380 PART III Research and Theory in Action: Implementing Nutrition Education
result of participating in the health fair. Health fairs take some effort larger program. Activities often described as social marketing are really
and planning, so you will have to start early. Develop a time line based
on the following considerations.
Getting Started
Be clear about the purpose or objectives of the health fair. Do you
want the fair to attract attention as a kickoff event to motivate people
to attend other activities of the program, such as group education or
physical activity sessions? Or is it a standalone event where you want
to motivate individuals to take a certain action and provide some skills
on how to do it?
Planning the Health Fair
Consider the following:
L Site. Select or find a location. This may depend on how many
people you think will attend and hence the space you will need.
Will you have break-out activities? Can all of these be done in the
same space, or will you need additional rooms?
L Other potential participants. Will program staff conduct all the
activities or will you invite other similar agencies or groups to par-
ticipate? For example, if the focus of the health fair is to increase
fruit and vegetable consumption, you may want to ask person-
nel from a nearby hospital to conduct blood pressure screenings
as motivation. Or you may want someone from a local gym to
demonstrate activities people can do in the home. This will help
you decide how many tables you will need.
L Raffles. If you will use raffles as a motivator to attend the health
fair, early on you will need to seek out local vendors who can
provide items to raffle off, such as membership to a gym. This
will require letters and/or phone calls.
L Activities. Brainstorm the topics or issues you will focus on. Limit
them depending on the scope of your fair. For each, decide on the
central message. Each message or topic should have a table or
booth on which you will display posters using a foamcore stand.
You will need to develop quizzes, activities, and handouts. These
need to be motivating and informative, using theory-based strate-
gies as appropriate.
L Promotion and advertising. You can promote the fair using a va-
riety of approaches, such as posters displayed around the insti-
tution, postcards sent to various departments or to community
groups, e-mail messages sent to selected audiences, or a story in
the institution’s newsletter or local newspaper.
Making the Experience Motivating and Effective
Staff or volunteers should have on name tags and be ready to greet at-
tendees. Staff should be assigned to meet other vendors or participants and
help them set up. The displays should look professional, attractive,
and welcoming. The raffle products should be displayed all on one table
so that attendees can see what they might get if they complete quizzes
or other activities. Have someone take pictures so that they can be used
as follow-up motivators if posted, for writeups about the event, and for
evaluation or documentation purposes.
8 MASS MEDIA AND SOCIAL MARKETING ACTIVITIES
A brief discussion of social marketing and mass media activities is in-
cluded here because a mass media campaign or social marketing com-
ponent often accompanies in-person, in-institution activities as part of a
mass media nutrition communication campaigns. Nutrition mass media
campaigns involve communication strategies to disseminate messages to
targeted audiences through a variety of mass channels such as newspaper
articles, radio public service announcements (PSAs), or paid advertising.
Social marketing, on the other hand, is a complex enterprise that often
includes mass media campaigns, but may not, and involves the larger
enterprise of marketing. It is described only briefly here in terms of its
use in nutrition education. Whether designing mass media campaigns or
developing social marketing activities, nutrition educators usually work
in collaboration with mass media or social marketing experts.
Nutrition Mass Media Communication Campaigns
A mass media communication campaign is usually described as an
intervention that “intends to generate specific outcomes or effects, in a
relatively large number of individuals, usually within a specified period
of time, and through an organized set of communication activities” (Rog-
ers & Storey 1988; Institute of Medicine [IOM] 2002). Such campaigns are
designed to reach large audiences using multiple channels. They usually
require substantial resources in terms of money and effort. Campaigns
seek to “influence the adoption of recommended health behaviors by
influencing what the public knows about the behavior and/or by influ-
encing actual and/or perceived social norms, and/or by changing actual
skills and confidence in skills (self-efficacy), all of which are assumed to
influence behavior” (IOM 2002). They are often part of social marketing
programs. Such campaigns are sometimes conducted along with efforts
to change the environment using a multiple-level, ecological model of
health promotion.
The process of developing such campaigns involves consideration of
the communication principles described in the last chapter and engage-
ment in a process somewhat similar to that described in the six-step
nutrition education design model used in this book, as follows: selecting
the intended audience and specific behavioral outcomes, conducting
extensive formative research (needs analysis) with the audience, choosing
the message strategy and how the messages will be worded and executed,
selecting the channels and settings for dissemination, and conducting
ongoing monitoring and evaluation. Detailed instructions on how exactly
to design and implement health communications can be found in docu-
ments such as Making Health Communication Programs Work, published
by the National Cancer Institute (2004), and Speaking of Health, from
the Institute of Medicine (2002).
Social Marketing
The term social marketing is defined in many different ways. Kotler
and Zaltman (1971) first proposed that marketing principles could be
applied to socially relevant programs, ideas, or behaviors. They saw
social marketing as the design, implementation, and control of programs
seeking to increase the acceptability of a social idea or practice of a
target group. The term often refers to a systematic planning process
that focuses on consumer behavior (understanding the target group’s
values, attitudes, barriers, and incentives to change), developing clear
messages, designing interventions, implementing them, and evaluating
results on a continual basis. It also refers to a particular conceptual
framework about how to bring about behavior change. The definitions
have in common the notion that social marketing is a set of systematic
procedures to promote personal and societal welfare. The following
subsections first describe the conceptual framework and then the social
marketing process.

Conceptual Framework
Social marketing is based on the following set of considerations (Kotler &
Zaltman 1971; Lefebvre & Flora 1988; Kotler & Roberto 1989; Andreasen
1995; Rothschild 1999; Alcay & Bell 2000; Kotler & Lee 2008):
L Social marketing is applied to causes that are considered to be
beneficial to both individuals and society.
L It seeks to promote the voluntary behavior of intended audiences
so as to reduce risk or enhance health, not simply to increase
awareness or alter attitudes.
L It does so by offering intended audience members reinforcing
incentives and/or consequences in an environment that invites
voluntary change or exchange (see below).
L Social marketing is tailored to the unique perspectives, needs, and
experiences of the intended audience with input from representa-
tives of that audience.
L Social marketing strives to create conditions in the social structure
that facilitate the behavioral changes promoted.
L Social marketing uses the processes and concepts of marketing.
This section focuses on some central ideas and practices that are
useful for nutrition education.
Self-Interest
Individuals are assumed to act in their own self-interest. Although there
are many determinants of behavior beyond self-interest (Mansbridge
1990), it has been proposed that self-interest plays some role in most
contexts of human interaction. Self-interest can be seen as similar to
the concept of outcome expectations (or anticipated outcomes) from
social psychological theory—outcomes people can expect from engaging
in healthy behaviors such as health or decreased risk of disease. The
anticipated outcomes are often long term rather than immediate as in
the example of urging people to increase their intake of calcium-rich
foods to reduce risk of osteoporosis. Indeed, these long-term outcomes
may be in conflict with more immediate outcomes based on self-interest.
For example, people choose to eat the unhealthy foods they do or not
to be physically active because they have evaluated their life situations
and have made their decisions based on their current judgment of their
self-interest. Social marketing thus seeks to promote change by offering
benefits that the intended audience perceives to be in their self-interest,
as identified through thorough market research or needs analyses. That
is, it offers “the benefits they (intended audience members) want, re-
ducing the barriers they are concerned about, and using persuasion to
participate in program activity” (Kotler & Roberto 1989).
Exchange Theory
Central to social marketing is the notion of voluntary exchange of re-
sources: one party gives up something in exchange for getting something
from another party. In the case of nutrition education, this means that
participants give up time, effort, convenience, or money in exchange for
the benefits of enhanced physical health, improved psychological well-
being, or a healthful, wholesome food system (Rothschild 1999; Alcay
& Bell 2000). Your job as a nutrition educator is to demonstrate that the
benefits outweigh the costs of taking action. In the design of strategies
for enhancing benefits and encouraging action, social marketing uses
other theories as tools, such as the theories described in Part I of this
book: the health belief model, the theory of planned behavior, social
cognitive theory, and the transtheoretical model.
CHAPTER 16 Beyond Groups: Other Channels for Nutrition Education 381
Focus on Intended Audience Members’ Wants
and Needs
The design of social marketing activities is based on what individuals
or consumers want or need. Although evidence from research studies is
important and best practices can be very useful, social marketing adds a
strong focus on what specific audience members in a given community
want and need. Hence it invests heavily in market research, which is
similar to the needs analysis process described in Chapter 8, to find out
about the specific perspectives, values, attitudes, interests, and needs of
a given audience. Social marketing also emphasizes pretesting potential
materials, messages, and themes with the intended audience so as to
refine the message based on their suggestions. If audience members
influence the development of the program, it is more likely the interven-
tion will be effective.
Segmentation of the Audience
To design messages and activities that are highly specific, social market-
ers try to segment or subdivide any broad category of individuals into
more homogeneous subgroups using demographic criteria such as age,
sex, income, and ethnicity; geographic criteria such as urban, suburban,
and rural settings; psychological criteria such as motivations, readiness
to change, or skill levels; and behavioral criteria such as the degree to
which the group already practices the behavior of concern. Selection
of which segment or subgroup to focus on can be based on various
criteria, such as which group has the greatest need based on the size of
the group and the incidence and severity of food- or nutrition-related
conditions, which group is most ready to change, or which group has
the most influence on others.
Tipping the Scales
Whereas education can increase awareness, promote active contem-
plation, enhance motivation, and teach food- and nutrition-related
behavioral skills and self-regulation skills, social marketing goes be-
yond education by attempting to modify the relative attractiveness of
the specific behavior. This is accomplished through the use of incen-
tives and other benefits that positively reinforce the behavior and
through the reduction of barriers or costs associated with the be-
havior, thereby tipping the scales in favor of the behavior, according
to Rothschild (1999). Social marketing focuses on providing direct,
immediate, and tangible benefits that are reinforcing. It also attempts
to reduce both personal barriers, such as beliefs and expectations,
and external barriers by making the environment favorable for the
appropriate behavior. In the case of an intervention to increase the
consumption of more fruits and vegetables, social marketers not only
provide educational messages but also reduce barriers by such activi-
ties as increasing the availability of fruits and vegetables in schools,
working with grocery stores to lower prices, or providing coupons that
participants can redeem at stores.
Key Elements in Planning Social Marketing
The social marketing planning process systematically addresses the five
Ps of the “marketing mix” considered by commercial marketers (Alcay &
Bell 2000; Maibech, Rothschild, & Novelli 2002; Kotler & Lee 2008).
Product
Product refers to what is exchanged with the intended audience for a
price. The product may not be a tangible item but a service, practice, or
intangible idea such as health. For the product to be “buyable,” people
382 PART III Research and Theory in Action: Implementing Nutrition Education
must first perceive that they have a problem and that the product being
offered is a good solution. Here, formative research is important to unveil
consumers’ perceptions about the problem and how strongly they feel
that they can do something to solve the problem. Thus, products are
desired behaviors, benefits of these behaviors, and any tangible objects
and services offered to support the behaviors.
The core product can be a health idea or behavior that is of benefit
to individuals. For example, the idea can be improved health, or the
action can be eating five to nine servings of fruits and vegetables daily.
Supporting products can be material items, such as coupons for fruits
and vegetables at farmers’ markets, or a service such as a WIC clinic or
nutrition education classes (but not the materials used in the classes—
which are described later in this chapter in a different category). In
designing a program, you have to be very clear about what exactly is
your product. If it is a behavior, you need to find out from the intended
audience what behaviors they see as realistic, effective, practical, or
easy to do. You should also be specific: is the product the behavior of
eating more fruits and vegetables, or eating a specific amount such as
2.5 cups a day or more?
Price
Price refers to the barriers or costs to the consumer associated with
obtaining the product, such as adopting the desired behavior, and any
monetary and nonmonetary incentives, recognition, and rewards used
to reduce the costs. Costs can include the economic costs of eating more
fruits and vegetables as well as the inconvenience and increased time
involved in the preparation of healthful foods, or perhaps the psychologi-
cal costs of learning new ways of eating. Social marketing recognizes
that decisions to act are based on considerations of both benefits and
costs. Individuals ask themselves, “What will I gain if I engage in this
behavior, and what will it cost me?” Often individuals fail to take ac-
tion not because they do not recognize the benefits, but because the
costs are too high.
Social marketing thus seeks to increase the benefits and decrease
the price or barriers of engaging in the behavior of concern (Andreasen
1995; Rothschild 1999). It does this by addressing the internal determi-
nants of behavior discussed earlier in the book, such as perceived risk,
beliefs about outcomes of taking action, knowledge, social norms, and
self-confidence or self-efficacy. Social marketing also addresses external
barriers such as policy, access, skills, and cultural trends by attempting
to create conditions in the social structure and environment to facilitate
the actions being promoted. More simply said, it attempts to make the
more healthful behavior the easy behavior.
In the case of promoting fruits and vegetables to low-income mothers
of young children, the benefits might be the good health of their chil-
dren or wanting to enhance their children’s educational opportunities
and performance. Internal barriers might be lack of time and cooking
skills or confusion about portion sizes for their children. External bar-
riers might include the high cost of healthful foods such as fruits and
vegetables. Food stamps and coupons for farmers’ markets would be
ways to reduce external barriers.
Place
Place refers to where and when the product will reach the consumer.
In the case of intangible products, it is the place where the audience
will receive the information. This may mean researching which media
channels are most effective for reaching the intended audience. It may
mean grocery stores, doctors’ offices, community centers, WIC clinics,
or food stamp offices. Place can also refer to where you might offer
program activities (such as classes) so that they are convenient to the
intended audience. Social marketing seeks to increase the places where
the product may be found, at the right times, and at the points at which
audience members make their decisions. Behaviors must be easy to
carry out; hence, placement must encourage the behavior. If increasing
consumption of fruits and vegetables is the behavior, then the place-
ment strategy might be to have information and messages conveniently
located in the grocery store, workplace, or school lunchroom.
Promotion
The targeted audience members can be expected to voluntarily exchange
their time, effort, and other resources if they are aware that the product,
such as eating fruits and vegetables, offers them attractive benefits at a
reasonable cost and can be practiced at convenient locations. The role
of promotion is to create this awareness. For example, the 5-a-Day cam-
paign complemented its efforts by placing the product (messages about
fruits and vegetables) in the right places via a promotional campaign
in the news media and point-of-purchase materials such as messages
on grocery store bags. Promotion requires considerations such as the
following:
L What channels to use to reach the intended audience. For fruit
and vegetable consumption among low-income mothers of young
children, the channels might be grocery stores, day-care centers,
WIC clinics, food stamp offices, community centers, newspapers,
and TV.
L What types of messages might be effective. The content of the
messages will be based on your audience analysis or needs as-
sessment, as described in Chapter 8. The nature of the message,
such as whether to use humor, emotion, or logical reasoning,
should again be based on your audience analysis. The tone of
the messages should be positive, such as “We know it is hard,
but we know that you want to make a change.” It should also be
respectful, fun, and personal.
Positioning
A fifth P often is considered in addition to the standard four Ps. The
product can be positioned in such a way as to maximize benefits and
minimize costs. Positioning is a psychological construct that involves
the location of the product relative to products with which it competes.
Positioning is difficult in nutrition education because it means having
your product (message) outweigh the competitors. For example, it is
very challenging to get teenagers to eat more fresh fruits and vegetables
when they feel that the alternative products, such as high-fat snacks,
taste much better. However, physical activity can be repositioned as a
form of relaxation rather than as exercise (which some may view nega-
tively). Serving fruits and vegetables can be positioned as taking care of
yourself, and serving healthful meals to your family can be positioned
as an act of love.
Designing Social Marketing Activities
As you have seen, social marketing programs are tailored to the unique
perspectives, needs, and experiences of the target audience and also
seek to create conditions in the social structure and environment that
facilitate the actions being promoted (Andreasen 1999; Alcay & Bell
2000). The set of procedures for designing social marketing is similar
to that described in models of health communication and the six-step
nutrition education design model used in this book. In social marketing
these steps are usually referred to as formative research and planning,
strategy design, implementation, and evaluation. To develop the social
marketing campaign or activities, nutrition educators usually work in