The Pharmaceutical Journal
Vol 280 No 7501 p573
10 May 2008

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Pharmacy Practice Research Trust

Selling public health: tricks of the trade

Commercial marketing is often thought to be smoke and mirrors, without good science behind it, Richard Featherstone, of the chartered institute of marketing, said.

But marketing uses key principles that are known to work and that can be applied in other areas, including public health campaigns, to get people to change their behaviour.

“It is your responsibility to change your behaviour if you’re not getting the effect you want. Know exactly what you want, notice whether you are getting it and, if you’re not, have the flexibility to change the way you communicate,” he advised.

Mr Featherstone described one of the principles used by marketeers: the frame of reference — how customers think, and what their values, beliefs and motivations are.

“Marketeers spend a huge amount of time and money trying to understand what it is like to be the customer,” he said. Central to this were two key questions: what is important to the customer? And why is it important? “Once a marketeer knows the answers to those questions they can design a persuasive campaign,” said Mr Featherstone.

Mr Featherstone conceded that marketeers did not always get it right. He described an advertising campaign used by Coca-Cola. After conducting a taste test, the company changed Coca-Cola’s recipe and embarked on a new campaign with the strapline: “The best just got better.” Mr Featherstone said the approach almost killed the brand. “The message was that Coke’s customers had been wrong to like Coke in the past.”

Mr Featherstone went on to describe how language was used within marketing campaigns — not always effectively.

“Words mean different things to different people,” he said. For example, “risk”, “healthy”, “too much” and “moderate” were all terms that could be interpreted in different ways. Campaigns that used phrases like “be more active”, “reduce alcohol” or “trim excess weight” might not share the same frame of reference as the intended recipients.

Mr Featherstone cited the Government’s “Five a day” healthy eating campaign as a good example of a shared frame of reference. When describing portions, the public was left in no doubt. “Seven strawberries are seven strawberries,” he said.

He stressed that pharmacists must shift their perceptual position. “Get into the mind of the customer. Use their words. Find out how they describe things.” He suggested that pharmacists should “parrot phrase” rather than paraphrase. “Your customer will instantly feel understood.”

He added: “The hardest lesson is to realise that what you think does not matter. What matters is what your customer thinks. If a patient thinks you see things the way they do, it’s easier to persuade them.”

Another tool used by marketeers, said Mr Featherstone, relates to what motivates people. Research had found that people were motivated along a continuum. However, 40 per cent of people had a tendency to be motivated towards a behaviour/goal and 40 per cent against a behaviour/endpoint.

For example, some people would be motivated by the thought of getting fit or living longer while others were motivated by not wanting to die.

“The words used by customers tells you whether they are motivated towards or away from something and provide clues as to what will get them motivated to change their behaviour.”

Mr Featherstone sounded a note of caution around the use of negatives and suggested pharmacists steer clear of them. “Marketeers avoid the negative because it’s hard to discount the negative. If you tell people what you don’t want them to think about they will think about it. Especially if it is reinforced through other senses.”

He gave the example of stop smoking campaigns, which often use images of cigarettes. The campaign material forces smokers to think about smoking in order for them to think about stopping smoking.

Mr Featherstone also described the rule of social proof. “When people are unsure of the decision they should make, they will tend to be influenced by those who they see as being in a similar situation to themselves.”

Clive Blair-Stevens, director of strategy and operations at the National Social Marketing Centre, echoed Mr Featherstone’s view that marketeers already have the tools and knowledge to change people’s behaviour. “There is enough evidence out there. The continual search for the answer stupefies us and stops us engaging with what we’ve learnt so far. The real challenge is to apply what we know,” he said.

Mr Blair-Stevens argued that the key to successful social marketing campaigns was to understand what influences social norms and social behaviour as well as what influences individual behaviour.

He described the layers of influence that could affect human behaviour and argued that a whole range of academic and professional disciplines could offer something helpful in terms of understanding how an individual behaves.

Mr Blair-Stevens argued that commercial marketeers had it easy since they were focused on short-term benefits. “[In the public sector] we offer long-term benefits to people but with immediate cost. You have to deny yourself pleasure to take up what we’re offering you. Why did we ever think that would be appealing to people?”

He suggested that the trick was for social marketing to turn the longer-term benefits into immediate benefits. “And those benefits must be benefits for the customer, not our benefits,” he added.

He gave the example of a campaign directed at the Hispanic population in Arizona in the US. Research revealed two critical things about why mothers were not using car seats to protect their children: mothers believe that their child is safest in their arms and also that God will decide when their child will come or go from the world.

The marketing solution was not about communicating anything to the mothers around the safety of car seats, said Mr Blair-Stevens, but rather to enlist God. By getting a priest to bless the car seats, overnight their take-up was massively increased. “It’s about thinking like the customer.”

Another campaign had focused on trying to encourage men to aim in the right direction when using public urinals. Men’s inability to do this meant cleaning costs for urinals were huge, said Mr Blair-Stevens.

Campaigns based on education failed. What did work, however, was applying a small transfer depicting a fly in the urinal bowl. “A fundamental insight into men’s behaviour is that men like to pee on something,” he declared.

The campaign was not about communicating a message or engaging or empowering men. It was about doing something based on an understanding of how men behave, Mr Blair-Stevens explained.