal connection
• Simple, direct
MULTI-CHANNEL • Traditional media
• One-to-one and group (Elders)
• Social media
• Subject
33
Stakeholder Engagement
First Nations & Inuit
Community Members
Local Stakeholders
Community
Leadership,
Chiefs &
Councils
Health Directors
& Managers,
Environmental
Health Mgrs, etc.
Health Care
Providers
Doctors
Nurses
Lay
Workers Children &
Youth Workers
Health Canada
Immunization
Coordinators
Env. Health
Officers
National & Regional Stakeholders
First Nations &
Inuit Orgs
National
Organizations
Provincial &
Territorial Orgs
Provincial & Territorial
Governments
Collaboration for Success
Health Promotion
34
Multi-focused Campaign Strategy
Deliver Information
Encourage & Enable Dialogue
Content Promotion
Gatherings Social Media
Social Marketing Campaigns for First Nations and Inuit Audiences
35
Immunization
Environmental Health
Seasonal Flu
Tuberculosis
APPENDIX
HEALTH CANADA CAMPAIGNS
37
First Nations and Inuit Immunization Campaign
Parents/Caregivers of Children 0-2
& Expectant Parents
Target Audience
Young population
(~50% under the age of 25*)
Young parents
(~30% children with mothers 15-24*) Increasing birth rate Population Size FN over 15: 473,235 Inuit over 15: 32,775
Primary: Decision Makers Parents/caregivers of children 0-2 years
and expectant parents
Secondary: Influencers Health care providers and lay workers,
elders, other parents, family and community members, chiefs and
councils, Aboriginal organizations, media
Most popular sources of information 1. Local Health Station: 35% 2. Internet (opportunity to connect with
other community members): 35 3. Doctor: 24% 4. Community nurse: 18% 5. Other health care provider: 5%
Opportunity to influence decision makers Through dialogue between decision
maker (parents/caregivers) and influencers
Campaign Purpose Background
Some vaccine-preventable diseases continue to be seen in First Nations communities Support better health outcomes and reduction of health inequalities between First Nations and Inuit and other Canadians
To build knowledge and increase positive attitudes and perceptions of immunization leading to positive behaviour change regarding immunization.
Objective
Desired Outcomes
A 5% increase in both awareness and usage of
immunization materials by nurses.
Increased vaccination rates and decreased incidence of
vaccine-preventable diseases among First
Nations and Inuit populations.
Decreased health-care costs and reduction of
health inequalities between First Nations and Inuit and
other Canadians.
Short Term Long Term Medium Term
Guides www.healthcanada.gc.ca/immunization
Radio
Ad/PSA TV PSA
Cable Channel Ad
Print Ad/PSA Poster
Web Banner Ads
Promotion
Search
Content
Stakeholder
Promotions
Information Delivery
One-on-one &
group sessions
Awareness
Items
Postcards
Gatherings
Discussion
Reminder
Discussion
Guide
Vaccination
Tips & Facts E-Cards
Share Your Story
Internet and Social Media
Ask an
immunization
question
Dialogue
First Nations and Inuit Environmental Health Campaign
43
Goal
Enable First Nations and Inuit to identify, prevent and
address potential environmental impacts on health through:
Increased awareness of the relationship between environmental contaminants and health
Increased knowledge of simple activities for prevention, assessment, and reduction of risk
44
Target Audience
Adults Youth & Children
Indoor & outdoor: equal concern
Ability to protect: limited confidence
First Nations: 473,235 (15+)
Inuit : 32,775 (15+)
More inclined to learn
Less knowledgeable
Young population (>50% under 25)
* Baseline Survey, April 2010
First Nations On-reserve & Inuit
Environmental Health issues are made more severe among First Nations & Inuit, by:
• Overcrowding
• Higher smoking rates
• Hunting, fishing, gathering
• Inadequate ventilation
• Artistry / traditional Crafts
45
Web Guides & Posters
Guide & DVD
4-part Videos
Poster
Mould & Food Safety
Direct Mail Youth Developed PSAs
Home Guide PSAs
TV &
Radio
Search
Information Delivery & Promotion
Information Sessions
Community Gatherings
& School Assemblies
Activity
Booklets
4th International Meeting
Indigenous Child Health
(March, 2010)
Aboriginal Nurses
Association of Canada
National Conference
(Oct, 2010)
Youth Art Contest
Dialogue
Questions, Polls
and Videos
Shared Tactics
48
Healthy First Nations and Inuit Facebook Page
49
Partnership with APTN
Aboriginal Peoples Television Network
Hosting & promotion of a microsite featuring Immunization
Participation in Aboriginal Day live annual event
Production of a short video that captures community
members sharing why immunization is important to them