In my December 21st post, I ranted about the how people seem to assume that a communication campaign is the answer to every societal problem. I also ranted about how people confuse social marketing, communication and social media. I felt much better! (Other colleagues are feeling a similar pain, and seeking relief. For a great discussion of what is wrong with “raising awareness,” and cures for that, see Alex Kesselborn’s blog post "Questions to Prevent Awareness Fever.") In this post I want to go beyond feeling better. I want to look at some of the reasons why behavior change practitioners default to a communication campaign, and why communication alone may not work. In the coming posts I will talk about conditions when is communication effective, and about some reasons for the confusion in terms. I have posted a PowerPoint presentation on Slideshare that you may want to look at, which explores the social marketing/communication/social media ball of confusion.
So, Why Do People Default to Communication?
1. The Audience Lacks Knowledge & Awareness. I think there is a long standing idea that people do not do the “right” thing (i.e., the healthy thing or the thing we want them to do) because they do not know: know they NEED to do something; know they CAN do something; know WHAT to do; know HOW to do it. If we just tell them enough, they will do that thing (often called the “rationale” choice). If they do not do it after all our good education, it must be due to a fault in them (e.g., “They are not motivated.” “They don’t seem to care.”)
2. It Worked Before! We or another program has used communication for health behavior change and it seemed to produce results. So, we do it again. (Problem: do we have the data to show it was the communication? Or to show what about the communication contributed to change?)
3. Everyone Else is Doing It! Everyone seems to be using communication for health (and other) behavior change. It must work. We will use it, too. (Problem: the communication component is often the most visible intervention. However, we don’t know what else was done that might have influenced behavior change.)
4. It’s How I Trained. In a discussion on the Georgetown Social Marketing List Serve (1/27/2010),
Communication Alone May Not Move the Needle on Behavior Change…
In both conversations with peers and in literature, we find frustration that even after people know what they are “supposed to do,” they don’t do it. Problems persist: initiating cigarette smoking; obesity; lack of recycling. Even the well-executed, commercial “Got Milk?” campaign did not result in increased sales the first time around—though it did result in increased awareness (see graph).
Recently, Leslie Snyder, director of the Center for Health Communication and Marketing at the University of Connecticut, conducted a meta-analysis of health communication campaigns. She found that the campaigns resulted in about a 5 percent change in behavior, on average, among people exposed to them. F-I-V-E %. Aye, yie yie!
1. Perhaps our approach was poorly planned or executed. We not did deliver a large enough “dose” of communication to elicit a “response.” We couldn’t afford to reach our audiences in a time and place when they were attending. We didn’t conduct audience research nor pretesting
2. Maibach, Abroms and Marosits (2007) remind us that, from the point of view of the Ecological Model of Health, communication may only seek to affect one “field of influence”—the individual level. And there may be other fields of influence (e.g. interpersonal, organizational, community, public policy) that we miss, which play a role in behavior.
3. There are determinants of behavior that communication alone cannot address. I have cited before work by a consensus panel (Fishbein, Triandis et al., 2001) of leading health behavior theorist that the National Institutes of Mental Health convened. They agreed that there are both external and internal determinants of behavior. Look below at these and think about which determinants communication and messaging can address. Even after our best practice communication efforts we may not get the behavior change we are looking for, because there are other determinants at play that we have not impacted.
- Actual Consequences
- Cultural Beliefs and Values
- Knowledge and Beliefs
- Perceived Risk
- Perceived Consequences
- Self Efficacy
Even after our best efforts to communicate, the audience may still experience barriers to acting on the good information and awareness we have provided.
So, where can we turn to get the most out of communication strategies? How can we deal with other barriers to acting?...Stay tuned!
(Sources: Photo-BillRhodes; Graph: Bill Smith)