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Improving the Quality of Care Delivered to Children Served by State Agencies

Changing Consumer Thinking


William A. Smith, Ed.D., Executive Vice President, Social Development Division, Academy for Educational Development, Washington, DC.

Social marketing can be used to change risky behavior, improve services, or build social capital. Social marketing is not a panacea but can make incremental changes.

Marketing is an exchange focusing on, "What do I have to give you in order to get you to do what I want?" Social marketing involves listening to populations in order to learn their wants and needs, then determining how to "sell the product" in order to meet those wants and needs.

Effective social marketing campaigns target behaviors of segments of the population. Such campaigns involve:

  • Listening.
  • Planning.
  • Designing.
  • Testing.
  • Implementing.
  • Monitoring.
  • Revising.

Competition is always a factor. The message the social marketer sends will be competing with the target audience's other priorities. Therefore, the program and message need to be:

  • Fun (offers benefits).
  • Easy (reduces barriers).
  • Popular.

For example, in Dayton, Ohio, women in managed care were excessively using the emergency room (ER). The original hypothesis was that they used the ER because it was easier and they did not understand the system. Therefore, the response was to organize a cadre of social workers to make in-home visits to women who used the ER more than five times to provide information about use of primary care providers. As a result of the visits, annual ER visits per 1,000 members dropped from 814 to 510.

Next, a study using several data-gathering methods was conducted of ER over-use.

  • Direct observation in ERs demonstrated improper use. But using the ER had many advantages, such as being open 24 hours a day, 7 days a week; not turning anyone away; not requiring appointments; and very little waiting time.
  • Focus groups with providers and patients demonstrated that the women did understand managed care policies regarding ER and using primary care providers.
  • Individual interviews with providers, patients, and staff uncovered a number of system problems.
  • Analyzing existing use data showed that 12 of 223 providers accounted for 50 percent of ER primary care visits. These providers told the women to go to the ER because they did not want poor people in their practices, feeling that the State paid too little and too late.

As a result of this study, the State created a targeted provider incentive system. This reduced annual ER visits per 1,000 members from 510 to 360.

At times, data can create a common language among entities with differing agendas. For example, opponents of the death penalty made little headway by using moral arguments; however, when data showed signs of government incompetence in conducting fair trials of people later sentenced to death, this created a focal point.


Social Marketing: The ESP of Behavior Change. Washington (DC): Academy for Educational Development; 2000.

Smith WA. Social Marketing: an Evolving Definition. Am J Health Behav Soc 2000; 24(1):1017-24.

Smith WA, Hornik R. Marketing, Communication, and Advocacy for Large-scale STD/HIV Prevention and Control. In: Holmes KK, et al, editors. Sexually Transmitted Diseases. The McGraw Hill Companies, Inc.; 1999.

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