George Washington University
Editor's note: Below is an excerpt from Silvio Waisbord's 2001 paper "Family Tree of Theories, Methodologies and Strategies in Development Communication: Convergences and Differences", commissioned by The Rockefeller Foundation. Click here to return to the Table of Contents.
"In the early 1970s, modernization theory was the dominant paradigm of development communication. The climate of enthusiasm and 'missionary zeal,' as Wilbur Schramm (1997) described it, that had existed a decade earlier had notably receded but the notion that the diffusion of information and innovations could solve problems of underdevelopment prevailed.
Social marketing has been one of the approaches that has carried forward the premises of diffusion of innovation and behavior change models. Since the 1970s, social marketing has been one of the most influential strategies in the field of development communication.
The origins of social marketing hark back to the intention of marketing to expand its disciplinary boundaries. It was clearly a product of specific political and academic developments in the United States that were later incorporated into development projects. Among various reasons, the emergence of social marketing responded to two main developments: the political climate in the late 1960s that put pressure on various disciplines to attend to social issues, and the emergence of nonprofit organizations that found marketing to be a useful tool (Elliott 1991). Social marketing was marketing's response to the need to be 'socially relevant' and 'socially responsible.' It was a reaction of marketing as both discipline and industry to be sensitive to social issues and to strive towards the social good. But it was also a way for marketing to provide intervention tools to organizations whose business was the promotion of social change.
Social marketing consisted of putting into practice standard techniques in commercial marketing to promote pro-social behavior. From marketing and advertising, it imported theories of consumer behavior into the development communication. The analysis of consumer behavior required to understand the complexities, conflicts and influences that create consumer needs and how needs can be met (Novelli 1990). Influences include environmental, individual, information processing, and decision-making. At the core of social marketing theory is the exchange model according to which individuals, groups and organizations exchange resources for perceived benefits of purchasing products. The aim of interventions is to create voluntary exchanges.
In terms of its place on the 'family tree' of development communication, social marketing did not come out of either diffusion or participatory theories, the traditions that dominated the field in the early 1970s. Social marketing was imported from a discipline that until then had little to do with modernization or dependency theories, the then dominant approaches in development communication. Social marketing grew out of the disciplines of advertising and marketing in the United States. The central premise of these disciplines underlies social marketing strategies: the goal of an advertising/marketing campaign is to make the public aware about the existence, the price, and the benefits of specific products.
Social marketing's focus on behavior change, understanding of communication as persuasion ('transmission of information'), and top-down approach to instrument change suggested an affinity with modernization and diffusion of innovation theories. Similar to diffusion theory, it conceptually subscribed to a sequential model of behavior change in which individuals cognitively move from acquisition of knowledge to adjustment of attitudes toward behavior change. However, it was not a natural extension of studies in development communication.
What social marketing brought was a focus on using marketing techniques such as market segmentation and formative research to maximize the effectiveness of interventions. The use of techniques from commercial advertising and marketing to promote social/political goals in international issues was not new in the 1970s. Leading advertising agencies and public relations firms had already participated in support of U.S. international policies, most notably during the two wars in drumming up domestic approval and mobilization for war efforts. Such techniques, however, had not been used before to 'sell' social programs and goals worldwide.
One of the standard definitions of social marketing states that 'it is the design, implementation, and control of programs calculated to influence the acceptability of social ideas and involving consideration of product planning, pricing, communication, distribution, and marketing research' (Kotler and Zaltman 1971, 5). More recently, Andreasen (1994, 110) has defined it as 'the adaptation of commercial marketing technologies to programs designed to influence the voluntary behavior of target audiences to improve their personal welfare and that of the society of which they are a part.' Others have defined it as the application of management and marketing technologies to pro-social and nonprofit programs (Meyer & Dearing 1996).
Social marketing suggested that the emphasis should be put not so much on getting ideas out or transforming attitudes but influencing behavior. For some of its best-known proponents, behavior change is social marketing's bottom line, the goal that sets it apart from education or propaganda. Unlike commercial marketing, which is not concerned with the social consequences of its actions, the social marketing model centers on communication campaigns designed to promote socially beneficial practices or products in a target group.
Social marketing's goal is to position a product such as condoms by giving information that could help fulfill, rather than create, uncovered demand. It intends to 'reduce the psychological, social, economic and practical distance between the consumer and the behavior' (Wallack et al, 1993, 21). The goal would be to make condom-use affordable, available and attractive (Steson & David 1999). If couples of reproductive age do not want more children but do not use any contraceptive, the task of social marketing is to find out why and what information needs to be provided so they can make informed choices. This requires sorting out cultural beliefs that account for such behavior or for why people are unwilling to engage in certain health practices even when they are informed about their positive results. This knowledge is the baseline that allows a successful positioning of a product. A product needs to be positioned in the context of community beliefs.
In the United States, social marketing has been extensively applied in public information campaigns that targeted a diversity of problems such as smoking, alcoholism, seat-belt use, drug abuse, eating habits, venereal diseases, littering and protection of forests. The Stanford Three-Community Study of Heart Disease is frequently mentioned as one of the most fully documented applications of the use of marketing strategies. Designed and implemented as a strictly controlled experiment, it offered evidence that it is possible to change behavior through the use of marketing methodologies. The campaign included television spots, television programming, radio spots, newspaper advertisements and stories, billboard messages and direct mail. In one town the media campaign was supplemented by interpersonal communication with a random group of individuals at risk of acquiring heart disease. Comparing results among control and experimental communities, the research concluded that media could be a powerful inducer of change, especially when aligned with the interpersonal activities of community groups (Flora, Maccoby, and Farquhar 1989).
Social marketing has been used in developing countries in many interventions such as condom use, breast-feeding, and immunization programs. According to Chapman Walsh and associates (1993, 107-108), 'early health applications of social marketing emerged as part of the international development efforts and were implemented in the third world during the 1960s and 1970s. Programs promoting immunization, family planning, various agricultural reforms, and nutrition were conducted in numerous countries in Africa, Asia and South America during the 1970s…The first nationwide contraceptive program social marketing program, the Nirodh condom project in India, began in 1967 with funding from the Ford Foundation.' The substantial increase in condom sales was attributed to the distribution and promotion of condoms at a subsidized price. The success of the Indian experience informed subsequent social marketing interventions such as the distribution of infant-weaning formula in public health clinics.
According to Fox (N.D.), 'problems arose with the social marketing approach, however, over the motives of their sponsors, the effectiveness of their applications, and, ultimately, the validity of their results. The social marketing of powdered milk products, replacing or supplementing breastfeeding in the third world, provides an example of these problems. In the 1960's multinational firms selling infant formulas moved into the virgin markets of Asia, Africa and Latin America. Booklets, mass media, loudspeaker vans, and distribution through the medical profession were used in successful promotion campaigns to switch traditional breastfeeding to artificial products. Poor people, however, could not afford such products, and many mothers diluted the formula to make it last longer or were unable to properly sterilize the water or bottle. The promotion of breast milk substitutes often resulted in an erosion of breastfeeding and led to increases in diarrheal diseases and malnutrition, contributing to the high levels of infant mortality in the third world.'
Critics have lambasted social marketing for manipulating populations and being solely concerned with goals without regard for means. For much of its concerns about ethics, critics argue, social marketing subscribes to a utilitarian ethical model that prioritizes ends over means. In the name of achieving certain goals, social marketing justifies any methods. Like marketing, social marketing deceives and manipulates people into certain behaviors (Buchanan, Reddy & Hossain 1994).
Social marketers have responded by arguing that campaigns inform publics and that they use methods that are not intrinsically good or bad. Judgments should be contingent on what goals they are meant to serve, they argue. Moreover, the widely held belief that marketing has the ability to trick and make people do what otherwise they would not is misinformed and incorrect. The reluctance of people to tailor behavior to the recommendations of social marketing campaigns, and the fact that campaigns need to be adjusted to socio-cultural contexts and morals are evidence that social marketing lacks the much-attributed power of manipulating audiences. If a product goes against traditional beliefs and behavior, campaigns are likely to fail.
Social marketing needs to be consumer oriented, and knowledgeable of the belief systems and the communication channels used in a community (Maibach 1993). Products need to be marketed according to the preferences and habits of customers. Market research is necessary because it provides development specialists with tools to know consumers better and, therefore, to prevent potential problems and pitfalls in behavior change. This is precisely marketing's main contribution: systematic, research-based information about consumers that is indispensable for the success of interventions. Marketing research techniques are valuable for finding out thoughts and attitudes about a given issue that help prevent possible failures and position a product.
For its advocates, one of the main strengths of social marketing is that it allows to position products and concepts in traditional belief systems. The inclination of many programs to forgo in-depth research of targeted populations for funding or time considerations, social marketers suggest, reflects the lack of understanding about the need to have basic research to plan, execute and evaluate interventions. They argue that social marketing cannot manipulate populations by positioning a product with false appeals to local beliefs and practices. If the desired behavior is not present in the local population, social marketing cannot deceive by wrapping the product with existing beliefs. When a product is intended to have effects that are not present in the target population, social marketers cannot provide false information that may resonate with local belief systems but, instead, need to provide truthful information about its consequences. For example, if 'dehydration' does not exist as a health concept in the community, it would be ethically wrong for social marketing to position a dehydration product by falsely appealing to existing health beliefs in order to sell it. That would be deceptive and manipulative and is sure to backfire. The goal should be long-term health benefits rather than the short-term goals of a given campaign (Kotler and Roberto 1989).
Theorists and practitioners identified with participatory communication have been strong critics of social marketing. For them, social marketing is a non-participatory strategy because it treats most people as consumers rather than protagonists. Because it borrows techniques from Western advertising, it shares it premises, namely, a concern with selling products rather than participation. To critics, social marketing is concerned with individuals, not with groups or organizations. They also view social marketing as an approach that intends to persuade people to engage in certain behaviors that have already decided by agencies and planners. It does not involve communities in deciding problems and courses of action. The goal should be, instead, to assist populations in changing their actions based on critical analysis of social reality (Beltrán 1976, Diaz-Bordenave 1976). According to participatory approaches, change does not happen when communities are not actively engaged in development projects and lack a sense of ownership.
Social marketers have brushed aside these criticisms, emphasizing that social marketing is a two-way process and that it is genuinely concerned about community participation. As Novelli (1990, 349) puts it, 'the marketing process is circular.' This is why input from targeted communities, gathered through qualitative methods such as focus groups and in-depth interviews, is fundamental to design campaign activities and content. Social marketing is premised on the idea of mutual exchange between agencies and communities. Marketing takes a consumer orientation by assuming that the success of any intervention results from an accurate evaluation of perceptions, needs, and wants of target markets that inform the design, communication, pricing, and delivery of appropriate offerings. The process is consumer-driven, not expert-driven.
Also, social marketing allows communities to participate by acting upon health, environmental and other problems. Without information, there is no participation and this is what social marketing offers. Such participation is voluntary: Individuals, groups, and organizations are not forced to participate but are offered the opportunity to gain certain benefits. Such explanation is not satisfactory to participatory communication advocates who respond that social marketing does not truly involve participation. More than a narrow conception of participation, they argue, social marketing offers the appearance of it to improve interventions that are centralized. Social marketing's conception of participation basically conceives campaigns' targets are 'passive receivers,' subjects from whom information is obtained to change products and concepts.
After three decades of research and interventions, the lessons of social marketing can be summarized as follows (Chapman Walsh et al 1993):
Persistence and a long-term perspective are essential. Only programs with sustainable support and commitment have proven to have impact on diffusion of new ideas and practices, particularly in cases of complex behavior patterns.
Segmentation of the audience is central. Some researchers have identified different lifestyle clusters that allow a better identification of different market niches.
Mapping target groups is necessary. Designers of interventions need to know where potential consumers live, their routines, and relations vis-à-vis multiple messages.
Incentives foster motivation among all participants in interventions.
The teaching of skills is crucial to support behavior change.
Leadership support is essential for program success.
Community participation builds local awareness and ownership. Integrating support from different stakeholders sets apart social marketing from commercial advertising as it aims to be integrated with community initiatives.
Feedback makes it possible to improve and refine programs.
Health promotion and health education
The trajectory of health promotion in development communication resembles the move of social marketing and diffusion of innovation, from originally gaining influence in the United States to being introduced in interventions in developing countries. The same approaches that were used to battle chronic diseases, high-fat diets, and smoking in the United States in the 1970s and 1980s, were adopted in development interventions such as child survival and other programs that aimed to remedy health problems in the Third World.
As it crystallized in the Lalonde report in Canada in 1974 and the U.S. Surgeon General's 1979 Healthy People report, health promotion was dominated by the view that individual behavior was largely responsible for health problems and, consequently, interventions should focus on changing behavior. It approached health in terms of disease problems (rather than health generally), namely, the existence of lifestyle behaviors (smoking, heavy drinking, poor diet) that had damaging consequences for individual, and by extension, social health (Terris 1992).
The prevalent view was that changes in personal behaviors were needed to have a healthier population. Although the idea that institutional changes were also necessary to achieve that goal made strides, health promotion remained focused on personal change at the expense of community actions and responsibility. A substantial number of studies were offered as conclusive evidence that personal choices determined changes in health behavior, and were positively related with new developments that indicated the decrease of unhealthy practices.
This highly individualistic perspective was initially criticized in the context of developed countries for “blaming the victim” and ignoring social conditions that facilitated and encouraged unhealthy behaviors. It gave a free ride to larger social and political processes that were responsible for disease and essentially depoliticized the question of health behavior. To its critics, individual-centered health promotion ignores the surrounding social context (poverty, racism) in which individual health behaviors take place as well as the fact that certain unhealthy behaviors are more likely to be found among certain groups (Minkler 1999, Wallack and Montgomery 1992). They pointed out that the overall context needed to be considered both as responsible and as the possible target of change.
Recent understandings of health promotion such as the one promoted by the World Health Organization have moved away from individualistic views by stressing the idea that individual and social actions need to be integrated. The goal of health promotion is to provide and maintain conditions that make it possible for people to make healthy choices.
Health education is an important component of health promotion. It refers to learning experiences to facilitate individual adoption of healthy behaviors (Glanz, Lewis & Rimer 1990). The evolution of health education somewhat mirrored the evolution of the field of development communication. Health education was initially dominated by conventional educational approaches that, like modernization/diffusion models, were influenced by individual behaviorist models that emphasized knowledge transmission and acquisition as well as changes in knowledge, attitudes and beliefs. Later, theories and strategies that stressed the importance of social and environmental changes gained relevance. This meant that both health education and health promotion became more broadly understood. Health education includes different kinds of interventions such as conventional education, social marketing, health communication, and empowerment actions (Steston & Davis 1999). Consequently, a vast range of activities such as peer education, training of health workers, community mobilization, and social marketing are considered examples of health education interventions.
Health promotion became no longer understood as limited to educational efforts and individual changes. It also includes the promotion of public policies that are responsible for shaping a healthy environment. The goal of health promotion is to facilitate the environmental conditions to support healthy behaviors. Individual knowledge, as conceived in traditional approaches, is insufficient if groups lack basic systems that facilitate the adoption of healthy practices. The mobilization of a diversity of social forces including families and communities is necessary to shape a healthy environment (Bracht 1990, Rutten 1995).
The emphasis on social mobilization to improve general conditions does not mean that behavior change models are absent in health promotion but, rather, that they need to be integrated among other strategies. Still, the behavior change model has incorporated the idea that interventions need to be sensitive to the education and the choices of receivers (Valente, Paredes & Poppe 1998), understanding the interests at stake, using social marketing technique to know individuals better, and the role of the community in interventions.
Entertainment-education is another strategy that shares behavior-change premises with the forementioned theories and strategies. Entertainment-education is a communication strategy to disseminate information through the media. As applied in development communication, it was originally developed in Mexico in the mid-1970s and has been used in 75 countries, including India, Nigeria, the Philippines, Turkey, Gambia, and Pakistan. Paradigmatic examples of this approach have been soap operas in Latin America (telenovelas) and in India that were intended to provide information about family planning, sexual behavior, and health issues. Literacy and agricultural development have also been central themes of several entertainment education efforts.
Entertainment-education is not a theory but a strategy to maximize the reach and effectiveness of health messages through the combination of entertainment and education. The fact that its premises are derived from socio-psychology and human communication theories place entertainment-education in the modernization/diffusion theory trunk. It subscribes to the Shannon-Weaver model of communication of sender-channel-message-receiver. Like diffusion theory, it is concerned with behavior change through the dissemination of information. It is based on Stanford Professor Albert Bandura's (1977) social learning theory, a framework currently dominant in health promotion. Entertainment-education is premised on the idea that individuals learn behavior by observing role models, particularly in the mass media. Imitation and influence are the expected outcomes of interventions. Entertainment-education telenovelas were based on Bandura's model of cognitive sub-processes: attention, retention, production and motivational processes that help understand why individuals imitate socially desirable behavior. This process depends on the existence of role models in the messages: good models, bad models, and those who transition from bad to good. Besides social learning, entertain-education strategies are based on the idea that expected changes result from self-efficacy, the belief of individuals that they can complete specific tasks (Bandura 1994, Maibach and Murphy 1995).
Entertainment-education refers to 'the process of purposely designing and implementing a media message to both entertain and educate, in order to increase audience knowledge about an educational issue, create favorable attitudes, and change overt behavior' (Singhal and Rogers 1999, xii). Like social marketing and health promotion, it is concerned with social change at individual and community levels. Its focus is on how entertainment media such as soap operas, songs, cartoons, comics and theater can be used to transmit information that can result in pro-social behavior. Certainly, the use of entertainment for social purposes is not new, as they have been used for centuries. What is novel is the systematic research and implementation of educational, pro-social messages in entertainment media in the developed world.
One of the starting points of entertainment-education is that populations around the world are widely exposed to entertainment media content. The heavy consumption of media messages suggests that the media have an unmatched capacity to tell people how to dress, talk and think. The problem is, as numerous studies document, that entertainment messages are rarely positive. In the attempt to maximize audiences by appealing to the lowest common denominator, the media are filled with anti-social messages such as violence, racism, stereotyping, and sexual promiscuity. However, the pervasiveness of the media provides numerous opportunities to communicate messages that can help people in solving a myriad of problems that they confront.
Another central premise is that education does not necessarily need to be dull but it can incorporate entertainment formats to generate pro-social attitudes and behavior. This could solve the problem that audiences find social messages uninteresting and boring, and prefer to consume entertainment media. What characterizes the latter is the intention of the messages (to divert rather than to educate) and to capture audiences' interest. These characteristics should not be dismissed as superficial and mindless but need to be closely examined to analyze the potential of entertainment to educate the public in an engaging manner. Moreover, because they are entertaining and widely popular, entertainment-education messages can also be profitable for television networks and other commercial ventures.
Simplemente María, a 1969 Peruvian telenovela, has been often mentioned as having pioneered entertainment-education even though it was not intended to have pro-social effects. The protagonist was a maid who attended night sewing classes. The program has been credited with having turned sewing into a craze among poor, migrant women as well as increasing the purchase of sewing machines and contributing to higher enrollment numbers in literacy classes. This example and subsequent ones were deemed to be important in two regards. The programs contribute to self-efficacy (an individual's belief that he or she is able to take action and control specific outcomes) and social learning (individuals not only learn through their own experiences but also by observing and imitating the behavior of other individuals as role models).
Besides television entertainment, entertainment-education interventions were also implemented in music and music videos promoting sexual control, and radio soap operas that promoted women's issues, AIDS and sex education, and family planning. In the mid-1980s, a campaign was implemented to promote sexual restraint among Mexican teenagers. It consisted of songs and music videos featuring a male and female singer as well as public service announcements. Evaluation analysis concluded that the campaign had a number of positive consequences: teenagers felt freer to talk about sex, became more sensitized about the relevance of sex, messages reinforced teenagers who already practiced abstinence, and demand for family planning services modestly increased (Singhal and Rogers 1999).
Comparable findings were documented in a similar intervention in the Philippines. The campaign also featured songs, video, live presentations of the performers, and PSAs. It resulted in positive changes in knowledge, attitude and behavior. Other less effective campaigns suggested that appeals that may work in some cultural contexts could fail in others. Performers need to be credible, that is, audiences need to believe that they truly represent the values promoted.
Some studies have concluded that entertainment-education strategies are successful in attracting large audiences, triggering interpersonal communication about issues and lessons from interventions, and in engaging and motivating individuals to change behavior and support changes among their peers. Rogers et al. (1999) concluded that a soap-opera radio broadcast in Tanzania played an important role in fertility changes. The broadcast increased listeners' sense of self-efficacy, ideal age at marriage of women, approval contraceptive use, interspousal communication about family planning, and current practice of family planning. Similarly, Piotrow et al. (1992) report that the “Male Motivation Project” in Zimbabwe, which involved a radio drama intended to influence men's decisions in opting for different reproductive choices, resulted in changes in beliefs and attitudes. Also, Valente et al (1994) found that individuals who listened to a radio drama in the Gambia have better knowledge, attitudes and practices than the control group. The study also concluded that substantial changes in use of contraceptive methods existed after the broadcast. Both studies concluded that audiences incorporate language presented in the programming, talk to others, and introduce behavior changes. A hierarchy of effects was observed in interventions in Mexico, Nigeria and the Philippines. In decreasing order, campaigns contributed to audience recall, comprehension, agreement, and talking with others about the messages promoted in the campaigns.
In contrast, other studies have found little evidence that entertainment education strategies have resulted in such effects (Yoder, Hornik and Chirwa 1996). Yoder and co-authors have argued that the changes in behavior reported in the Zimbabwe and Gambia studies were not statistically significant. An analysis of the impact of a radio drama in Zambia suggested that improvement in knowledge and awareness about AIDS could not be directly attributed to the intervention. Significant changes in condom use were not associated with exposure to the radio drama as there was a substantial amount of information and public debate about HIV/AIDS during the time the drama was broadcast. Exposure to discrete radio programs per se did not account for changes between target and control groups. Moreover, a return to previous behavior after the broadcast suggested the lack of evidence of long-term impact and attributed the findings to the timing when the data were collected. Exposure to entertainment-education messages was positively associated with use of modern contraceptive methods but the data did not allow a direct causal inference. It was not clear whether the campaign had influenced knowledge and practices. Studies did not reject the possible counter-explanation that people more predisposed to family planning were more likely to be exposed and recall media content (Westoff and Rodriguez 1995).
Rather than discounting the possibility of any media effects, Yoder and associates concluded that it is problematic to reach comprehensive conclusions about the effectiveness of entertainment education. In contrast to more optimistic evaluations that suggest that the task ahead is to measure what works better, they recommended a more cautionary approach. Entertainment-education projects are effective in stimulating people predisposed to change behavior to engage in a new behavior (e.g. use contraceptive methods). They provide the push for those already inclined to act to behave differently. Media interventions catalyze latent demand into contraceptive use among ready-to-act populations (see Freedman 1997, Zimicki et al 1994)."
Image credit: Chris Morry, The Communication Initiative