Social marketing in public health: the adoption and diffusion of practice

Since its introduction as term in 1971, social marketing has undergone continuous developments. Evidence of its effectiveness as a behavioural change technique has been presented across various contexts including environment protection, injury prevention and health related issues. As a result, social marketing is increasingly applied and adopted by governments and public sector organizations in order to attain social good. Specifically, from a public health perspective, it is estimated that 70% of annual global mortality, approximately 40 million deaths/year, are attributed to non- communicable, chronic diseases such as cardiovascular diseases, cancer, diabetes and lung diseases. It is generally accepted that lifestyle factors and associated behaviours such as physical inactivity, smoking, and unhealthy diets contribute significantly to, and are largely driving, this increasing prevalence of non-communicable diseases (NCDs). Governments worldwide are shouldering a growing social and economic burden to mitigate the associated health and other related complications arising from this global NCD pandemic, a pandemic which is disproportionately affecting developing countries, including many Islamic nations. While public health organizations in western countries have been adopting and practicing social marketing to promote healthier lifestyles and behaviors, the adoption and diffusion of social marketing practice by such organizations in developing non-western countries has been much slower and not well investigated. Therefore, the main aim of this study is to contribute to our knowledge and understanding of social marketing through investigating whether, and how, social marketing is practiced and understood by the public health professionals in a developing non-western country context. To achieve this, this study uses the theories of diffusion of innovation, internal marketing, and organizational change in order to understand the implications associated with the adoption, and practice, of social marketing within public health organizations. In addition, the study utilizes the social marketing bench mark criteria (SMBMC) to determine whether, and how, social marketing principles are guiding the development of public health campaigns addressing NCDs. The Omani Ministry of Health has been selected as the case for this study. Oman, located in the southeast coast of the Arabian Peninsula, is considered the oldest independent state in the Arab world, with a population of approximately 4 million. Islam remains central to the Omani identity, with the majority of the country’s citizens being Ibadi Muslims. Oman has taken firm steps towards combating NCDs, as the first country in the region to create a National Multi-Sectoral Committee to address NCDs, and in 2016 was the first high income developing country to receive a United Nation’s integrity task force to help with the control and prevention of NCDs. A qualitative case study design is employed targeting three different groups from multiple levels of the organization. The study combines primary data collected via (n= 27) semi-structured face to face expert interviews, with detailed secondary data in the form of documents detailing all Omani public health campaigns developed to address NCDs between 1994-2017. The primary and secondary data was analysed through thematic data analysis and document analysis. The study’s theoretical contribution is as follows. Firstly, the findings indicate that social marketing is not comprehensively understood nor effectively utilized by Omani campaign developers and health educators. Despite their lack of understanding of the concept of social marketing, evidence of the utilisation of some elements of the SMBMC exist. However, this incomplete utilization of the SMBMC, in addition to the limited planning and evaluation efforts, indicate that campaigns are lacking a strategic view, which is required to accomplish behavioural change. This in turn leads to wasted resources and hampers the organisation’s efforts in combating NCDs. Secondly, findings from this study revealed that there is wide reliance on, and acceptance of, the use of religious references by health educators in Oman, as a culturally driven technique for influencing positive health related behaviors. This finding has addressed an identified gap in the literature concerning the differences in perceptions between western and Islamic contexts with regards to the adoption, and utilization, of religious references by public health campaign developers. Thirdly, the study found that organizational officials and decision makers have limited knowledge and understanding of social marketing despite its place in the organisation’s strategy since 2007, which in turn has contributed to its lack of adoption, and diffusion of practice, within the organization. As result, there has been limited training opportunities and resources allocated to support its adoption and practice. This finding affirms the existing literature which indicates that social marketing needs to be effectively internally marketed before it can be comprehensively practised. Therefore, internally marketing social marketing within an organisation is required to inform and educate decision makers about the benefits and relevance of social marketing to their organization, before it can be effectively adopted. In addition to the theoretical contributions, this study provides important practical implications pertaining to the prevention of NCDs, through the adoption of social marketing by public organizations in a non-western country context