Developing a National Social Marketing Plan for
Preconception Health and Health Care:
Perspectives from the Consumer Workgroup
Elizabeth W. Mitchell, PhD
Division of Birth Defects and Developmental
Disabilities
June 13, 2011
National Center on Birth Defects and Developmental Disabilities
Division of Birth Defects and Developmental Disabilities
Presentation Overview
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Social marketing- what is it?
Phases of a social marketing plan
Status of the consumer workgroup’s social marketing
planning by phase
Next steps
WHAT IS SOCIAL MARKETING?
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Social marketing is:
"The application of commercial marketing technologies
to the analysis, planning, execution, and evaluation of
programs designed to influence voluntary behavior of
target audiences in order to improve their personal
welfare and that of society."
* Andreasen, AR. Marketing Social Change: Changing Behavior to Promote Health, Social Development, and the Environment. San
Francisco, CA: Jossey-Bass; 1995.
Problem
Description
Market
Research
Implementation
Social
Marketing
Phases
Market
Strategy
Evaluation
Interventions
Source: http://www.orau.gov/cdcynergy/demo/
1
Social Marketing Phases
Problem
Description
PUBLIC HEALTH, SOCIAL
MARKETING AND CONSUMER
WORKGROUP
Defining the Issue - Public Health Perspective

Goal: To improve women’s health before
pregnancy in order to optimize pregnancy
outcomes
 Pregnancy intention is associated with improved health
behaviors and birth outcomes*
Shah PS, Balkhair T, Ohlsson, A, Scott F, and Frick C. (2009). Systematic Review. Matern Child Health J. Published online: 10 December
2009).
Key Challenges
 Half of all pregnancies are not planned*
 Target audience has a wide age range (18-44) and is
diverse
 The list of PCH behaviors is long
 Messaging is challenging (language of PCH ; time
period for promoting behaviors is unclear)
 Health disparities
Finer LB, Henshaw SK. Disparities in rates of unintended pregnancy in the United States, 1994 and 2001. Perspect Sex Reprod
Health2006;38(2):90-6
Defining the Issue- Social Marketing Perspective
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The social marketing process involves
 Identifying an effective marketing mix
• 5 P’s (product, price, promotion , place and partners)
o What is the preconception health concept we are trying to sell to
consumers? (product)
o What are the costs to consumers ? (price)
o How should demand for preconception health and healthcare
(PCH & HC) to consumers be achieved? (promotion)
o Where should PCH & HC messages be promoted? (place)
o How can efforts be supported and sustained? (partners*)
 Offering the customer clear and compelling benefits
 Minimal barriers
 And advantage over other options (competition)**
*Luca, Nadina Ralulca and Suggs, L. Suzanne (2010) ‘Strategies for the Social Marketing Mix: A systematic Review’, Social Marketing
Quarterly, 16: 4, 122-149.
** CE Prue, KL Daniel. Social marketing: planning before conceiving preconception care. Matern Child Health J2006;10(5 Suppl):S79-84.
Defining the Issue- Consumer Workgroup
Perspective
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Responding to call to action
 Strategic planning (2010-11)
• Revisited overarching goals
• Developing an actionable multi-organizational
social marketing plan
o Group attributes, gaps, needs
o Sustainable
o Monthly calls among partners to work on plan
2
Social Marketing Phases
Market
Research
RESEARCH TO INFORM SOCIAL
MARKETING STRATEGY
Market Research Conducted or Underway
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Literature review (2009-2010)
Materials evaluation (2009)
Environmental scanning (2010)
Partner assessments (2010 & 2011)
Audience segmentation analyses (2009 & 2010)
Focus groups (2010)
Couple interviews (2010)
Secondary data analysis- underway
Concept development and testing (2011)
Adcept development and testing- underway
Market Research (cont’d)

Literature review
 Synthesized research on PCH & HC by audience
(women, couples and clinicians) and by 4 P’s to inform
formative research plan

Materials evaluation
 Analysis of consumer PCH materials to understand
what is being communicated, to whom, and with what
clinical emphasis
 Findings- D. Levis (CON1)
Market Research (cont’d)
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Environmental scanning
 Web based assessments across range of areas
• PCH branding, target audiences, existing materials, tools and
campaigns, focus area (preconception, pregnancy, general
health etc.)
 Among a number of sectors: insurance, media (TV,
magazine), foundations, public health, advocacy, web,
business
 Provided insight into the landscape of PCH,
partnership and dissemination opportunities
Market Research- Partner Assessments
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Two partner assessments conducted (partner “P”)
August 2010 and February 2011
 Conducted in order to assess the attributes of the consumer
workgroup in order to inform strategic planning, “center” social
marketing planning efforts, assess gaps and opportunities
 Focused on:
•
•
•
•
•
•
Each organization’s goals
Their audiences
Activities (research, evaluation, education, communication)
Opportunities/barriers
Partnerships
Desired role in a national social marketing plan
 Created a partnership database
Market Research- Audience Segmentation
Analyses

Purpose
 Explore how women of childbearing age can be
disaggregated into smaller groups so that effective and
appropriate PCH social marketing interventions can be
crafted
Market Research- Audience
Segmentation Process
Entire Population
Target Population Groups
i.e. Women of Childbearing
Age
Kirby Marketing Solutions
Determined by
Epidemiology or
stratification data
Market Research- Audience
Segmentation Process
Entire Population
Target Population Groups
i.e. Women of Childbearing
Age
Determined by
Behavioral, Theoretical,
or Multivariate Data
Kirby Marketing Solutions
Audience
Segments
Determined by
Epidemiology or
Stratification Data
Market Research- Audience
Segmentation Process
Entire Population
Target Population Groups
i.e. Women of Childbearing
Age
Determined by
Behavioral, Theoretical,
or Multivariate Data
Audience
Segments
Intended
Audience
Kirby Marketing Solutions
Determined by
Epidemiology or
Stratification Data
Determined by
Selection Criteria
Market Research- Audience Segmentation
Analyses
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Data
 Porter Novelli’s HealthStyles survey (2007 & 2009)
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Methods
 Classification and regression tree (C&RT) and Chi- square
automatic interaction detection (CHAID) to define factors most
associated with level of pregnancy planning
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Results
 Factors most associated with pregnancy planning**
• timing,* contraception, marital status*, income
 Insight into segmentation strategies
*Mitchell, E. W., Lewis, MA., Bann, C. et al. Formative Research on Preconception Health for Consumers. Poster presentation at the
National Conference on Health Marketing Communication, Marketing and Media, August 11-13th, 2009, Atlanta GA
**Mitchell, EW. , Miracle-McMahill, H, Levis, D. Opportunities for Preconception Health Social Marketing among Women- A U.S.
Consumer Perspective. Presented at the First European Congress on Preconception Health, October 2010, Brussels, Belgium
Market Research- Focus Groups
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Purpose
 To learn more about women’s knowledge, attitudes, and beliefs about
PCH behaviors and services (4 P’s)
•
•
•
•
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What do women know, think and believe about PCH & HC?
What does PCH as a term mean?
What are the motivators and barriers ?
How do we communicate with women about PCH & HC?
10 focus groups (N= 65) in Atlanta
 Segmented by pregnancy planning status (planner, non-planner,
interconception)
• By low and middle SES
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Findings- L. Squiers (CON1)
Market Research- Couple Interviews
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Purpose
 To understand how couples consider, discuss, and support each other in
the context of PCH and related behaviors (4 P’s)
•
•
•
•
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What do couples know, think and believe about PCH & HC?
What does PCH as a term mean to them?
What are the motivators and barriers for them?
How do we communicate with couples about PCH & HC?
Telephone interviews (N = 58 couples), ~5,000 screened
 Women 18-44 who were married or in committed relationship with a
partner who was willing to participate in the interview
 Segmented by pregnancy planning status (planner, non-planner,
interconception)
• By low and middle SES
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Findings- M. Lewis (CON1)
Market Research- Secondary Data Analysis
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Additional data sources triangulated
 PRAMS (2004-2008)
 Growth from Knowledge/Mediamark Research and Intelligence
(2009-2010)
• GFK/MRI- E. Mitchell (CON1)
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Accumulation of data streams used to inform
 Segmentation recommendations
 Social marketing plan
 Dissemination opportunities
AUDIENCE SEGMENTS FOR SOCIAL
MARKETING PLAN
Women of Childbearing Age- Planners and Non-
Planners
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Pregnancy Planners
 Women who intend to have a child in the next 1-2 years
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Non-Pregnancy Planners
 Women who do not intend to have a child in the next 1-2 years
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Segmentation based on
 Desire to make concepts and messages relevant
• Increase attention and engagement in messages
 Desire to reach the audience
• What channels and why?
Planners are Contemplators
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More likely to pay attention to and be receptive to
messages about PCH
 In the “pregnancy mindset”
 May be starting to mentally prepare to get pregnant or are actively
trying to get pregnant
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Motivated by messages that focus on
 Health of the baby
 Health of mother during pregnancy and delivery
 Prospect of enhancing fertility
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Desire to be pregnant is a strong motivator to engage
in PCH behaviors
Non-Planners are Pre-Contemplators
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Lower levels of awareness of PCH
Less likely to be receptive to messages about PCH
 Pregnancy is not on their radar
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Less likely to engage in and be motivated to engage in
PCH behaviors (e.g., folic acid)
 Viewed as irrelevant to their current life
 More likely to engage in unhealthy lifestyle behaviors (e.g., smoke)
and question need to stop
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More likely to be receptive to messages about overall
healthy behaviors/lifestyle
 There is not a trigger event for non-planners to motivate behavior
change
Stages of Change
Precontemplation
PLANNERS
Contemplation
NONPLANNERS
Preparation
Action
Prochaska, J. O., & DiClemente, C. C. (1983). Stages and processes of self-change of smoking: Toward an integrative model of change.
Journal of Consulting and Clinical Psychology, 51, 390-395.
Short Term Communication Goals
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Planners
 Increase awareness of PCH behaviors
 Increase awareness that there is a preconception time period
 Increase awareness that what they do before they get pregnant
can affect the health of their baby
 Increase awareness about where to obtain information about PCH
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Non-Planners
 Increase awareness about being healthy (PCH)
 Increase awareness about contraception (RLP)
 Increase awareness about where to obtain information about
women’s health (PCH)
CREATIVE DEVELOPMENT AND
TESTING
Market Research- Concept Development and
Testing
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Purpose (product “P”)
 Position PCH & HC (empowering, engaging, memorable)
 Create an overarching umbrella brand that can be used by the
CDC and partners
• Link PCH to consumer values
• A relationship between a product, service, or behavior and its
consumers
• Creates a set of expectations in the mind of consumers (brand
promise)
 Create a vehicle for promoting PCH & HC
• One communication channel will reinforce another and increase
credibility (among partners, health care providers, media, web etc.)
Market Research- Concept Development and
Testing
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Positioned PCH and HC
 A unique time (WOMAN’S WINDOW)
 An opportunity (CREATE YOUR FUTURE)
 An invitation (Baby YOURSELF, BABY yourself )
Market Research- Concept Development and
Testing
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Concept testing completed in May
 4 focus groups (N = 32) in Atlanta
• Segmented by planning status (planners vs. non-planners)
• Two age groups: 18-30 and 31-44
• All low to middle income
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Purpose
 Gauge women’s understanding, impressions and attitudes toward
concepts
• Clarity, appeal, motivation (text, images and then PCH context)
Market Research- Concepts, Adcepts and Testing
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Findings
 Important feedback
 Creative executions (headline, tagline, images, text box)
• Making revisions to a “Woman’s Window” and “Baby Yourself”
• Developing one new concept
 “Create Your Future”- dropped
• Instead of inspiring respondents it evoked stress (school, career,
financial)
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Kaiser Women’s Health Survey (2008):
“Approximately a quarter of women report feeling high levels of stress
from career (23%), and financial concerns (26%)”.
Market Research- Concepts, Adcepts and Testing
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Next steps
 Analyze transcripts and develop creative recommendations
 Develop adcepts (will include logo, more PCH messaging)
 Test adcepts via on-line survey
• Nationally representative sample of women 18-44 years of age using a
panel with an oversample of African American and Latina women
(N=1200)
• Groups:
o Non-planners (never intend or intend to have a baby in more
than 2 years)
o Planners (intend to have a baby <2 years)
 Early Winter 2011
Social Marketing Phases
3
Market
Strategy
MARKETING MIX AND ACTION PLAN
5 Ps
Product
Data Sources
Literature review
Materials evaluation
CWG input
Environmental scanning
Formative research
Concept/adcept testing
CWG input
PRODUCT
Literature review
Literature review
Environmental scanning
Price
Materials evaluation
Formative research
Materials evaluation
CWG input
Secondary data analysis
Concept/adcept testing
Environmental scanning
Literature review
Partner assessment
Promotion
Partner assessments
Materials evaluation
Audience segmentation analyses
Environmental scanning
Formative research
Audience segmentation
analyses
CWG input
Secondary data analysis
Focus groups
Literature review
Audience segmentation analyses
PlaceCouple interviews
Environmental scanning
Formative research
CWG input
Secondary data analysis
Secondary data
analysis
Partner assessment
Concept/Adcept testing
Partners
Materials evaluation
Environmental scanning
Partner assessment
CWG input
Formative research
Secondary data analysis
Problem
Description
Market
Research
Social
Marketing
Phases
Source: http://www.orau.gov/cdcynergy/demo/
Problem
Description
Market
Research
Implementation
Social
Marketing
Phases
Market
Strategy
Evaluation
Interventions
Source: http://www.orau.gov/cdcynergy/demo/
NEXT STEPS
Next Steps
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Finalize
 Marketing strategy, intervention, implementation and evaluation
plan (early 2012)
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Complete and disseminate PCH & HC social marketing
tools
 Audience profiles
 Brand support products (sample materials, logos etc.)
 Manuscripts and reports

Recruit additional partners
Thank You Project Team
Project team
Consumer Workgroup
CDC : Heidi Miracle-McMahill, MPH, MS; Denise Levis, MA,
PhD, Mindy Barringer
RTI : Linda Squiers, PhD; Megan Lewis, PhD; Molly Lynch,
MPH; Karen Isenberg, MPH; Julia Kish-Doto, PhD;
Rebecca Munch
AIR : Lori Agin, Mark Cohen, Lynda Bardfield, Jon Stapp,
Tom Hrabal, Martha Mater, Margarita Hurtado, PhD,
Tamika Owens, Allison Fratto
Questions?

On-line social marketing planning tool:
 http://www.orau.gov/cdcynergy/demo/
Thank you
For more information please contact Centers for Disease Control and Prevention
1600 Clifton Road NE, Atlanta, GA 30333
Telephone, 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348
E-mail: cdcinfo@cdc.gov Web: www.cdc.gov
The findings and conclusions in this report are those of the authors and do not necessarily represent the official
position of the Centers for Disease Control and Prevention.
National Center on Birth Defects and Developmental Disabilities
Division of Birth Defects and Developmental Disabilities