Abstract

Health sector is an essential investment in human resources. Any effective health communication strategy should provide for adequate social interaction to generate faith about the sincerity of efforts. The concept of social marketing has inbuilt components of marketing ethos and effective communication to translate efforts into desired effects. Thereby bringing desirable changes in the knowledge, ideas, attitudes and practices of the target groups. Communication strategy has significant role in deriving the necessary social impact out of social marketing. An effective strategy takes adequate note of audience segments, differential communication needs, level of communication-intervention and result oriented media mix including proper media planning. The need is to break down the barrier of apathy and indifference through poly media and interpersonal campaigns to meet our healthy goals.

Key Words

Health communication, Communication dynamics, Concept of social marketing, Communication strategy, Communication intervention

Introduction

Health, according to a WHO Information Bulletin (1974), is a “state of complete physiological, mental and social well being (of a human being), and not merely the absence of disease and infirmity.” Further, the community health refers to the health status of the members of the community, the problems affecting their health and the totality of health care provided to the community.

Health, until now a low priority area, has come to occupy a central place in government policies and programmes as is evident from the number of health campaigns launched in various media. Woken by the Surat plague scare, the government has initiated long term plans to expand the health infrastructure and increase the availability of health care services, especially in rural areas. To this effect, the government of India, exhorted by the Constitution of India “to raise the level of nutrition and standard of living of its people and improvement of public health as its primary duty”, has reiterated its commitment to attain ‘Health for All’ (originally by the year 2000), vide its National Health Policy (1983). The government believes that health of people is not only a desirable social welfare goal but an essential investment in human resources. The national health communication goals are to promote bio-psycho-social fulfillment of every individual in society.

Health perceptions

Health is a culturally bound sociogenic phenomena and has different meanings — etic (researcher imposed) and emic (subjects generated); emphasizing biological, psychological and sociological aspects of human behaviour. Causal attributions and explanation of health problems varies from culture to culture, ranging from internal biological disorders/imbalances in western/modern culture to such external factors as evil spirits, souls, punishment by God, sorcery, etc. in traditional societies. This determines whether the people will seek medical help or resort, instead, to the ways of appeasing the spirits that have caused the illness.

These perceptions go a long way to determine their attitude towards health, and consequently have a great (adverse) impact upon the health communication efforts. Moreover, as these cognitions are deeply ingrained in their values and belief system, any efforts to change them will be met with stiff resistance.

Therefore it is of paramount importance to understand the dynamics of health communications, internalise the different health perceptions and address these differences in attitudes and interpretation/understanding in all the health communications before administering any ‘external’ solutions. All the health communications should provide for adequate social interaction that generates faith about the sincerity of efforts and effectiveness of solutions offered.

A note on social marketing

Wiebe (1951-52) posed a question — “why can’t you sell brotherhood and rational thinking like you sell soaps?”
The adoption of an idea, like the adoption of any product, requires a deep understanding of the needs, perceptions, preferences, reference groups and behavioural patterns of the target audience. This is made possible by social marketing which is concerned with increasing the acceptability of a social idea or cause in a target group.

The concept of social marketing has gained widespread use and support during the last two decades. Phillip Kotler, one of its chief advocates, opines that social marketing is the application of marketing philosophy and principles for the introduction and dissemination of ideas and issues of social significance, e.g. family planning, road safety, controlling infant mortality, primary education, health care and support services, etc. Kotler and Zaltman (1971) defined social marketing as “the design, implementation and control of programmes calculated to influence the acceptability of social ideas and involving consideration of product planning, pricing, communication, distribution and marketing research.” Thus, “it is the explicit use of marketing skills to help translate social action efforts into more effectively designed and communicated programmes that elicit desired audience response. The marketing techniques are the bridging mechanism between the simple processes of knowledge and the socially useful implementation of what knowledge allows.”

Social marketing, therefore, provides a rich conceptual system for thinking through the problems of bringing about changes in the knowledge, ideas, attitudes and practices of a target audience. Although, conceptually social marketing and commercial marketing are the same as they draw their inspiration from the marketing philosophy, the difference lies in the goals pursued. The goal of commercial marketing is to maximise profit whereas social marketing is essentially concerned with the promotion of socially beneficial ideas and practices. It sells a product as well as an idea. The most significant component of social marketing strategy is the communication strategy which is persuasive and makes the ‘idea’ or programme familiar, acceptable and socially desirable in the larger interest of the society.

Communication strategy

Communication strategy provides an ideal situation for the study of human behaviour as it attempts to engineer changes in the society (social engineering). It represents enormous variety of purposes e.g. attempting to influence individuals’ voting behaviour (Political Communications), consumers’ purchase decisions (Marketing Communications), discourage/promote certain social behaviour (Social Communications), promote use of contraceptives and other methods (Family Planning Communications), promotion of birth control measures (Population Communications), promotion of better health care and support services (Health Communications). Whatever be the content of communication or the objectives being sought, the formulation of a strategy involves the following steps:

1. Audience segmentation: Similar to the concept of market segmentation, this involves identification of target audience and then dividing the same into smaller groups for easy access and handing. For example, a population communication strategy would segment the entire population into groups e.g. adolescents, young couples, middle-aged couples; male and female; married and unmarried; rural and urban, etc. The basic idea behind audience segmentation is to direct the flow of communications towards a specific group and increase the concentration of efforts in a particular direction to get high efficiency/success rate.

2. Differential communication strategy: Once, through audience segmentation, we have divided the target audience into smaller groups, we proceed to determine specific characteristics (nodal points) of each group. These ‘nodal points’ serve as ‘entry points’ to penetrate the group and influence their behaviour and attitudes. Since each group would be different from the other, it will require a different communication strategy. Differential communication strategy involves direction of communication efforts suited to the ‘needs’ of each group in order to bring about desired changes.

3. Level of communication intervention: The society is not a homogenous mass; rather it is a bewildering mix of individuals with great diversity in terms of comprehension, understanding, response and other psycho-social and personal traits. Therefore, before we design a communication strategy, we, better, ascertain the level of communication intervention. Three levels of communication intervention are generally included in any communication strategy. They are — mass level, group level and individual level.

The philosophy behind mass communication intervention is to attract the public attention towards some general issues important for the society as a whole; or create/generate public awareness/interest towards some ongoing activities. For example, a mass campaign may be undertaken to create awareness about the unhygienic surroundings and its relation to some diseases (e.g. malaria). This helps create a certain degree of ‘attitudinal readiness’ towards solving community problems.

The group intervention demands focussing the communication efforts and give it a purpose and direction. For example, popularisation of science in the society may be broken down into popularisation of science among kids, school going children, college students; or popularisation of science in rural areas, urban areas, among farmers, businessmen, labourers, etc.

The third level of communication intervention (i.e. individual) identifies the potential beneficiaries and designs the communication, which is need-based, specific and purposive, through individual contact. For example, popularisation of bio-gas plants will target only those individuals/families which have enough space and maintain the requisite number of livestock. At this level, the individual person/family is given very specific and useful communication and can easily observe the impact of such intervention.

4. Media mix: Once the levels of communication intervention have been finalised, we need to identify various media for the delivery of the message. An ideal media strategy would be to select a mix of mass media and personal media which will supplement each other, thereby increasing the effectiveness of communication intervention. Information density (i.e. the capacity of a medium to carry the information load and disseminate the same efficiently and effectively) of different media is different. Mass media have low information density as compared to personal media. Therefore treatment of the message to be disseminated should be carried out accordingly. Packing too much information in a message to be delivered through mass media will not be effective and might fail to evoke a positive response or create confusion in the mind of the public as well. They would not be able to attract/hold/sustain public interest. For example, a family planning campaign may, through mass media, carry such messages as ‘small family, happy family’ or ‘space the children, grace the children’. And, the methods to achieve these objectives i.e. message regarding various contraceptive measures can be delivered through personal media which has a high information density.

5. Media planning: Media planning calls for an intimate knowledge of effective reach, range and value of the available media. Before working out a media plan and launching of any media campaign, two things are considered.

(i) Frequency of media exposure i.e. number of times a message will be exposed or delivered through a media, say television, over a period of time e.g. once/twice/thrice per week or per month.

(ii) Intensity of media exposure i.e. repetition of a message through several media (e.g. radio, television, newspaper) over a period of time.

The frequency and intensity of media exposure is measured in terms of OTS (opportunity to see) or OTH (opportunity to hear).

In order to bring about desirable behavioural changes and induce practice adoption, at the start of the communication campaign it would be prudent to have a high frequency and intensity of media exposure in order to attain high ‘awareness levels’. But, as the campaign goes on, the intensity and frequency of exposure through mass media may gradually be brought down, and the momentum (i.e. public interest) could be further sustained through low intensity/frequency of exposure. This can be very effectively compensated with the increased usage of personal media. NGOs/grass root level workers can carry out the interpersonal communication with the target individuals/families. The specific and detailed information concerning health can easily ‘sink in’ through interpersonal discussions with the target audience as it can also effectively break down the barriers of apathy and indifference which are usually encountered by the grass root health workers in health promotions.

Conclusion

Various health communication campaigns have been undertaken ever since independence but very little impact has been there on the lives of our people. Infant mortality, epidemics, malnutrition and several diseases still strike the population with unknown regularity. We have tried to ‘sell’ many ideas but, evidently, there have been few buyers. Something somewhere has been amiss in our approach to the issues concerning health.

Of late there has been a rethinking in our priorities and consequently new strategies are being tried out. We have to identify the right issues, the end recipient and his capacity to absorb the messages of health communication campaigns. For this the changing psyche of the society and various avenues available need to be assessed and understood. Only a poly media campaign with a social marketing perspective based on the inner dynamics of society derived through an inter-disciplinary approach can correct the social imbalance and remove the problems of health, hunger, want and ignorance.

References

1. Kotler Philip, Marketing for Non Profit Organizations, 1985, Prentice Hall Inc., New Delhi.

2. Kotler Philip and Zaltman Gerald, Social Marketing - An approach to planned social changes, Jounal of Marketing, 35, 1971, pp. 3-12.

3. Solomon Douglas S A, Social marketing perspective on communication capaigns, Public Opinion Campaigns, Ed. by Roland E Rice and Charles K Atkin, 1987, Sage, New Delhi.

4. The World Bank, Media strategies for health communications in Karnataka, May 1994, Consultancy Report submitted by Mudra Communications Ltd., Bangalore.

5. Wiebe G D, Merchandising Commodities on Televisions, Public Opinion Quarterly, 15, 1951-52, pp. 679-691.

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