Public Health Managers' Perspectives on the Use of Social Marketing Among Public Health Nurses in Saskatchewan
Social marketing is a branch of health communication that has, over the last thirty years, become widely accepted in public health practice. By definition, "social marketing is the use of marketing principles and techniques to influence a target audience to voluntarily accept, reject, modify, or abandon behavior for the benefit of individuals, groups, or society as a whole" (Kotler, Roberto, & Lee, 2002, p. 5). Because social marketing is consumer focused and client centered, it is consistent with the accepted paradigm of health promotion in public health nursing. In Canada, population focused health promotion strategies, such as social marketing, are an integral part of the mandate of public health nurses (PHNs) (Community Health Nurses Association of Canada, 2003). Despite this mandate, a review of recent literature points to a misunderstanding and under-use of the strategy (McDermott, 2000; Quinn, Albrecht, Marshall, & Akintobi, 2005; Schoenfeld & MacDonald, 2002). Using a qualitative approach, the author of this study examined the use of social marketing among public health nurses from the perspective of public health managers in the province of Saskatchewan. Community based action research approach was used to identify enablers, barriers and strategies associated with social marketing use. In addition, a quantitative participant demographics questionnaire was employed to aid in the analysis of qualitative data. Two health regions were chosen for data collection sites as convenience samples in this study. Within these health regions, complete population sampling was employed. The total population group comprised of 19 public health managers. Of these, 12 directly managed, and 7 indirectly managed public health nurses. The total number of study participants was 11 of 12 direct managers, representing 92% of that population. Within focus group sessions, enablers and barriers to the use of social marketing were identified using nominal group process. Enablers included: BSN preparation, client centered and evidence-based practice, established community relationships, nature of health challenges, and support of nursing organizations. Barriers included: human resources, financial resources, familiarity with the strategy, and formal process to maintain momentum. Strategies for reinforcing enablers and overcoming barriers were also identified in group discussion. These included: a social marketing elective in health science, an increase in the number of PHNs and support staff, core funding for social marketing, in-service training, and a social marketing consultant. Ultimately, an increase in the awareness of social marketing among upper-level health management was identified as a necessary precursor to the successful implementation of all the identified strategies. Finally, the potential applicability of two theoretical models in explaining and/or predicting the influence of factors on public health nurses' use of social marketing in Saskatchewan was explored. The Diffusion of Innovation Model was proposed as a framework through which to examine the factors associated with social marketing use because of its inclusion of both individual and system level influences. It was determined that the Health Promotion Model was not the most appropriate model for this purpose, as it primarily focused on individual influences on behavior. This focus was inconsistent with the system level nature of factors identified by participants. It is the hope of the researcher that an understanding of the factors associated with social marketing use among PHNs may facilitate its diffusion throughout public health in Saskatchewan. The resulting increase in social marketing campaigns could have significant potential for the promotion of health in this province.