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Applying social marketing principles

Programme managers and practitioners using this guide will gain a better understanding of how social marketing can help them develop and implement behaviour change interventions. For those already familiar with social marketing concepts and approaches, this guide will serve as a useful checklist for key activities. Those with less experience will need to supplement the information provided here with support materials listed in the resource section and with advice from more experienced colleagues and consultants.

The guide uses a logical social marketing action framework that includes four action steps: scope, test, enact and, learn and act (Figure 8).

Figure 8. A four-step social marketing action framework [1]

(This planning cycle builds on the STELa model (www.stelamodel.com) which was developed as a response to the need for a simple yet robust model that could be applied by practitioners and those not trained in formal planning systems and procedures [1].)

social_marketing_action_framework

For each action step, representative tasks, activities to address each task and support ‘tools’ are identified and described (see Table 3). Most professionals tend in reality not to follow a set structured approach to developing, delivering and evaluating interventions intended to influence behaviour changes. This social marketing action framework accepts this reality. Instead of setting out a fixed set of planning steps it sets out a basic planning framework and then supplements this with a compendium of tools that can be used by professionals in a flexible way that best suits the particular challenges they face.

Short case studies, with examples from communicable disease prevention and control initiatives, illustrate how key tasks and activities may be applied. Tools described include a variety of checklists and workflow sheets that can help public health programme managers and practitioners track processes and progress of the activities they choose to undertake. Copies of all the worksheets described are available in Part 3 of this guide.

Table 3. Social marketing action framework – steps, tasks, activities and tools

  • STEPS
    • TASKS > ACTIVITIES > TOOLS
  • SCOPE
    • 1. Setting goals and SMART objectives > 1. Explain what action is needed, 2. Identify the target group and behaviours you want to change, 3. Set SMART objectives > Tools 1–3
    • 2. Analysing situation and influencing factors > 1. Do situation analysis, 2. Do competition analysis, 3. Review evidence and data, 4. Map and record assets > Tools 4–11
    • 3. Understanding target audience(s) > 1. Gather target audience insights, 2. Segment your audiences > Tools 12–17
    • 4. Developing exchange proposition(s) > 1. Develop behaviour promotion strategy, 2.Make the case for compliance > Tools 18–22
    • 5. Selecting marketing interventions > 1. Select interventions, 2. Do intervention cost-benefit analysis > Tools 23–26
  • TEST
    • 6. Pre-testing and piloting > 1. Test each potential intervention and hypothesis, 2. Report on the impact of the pilot programme > Tools 27–29
  • ENACT
    • 7. Planning implementation > 1. Intervention plan > Tools 30–36
    • 8. Initiating and managing implementation > 1. Manage partners, risk and opportunities, 2. Report on process > Tools 37–43
  • LEARN&ACT
    • 9. Evaluating and reporting > 1. Evaluate outcomes, 2. Make recommendations > Tools 44–46
    • 10. Reviewing and building learning > 1. Identify follow-up actions, 2. Identify future implications > Tools 47–50

Step 1: Scope

Figure 9. Scoping Tasks

Scoping_Tasks

All steps of the social marketing action framework are important. However, this step is most often ignored or minimised. Public health programme managers and practitioners, particularly those that are new to social marketing, often start generating solutions before a deep understanding and insight into the target audience’s beliefs, understanding, and behaviour have been achieved. Investing time in scoping is critical and helps identify clear and appropriate behavioural objectives from the start, thus avoiding many of the common difficulties associated with delivering behaviour change initiatives.

The scope step has five key tasks:

• setting goals and SMART objectives
• analysing situation and influencing factors
• understanding target audience(s)
• developing exchange proposition(s)
• selecting marketing interventions.

Task 1- Setting goals and SMART objectives

This task involves three activities.

Activity 1- Explain why action is needed. Set out why action is needed on the identified social issue. A useful approach is to identify a problem and look at the scale of the problem and its social, health, service, cost and political consequences (see Tool 1).

Example – Measles vaccination – problem scale and impact summary

Scale – how big is a problem – how many children are unvaccinated or under vaccinated?

Social consequences – parents avoid socialising in public places for fear of contracting infection.

Health consequences – 20% of children with measles in UK, for example, need hospitalisation. [2]

Service consequences – the number of cases of measles fill up hospital beds.

Cost consequences – the cost of measles cases far outstrips costs of mass vaccination and adverse effects [3]. We should also consider other economic costs such as those associated with loss of work time and emotional costs.

Activity 2 – Identify the target groups and behaviours you want to change. Identify the specific audience who will be the primary targets of your intervention and the behaviours you want to influence – change, modify, develop or sustain (see Tool 2). The key assumption made here is that changing behaviours of this group will help solve the problem identified.

Example – Healthcare provider vaccine uptake communication capacities

Multiple studies [4, 5, 6,] show that in all European Union (EU) countries, healthcare providers (HCPs) are identified as the most important and trusted source of information on how to be protected from vaccinepreventable diseases. This is particularly true for parents with the most questions and concerns. A 2013 study [7], supported by ECDC, utilised primary and secondary research to identify behaviour changes that would help healthcare providers help parents to want and get their children protected by vaccination as a desired behavioural goal and outcome, particularly those in population groups whose children are currently un- and under-vaccinated. Three key behaviours emerged from the research.

1. Use two-way communication – healthcare provider communication, often due to time constraints, was generally too focused on one-directional communication and the sending of well-intentioned but uniform messages to all. HCPs were advised to place more emphasis on dialogues – two-way conversations – which first elicit information about parents’ specific concerns and anxieties and then adapt and customise messages to the identified needs of individuals and groups.

2. Keep the focus on protection – while vaccine safety issues need to be directly and clearly addressed and reassurance given where parental concerns exist, parents and other experts called for HCPs to keep the focus of vaccination discussions on the benefits of protection. People need to fully understand that when they get their children vaccinated that they are protecting them, and the communities in which they live, from serious and potentially deadly diseases.

3. Create effective design and reconfiguration of services – stakeholders uniformly reported a need for improving the design and provision of services and delivery systems. Advice calls for more attention to be paid to costs, location, staffing, transport, scheduling and timing as key determinants of vaccination programme uptake and success. ‘Vaccination journeys’ need to be made easier.

Activity 3 – Set objectives that can be measured. Develop a set of SMART behavioural objectives as listed below (Use Tool 2 and 3 to support this activity):

• Specific: precise – not open to different interpretations.
• Measurable: can observe and collect objective measures.
• Achievable: with the resources available.
• Reliable: consistent, relevant, can be gathered.
• Time bound: measured within the time frame of the intervention.

N.B. Interventions which aim to measure behaviour changes will need time as behaviour change can be a long process.

Example – Measles vaccination – SMART objectives

When setting up a social marketing intervention in support of a MMR programme, for example, it is helpful to identify how the behaviours that specific audiences need to take up in order to achieve the goals of the programme will be measured.

Two examples of a SMART behavioural objective related to such a programme are:

• During 2015 over 95% of invited parents living in Town X will bring their child to their allotted vaccination clinic appointment.
• During 2015 over 95% of parents living in Town X will attend their follow up invitation appointment.

 

Task 1: Setting goals and SMART objectives

Activity support toolbox

Tool 1. Problem/challenge: scale and impact summary – use this problem description and impact recording form to help clarify why an intervention is needed.

Tool 2. *Desired behaviour tool – use this tool to specify what behaviours need to be influenced amongst what groups

Tool 3. *Agreed SMART behaviour change or maintenance objective by segment – use this tool to further specify in measurable terms what behaviours will be targeted with which target group segment.

* =priority tools

NB. See Part 3 for full compendium of tools including recording forms, worksheets and checklists

Task 2 – Analysing situation and influencing factors

This task involves four activities.

Activity 1 – Perform a situation analysis. Before initiating any intervention it is useful to identify key issues that may impact on your proposed programme/campaign/action or on the receptivity of your target audiences. This activity involves developing a subjective list of factors which may influence the interventions. A SWOT (Strengths, Weaknesses, Opportunities and Threats) analysis is one tool that can help identify relevant issues. Use Tool 4 to support this activity. An individual or small group can develop a SWOT analysis, but it will be more effective if you take advantage of many stakeholders. Each person or group offers a different perspective on the strengths and weaknesses of your programme and has different experiences of both. It would also be useful to undertake a PESTLE (Political, Environmental, Social, Technological, Legal and Ethical issues) analysis (see http://pestleanalysis.com and Tool 5). Situational factors identified should be prioritised [8] (weighted) according to the likelihood and the level of impact they may have.

Example – SWOT analysis related to vaccination programme

‘During September 2002, Israel began its current revaccination program against smallpox, targeting previously vaccinated “first responders” among medical and emergency workers. In order to identify the potential strengths and weaknesses of this program and the conditions under which critical decisions were reached a SWOT analysis was conducted of the current Israeli revaccination program, designed to identify its intrinsic strengths and weaknesses, as well as opportunities for its success and threats against it. The SWOT analysis revealed a number of threats that may jeopardise the success of the current program, chief among them the appearance of severe complications of vaccination. The finding of a lack of a generation of knowledge on smallpox vaccination highlighted the need for improved physician education and dissipation of misconceptions that were prevalent in the public.’ [9]

Activity 2 – Perform a competition analysis. In addition to looking at situational issues affecting programmes, it is useful to look at enabling factors and barriers to adopting the behaviour(s) you are promoting. You should analyse what or who may be influencing the target audience to act in a way that is detrimental or positive. Strategies and intervention plans can then be developed to address these influencing factors. Tools 6 and 7 can be used to support this activity.

Example – Barriers and enabling factors related to vaccination uptake

Recent studies have identified the following barriers and enabling factors to vaccination uptake [8, 10, 11, 12]:

Enabling factors that encourage the uptake of vaccination (these may also be seen as strengths of programme):

• feeling of safety and wellbeing associated with having protected your child
• community social norm in favour of vaccination
• service is offered locally
• target group perceive the invitation letter favourably
• service is offered free of charge
• service is offered at convenient times
• follow up and reminders encourage attenders
• service staff are welcoming and encouraging.

Barriers to taking the vaccination service (these may also be seen as obstacles to uptake):

• Single working parents perceive difficulty in attending clinics due to their opening times
• Some parents perceive service as being slow and inefficient
• Community social norm amongst sub group not in favour of vaccination (e.g., anthroposophists thinking that vaccination is ‘unnatural’)
• Access to service is more difficult for some (e.g. Roma communities) than the rest of population
• Social media and some press reports highlight negative stories and myths about side effects
• Religious beliefs which preclude vaccination (e.g. Bible belt in Netherlands).

Activity 3 – Review evidence and data. Gather information about what is known about the issue(s) and how to tackle them from published and unpublished sources such as professional journals, case study reports, and interviews with others who have undertaken work in the field. ECDC, for example, has supported a wide variety of literature and experiential reviews of communicable disease prevention and control communication interventions. [13–17] Ethical and risk considerations should also be identified and noted, and any preliminary action such as seeking of ethical approval should be started. If major risks are identified preliminary plans to mitigate them should also be developed. Tools 8 and 9 can be used to support this activity.

Example – Gathering evidence on factors influencing healthcare providers’ recommendations for vaccination

A Dutch study [18] examining factors related to healthcare providers’ intentions to recommend vaccinations to parents of young children revealed:

• 1) perceived responsibility to promote vaccines and discuss pros and cons with parents (although this was usually not done if parents readily accepted the vaccination).
• 2) attitudes toward vaccination were mainly positive, but doubts about National plans to vaccinate against diseases with a low perceived burden were raised.
• 3) organizational factors such as limited time and information can hamper discussions with parents;
• 4) relationship with parents are crucial and based mainly on communication to establish trust.

Conclusions

Healthcare providers were motivated to support the National Immunisation Programme but their intentions to recommend vaccinations were affected by the perceived relevance of the vaccines, by practical issues like limited time and by certain types of resistant parents. These results were used to inform additional studies, to test the magnitude and relative impact of these factors and to design interventions to address challenges raised.

Activity 4 – Map and record assets. Identify all assets that can help you influence the behaviour amongst the target groups you are interested in. These assets may include: social networks, community, environmental, stakeholder and health service assets. Other assets also include all potential partner and stakeholder organisations and communities and individuals that could help with the implementation of the programme. All these could be used to tackle the problem. Tools 10 and 11 can be used to support this activity.

Example – Hidden assets

Immunisation programmes can, for example, benefit from ‘hidden’ contributions/resources/assets of many interested parties (partners and stakeholders). These include: information materials published by public and private agencies, spaces in schools given over for vaccination sessions, ‘free’ public advertising, etc. by commercial sector partners in the retail sector or media companies. Community groups, and concerned parents can also help inform communities about the need for action.

 

Task 2 – Analysing situation and influencing factors: activity support toolbox

Tool 4. SWOT analysis of existing public health programme – use this tool to assess the strengths and weaknesses of your existing interventions and highlight the aspects of current work you may need to change.

Tool 5. PESTLE analysis – use this tool to set out broader contextual issues that may impact on the programme or target audiences.

Tool 6. Barriers and enabling factors tool – use this tool to identify what barriers you might need to address and what enabling factors may help you influence uptake of health behaviour.

Tool 7. * Competition analysis map – use this tool to identify forms of competition that you may need to address to influence your target behaviour.

Tool 8. Key data summary – use this tool to summarise evidence from other research reviews about what is known about how to influence the behaviour you are interested in.

Tool 9. * Key lessons from the evidence summary – use this tool to summarise learning from case studies and experience about what works to influence issue or the target group you are interested in.

Tool 10. Other assets map – use this tool to assess and record all the assets that are available to assist your programme objectives.

Tool 11. Partnership/stakeholder contribution record tool – use this tool to record the partners you want to work with and how they could help you deliver the behavioural programme.

*priority tools

NB: See Part 3 for full compendium of tools, including recording forms, worksheets and checklists

Task 3 – Understanding target audiences

This task involves two activities.

Activity 1 – Gather target audience insights. Utilise qualitative and quantitative target audience research such as surveys, focus groups and observational studies to gather intelligence on target audience knowledge, attitudes and behaviours. Tools 12–15 can be used to support this activity.

Example – Measles vaccination uptake communication – advice from parents

As part of the ‘Let’s talk about Protection’ guide development [7], insight gathering focus groups were held with parents, grandparents and carers in several different European countries. When asked how healthcare providers can best build on their trustworthiness and make an effective case for being protected by vaccination they gave the following advice:

• do what you recommend others do.
• teach us about the risks of non-vaccination.
• tell stories as well as sharing scientific facts.
• take time to listen to our concerns and tell us about possible side effects and risks.
• don’t ignore those of us who get immunised – we need reassuring and valuing as champions.
• don’t be put off by our efforts to find out more.
• make vaccination easier to access and less stressful.
• redefine success (recognise that some may need more time than others to decide).
• help enhance our vaccination health literacy.

Activity 2 – Segment your audiences. Segmentation is the division of an audience you intend to address into groups who share similar beliefs, attitudes and behavioural patterns. This approach goes beyond demographic, epidemiological and service uptake data-based targeting to include data about people’s beliefs, attitudes, understanding and observed behaviours. Target audiences are segmented using these data sets. Cluster people based on factors including risk, understanding, attitudes, beliefs, and existing behaviours. Tools 16 and 17 can be used to support this activity.

Example – Low measles uptake populations – segmenting audiences

In his study of measles outbreaks in Europe, Muscat [19] describes three categories of reasons for low immunisation coverage:

• poor access to healthcare — a major factor driving under-vaccination among vulnerable communities (e.g., Roma, Travellers, migrant populations).
• opposition to vaccination based on the community’s belief system, among those people and communities who adopt alternative health practices based on its religious, philosophical or medical belief systems (e.g. Anthroposophists).
• lack of information, false information, fear, distrust, competing priorities, causing hesitancy, delay, omission and opting out of the recommended vaccination schedule. The causes of non-vaccination in these cases are multiple and complex (and parents in this category would need to be further segmented).

 

Task 3 – Understanding target audience(s): activity support toolbox

Tool 12. Audience differentiation tool– use this tool to describe the audiences you are seeking to influence.

Tool 13. * Current behaviour analysis tool– use this tool to record current behaviours both positive and negative as this will help you develop insight about the target audiences and how to help them.

Tool 14. Behaviour change theory insight summary: record relevant models and theories – use this tool to set out what is known using behavioural theory and models about what might be influencing behaviour and potential intervention points.

Tool 15. *Audience insight data summary log – use this tool to record a summary of all the data and research you have about the audiences you want to influence.

Tool 16. Initial segmentation definition tool– use this tool to describe each sub segment of the population that you have identified or think exists.

Tool 17. Initial segmentation – use this tool to set out your initial segmentation of each target audience group including their behaviour and attitudes to the recommended behaviour.

*priority tools

NB. See Part 3 for full compendium of tools, including recording forms, worksheets and checklists

Task 4 – Developing exchange propositions

This task involves two activities.

Activity 1 – Develop behaviour promotion strategy. Based on target audience insight and understanding, set out how the proposed behaviour will be positioned and promoted with the target audience(s). In the case of a positive behaviour change, such as vaccination, uptake may be promoted by focusing on what emotional and physical benefits will be attained and how costs, such as inconvenient times, might be reduced. Tools 18 and 19 can be used to support this activity.

It is often useful to think of the benefits associated with the behaviour as a product. The core product is the actual value or benefit people get from taking the action; the actual product is the physical object of experience for example, an injection or pill; the augmented product is everything that is associated with the product, such as the way a service is provided, the way that staff act and communicate with people taking up a service.

Example – Promoting vaccination: ‘product’ benefits

Core product: Feeling of safety and wellbeing associated with having protected your child.

Actual product: Received vaccination that will protect child from measles.

Augmented product: Easy access to the service, friendly and welcoming staff, who can also help with other health issues.

Activity 2 – Making the case for compliance. In the case of a refusal or reluctance to take up services, set out how the benefits of compliance could be maximised and the costs of noncompliance could increase. In the case of non-rational choice situations, set out how the chosen environment could be structured, or what policy or service transformation (simple or comprehensive) could be introduced to encourage compliance. Tools 20 and 21 can be used to support this activity.

Example – Assisting behaviour change

Often people are too busy to actively consider all the actions and choices they have. To help physicians to follow infection control protocols and read reviews of antibiotic prescribing, nurses may add reminder notes or flags to patient’s medical records to remind physicians to do a review of what is being prescribed.

Some hospitals have found that providing a shelf for staff to put their papers by hand washing facilities increases compliance.

 

Task 4 – Developing exchange proposition(s): activity support toolbox

Tool 18. Price/exchange development tool – use this tool to set out the benefits and costs of what you are proposing to each target segment.

Tool 19. Product/service descriptor and benefits record– use this tool to set out in more detail the benefits you will be promoting.

Tool 20. Product/service descriptor – use this tool to describe all the benefits of the social product you will be promoting.

Tool 21. *Final offer/proposition recommendation – use this tool to set out the proposition you will make to each target segment. This will help you develop promotional tactics that are consistent and based on the data and evidence you have gathered.

*priority tools

NB: See Part 3 for full compendium of tools, including recording forms, worksheets and checklists

Task 5 – Selecting marketing interventions

This task involves two activities.

Activity 1. Select intervention forms and types.

This activity is focused on selecting which combination of intervention ‘types’ and ‘forms’ will be used to assist the adoption of the desired behaviours that you want to influence. ‘Types’ of intervention (see Figure 9) include: controls (laws and regulations); information (e.g. leaflets, SMS appointment reminders); environmental or system design changes (e.g. timing or location of services); educational (e.g. continuing medical education for providers on antimicrobial diseases); support (e.g. providing health mediators to support poorly reached populations). ‘Forms’ of intervention (see Figure 10 and discussion Part 1) focus on use of incentives and penalties used to reinforce messages and increase compliance. These include a variety of nudges, smacks, hugs or shoves.

Figure 10. Five types of intervention [20]

intervention

Figure 11. Four intervention forms [1]

intervention_forms

Tools 22–25 can be used to support this activity. A mix of ‘types’ and ‘forms’ of interventions, customised for each target segment that you want to influence, has been found to be most effective [1].

Example – Selecting interventions to reduce antimicrobial resistance [21]

ECDC developed communication toolkits for a variety of target audience in support of Antibiotic Awareness Day (18 November). The primary care prescriber toolkit offers advice on how campaign organisers could use a mix of different intervention methods to engage with primary care prescribers so as to promote appropriate and responsible use of antibiotics. There is information, education and support materials provided aimed at encouraging and empowering primary care prescribers to follow prescription guidelines for antibiotics and to provide them with the necessary information, messages and tools to inform patients about the risks of antibiotic resistance and direct their patients towards appropriate use of antibiotics and alternative treatments for viral infections such as common colds and flu.

Activity 2 – Do intervention cost benefit analysis. When you develop your plans, you will also need to consider the ‘types’ and ‘forms’ of intervention that give the best value for money and return on investment in terms of the lowest cost for the biggest behavioural response.

Example – Cost-benefit of intervention

Building sustainable programmes requires understanding how resources should be best allocated and making decisions about reallocations based on cost-benefit, returns on investment and value for money analysis. This is especially important when applying a new form of intervention that has not been rigorously evaluated; e.g. mass media campaigns or direct mail promotions may prove to be less costeffective than face-to-face communication about a vaccination programme to encourage the uptake of the service.

 

Task 5 – Selecting marketing interventions: activity support toolbox

Tool 22.*Final intervention description – use this tool to describe every type of intervention that your data, research, behavioural modelling and insight research indicates might work.

Tool 23. Evaluating intervention options – use this tool to evaluate all the options you set out using Tool 22.

Tool 24. Ethical issues and action record – use this tool when evaluating potential intervention options alongside Tool 22.

Tool 25. *Justification for the recommendations from the evidence, data, theory and test stage evaluation record – use this tool to set out your justification for your final recommendations about the mix of interventions you will use to influence the behaviour of each target segment you want to influence.

Tool 26. Final intervention matrix – use this tool to record the final mix of interventions you will use for each target segment

*priority tools

NB: See Part 3 for full compendium of tools, including recording forms, worksheets and checklists

Step 2: Test

Figure 12. Test tasks

Test_tasks

This step can involve developing prototypes, testing promotions and experiments and it culminates in a report recommending what mix of interventions should be developed into a full implementation plan. Methods of collecting and analysing data for evaluation purposes can also be tested and developed during this stage. The key tasks in this step are focused on testing initial intervention ideas and concepts to see how well they perform.

The test step has one task:

• Pre testing and piloting

Task 6 – Pre-testing and piloting

This task involves two activities.

Activity 1 – Test each potential intervention and hypothesis that you have developed with representative target populations. This planning should include the development of an experimental design and address any ethical issues raised. Tools 27–29 can be used to support this activity.

Example – Prototyping

A prototype of this guide was developed and tested through review by a group of communication, infectious disease, social marketing and risk communication experts as well as a group of potential end-users (public health programme managers and practitioners). A common set of questions guided the review.

Recommendations were analysed by the authors and a second draft was sent around for comment before finalisation.

Prototyping is a system development method usually employed when it is difficult to obtain exact requirements from the customer or when a new product or concept is being developed. The advantages of this model* include:

• the user gets a proper clarity and ‘feel’ of the prototyped product and can suggest changes and modifications;
• It is particularly useful when the content of the product may be new or unfamiliar to the potential target audience. Without a prototype, for example, ‘Social Marketing illiterate’ users would not be good at specifying their requirements, nor could they explain properly about what they expect from the product.
• When work is venturing into a new field of endeavour or work is carried out with a new target audience/ beneficiary a prototype approach can help into gaining insights and adjust accordingly the product/ tool.
• Sometimes it helps to demonstrate the value of the concept before great investments are made.
• It reduces risk of failure, as potential risks can be identified early and mitigation steps can be taken.
• Iteration between development team and client provides a very good and conductive environment during the project.

The main disadvantages of the prototype approach relate to the slowness of process and the need for ongoing iterative feedback between developers and clients.

* Adapted from: Prototype Model: Advantages and Disadvantages http://www.ianswer4u.com/2011/11/prototype-modeladvantages-and.html#axzz2mtopldu1

Activity 2 – Report on the impact of the pilot programme. Reports should include information on the immediate effect of the intervention/s on issues such as knowledge gain, attitude and beliefs. They should also measure impact on short-term behaviours and systems efficiency such as the cost of generating interest in the programme and costs of different methods of generating contact with the intervention or short-term behavioural action.

Task 6 – Pre-testing and piloting: activity support toolbox

Tool 27 Intervention issues to be investigated in the test stage – use this tool to list the interventions you have selected as possible elements of your final intervention mix.

Tool 28 Hypothesis/insight concepts testing methodology record – use this tool to set out any hypothesis that you want to test before you develop plans for the final intervention mix.

Tool 29. Pretesting and piloting plan – use this tool to record how you intend to test or pilot specific interventions.

*priority tools

NB: See Part 3 for full compendium of tools, including recording forms, worksheets and checklists

Step 3: Enact

Figure 13. Enact task

Enact_task

This step is focused on implementing and managing an intervention plan based on the findings of the scoping step and on the results and learning from the testing step. At the beginning of this step a full social marketing implementation plan will be produced together with a clear budget and evaluation strategy that will include details about how the programme will be managed, how it will report, and how it will manage both risks and opportunities.

The plan will outline the ways the programme will be monitored for its impact and efficiency, how it will be evaluated and how it will report back to funders, sponsors, and stakeholder and target groups.

The Enact step has two tasks:

• planning implementation
• initiating and managing implementation.

Task 7 – Planning implementation

Building on the outcomes of the pilot project and the scoping findings and decisions, this task focuses on developing a full social marketing plan.

This task involves one activity.

Activity 1- Intervention plan

This plan should include:

• Problem statement and situation analysis.
• Intended audience segmentation, SMART behavioural objectives for the programme and how these will be measured. Tool 30 can be used to support this activity.
• Details of each product or service that you will use in the full programme. Tools 31–34 can be used to support this activity.
• Anticipated impact and outcomes for the selected target audiences over a designated time frame.
• Budget which sets out the resources required from main sponsors, partners and stakeholders and how they will be deployed against the intervention and marketing mix you have proposed and how the budget will be allocated to achieve the agreed objectives of the intervention. Tools 35 and 36 can be used to support this activity.
• Evaluation strategy including measures of the short-term change (impact evaluation), the efficiency of interventions (process evaluation) and the desired behaviour (outcome evaluation). Selected indicators are listed below.

Selected process, impact and outcome evaluation indicators

Process evaluation. Indicators: How many people took part in or took advantage of a service (e.g. number vaccinated) that was offered? How many people were contacted (e.g. number invited for vaccination)?

Impact evaluation. Indicators: data on immediate impact of the work. For example: reported increase in knowledge, reported behaviour or an immediate increase in the take up of a service. (e.g. percent increase in vaccination uptake by specified group over 6-month period following intervention).

Outcome evaluation. Indicators: data on the longer term effects of the project, observed behaviour and its consequences. For example: reduced incidence of measles in community.

 

Example

The ECDC ‘Let’s Talk about Protection’ guide [7] was translated and adapted into Bulgarian (as well as Czech, Hungarian and Romanian) through a rigorous structured process which involved national language and public health experts as well as end-users (e.g. Roma health mediators and GPs) throughout the review process. The adapted material has now been introduced for use (enacted) in three different Roma communities. The introduction of the materials is being accomplished within a research evaluation protocol approach that gathered pre-intervention information (baseline data) about knowledge attitudes and behaviours of both HCPs and Roma parents and grandparents living in ‘pilot’ communities. The impact of the use of materials will be tracked over time (with both quantitative and qualitative studies; e.g. post-intervention studies, vaccination uptake rates, etc.) and compared with similar control communities.

 

Task 7 –Planning implementation: activity support toolbox

Tool 30. Agreed SMART behaviour change or maintenance objective by segment – use this tool to capture the final SMART objectives you agree for each behaviour and each target segment using this tool.

Tool 31. Product/service descriptor – use this tool along with Tool 32 to help you set out clearly the benefits and features of interventions that you will include in your programme.

Tool 32. Product/service descriptor and benefits record – use this tool along with Tool 31 can help you set out clearly the benefits and features of interventions that you will include in your programme.

Tool 33. Final intervention descriptions – use this tool to record your final descriptions of the interventions that you have selected following testing or piloting them.

Tool 34 Final intervention matrix – use this tool to refine your initial intervention mix and sets out the final set of interventions that you will enact to achieve the programme SMART objectives.

Tool 35. Budget and other resources that you control or can influence – use this tool to record all the resources that you have available to help deliver the programme.

Tool 36. Programme budget and resource allocation record – use this tool to capture in summary form the allocations to each intervention Type or Form that are part of your final intervention plan.

*priority tools

NB: See Part 3 for full compendium of tools, including recording forms, worksheets and checklists

Task 8 – Initiating and managing implementation

This task has two activities.

Activity 1 – Manage partners, risk and opportunities. Track that each partner has delivered on what they promised and record how well they have been engaged with the programme. Tools 37 and 38 can be used to support this activity. Review and manage risks associated with the project. Tool 39 can be used to support this activity. Undertake opportunity spotting, horizon scanning and programme adjustment. Tool 40 can be used to support the recording of potential opportunities and the identification of ways to exploit them.

Activity 2 – Report on process. Gather process, impact, and outcome data. Record progress and setbacks, analyse and report. Tool 41 can be used to support the recording of this data at regular intervals. Organise your reporting to sponsors and stakeholders. Tool 42 can be used to support this activity. Track and manage the intervention budget ensuring that there are no significant cost overruns or underspends and that the intervention is being delivered in the most cost effective way possible. Tool 43 can be used to support recording and summarising of budgetary data.

Task 8 – Initiating and managing implementation: activity support toolbox

Tool 37. Partner/stakeholder contribution record tool – use this tool to help you record what each partner or stakeholder will contribute to the programme.

Tool 38. Partner/stakeholder management plan – use this tool to set out how you will manage the relationship with each stakeholder

Tool 39. Risk register – use this tool to record risks to your programme and how you will mitigate them, programme risks will have been identified in the scoping step of the planning process

Tool 40. Opportunities record – use this tool to record opportunities that arise as you deliver the programme and how you will maximise the opportunity to deliver your programmes objectives.

Tool 41. Short term impact tracking (monitoring) plan – use this tool for recording a summary of how well the programme is delivering its interventions.

Tool 42. Management and reporting strategy – use this tool to record how individual interventions will be managed, who is responsible and how they will report progress.

Tool 43. Budget tracking tool – use this tool to summarise how allocated budgets are being used in delivering the intervention mix.

*priority tools

NB: See Part 3 for full compendium of tools, including recording forms, worksheets and checklists

Step 4: Learn and act

Figure 14. Learn and act tasks

Learn_and_act_tasks

This step of the social marketing process is focused on gathering and disseminating findings about the impact of the programme as well as its efficiency. It also seeks to help practitioners and their agencies learn from the programme about what worked well and what did not. This information can be used to inform decision-making processes related to subsequent follow-on or new programmes.

The learn and act step has two tasks:

• evaluating and reporting
• reviewing and building learning.

Task 9 – Evaluating and reporting

This task involves two activities.

Activity 1 – Evaluate outcomes. Utilise your SMART objectives developed in Task 1 Activity 3 as the basis for evaluation. Follow the evaluation plan developed in the enacting step. Record the outcomes from your individual interventions and the overall programme. Use Tool 44 to support this activity. You can also usefully evaluate the contribution of different stakeholders and partners. Use Tool 45 to support this activity.

Example – Evaluation plan – Testing utility of the use and impact of vaccination guide and support materials on knowledge attitudes and behaviours*.

The target audiences for the evaluation research will be healthcare providers, health mediators and Roma parents and grandparents of children up to 18 years of age in the three selected study communities and one control community. Healthcare providers include doctors (GPs, paediatricians and school doctors, if appropriate), nurses (school and office-based) and inspectorate epidemiologists responsible for vaccination management and delivery.

The evaluation component will be performed pre- and post-interventions.

The aims of the evaluation are to:

• assess the impact of the intervention on knowledge, attitudes and behaviours related to childhood vaccination amongst community based healthcare providers (HCPs) and health mediators(HMs)
• assess the material’s utility as perceived by GPs, HMs and regional health inspectorate epidemiologists to communicate on immunisation
• conduct research on current knowledge, attitudes and behaviours related to childhood vaccination amongst Roma parents and grandparents in study and control communities
• the collected data on baseline indicators would create a possibility to measure the changes in knowledge, attitudes and behaviours after one year of using the materials by HPs.

*This is based on the evaluation plan for an ECDC-supported project in Bulgaria testing the utility of the adapted version of Let’s Talk about Protection. Report will be available in June 2014.

Activity 2 – Make recommendations. The key focus of this activity is to report to stakeholders and funders and present a set of recommendations based on what you have found works and what does not in terms of influencing behaviour. Use Tool 46 to summarise the recommendations that flow from your programme evaluation.

Task 9 – Evaluating and reporting: activity support toolbox

Tool 44. Outcome evaluation record – use this tool to record the outcomes of your evaluation

Tool 45. Partner/stakeholder evaluation – use this tool to record the contribution of your stakeholders and partners.

Tool 46. Evaluation report and recommendations – use this tool to make recommendations based on your evaluation.

*priority tools

NB: See Part 3 for full compendium of tools, including recording forms, worksheets and checklists

Task 10- Reviewing and building learning

The key purpose of this final task is to ensure that the learning gained as part of the evaluation of your programme and individual elements of it are used to help shape future interventions and allocation of budgets. Ultimately this should result in better performance in the next wave of implementation. This task involves two activities.

Activity 1 – Identify follow-up actions. Set out actions that should be taken by policy makers, planner professional staff and community groups based on your evaluation recommendations. Use Tool 47 to support this activity. Identify ways to disseminate the results and recommendations that you have developed. Use Tool 48 to support this activity.

Activity 2 – Identify future implications. Set out an agreed plan for how your organisation and those of stakeholders can adapt and improve based on the learning and evaluation of the programme. Use Tool 49 to support this activity. Reassess PESTLE issues in the light of findings from your evaluation and any implications of these for future strategy or implementation. Use Tool 50 to support this activity.

Task 10 – Reviewing and building learning: activity support toolbox

Tool 47. Organisational learning strategy – use this tool to record actions that organisations should take based on your evaluation of your programme.

Tool 48. Dissemination strategy – use this tool to record how you will disseminate the results of your programme evaluation.

Tool 49. Organisational development plan – use this tool to set out your recommendations for organisational change and development based on your evaluation.

Tool 50. Forward strategic PESTLE analysis – use this tool to help you with your forward strategic development of the next stage of your programme.

*priority tools

NB: See Part 3 for full compendium of tool, including recording forms, worksheets and checklists

© European Centre for Disease Prevention and Control, 2014

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