Addressing barriers to help-seeking behaviour through M-mental health services : a social marketing perspective

Although seeking help for mental ill-health is beneficial, the majority of persons afflicted do not access available help services. Young adults (16-24 years old) in particular have the highest prevalence of mental health problems and the lowest rate of help-seeking behaviour. Key barriers to help-seeking for young adults, including cost, privacy concerns, inconvenience, access to health professionals and interpersonal interaction, appear to derive from the face-to-face method of service delivery traditionally used to distribute mental health services. Social marketing employs the principle of value exchange, whereby consumers will choose a behaviour in exchange for receiving valued benefits and/or a reduction in key barriers, to achieve behavioural goals for social good. The appropriation of mobile digital technology to deliver self-help mental health services may reduce the current barriers to help seeking, however, extant literature offers no empirical support for this proposition. Our research addresses this gap by examining the perceptions of young adults regarding M-mental health services. Depth interviews were undertaken with 15 young adults (18-24 years old), who had self-reported mild-moderate stress, anxiety or depression. The data were thematically analysed with the assistance of Nvivo. The findings reveal M-mental health services reduce the barriers to accessing face-to-face help services to a large extent. However, they also present their own barriers to help-seeking that must be considered by social marketers, including negligible cost expectations and service efficacy concerns. Overall, this study highlights the potential of M-mental health services to encourage early intervention and help-seeking behaviour as part of a social marketing strategy to address mental illness in young adults.

Exploring urban consumers’ attitudes and intentions to purchase local food in Chile

Although local food consumption is growing in importance there remains a lack of research addressing local food consumption preferences in less-developed countries. This paper aims to examine the drivers of local food purchase intentions for Chilean consumers. A model of local food behavioral intention was developed from consumer behavior theory. The model was tested using structural equation modeling with data from Chilean shoppers located in Santiago (n=283). The analysis revealed that Chilean consumers are willing to purchase local food based on their positive attitude towards buying local food and their feelings of connectedness with the environment, but not because they have a desire to support local businesses. These findings have implications for retailers, marketers and food producers.

Delving deeper into maintenance behaviour

Andreasen (2003) argues that there is a ‘starting change’ bias in the social marketing field as much research is centred on inducing initial behavioural change. However, repeat or maintenance behaviour is often critical to achieving social goals across many domains. For instance, the repeat use of professional therapeutic services is vital for improved mental health, although premature discontinuance of service use is common (Wang, 2007). This study contributes to addressing this gap in the social marketing literature by exploring key drivers of maintenance behaviour, in the form of repeat service use, in mental health. This is in line with Andreasen’s (1994) argument that social marketing is an appropriate approach to addressing mental health challenges.

Understanding carers' intention for their child to walk to school : further application of the theory of reasoned action

One quarter of Australian children are overweight or obese (ABS, 2010), putting them at increased risk of physical and psychological health problems (Reilly et al., 2003). Overweight and obesity in childhood tends to persist into adulthood and is associated with premature death and morbidity (Reilly & Kelly, 2011). Increases in Australian children’s weight have coincided with declines in active transportation, such as walking, to school (Salmon et al., 2005). Investigating the factors which influence walking to school is therefore important, particularly since walking to school is a low cost and effective means of reducing excess weight (Rosenberg et al., 2006) that can be easily integrated into daily routine (Brophy et al., 2011). While research in this area has expanded (e.g., Brophy et al., 2011; Giles-Corti et al., 2010), it is largely atheoretical (exceptions Napier et al., 2011). This is an important gap from a social marketing perspective given the use of theory lies at the foundation of the framework (NSMC, 2006) and a continued lack of theory use is observed (Luca & Suggs, 2013). The aim of this paper is to empirically examine a widely adopted theory, the deconstructed Theory of Reasoned Action (TRA) (Fishbein & Azjen, 1975), to understand the relative importance of attitude and subjective norms in determining intentions to increase walk to school behaviour.

A stakeholder process evaluation of a social marketing walking intervention targeting children

One quarter of Australian children are overweight or obese (ABS, 2010), putting them at increased risk of physical and psychological health problems (Reilly et al., 2003). Overweight and obesity in childhood tends to persist into adulthood and is associated with premature death and morbidity (Reilly & Kelly, 2011). Increases in Australian children’s weight have coincided with declines in active transportation, such as walking, to school (Salmon et al., 2005). To address this problem, the Victorian Health Promotion Foundation (VicHealth), which is an independent statutory authority which advises government and contributes to promoting good health in Victoria (VicHealth, 2014), developed the Walk to School program. Walk to School aims to encourage primary school children in Victoria to walk to and from school more often. Walking to school is a low cost and effective means of reducing excess weight (Rosenberg et al., 2006) that can be easily integrated into daily routine (Brophy et al., 2011). The purpose of this paper is to present the results of the stakeholder process evaluation of Walk to School 2013, which forms part of a broader outcome evaluation that is currently in field. Although there is an emphasis on outcome evaluation of programs, process evaluation can be equally important in determining program success (Saunders et al., 2005). Further, process evaluation to assess program delivery and utilization is explicitly recommended by two social marketing frameworks (see Lefebvre et al., 1988; Walsh et al., 1993).

Segmenting Australian high school students : two-step cluster analysis preliminary results

A one size fits all approach dominates alcohol programs in school settings (Botvin et al., 2007), which may limit program effectiveness (Snyder et al., 2004). Programs tailored to the meet the needs and wants of adolescent groups may be more effective. Limited attention has been directed towards employing a full segmentation process. Where segmentation has been examined, the focus has remained on socio-demographic characteristics and more recently psychographic variables (Mathijssen et al., 2012). The current study aimed to identify whether the addition of behaviour could be used to identify segments. Variables included attitudes towards binge drinking (α = 0.86), behavioral intentions’ (α = 0.97), perceived behavioral control (PBC), injunctive norms (α = 0.94); descriptive norms (α = 0.87), knowledge and reported behaviour. Data was collected from five schools, n = 625 (32.96% girls). Two-Step cluster analysis produced a sample (n = 625) with a silhouette measure of cohesion and separation of 0.4. The intention measure and whether students reported previously consuming alcohol were the most distinguishing characteristics - predictor importance scores of (1.0). A four segment solution emerged. The first segment (“Male abstainers” – 37.2%) featured the highest knowledge score (M: 5.9) along with the lowest-risk drinking attitudes and intentions to drink excessively. Segment 2 (“At risk drinkers” - 11.2%) were characterised by their high-risk attitudes and high-risk drinking intentions. Injunctive (M: 4.1) and descriptive norms (M: 4.9) may indicate a social environment where drinking is the norm. Segment 3 (”Female abstainers” – 25.9%) represents young girls, who have the lowest-risk attitudes and low intentions to drink excessively. The fourth and final segment (boys = 67.4%) (“Moderate drinkers” – 25.7%) all report previously drinking alcohol yet their attitudes and intentions towards excessive alcohol consumption are lower than other segments. Segmentation focuses on identifying groups of individuals who feature similar characteristics. The current study illustrates the importance of including reported behaviour in addition to psychographic and demographic characteristics to identify unique groups to inform intervention planning and design. Key messages The principle of segmentation has received limited attention in the context of school-based alcohol education programs. This research identified four segments amongst 14-16 year high school students, each of which can be targeted with a unique, tailored program to meet the needs and wants of the target audience.

Game On: Know Alcohol - Co-creating a tailored alcohol social marketing program

Research demonstrates that education programs are more effective when their target audiences and other key stakeholder groups are involved in the design. The majority of programs continue to be researcher and expert driven. This study extends upon previous research by employing a co-creation research design to offer a consumer driven alternative to education program design. Two co-creation groups involving twenty 14-16 year old Year 10 students who had previously participated in the Game On:Know Alcohol (GOKA) program, which aims to moderate alcohol drinking attitudes and behaviour, were conducted. Analysis revealed that a co-created GOKA program will differ substantially from the researcher and expert driven program that is currently being field tested. Students prefer interactive activities and activities that engage and challenge. Co-creation offers the potential to contest researcher and expert views and may offer to assist in the generation of new insights for the development of education programs.

Game On: Know Alcohol - Interim findings from the first nine schools

A six module program designed to 1) show students the effects of alcohol, 2) impart knowledge of standard drinks and 3) provide students with strategies to moderate (or abstain) from alcohol drinking, is currently being tested in a cluster randomised control design in Queensland. This paper presents immediate evaluation results for the program that was designed using the eight National Social Marketing Centre (2009) benchmark criteria. Students have participated in baseline and/or immediate follow up evaluation in six intervention and three control schools to date. Early results suggest that Game On:Know Alcohol increases knowledge relating to alcohol and moderates attitudes towards binge drinking while maintaining behavioural intentions to drink alcohol excessively. Limitations of the current study and opportunities for future research are outlined.

Market segmentation : insights for changing children's physical activity behaviour

Market segmentation has received relatively limited attention in social marketing, particularly within the context of changing children’s physical activity behaviour. This is an important area of investigation given growing concern over childhood obesity globally. The present research aims to extend current understanding of the applicability of market segmentation within this context. The results of a two-step cluster analysis on data from 512 respondents of an online survey show three distinct segments of caregivers, each with unique beliefs about their primary school children walking to/from school. The results demonstrate the validity of employing the process of market segmentation within this social context and provide further insights for targeting the identified segments through tailored social marketing programs.

Competition and its influence on consumer decision making in social marketing

This paper extends the largely conceptual understanding of competition in social marketing by empirically investigating, from a consumer perspective, the nature of competition and its influence on decision making at the individual level. Two phases of qualitative inquiry in Australia, comprising 30 and 20 semi-structured interviews respectively, examined the role of competition in young adults’ decision to adopt and maintain help-seeking for mental ill-health. The findings from thematic analysis suggest that competition operates at both the behavioural and goal level to influence consumers’ decision to perform behaviour and that the types of competition in operation may vary from the adoption to the maintenance of behaviour. The findings are integrated into a framework that social marketers could employ to identify, analyse and address competition.

Maintaining or changing a drinking behavior? GOKA's short-term outcomes

During the critical neurobiological and social developmental period of adolescence, binge drinking of alcohol increases the risk of mental health problems, school exclusion, convictions, fatal and non-fatal accidents. The present research utilizes a simple cluster randomized control trial design to evaluate a social marketing program, Game On: Know Alcohol (GOKA), employing innovative online edutainment games to target binge drinking. Pre and post data were collected for seven program (942 students, mean age: 14.6 years) and five control schools (578 students, mean age: 14.4 years). Significant improvements in alcohol knowledge and affective attitude toward binge drinking was observed for adolescents who participated in GOKA compared to the control group, with maintenance of desirable subjective norms, instrumental attitudes and intentions. Given considerable external competition from messages promoting the benefits of alcohol use, a one-off program that modifies incorrect knowledge and alters perceptions of binge drinking as a fun, recreational activity represents an important step. This research contributes to current understanding of social marketing’s capacity to change drivers and maintain inhibitors of binge drinking intentions of adolescents and provides an important basis for future research in the domain.

Understanding caregivers’ intentions for their child to walk to school : further application of the theory of planned behaviour

Increases in childhood obesity have coincided with declines in active transportation to school. This research builds on largely atheoretical extant literature examining factors that influence walk to school behavior through application of the Theory of Planned Behavior (TPB). Understanding caregivers’ decision for their child to walk to/from school is key to developing interventions to promote this cost-effective and accessible health behavior. The results from an online survey of 512 caregivers provide support for the TPB, highlighting the important role of subjective norms. This suggests marketers should nurture caregivers’ perception that important others approve of walking to school.

A theoretical approach to segmenting children’s walking behaviour

Childhood obesity is a leading public health concern globally. This study aimed to extend research applying the principle of market segmentation to gain insight into changing the physical activity behaviour of children, particularly their walk to/from school behaviour. It further examined the utility of employing theory, specifically the Theory of Planned Behaviour (TPB), for this purpose. The study demonstrates the usefulness of behavioural, geographic and psychographic variables, as measured by the TPB, in distinguishing segments, offering an important contrast to prior segmentation studies emphasising demographic variables. This result provides empirical evidence of the value of employing the four segmentation bases, extending beyond a demographic focus, and the importance of incorporating behavioural theory in market segmentation. In so doing, this research provides key insights into changing children’s walking behaviour.

The impact of Internet marketing capabilities on international network capability, a cross country study comparison between Australia, Chile and Taiwan internationalised SMEs

The Internet has been shown to positively enhance internationalisation for SMEs, but scant empirical testing limits our understanding of the explicit impact of the Internet on firm internationalisation. This paper highlights key areas where the integration of the Internet can be leveraged through Internet-related capabilities within the internationalisation of the firm. Specifically, this study investigates how Internet marketing capabilities play a role in altering international information availability, international strategic orientation, and international business network relationships. This study provides evidence, indicating that these key relationships may vary between countries. To examine these key relationships this study utilises draws from data small and medium sized enterprises (SMEs) in three export intensive markets; Australia (215 international SMEs), Chile (204 international SMEs) and Taiwan (130 international SMEs); and tests a conceptual model through structural equation modelling. Results from the data show the impact of Internet marketing capabilities in positively impacting traditional internationalisation elements, which varies between countries. That is, our findings highlight the international business network relationships in Australia and Taiwan are directly impacted by Internet marketing capabilities, but not in Chile. We offer some insight into why we see variance across comparative exporting countries in how they leverage new technological capabilities for internationalisation and firm performance.