Marketing: A Consumer-based approach to
promoting safe hygiene behaviours
Beth Scott, January 2005
Assurance: Sandy Cairncross
is a shortage of good evidence to suggest the
positive impact of traditional; health education
approaches to produce sustained behaviour change.
factsheet argues that social marketing offers a more
promising approach to promoting positive hygiene
behaviours. It offers a concise definition of the
approach outlines its central pillars and gives
examples of where such an approach has produced
positive results within the wider field of
recently pointed out the health messages on a
friend’s tobacco packet to her, encouraging her to
think about the consequences.
die younger – so what? My granny lived to be one
hundred, I definitely don’t want to live that
harms those around me – why should I care about
those around me? Anyway, there are other people
anecdote provides a perfect example of the failure
of health education to induce behaviour change.
Health-related messages frequently fail to
drive a change towards positive behaviours, often
because health consequences of negative behaviours
are not immediate or are hard to see, or because
they are not seen to be relevant or potent enough.
Indeed, a wealth of studies indicates that
enhancing knowledge and creating supportive
environments are not in themselves enough to produce
any sizeable impact upon behaviour (Cave &
alternative approaches to health promotion are
marketing represents one such alternative.
This factsheet seeks to define this approach,
summarise its defining features and the processes
involved, and give arguments and examples to show
how social marketing might prove the key to
achieving sustained behaviour change. Another
Factsheet focusing on sanitation marketing can also
be found in this series.
idea of social marketing is not new. However, over
the years numerous definitions of the term have been
given and a huge range of programmes have claimed to
use this approach. Programmes that do not focus on
the consumer, do not involve adequate market
research, segment the target audience according to
needs, recognise ‘competition’ or consider the
placement or pricing of products (necessary for
behaviour change) are not social marketing (Andreasen
fact sheet uses the following definition:
of Social Marketing
use of commercial marketing techniques to
promote the adoption of behaviour that will
improve the health or well-being of the target
audience or of society as a whole' (Weinreich,
Marketing – The 5 Ps
key fallacy of social marketing is that marketing is
just about communications, while in fact it goes
beyond communications to encompass what is known in
industry as ‘The 4 Ps’: Product, Price, Place
the heart of successful marketing, whether it is
commercial or socially orientated is an
understanding of what the consumer (target audience)
wants. This contrasts to the traditional
educational approach which promotes reasons as to
why the consumer should change their
recognises that people have many competing
priorities in their lives and thus in order to
induce behaviour change the particular change being
promoted needs to be perceived as a top
priority. If behaviour change is to occur, the
target audience must both want and be able
to change their behaviour. An exchange
process is key to the approach, benefit being
received in return for behaviour change.
strategy is developed around the structure of the '4
Ps Framework' - Product, Price, Place and
Promotion. An understanding of the 4Ps allows
the development of the appropriate product, at the
right price, easily available through strategic
sales placement, and known about through promotion
which also aims to enhance desire.
four central pillars of MARKETING
Social MARKETING a 5th P is
the marketing of behaviour change product is often
perceived to be a problematic concept. It needn’t
be. A ‘product’ may be a physical object (e.g.
household latrine), a service (e.g. toilet emptying
service) or a practice/behaviour (e.g. sleep
under an impregnated bednet).
when the ‘product’ is behaviour, there may be
associated physical products necessary to allow this
behaviour change, e.g. bednet or soap. These
need be considered here.
To have a viable product, consumers must first
believe that they have a problem and that this can
be addressed by the product (incl. behaviour
change). Offering a range of product choices
can prove instrumental in meeting this aim.
change itself may have no price tag; however
associated products that make it easier can come at a price.
These products need to be available at an
affordable price to the target audience.
N.B. While price is often an important contributor to the
viability of a behaviour change programme, it is
rarely the most important factor ruling product
uptake as many assume, even when the very poor are
Further, price is not necessarily just monetary. There can be high
transaction costs associated with behaviour change.
These too must be considered.
The products needed for behaviour change need to be available at outlets
accessible to the target audience in order to make
behaviour change truly possible.
For example, the urban elite may be able to
access the supermarket to buy mosquito coils, but
for the rural poor they need to be available at the
local market. Or, if people are to wash their hands
with soap after using public toilets, handwashing
facilities must be available alongside in order to
make this behaviour possible.
Having a product available in the right place, for the right price
creates an enabling environment for behaviour change
to occur. However, challenging social norms and
promoting a new behaviour remains difficult.
Awareness needs to be raised, and a desire to adopt
the new behaviour created.
This is done via promotion based upon an
understanding of the motivations of the target
audience and knowledge of their primary and trusted
channels of communication (Cave
& Curtis 1999).
the case of social marketing programmes a 5th
P may be applied – policy. Policy
can be used to make the unhealthy behaviour harder,
for example through the banning of smoking in public
places, or by making the desired behaviour easier,
by enforcing the provision of handwashing facilities
in schools for example. An enabling policy
environment can also be vital for sustaining
behaviour change in the longer term.
Marketing – Not Just Promotion
behaviour change programmes target only the fourth P
- promotion. However,
if the products necessary to allow behaviour change
are not available in the right places at the right
price then behaviour change will be incredibly
difficult to achieve.
example, in Ghana, where a national handwashing
marketing campaign is running, a recent evaluation
showed that although children reported increased
behaviour change at home, this increase was markedly
less at school, the primary reason being the
unavailability of soap and/or water in schools.
the social marketing of condoms across Africa, PSI
found that as condoms were primarily sold in shops,
they were frequently unavailable at night when many
people wanted to buy them.
Thus they have introduced vending machines in
places like bars, allowing people to buy condoms
privately at any time (www.psi.org).
steps in designing a social marketing campaign
speaking there are five major stages in the
development and execution of a social marketing
Communications message and placement planning
Pre-testing of materials
Evaluation and feedback
first stage of planning is to define – what the
desired behaviour, the programme goals and who the
target audience (TA) are.
known as consumer research in commercial marketing,
is then used to gain a deeper understanding of the
target audience (TA) and the context of their
current behaviours in order to plan programme
activities and messages.
questions to be addressed include:
is the TA behaving now?
are the (perceived) barriers and drivers to
can the product (behaviour) offer to help overcome
these barriers and/or appeal to these drivers and
address the TA’s needs and desires?
does the TA communicate and learn about new products
both qualitative and quantitative methods, including
in-depth interviews, focus group discussions and
surveys, are utilised to gain insight into these
results commonly lead to TA segmentation,
that is the division of the target audience into
sub-groups of individuals with common attributes and
these groups will respond to different promotional
messages and product placement strategies. For
example, the National Handwashing Campaign in Ghana
divided the TA into two primary segments – mothers
of children under five years and school age
the programme decided to target that section of
society that currently washes their hands at key
junctures, but with water alone. This represents a
sizable proportion of the target audience. Targeting
both those not washing hands at all and those
washing hands with water in a single communications
campaign was not pursued, as different messages
would be appropriate to each group.
message and placement planning
this stage the results of formative research are
used to develop a set of possible promotional
messages and positioning strategies to drive
Commonly these messages, on the surface, have
little to do with health concerns.
For example, the key driving forces for
handwashing with soap in Ghana were found to be a
fear of contamination and disgust of the unknown.
Further, mothers were driven by a desire to
care for their children and appear in a positive
social light. As messages were only implicitly
health related, health centres were not necessarily
the best way of communicating these messages.
insights further indicated that while ownership of
radios was higher than of televisions, viewership of
the latter was higher, as TV was often watched in
groups providing an opportunity for discussing
Further, the use of visuals meant that
television messages were seen to be more trusted
than radio ones.
the case of marketing bednets, it has frequently
been found that protection from malaria is not the
primary driving force determining net use, but a
desire to prevent the itching and irritation caused
by mosquito bites and bedbugs experienced in the
absence of bednets.
formative research allows the development of a set
of possible promotional messages and message
carriers (stories that carry the message), it does
not give a definitive answer to the question of
which message will work best.
Thus, marketers employ ‘concepts testing’
whereby proposed materials are tested with small
groups of the target audience.
This allows the favoured messages to be
picked out and refined before the final materials
to implementation is the development of a
This brings together all the results of
stages 1-3 and defines strategies for product
placement and the placement of communications
materials across a range of channels. It defines the frequency and placement of messages.
This plan is then used to carry the programme
through into implementation.
is implicit throughout all stages of the marketing
process; for instance, materials pretesting serves
to evaluate materials. Once the programme is being implemented, it must be monitored
on a regular basis in order to ensure that the
appropriate messages are reaching the desired TA and
having an effect.
At the early stages of a programme it may
prove futile to measure behaviour change itself, as
changing behaviour change can take time. However, measuring indicators such as message and product
reach, message awareness and interpretation and
propensity towards behaviour change are key.
Where the programme objectives are not being
reached, the marketing mix must be revisited and the
programme adjusted accordingly.
for the impact of social marketing in
evidence for the impact of knowledge enhancement
programmes on behaviour change may be limited, but
is it any better for social marketing campaigns in
environmental health? The answer is probably
example, large-scale social marketing of treated
bednets in rural Tanzania showed an increase in the
number of infants sleeping under bednets from under
10% at baseline to over 50% three years later.
This was further associated with a 27%
increase in child survival among the 1mth-4yr olds (Schellenberg
et al 2001).
Zambia, the Safe Water Systems social marketing
programme has shown a similar success, with the use
of Chlorine for household drinking water treatment
rising from 13.5% in 2001 to 42% in 2004
in Ghana the first phase of a national handwashing
with soap marketing programme has just been
it was deemed too early to measure actual behaviour
change after just six months of the intervention,
the initial results are extremely promising, with
very high levels of reported behaviour change.
evaluation of the first sixth month phase has
yielded promising results.
Among mothers, reports of handwashing with
soap before eating have risen by over 40%, and among
children (at home) by over 60%.
It is hard to believe that such great changes
in reported behaviour change have not been
accompanied by at least some degree of change in
Marketing – An effective approach to behaviour
conclusion, while the evidence for the effectiveness
of traditional health promotion approaches is
limited, social marketing may provide a fruitful
alternative in the promotion of household
environmental health, even at scale (as illustrated
by the three examples).
Indeed, the marketing approach to the
promotion of handwashing
with soap is taking off internationally as
indicated by the development of national and
state-wide handwash marketing programmes (via
public-private partnerships) in Ghana, Peru,
Senegal, South Africa, Indonesia, Madagascar, Nepal,
and Ethiopia among others (globalhandwashing.org).
Only if the approach held promise would it be
replicating so far.
discussed in another factsheet (Obika, 2005),
interest in a marketing approach to sanitation
programmes is also gaining impetus internationally.
to the social marketing approach is an exchange
process and an understanding of the target audience,
how and why they behave and what drives and prevents
adoption of the product or new behaviour.
It need not be a difficult approach to
references below should also serve as a guide to
A. (1995) Marketing Social Change: Changing
Behaviour to Promote health, Social Development, and
B. and Curtis, V. (1999) Effectiveness of
promotional techniques in environmental health
WELL Study No.165. London School of Hygiene
& Tropical Medicine for DFID www.lboro.ac.uk/well/resources/
A. (2005) The process for sanitation marketing.
WELL Factsheet. www.lboro.ac.uk/well/resources/factsheet/
N.K. (1999) Hands-on Social Marketing: A
Step-by-Step Guide. Sage Publications.
Schellenberg J. et al (2001). Effect of a
large-scale Social Marketing of Insecticide-treated
nets on Child Survival in rural Tanzania. In The
Lancet v.357: 1241-47
L. et al (2004) Safe Water Systems: An Evaluation
of the Zambia CLORIN Program: Narrative Safe Water
System Evaluation Final Report.
BACK TO TOP
Home > Resources > Fact sheets > Some global statistics for water and sanitation related disease