Free is not enough: Use of social marketing theory as a means for increasing client participation in a prenatal preventive health program

Although more preventive health programs are being funded and made available to needy populations, these services are not always successful in reaching the potential clients. Client Inducement Theory, an adaptation of social marketing theory for nursing, was developed as a framework for this study.The purposes of this study were (a) to identify factors which would predict the likelihood of members of an identified target population to consent to participation in preventive health programs which are designed to reduce the incidence of infant mortality and low-weight births, and (b) to investigate potential incentives to induce more women to choose to make use of such services.The sample consisted of 183 inner-city African American women who were found to be at risk for poor pregnancy outcome. Attitudes toward health behaviors, consumer satisfaction with services, and evaluation of service quality, as measured by standard instruments, were examined and correlated with consent to use a preventive health program designed to improve pregnancy outcomes (Healthy Start). The perceptions of high-risk mothers about the value of preventive health and usage of preventive programs were explored in unstructured interviews with 10 potential clients of the program. A taxonomy of behaviors involved in Getting a Healthy Start was constructed.The only statistically significant difference between the two groups on the instruments was that the Healthy Start group placed a higher value on gratification than impact in assessing consumer satisfaction as compared to the control group. For the total sample, there was a highly positive correlation between consumer satisfaction and perception of service quality. Results of all three instruments indicated favorable attitudes toward health behaviors, high consumer satisfaction, and positive evaluation of service quality. These findings were expressed verbally by the clients in the interviews. They were highly supportive of the use of incentives to increase participation.The study concluded that the reason some clients in the control group did not receive the Healthy Start services was because of lack of awareness of the program rather than refusal to participate. The Social Marketing process holds much potential for incorporation into nursing practice, education and research