Social marketing 711
established. However, its relevance is clear.
Many of the major causes of mortality and
morbidity in the developed world are lifestyle
related, and health promoters have in the last
20 years or so reoriented their efforts from a
focus on specific disease prevention to a focus
on the lifestyle risk factors which impact on a
wide range of disease – exercise, nutrition,
smoking, drinking, safer sex. Knowing that
middle aged C2DE men are at most risk of
coronary heart disease is not sufficient: the
social marketer needs to understand why some
men in this group are motivated to engage in
lifestyle behaviours which are protective of
their health and why others are not, and to
develop product offerings accordingly. Social
marketers need to adopt segmentation approa-
ches that acknowledge the complex psycho-
social determinants of health behaviour (Slater,
1995).
Information which enables the social mar-
keter to distinguish between targets on the
basis of their values, beliefs and norms is also
important. Various behaviour change theories,
such as the theory of reasoned action (Fishbein
and Ajzen, 1975), social learning theory (Ban-
dura, 1977, 1986) and social cognitive theory
(Maibach and Cotton, 1995) have posited that
traits such as attitudes and norms influence
adoption of health and risk behaviours (e.g.
Manstead, 1991; Fishbein et al., 1997). Increas-
ingly, these theories are being adopted as the
theoretical basis for segmented social market-
ing interventions (e.g. Fishbein et al., 1997).
Geodemographics
This is the classification of people on the basis
of where they live (Sleight, 1995). The geo-
graphical distribution of much ill-health (e.g.
Whitehead, 1992; Smith, 1997a) and the cluster-
ing of health and social problems in certain
areas, particularly urban areas of deprivation
(e.g. Glasgow City Council, 1998), suggest that
this approach can contribute usefully to social
marketing. Obvious applications of geodemo-
graphics to social marketing are in selecting
channels for health advertising, identifying
locations for health services, and direct mail.
A number of syndicated geodemographic
information systems have been developed in
the commercial marketing context (Sleight,
1995). While these are already proving to be
useful to social marketers, public health is very
often most concerned with geodemographic
segments who are of least interest to many
commercial marketers – the very poor. Classifi-
cation systems such as ACORN and MOSAIC
provide socio-economic indicators of small
areas, and these can be combined with classifi-
cation systems such as the Carstairs index for
Scotland (McLoone, 1991) which provide a
measure of affluence or deprivation within
postcode sectors. Measures of deprivation, such
as housing tenure, telephone and car owner-
ship, and financial status, can also be incorp-
orated to provide accurate targeting data for
social marketers.Behavioural characteristics
In commercial marketing, behavioural charac-
teristics may include volume of product usage- heavy, medium, light users – transactional
history (previous usage), readiness to use,
responsiveness, and attitudes towards usage
(Wilkie, 1994).
Again, these categories are of relevance to
social marketing. Social marketers planning an
initiative to encourage participation in a health
promotion clinic could segment on the basis of
current health behaviour, previous usage of
health clinics, frequency of GP consultation and
so on. Health service records held by GP
practices and health authorities provide valu-
able information on patients’ previous transac-
tions with health services as well as on their
current health behaviours (e.g. smoking, drink-
ing, use of medicines).
A particularly important behavioural char-
acteristic in social marketing is the concept of
readiness to change. The transtheoretical model
of behaviour change (Prochaska and DiCle-
mente, 1983) posits that behaviour change is