DEVELOPING EFFECTIVE SOCIAL

MARKETING PROGRAMS FOR ABORIGINAL

PEOPLE: REVIEWING

BEST PRACTICE

J U D I T H J . M A D I L L , P R O F E S S O R A N D H O L D E R O F T H E D E S M A R A I S P R O F E S S O R S H I P I N M A R K E T I N G , U N I V E R S I T Y O F O T T A W A , E - M A I L : M A D I L L @ T E L F E R . U O T T A W A . C A

L I B B I E W A L L A C E , S E N I O R M A R K E T I N G A D V I S O R , H E A L T H C A N A D A , L I B B I E . W A L L A C E @ H C - S C . G C . C A

K A R I N E G O N E A U - L E S S A R D , C H I E F O F M A R K E T I N G , H E A L T H C A N A D A , K A R I N E . G O N E A U - L E S S A R D @ H C - S C . G C . C A .

C E L I N E N D I O N , M A R K E T I N G O F F I C E R , H E A L T H C A N A D A , C E L I N E . N . D I O N @ H C - S C . G C . C A

R O B B M A C D O N A L D , S E N I O R C O N S U L T A N T , M A C C O M M S O C I A L M A R K E T I N G , R O B B @ M A C C O M M . C A

HOW DID THIS COLLABORATION AND PAPER COME

TO BE…

Health Canada:

Has the mandate to address and improve the health of Aboriginal people living in Canada

Commissioned an environmental scan of the literature focused on social marketing programs that targeted Aboriginal and Indigenous audiences

findings are being used to inform the development of Health Canada’s social marketing campaigns.

THE ACADEMIC HEALTH CANADA MIX

We have begun our research partnership examining

social marketing best practices for Aboriginal groups –

thinking we can add to each other’s worlds!

How we have approached this will be described in the

presentation.

WHY THIS TOPIC?

Important Yet Under Researched Field

Much evidence showing significant disparity between the

health of Aboriginal people (including Inuit, First Nations

and Métis) and that of non aboriginal populations in

Canada (cf. Jenkins et al. 2003; Public Health Agency of

Canada, 2011; Smylie, 2000), the US (Parker et. al. 2011),

Australia (Ipsos-Eureka 2010).

FAILURE OF INTERVENTIONS INTERNATIONALLY

Literature notes failure to show significant

impact – Why?

Many reasons:

Insufficient formative research, lack of incorporating

local concepts and values, failure to evaluate and

document impact (Parker et al 2011; Ho et al 2006;

Smylie et al 2004; 2009).

ABORIGINAL AUDIENCES ARE AN IMPORTANT GROUP FOR

REALIZING HEALTH CHANGES

We could locate no overall literature review

that could help influence social marketing

development for this audience…

Definitely are excellent points made and

supported in the research, but no published

attempt to pull this knowledge together

PURPOSE OF TODAY’S PRESENTATION

To identify and review research literature on social

marketing to Aboriginal populations;

To provide conclusions and highlight key avenues for

future research in order to improve social marketing

campaigns targeting Aboriginal peoples;

To present a model developed from the literature

outlining effective social marketing in Aboriginal

groups;

IN ORDER TO IDENTIFY AND REVIEW LITERATURE…

Needed to identify the benchmarks of social marketing campaigns and approaches

Not the first to face this problem (Stead et. al. 2006; Madill and Abel 2007)

Most common approach is to go back to Andreasen (2002) who developed key benchmarks for identifying an approach that could legitimately be called social marketing:

voluntary behavior – change being the goal,

consumer research forms the foundation,

segmenting and targeting are done,

crafting strategies to create exchanges with selected target audiences,

developing strategy utilizing the 4 P’s while paying attention to one’s competitors.

FOR INCLUSION IN THIS LITERATURE REVIEW

Campaigns don’t have to exhibit all the characteristics , but can’t

just be communications campaigns.

OUR METHODOLOGY Conducted literature search and review at two different times – literature

summarized here is from both

Time A: 2011 (Environmental Scan and Evidence Review) (Commissioned by Health Canada)

Identified 120 possible sources in literature review related to social marketing programs target to Aboriginal and Indigenous audiences in Canada, the US, Australia and New Zealand.

Dates 2004-2012

Filtered and selected 28 citations

Summarized each citation and noted key findings

Time B: Winter 2013 (Literature Review)

U of Ottawa Databases on Scholars Portal using “social marketing” and “aboriginal’ as well as ‘social marketing’ and’ indigenous’ (conducted by Madill)

Dates 2008-2013 – five years.

Examined each citation to determine if it met the criteria of research involved in social marketing campaigns.

Duplications from Time A were eliminated

Noted a number of other research papers targeted to aboriginal audiences

FINDINGS: IDENTIFICATION AND REVIEW OF

RESEARCH LITERATURE ON SOCIAL MARKETING FOR

ABORIGINAL POPULATIONS

Challenge of reporting literature – lots of words!

Approach – show summaries on PP

Will not go through in huge detail, but enough to

give flavour!

Will draw conclusions

Will then present model developed from this

review.

Wrap-up with conclusions and suggestions for

future research

LITERATURE OVERVIEW

Author/

Date

Source Methods Focus Subjects Findings

Parker et al.

2011

J of Nut Ed. &

Beh.

Refereed

Qualitative

FGs = 8

Ints n=8

Total n = 42

Diabetes Native

Am Women

US

Prefer:

Family based

Prominent role by

elders

Tribe sites at times

conducive to work

schedules

Ho et al.

2006

Health Prom.

Int.

Refereed

Qualitative

Ints = 78

Oberv. =6

Demons = 13

Quant

Survey = 72

Diabetes Canada

First

Nations on

3 Ontario

reserves

Variations in health

beliefs, attitudes

and environs

required tailoring

of programs to

each reserve

Importance of

formative research

LITERATURE OVERVIEW

Author

/Date

Source Methods Focus Subjects Findings

Ipsos-

Eureka

2010 (a)

Non

Refereed

Consulting

Research

Report

Qualitative

FGs = 37

(Indigenous)

Depth Int =

30

(Health

Pros)

Behaviour

and

awareness

of health

services

and how

they can be

accessed

Australian

Indigenous

and Health

Pros

Belief – chronic diseases

unavoidable part of

contemporary life

Low motivation re why

take action and how take

action now

Negative health

behaviours often shared

activities – important for

social cohesion

Shyness re exercise but

positive view of sport and

walking culturally

appropriate

FINDINGS IPSOS-EUREKA 2010 (a) CONT’D

Healthy food perceived costly. Low levels of understanding about healthy food, cooking and food budgeting skills

Fear of unknown concerning health services - lack of information about the nature of local services and personnel

Preference for holistic health services, perception that health services geared to acute health issues not health promotion/prevention

Costs barrier to accessing preventative health services

Benefits for children and family important

Awareness of past SM campaigns

Term ‘chronic disease’ not commonly used

Preference for visual communications, conversational storytelling approaches

Internet suitable for younger

Social gatherings – information hubs

Little support for gender segmentation

Remote areas have unique needs – English often second or third language

LITERATURE OVERVIEW

Author Source Methods Focus Subjects Findings

Ipsos-

Eureka,

2010 (b)

Research

Consulting

Report

Non-

Refereed

Qualitative

(large-scale)

37 FGs by

age and

smoking

status

(n=220)

Depth

Interviews =

37 (health

pros)

Inform

development

of anti-

smoking

campaigns

Australian

Indigenous

and health

pros in

metro and

remote

Nation wide

Superficial awareness

of negative smoking

health effects –

conscious re effects on

children

Some interest in

cessation

Barriers – social

normalization of

smoking, cost

Motivators – family and

kin, decreased fitness

and sports

performance

Moderate awareness

of mainstream

campaigns

FINDINGS IPSOS-EUREKA 2010 (b) CONT’D

Positive – feature Indigenous faces, voices, cultural

imagery, tied to holistic approach to health

Conversational approach – storytelling

Television popular – radio, poster, billboards

LITERATURE OVERVIEW

Author

/Date

Source Methods Focus Subjects Findings

McShane

et al

2006

Cdn J of

Pub

Health

Refereed

Qualitative

KI

Interviews

FGs

Understand

Health

information

Sources/

Dissemination

Urban Inuit

Canada

Importance of visual

learning, community

elders, community

cohesion, Inuit-non-Inuit

distinction

Core sources – family,

within Inuit community

Prefer direct

communication, one on

one or small groups

Smylie et

al 2009

Health

Promo

Pract.

Refereed

Qualitative

Community

Case

Studies (3)

FGs

KI

interviews

Documents

Understand

Health

information

Sources/

Dissemination

Ontario,

Canada

1 urban

Metis, 1

urban Inuit,

1 semirural

First

Nations

Community

Hypothesis supported

– understanding local

Indigenous processes is

pre-req to effective

knowledge translation

Distinct differences in

each community as well

as commonalities

Theoretical FW –

Decolonization.

FINDINGS CONT’D

Common Themes:

Valuing experiential knowledge – shared

Influence of community structure on health

information dissemination – i.e. WOM in cohesive

community, but challenge in socially fragmented

Preference for within community messages

Local effects of colonization – replacement of

traditional systems

LITERATURE OVERVIEW

Author/

Date

Source Methods Focus Subjects Findings

Consultancy

for Alternative

Education

2010

Non-

Refereed 9

page report

Description of

programs,

services and

practices

Tobacco

reduction

Opinion piece

on practices

most relevant

for Inuit

communities

Didn’t include here

as not research

based

National

Social

Marketing

Centre

Research

Team 2011

Case Study

Non-

Refereed

SMQ

Description of 3-

phase program,

2007-13

Qualitative

In-depth

interviews,

paired

interviews, FGs

with TM, 58

telephone with

Health Pros

Increase

cervical

screening

New

Zealand’s

Maori and

Pacific women

Embarrassment

Lack of awareness

discussion and

ways of talking

about issue

Perception - clinics

difficult to access

and inconvenient

Worry about painful

procedures, costs

Competition for

time

Differences

between groups

LITERATURE OVERVIEW

Author/

Date

Source Methods Focus Subjects Findings

McDonald, et

al. 2011

Global

Health

Promotion

Non-

refereed

Secondary

Literature

reviews

informed the

design

Promote

hand-

washing

with soap

Remote

Australian

Aboriginal

communities –

children

Pre and post

surveys

Found use of

literature evidence

helpful in

increasing success

of campaign

Majid and

Grier, 2010

SMQ

Non-

refereed

Qualitative

Case

description

Interviews

Food Mail

Program –

subsidsize

cost of

shipping

food to

isolated

northern

Canadian

communities

Stakeholders

– customers,

Retailers,

airlines,

government

officials

Outcomes mixed –

growth in past 5

years, yet, rate of

obesity and dietary

related illness is

increasing

Challenges faced

in changing

established food

consumption

behaviours

LITERATURE OVERVIEW

Author/

Date

Source Methods Focus Subjects Findings

Filiault and

Drummond

2009

Refereed

Critical

Public

Health

Literature

review

Health

Call

Centres

Use

Australian

Men –

including

aboriginal

Indigenous men more likely

to use health call centres.

Knowledge determines use

SM that takes into account

vocies and concerns may

enhance use

Adams et

al

2011

Refereed

Australian

Social Work

Quantitative

Survey

N=82

(Online and

Postal)

Nutrition

Physical

Activity

Tobacco

Urbanized

Indigenous

Australians

Respondents more likely to

change behaviours related to

nutrition and physical activity

– less ready to cease

smoking

Peer support preferences

were for face-to face or

group support for physical

activity and smoking and

assistance with food costs

for nutrition.

SUMMARY: RESEARCH SUBJECTS AND COUNTRY

VENUES

Very little published research (N = 12)

US Women – 1 Study

Canada (6 total) General north – 1

First Nations – 2

Inuit – 2

Metis – 1

Australia – 4

New Zealand – 1

Implications….

SUMMARY: FOCUS OF RESEARCH

Physical Activity – 3

Nutrition, food, diabetes – 4

Accessing health services – 4

Tobacco – 2

Cervical Screening – 1

Hand Washing – 1

Implications…..

KEY OBSERVATIONS: OTHER LITERATURE

Tangential literature available that might help build

understanding of Aboriginal populations and health

behaviours, BUT not specifically SM oriented

For example, France et. al. (2010) in Substance Use

& Misuse – qualitative study in West Australia to

identify barriers that health professionals encounter

when addressing alcohol used with Aboriginal

pregnant women

KEY OBSERVATIONS: OTHER LITERATURE

Literature available on socially disadvantaged

groups more generally that might help, but not

focused on Aboriginal or Indigenous populations

specifically

For example, Guillaumier et al, 2012 in Drug and

Alcohol Review, focused a systematic review of

the effectiveness of anti-tobacco mass media

campaigns and socially disadvantaged groups

Found weak study designs and recommends

improved methodological rigour

CONCLUSIONS FROM

LITERATURE REVIEW

Theory:

Reviewed only one paper that utilized decolonization theory as theoretical frameork for the paper (Smylie et al 2009).

From 1996 Canadian Royal Commission on Aboriginal Peoples.

Implications: Research weak theoretically

SUMMARY/CONCLUSIONS FROM

LITERATURE REVIEW

Methodologies: Research is often/always formative concerning the

development of specific campaigns

Research most always qualitative (focus groups and interviews)

Support of use of focus group methodology (in keeping with storytelling tradition, Parker et. al. 2011)

Support for use of moderators with indigenous connections.

Subjects include target markets as well as health professionals involved with the target markets (focus groups often had n of 1 or 2).

Conclusions

Predominance of qualitative research

Limited generalizability based on type of methodologies used, yet considerable convergence of findings

Considerable support for using focus groups, but noted recruitment difficult and very small n’s.

Limited research overall – half refereed, half (6) was not.

CONCLUSIONS

Given the paucity of research - especially peer reviewed findings, the limitations of study designs, practitioners advised to be cautious and recognize that much needs to be learned.

Many recommendations are presented in each report, for example: Not limited to print – provide opportunities to come together Role of elders – influential and valued Family based and tribe specific

The recommendations are very diverse – developed model which tries to pull the most important together….

SUGGESTIONS FOR FUTURE RESEARCH

Given importance of Aboriginal/Indigenous peoples health

problems, critical to continue efforts to improve health

outcomes

Critical to pull research together in a literature review

concerning what is known – we intend to move our paper

forward with this intention

Have proposed model and useful next step would be to test

empirically in a variety of settings, countries and health issues

and report upon its effectiveness – we intend to do this and

hope others will as well.

Social Marketing Approach for First

Nations and Inuit in Canada

April, 2013

32

Lessons Learned

Individual

Family

Community

APPROPRIATE • Segment

• Relevant

• Culture

• Oral, story-telling

• Visual

MOTIVATION &

BARRIERS • Knowledge, attitude, belief

• Emotional

• Practical

Considerations

COMPELLING • Community-based, participatory

• Balanced

• Emotional, personal connection

• Simple, direct

MULTI-CHANNEL • Traditional media

• One-to-one and group (Elders)

• Social media

• Subject

33

Stakeholder Engagement

First Nations & Inuit

Community Members

Local Stakeholders

Community

Leadership,

Chiefs &

Councils

Health Directors

& Managers,

Environmental

Health Mgrs, etc.

Health Care

Providers

Doctors

Nurses

Lay

Workers Children &

Youth Workers

Health Canada

Immunization

Coordinators

Env. Health

Officers

National & Regional Stakeholders

First Nations &

Inuit Orgs

National

Organizations

Provincial &

Territorial Orgs

Provincial & Territorial

Governments

Collaboration for Success

Health Promotion

34

Multi-focused Campaign Strategy

Deliver Information

Encourage & Enable Dialogue

Content Promotion

Gatherings Social Media

Social Marketing Campaigns for First Nations and Inuit Audiences

35

Immunization

Environmental Health

Seasonal Flu

Tuberculosis

APPENDIX

HEALTH CANADA CAMPAIGNS

37

First Nations and Inuit Immunization Campaign

Parents/Caregivers of Children 0-2

& Expectant Parents

Target Audience

Young population

(~50% under the age of 25*)

Young parents

(~30% children with mothers 15-24*) Increasing birth rate Population Size FN over 15: 473,235 Inuit over 15: 32,775

Primary: Decision Makers Parents/caregivers of children 0-2 years

and expectant parents

Secondary: Influencers Health care providers and lay workers,

elders, other parents, family and community members, chiefs and

councils, Aboriginal organizations, media

Most popular sources of information 1. Local Health Station: 35% 2. Internet (opportunity to connect with

other community members): 35 3. Doctor: 24% 4. Community nurse: 18% 5. Other health care provider: 5%

Opportunity to influence decision makers Through dialogue between decision

maker (parents/caregivers) and influencers

Campaign Purpose Background

Some vaccine-preventable diseases continue to be seen in First Nations communities Support better health outcomes and reduction of health inequalities between First Nations and Inuit and other Canadians

To build knowledge and increase positive attitudes and perceptions of immunization leading to positive behaviour change regarding immunization.

Objective

Desired Outcomes

A 5% increase in both awareness and usage of

immunization materials by nurses.

Increased vaccination rates and decreased incidence of

vaccine-preventable diseases among First

Nations and Inuit populations.

Decreased health-care costs and reduction of

health inequalities between First Nations and Inuit and

other Canadians.

Short Term Long Term Medium Term

Guides www.healthcanada.gc.ca/immunization

Radio

Ad/PSA TV PSA

Cable Channel Ad

Print Ad/PSA Poster

Web Banner Ads

Promotion

Search

Content

Stakeholder

Promotions

Information Delivery

One-on-one &

group sessions

Awareness

Items

Postcards

Gatherings

Discussion

Reminder

Discussion

Guide

Vaccination

Tips & Facts E-Cards

Share Your Story

Internet and Social Media

Ask an

immunization

question

Dialogue

First Nations and Inuit Environmental Health Campaign

43

Goal

Enable First Nations and Inuit to identify, prevent and

address potential environmental impacts on health through:

Increased awareness of the relationship between environmental contaminants and health

Increased knowledge of simple activities for prevention, assessment, and reduction of risk

44

Target Audience

Adults Youth & Children

Indoor & outdoor: equal concern

Ability to protect: limited confidence

First Nations: 473,235 (15+)

Inuit : 32,775 (15+)

More inclined to learn

Less knowledgeable

Young population (>50% under 25)

* Baseline Survey, April 2010

First Nations On-reserve & Inuit

Environmental Health issues are made more severe among First Nations & Inuit, by:

• Overcrowding

• Higher smoking rates

• Hunting, fishing, gathering

• Inadequate ventilation

• Artistry / traditional Crafts

45

Web Guides & Posters

Guide & DVD

4-part Videos

Poster

Mould & Food Safety

Direct Mail Youth Developed PSAs

Home Guide PSAs

TV &

Radio

Search

Information Delivery & Promotion

Information Sessions

Community Gatherings

& School Assemblies

Activity

Booklets

4th International Meeting

Indigenous Child Health

(March, 2010)

Aboriginal Nurses

Association of Canada

National Conference

(Oct, 2010)

Youth Art Contest

Dialogue

Facebook

Questions, Polls

and Videos

Shared Tactics

48

Healthy First Nations and Inuit Facebook Page

49

Partnership with APTN

Aboriginal Peoples Television Network

Hosting & promotion of a microsite featuring Immunization

Participation in Aboriginal Day live annual event

Production of a short video that captures community

members sharing why immunization is important to them