The Boston Public Health Commission Play Safe Campaign: An Under-Developed Use of Social Marketing Theory– Sara Gille
Introduction
According to the Institute for Highway Safety a total of 630 bicyclists were killed in crashes involving motor vehicles alone in 2009, the most recent year that data from the U.S. Department of Transportation’s Fatality Analysis Reporting System was analyzed (6). Of those killed, over 91% were not wearing helmets (6). At Boston Medical Center, New England’s busiest trauma center, only 10 of the 60 patients treated for bicycle related injuries were wearing helmets (4). Riders under the age of 21 account for the majority of the 500,000 bicycle accidents occurring yearly in the United States, and this age group also has one of the lowest proportion of bicycle helmet use among all age groups (5).
The Boston Public Health Commission introduced the Play Safe Bicycle and Other Sports Safety campaign (the Campaign) to encourage helmet use in children and youth in the city of Boston (3). It is widely known that head injury is the most reported type of injury sustained by bicyclists, and the most likely to cause death (11), thus helmet use would be an appropriate intervention to reduce injury in children and youth in Boston.
The Campaign used aspects of social marketing to target two groups: parents of children under age 17 (when a child is legally required by Massachusetts law to wear a helmet) and youth over the age of 17. The message aimed at parents focused on increasing awareness of i) the injuries caused by bicycle accidents, ii) how the use of helmets can decrease or prevent injury, iii) the law requiring helmet use for children under age 17 and iv) the discounted helmet program offered in conjunction with the Boston Medical Center Emergency Department.
The message aimed at youth, centered around three short videos promoting “three reason’s you’d be cooler in a helmet (3).” The first video “You’d be cooler in a helmet. Literally!” shows a group of sweaty youth sitting on a bench wiping their brow, with the final person wearing a helmet and smiling. The second, “Helmet romance,” shows a girl in a coffee shop turning away a potential suitor (sans helmet) followed by the successful approach of a young man wearing a helmet. The final video, “The intervention,” features a group of peers holding an “intervention” for a non-helmet wearing friends about the dangers of riding without a helmet. The videos ended with a link to the Healthy Boston Facebook page, where viewers could register to win a free bike.
Using insights from Social Marketing Theory and Social Cognitive Theory, this paper will explain how the Play Safe Campaign failed in its design in three distinct ways: through a misguided message, a non-engaging medium, and missed methods of reaching its target . Once the shortcomings of the Campaign have been established, this paper will offer explicit ways in which this Campaign can apply the understandings of Social Marketing and Social Cognitive Theories to improve the outcomes of the Campaign.
Frameworks for Health Intervention
Social Marketing Theory presents a framework for promoting a health intervention to a media-receptive public. It employs the same concepts of corporate marketing, Product, Price, Place and Promotion, and then adds a few of its own, Publics, Partnership and Policy (10). According to Social Marketing Theory, these different elements of a marketing campaign must match the needs, desires and abilities of your target population in order to have an effective campaign and “sell” your product (10). This paper will show that while the Campaign applied aspects of this theory, it did so inadequately and inconsistently, thereby reducing the potential impact of the campaign.
Social Cognitive Theory is a way of explaining behavior that incorporates environmental and personal factors (10). The premise behind Social Cognitive Theory is that individual behavior is influenced by more than just personal preference; it is shaped through interactions with an individual’s physical and social environment and through self-efficacy, or their belief that they can undertake and succeed with a new behavior within their environment (10). The following critiques demonstrate how the Campaign did not utilize insights from Social Cognitive Theory that would aid in achieving increased helmet use.
The Misguided Message
One critique of the design of the Play Safe Campaign is the messaging the Campaign chose. Specifically, the Campaign lacked coherent or relevant products and pricing to appeal to its target audience, children and teens. Social Marketing Theory emphasizes that a successful campaign should offer a “product” that is appealing and relevant to the target populations.
Product: The Play Safe Campaign videos attempted to promote helmets as a product that makes teens “cooler”, both physically and socially. They miss their mark by portraying actors in situations that, although humorous, are unrealistic. Helmets generally do not cool your head, it is far-fetched to believe that wearing a helmet indoors makes you more attractive, and a group of friends are unlikely to get together to have an intervention about your helmet use. These types of unrealistic portrayals have been shown to have a limited effect on behavior change (7). The “Intervention” video has five friends sitting in a living room when their friend bikes over, without a helmet, and enters the room. His friends then proceed to have a serious talk using very mature language about their “intervention” to get him to use his helmet, because they care about him. Apart from being unrealistic, the video could induce psychological reactance, which is when the audience reacts negatively to a message that they feel threatens their sense of freedom (10). The Campaign poster, which states, “Use Your Head! Wear a Helmet!” could also cause reactance with youth and teens averse to the authoritarian tone of the message.
Price: The material price of the helmet for in the Play Safe Campaign is $5, when purchased at Boston Medical Center (BMC). For users, the actual “price” of the helmet is more than monetary. For parents, it is also the expense of taking the time to travel to BMC and to measure their child’s head for the helmet. Furthermore, a parent may not want a discounted helmet for their child, because they may see it as being of inferior quality because of the decreased cost. For teens, the “price” of wearing a helmet could be their social status and standing, if they do not already have a social group that supports helmet use. The Campaign attempts to persuade its audience, parents of children, and teens, that the price of not wearing a helmet is serious injury and possible death, by listing statistics and facts on their website. While this may be affective in appealing to a core value of parents, protecting their children, it does not appeal to the core values of teens, which is to be respected by their peers.
The Non-Engaging Medium
The second critique of the Campaign was the ways in which the city attempted to reach the target. This includes where the Campaign promoted and advertised the campaign, as well as what the how interactive and engaging their campaign materials were.
Place: The “Place” is where the audience will be exposed to the campaign message (3). In the Play Safe Promotion the Campaign messages were advertised on posters at BMC (where the helmets are sold in the gift shop for $5) and on the internet through the Boston Public Health Commission website, Boston Medical Center Trauma webpage, and Facebook. It has been suggested by analyzing user data that online-health seekers are typically college-educated with higher incomes (7)-not the demographic in need of discounted helmets. Therefore, limiting the Campaign to promotion on the internet (especially on a page that was not easy to find) limited the exposure to the Campaign’s target audience.
The Campaign website is dominated with information about bicycle injury statistics, the rules of the road, how to play safe, and bicycle fit and maintenance, with information about discounted helmets bolded and the three teen-oriented videos embedded towards the bottom of the page. Much of this information is written for the parent who will make their child wear a helmet, not to the teen that will likely be making the decision about helmet use on their own. In order to engage the teen audience, the information relevant to them-the videos and the Facebook page, should be prominently located and easy to find, which it is not. Otherwise they will click out of the webpage (7). The Campaign page is not immediately accessible from the home page of the Boston Public Health Commission, and the link to the Healthy Boston Facebook page is only visible at the end of the videos. In order for a Social Marketing Campaign to be effective, the audience should be able to interact easily with agents delivering the message, either a person or a webpage (7). Other than on Facebook, there is no space to leave comments or to ask questions on the page, only a phone number, e-mail and fax for a general Injury Prevention Program.
Promotion: Social Marketing Theory also highlights the use of promotions, either in the form of discounts or free products, to encourage behavioral change. The Campaign utilized a promotion, but the promotion offered was inadequate. The main Promotion used in the Play Safe Campaign is discounted helmets offered through a partnership with Boston Medical Center, and the Free Bike Giveaway offered on their Facebook page (although no information on the giveaway could be found at the time of writing). The problem with these offers is that they are one-off activities; they fail to engage the audience in the Campaign in a sustained way (8). Once the teen or parent has the helmet, or wins the free bike, they have no incentive to return to the website or to stay connected to the Campaign, or to the Campaign goal of increased regular helmet use.
The Missed Methods
Finally, the Campaign failed to fully utilize all the methods central to both Social Marketing and Social Cognitive Theories. The final three “Ps” of Social Marketing Theory, public, partnerships and policy, recognize the impact of two key Social Cognitive Theory concepts: the role of environment and self-efficacy on behavior (10). An effective Social Marketing campaign would incorporate these concepts into its campaign, yet the Play Safe Campaign does not succeed in using the Public or Partnerships to their full potential.
Public: This aspect of Social Marketing Theory refers to the influence of those who comprise the wider social circle of the individual whose behavior the campaign is trying to change (10). In the Play Safe Campaign the influence of a child or teen’s parent is thought of only as a resource for providing a helmet, and as an authoritarian figure who “insist that children wear” their helmets when cycling, according to the Campaign website (3). By only focusing on a child’s helmet use, and not directly promoting helmet use by parents themselves, the Campaign neglects an important environmental source for modeling behavior.
Simply providing information about the “Rule of the Road,” “Sports Safety,” and “Bicycle Fit and Maintenance” on the Campaign website is not going to cause a teen to adopt and follow all the recommendations, and it is not going to give them the self-efficacy, or confidence, to believe that they can adopt those behaviors and successfully maintain them. Studies have shown that parents and peers influence helmet use behavior (5). Teens need to see a role model have success with helmet use and bicycle safety in order to feel confident in his or her own ability (9).
Partnerships: The Play Safe Campaign also failed to exploit the power of partnerships in their campaign to promote helmet use. The only partnership advertized on their website was with Boston Medical Center, who sold the $5 helmets in their gift shop and provided information on safe helmet use on their Boston Trauma blog (4). Although it is accessible by public transportation, the Boston Medical Center gift shop is not in an ideal location. There is limited free parking in the South End neighborhood of Boston, it is near a very busy intersection, and it is in a hospital, not an environment generally associated with safety. Furthermore, there is no additional incentive or benefit for the parent, child or teen to go to the hospital. They cannot provide additional information about safe biking, or be a source for peer role models in biking and helmet use in the way that a bike shop could (8).
Policy: The final “P” in Social Marketing Theory, is for Policy. Policies enacted by governments, schools and communities can have a profound effect on the environment that an individual acts within, and can work to increase the self-efficacy of the targeted individuals. But policies can also be over-emphasized, and the effect of a policy can be diluted if it is not regularly enforced. The helmet law in Massachusetts requires that all residents under the age of 17 wear a helmet while riding a bicycle, and the Play Safe Campaign does discuss the law on their website. Highlighting the law on the website may actually cause psychological reactance, discussed earlier, in some teens who see the law as an infringement of their personal freedom, and to exercise that freedom they may choose to not wear a helmet.
Articulation of Proposed Intervention
The Play Safe Campaign of the Boston Public Health Commission has many serious flaws, as outlined above, that prevent it from effectively increasing helmet use in children and teens in Boston. Although the Campaign appears to be based on Social Marketing Theory, it provides a misguided message, uses a non-engaging medium, and does not utilize all possible methods of reaching its target audience, thereby limiting the ability to build a strong Campaign to increase helmet use in youth and teens. Additionally, the Campaign failed to fully incorporate insights from Social Cognitive Theory, which have clear applicable benefits to a public campaign such as this.
What could they have done better? The three sections below describe ways in which the Boston Public Health Commission could adjust their current Campaign to better incorporate the tenets of Social Marketing Theory and by incorporating aspects of Social Cognitive Theory.
A Direct Message
The “product” that the Play Safe Campaign should be trying to “sell” to youth and teens in Boston is not increased helmet use to reduce injury. They should be trying to sell the idea that wearing a helmet makes you part of a popular campaign that you would want not only to be a part of, but to promote among your friends and family as well. Youth should be a part of the Campaign process, from designing the slogan, to creating a logo to “brand” the Campaign (8). Social Cognitive Theory says that the perceived social norms of a group can influence individuals to act in accordance with those norms, even if the truth is that the majority of the individuals in the group would not choose to act in line with these norms if they were outside of social influence, for example many teens believe that all teens have sex before college, yet most teens wish they had waited to have sex (9). Therefore, the Play Safe Campaign should focus on shifting the perception of the norm to that of regular helmet use.
One effective way to shift perceptions of the norm is through TV and promotions involving young, popular people in youth culture. The YouTube videos on the Campaign website showed young, attractive teens wearing helmets in their videos, but they were not widely distributed and, as previously mentioned, did not portray teens wearing helmets in realistic situations. Young people spend 3 to 4 hours a day watching TV, and gain self-efficacy in performing activities they see actors perform with success through programming (9). This means that the Boston Public Health Commission should craft a public service announcement (PSA) to be aired in the evening, at a time when youth are most likely to be watching TV, that features a local sports figure or actor promoting helmet use. Another alternative would be to feature a popular BMX biker or skateboarder who wears a helmet, although there is the risk that youth would not connect their bike riding behavior to that of a professional BMX rider, and therefore decide that a helmet is not necessary for them.
If airing a TV spot with a famous actor is out of the budget for the Boston Public Health Commission, another alternative would be to share personal stories of youth who have survived serious bicycle accidents because they were wearing their helmet. Social Cognitive Theory tells us that individuals learn through the stories of others (10). The videos currently on the Campaign website are not real stories. However, there are a few videos on the Boston Trauma website of patients sharing their true stories of survival due to their helmet use (4). These types of stories should be in a prominent location on the Campaign website.
The Engaging Medium
The “place” for finding Campaign information was not visually appealing or easy to interact with. In order for an audience to feel like they are involved in the Campaign, they need to be able to interact with the Campaign material and media. As youth are a target audience, it makes sense to use Facebook to connect and to promote the messages of the Campaign. However, information on the Campaign should be easy to find, share, and interact with. There should be an easy way to submit questions on helmet use, locations, and styles. As three of the top reasons for not wearing a helmet among youth and adults are that it is uncomfortable, hot and ugly (5) there should be a section to exchange pictures and suggestions for comfortable, cool and fashionable helmets that Campaign viewer’s have purchased and had success with. Contests, such as the free bike giveaway, could be made a more regular part of the Campaign, but on a smaller scale to enable more frequent giveaways and to keep the target audience engaged. A contest to find and post a picture of someone wearing a helmet in their community, or to find a clip of someone wearing a helmet on TV or in a movie, on the Facebook page would encourage the target audience to find out for themselves what the true norm is in their community, and to shift their attention to seeking out examples of positive behavior in their environment. In Social Cognitive Theory this is the concept of “situational perception,” or how the individual perceives what is happening in their environment (10).
Increased Methods
The Play Safe Campaign is actively partnered with Boston Medical Center to provide discounted helmets in their gift shop. While this is positive, the Campaign would have more success by partnering with organizations that youth and teens find more accessible and that they are more likely to find positive role models that they can relate to (8). Bike shops have more variety in the types of helmets they carry, and youth and teens would have the freedom to express their personality by not being forced to buy a generic helmet from the hospital gift shop. This freedom of choice will lessen the possibility for psychological reactance to take hold. They may also be encouraged to learn more about biking in general, find bike maps, learn about bike maintenance and safety, and to see bike shop employees naturally promote helmet use (8). Furthermore, by bringing the Campaign to more neighborhood bike shops throughout Boston, the self-efficacy of the target audience is increased; they will believe that it is possible to get a helmet because it is physically accessible to them, rather than having the barrier of taking public transportation or asking for a ride to the Boston Medical Center, a large intimidating structure in what may be an unfamiliar part of town.
In addition to partnering with bike shops, the Play Safe Campaign should shift a part of its resources to encouraging parents to wear helmets themselves, not just to impose compliance with the law by making their children wear helmets. According to Social Cognitive Theory, individuals watch the actions and behavior’s of those they admire (both those in their lives, such as parent, teacher’s and friends, and actors on TV) and use what they see to inform their own actions (9). Other than the 11-19 year old age group, 30-39 year olds have one of the smallest percentages of helmet use out of all age groups (5). Studies have shown that their reasons for not wearing them are similar to those of children and youth; they don’t own one, they find them hot, they find them annoying (5). These 30-39 year olds could potentially be the parents of 11-19 year olds, and as previously mentioned, teens are influenced by the behavior of theiparents (5). Therefore it makes sense to target parents helmet wearing behavior directly, even though they are considered “secondary” targets of the intervention.
Conclusion
In summary, the Play Safe Campaign of the Boston Public Health Campaign fails to adequately market helmets and increased helmet use to the parents of children and to the teens and youth of Boston. While elements of Social Marketing Theory are applied (teen actors in videos, a Facebook page), the Campaign appears piecemeal and incomplete. The risks of injury from not wearing a helmet are over-emphasized, while the benefits of being a part of a greater social campaign are overlooked. With a few adjustments, utilizing insights from Social Marketing and Social Cognitive Theories, the Campaign could see success; however, it will require the feedback and input from Boston youth themselves, a reworking of the Campaign web pages, and a wider net of partnerships with local bike shops and local or national teen figures.
REFERENCES
1. Bicycle Helmet Safety Institute. Bicycle Helmet Statistics.
2. Boston Bikes. Safety Campaigns. Boston, MA.
3. Boston Public Health Commission. Play Safe-Bicycle and Sports Safety. Boston, MA.
4. Boston Trauma. Boston Medical Center Injury Prevention. Boston, MA.
5. Finnoff J., Laskowski E., Altman K. and Diehl N. Barriers to bicycle helmet use. Pediatrics 2001. 108(4): 1-7.
6. Insurance Institute for Highway Safety. Research: Fatality Facts 2009.
7. Lin C. and Hullman G. Tobacco-prevention messages online: social marketing via the web. Health Communication 2005. 18(2):177-193.
8. Ludwig T., Buchholz C. and Clarke S. Using social marketing to increase the use of helmets among bicyclists. Journal of American College Health 2005. 54(1):51-58.
9. Martino S., Collins R., Danouse E. et al. Social cognitive processes mediating the relationship between exposure to television’s sexual content and adolescent’s sexual behavior. Journal of Personality and Social Psychology 2005; 89(6):914-924.
10. Sharma M. and Romas J. Theoretical Foundations of Health Education and Health Promotion. Sudbury, MA: Jones and Bartlett Publishers, 2008.
11. Thompson DC., Rivara F. and Thompson R. Helmets for preventing head and facial injuries in bicyclists. Cochrane Database of Systematic Reviews 1999.
Introduction
According to the Institute for Highway Safety a total of 630 bicyclists were killed in crashes involving motor vehicles alone in 2009, the most recent year that data from the U.S. Department of Transportation’s Fatality Analysis Reporting System was analyzed (6). Of those killed, over 91% were not wearing helmets (6). At Boston Medical Center, New England’s busiest trauma center, only 10 of the 60 patients treated for bicycle related injuries were wearing helmets (4). Riders under the age of 21 account for the majority of the 500,000 bicycle accidents occurring yearly in the United States, and this age group also has one of the lowest proportion of bicycle helmet use among all age groups (5).
The Boston Public Health Commission introduced the Play Safe Bicycle and Other Sports Safety campaign (the Campaign) to encourage helmet use in children and youth in the city of Boston (3). It is widely known that head injury is the most reported type of injury sustained by bicyclists, and the most likely to cause death (11), thus helmet use would be an appropriate intervention to reduce injury in children and youth in Boston.
The Campaign used aspects of social marketing to target two groups: parents of children under age 17 (when a child is legally required by Massachusetts law to wear a helmet) and youth over the age of 17. The message aimed at parents focused on increasing awareness of i) the injuries caused by bicycle accidents, ii) how the use of helmets can decrease or prevent injury, iii) the law requiring helmet use for children under age 17 and iv) the discounted helmet program offered in conjunction with the Boston Medical Center Emergency Department.
The message aimed at youth, centered around three short videos promoting “three reason’s you’d be cooler in a helmet (3).” The first video “You’d be cooler in a helmet. Literally!” shows a group of sweaty youth sitting on a bench wiping their brow, with the final person wearing a helmet and smiling. The second, “Helmet romance,” shows a girl in a coffee shop turning away a potential suitor (sans helmet) followed by the successful approach of a young man wearing a helmet. The final video, “The intervention,” features a group of peers holding an “intervention” for a non-helmet wearing friends about the dangers of riding without a helmet. The videos ended with a link to the Healthy Boston Facebook page, where viewers could register to win a free bike.
Using insights from Social Marketing Theory and Social Cognitive Theory, this paper will explain how the Play Safe Campaign failed in its design in three distinct ways: through a misguided message, a non-engaging medium, and missed methods of reaching its target . Once the shortcomings of the Campaign have been established, this paper will offer explicit ways in which this Campaign can apply the understandings of Social Marketing and Social Cognitive Theories to improve the outcomes of the Campaign.
Frameworks for Health Intervention
Social Marketing Theory presents a framework for promoting a health intervention to a media-receptive public. It employs the same concepts of corporate marketing, Product, Price, Place and Promotion, and then adds a few of its own, Publics, Partnership and Policy (10). According to Social Marketing Theory, these different elements of a marketing campaign must match the needs, desires and abilities of your target population in order to have an effective campaign and “sell” your product (10). This paper will show that while the Campaign applied aspects of this theory, it did so inadequately and inconsistently, thereby reducing the potential impact of the campaign.
Social Cognitive Theory is a way of explaining behavior that incorporates environmental and personal factors (10). The premise behind Social Cognitive Theory is that individual behavior is influenced by more than just personal preference; it is shaped through interactions with an individual’s physical and social environment and through self-efficacy, or their belief that they can undertake and succeed with a new behavior within their environment (10). The following critiques demonstrate how the Campaign did not utilize insights from Social Cognitive Theory that would aid in achieving increased helmet use.
The Misguided Message
One critique of the design of the Play Safe Campaign is the messaging the Campaign chose. Specifically, the Campaign lacked coherent or relevant products and pricing to appeal to its target audience, children and teens. Social Marketing Theory emphasizes that a successful campaign should offer a “product” that is appealing and relevant to the target populations.
Product: The Play Safe Campaign videos attempted to promote helmets as a product that makes teens “cooler”, both physically and socially. They miss their mark by portraying actors in situations that, although humorous, are unrealistic. Helmets generally do not cool your head, it is far-fetched to believe that wearing a helmet indoors makes you more attractive, and a group of friends are unlikely to get together to have an intervention about your helmet use. These types of unrealistic portrayals have been shown to have a limited effect on behavior change (7). The “Intervention” video has five friends sitting in a living room when their friend bikes over, without a helmet, and enters the room. His friends then proceed to have a serious talk using very mature language about their “intervention” to get him to use his helmet, because they care about him. Apart from being unrealistic, the video could induce psychological reactance, which is when the audience reacts negatively to a message that they feel threatens their sense of freedom (10). The Campaign poster, which states, “Use Your Head! Wear a Helmet!” could also cause reactance with youth and teens averse to the authoritarian tone of the message.
Price: The material price of the helmet for in the Play Safe Campaign is $5, when purchased at Boston Medical Center (BMC). For users, the actual “price” of the helmet is more than monetary. For parents, it is also the expense of taking the time to travel to BMC and to measure their child’s head for the helmet. Furthermore, a parent may not want a discounted helmet for their child, because they may see it as being of inferior quality because of the decreased cost. For teens, the “price” of wearing a helmet could be their social status and standing, if they do not already have a social group that supports helmet use. The Campaign attempts to persuade its audience, parents of children, and teens, that the price of not wearing a helmet is serious injury and possible death, by listing statistics and facts on their website. While this may be affective in appealing to a core value of parents, protecting their children, it does not appeal to the core values of teens, which is to be respected by their peers.
The Non-Engaging Medium
The second critique of the Campaign was the ways in which the city attempted to reach the target. This includes where the Campaign promoted and advertised the campaign, as well as what the how interactive and engaging their campaign materials were.
Place: The “Place” is where the audience will be exposed to the campaign message (3). In the Play Safe Promotion the Campaign messages were advertised on posters at BMC (where the helmets are sold in the gift shop for $5) and on the internet through the Boston Public Health Commission website, Boston Medical Center Trauma webpage, and Facebook. It has been suggested by analyzing user data that online-health seekers are typically college-educated with higher incomes (7)-not the demographic in need of discounted helmets. Therefore, limiting the Campaign to promotion on the internet (especially on a page that was not easy to find) limited the exposure to the Campaign’s target audience.
The Campaign website is dominated with information about bicycle injury statistics, the rules of the road, how to play safe, and bicycle fit and maintenance, with information about discounted helmets bolded and the three teen-oriented videos embedded towards the bottom of the page. Much of this information is written for the parent who will make their child wear a helmet, not to the teen that will likely be making the decision about helmet use on their own. In order to engage the teen audience, the information relevant to them-the videos and the Facebook page, should be prominently located and easy to find, which it is not. Otherwise they will click out of the webpage (7). The Campaign page is not immediately accessible from the home page of the Boston Public Health Commission, and the link to the Healthy Boston Facebook page is only visible at the end of the videos. In order for a Social Marketing Campaign to be effective, the audience should be able to interact easily with agents delivering the message, either a person or a webpage (7). Other than on Facebook, there is no space to leave comments or to ask questions on the page, only a phone number, e-mail and fax for a general Injury Prevention Program.
Promotion: Social Marketing Theory also highlights the use of promotions, either in the form of discounts or free products, to encourage behavioral change. The Campaign utilized a promotion, but the promotion offered was inadequate. The main Promotion used in the Play Safe Campaign is discounted helmets offered through a partnership with Boston Medical Center, and the Free Bike Giveaway offered on their Facebook page (although no information on the giveaway could be found at the time of writing). The problem with these offers is that they are one-off activities; they fail to engage the audience in the Campaign in a sustained way (8). Once the teen or parent has the helmet, or wins the free bike, they have no incentive to return to the website or to stay connected to the Campaign, or to the Campaign goal of increased regular helmet use.
The Missed Methods
Finally, the Campaign failed to fully utilize all the methods central to both Social Marketing and Social Cognitive Theories. The final three “Ps” of Social Marketing Theory, public, partnerships and policy, recognize the impact of two key Social Cognitive Theory concepts: the role of environment and self-efficacy on behavior (10). An effective Social Marketing campaign would incorporate these concepts into its campaign, yet the Play Safe Campaign does not succeed in using the Public or Partnerships to their full potential.
Public: This aspect of Social Marketing Theory refers to the influence of those who comprise the wider social circle of the individual whose behavior the campaign is trying to change (10). In the Play Safe Campaign the influence of a child or teen’s parent is thought of only as a resource for providing a helmet, and as an authoritarian figure who “insist that children wear” their helmets when cycling, according to the Campaign website (3). By only focusing on a child’s helmet use, and not directly promoting helmet use by parents themselves, the Campaign neglects an important environmental source for modeling behavior.
Simply providing information about the “Rule of the Road,” “Sports Safety,” and “Bicycle Fit and Maintenance” on the Campaign website is not going to cause a teen to adopt and follow all the recommendations, and it is not going to give them the self-efficacy, or confidence, to believe that they can adopt those behaviors and successfully maintain them. Studies have shown that parents and peers influence helmet use behavior (5). Teens need to see a role model have success with helmet use and bicycle safety in order to feel confident in his or her own ability (9).
Partnerships: The Play Safe Campaign also failed to exploit the power of partnerships in their campaign to promote helmet use. The only partnership advertized on their website was with Boston Medical Center, who sold the $5 helmets in their gift shop and provided information on safe helmet use on their Boston Trauma blog (4). Although it is accessible by public transportation, the Boston Medical Center gift shop is not in an ideal location. There is limited free parking in the South End neighborhood of Boston, it is near a very busy intersection, and it is in a hospital, not an environment generally associated with safety. Furthermore, there is no additional incentive or benefit for the parent, child or teen to go to the hospital. They cannot provide additional information about safe biking, or be a source for peer role models in biking and helmet use in the way that a bike shop could (8).
Policy: The final “P” in Social Marketing Theory, is for Policy. Policies enacted by governments, schools and communities can have a profound effect on the environment that an individual acts within, and can work to increase the self-efficacy of the targeted individuals. But policies can also be over-emphasized, and the effect of a policy can be diluted if it is not regularly enforced. The helmet law in Massachusetts requires that all residents under the age of 17 wear a helmet while riding a bicycle, and the Play Safe Campaign does discuss the law on their website. Highlighting the law on the website may actually cause psychological reactance, discussed earlier, in some teens who see the law as an infringement of their personal freedom, and to exercise that freedom they may choose to not wear a helmet.
Articulation of Proposed Intervention
The Play Safe Campaign of the Boston Public Health Commission has many serious flaws, as outlined above, that prevent it from effectively increasing helmet use in children and teens in Boston. Although the Campaign appears to be based on Social Marketing Theory, it provides a misguided message, uses a non-engaging medium, and does not utilize all possible methods of reaching its target audience, thereby limiting the ability to build a strong Campaign to increase helmet use in youth and teens. Additionally, the Campaign failed to fully incorporate insights from Social Cognitive Theory, which have clear applicable benefits to a public campaign such as this.
What could they have done better? The three sections below describe ways in which the Boston Public Health Commission could adjust their current Campaign to better incorporate the tenets of Social Marketing Theory and by incorporating aspects of Social Cognitive Theory.
A Direct Message
The “product” that the Play Safe Campaign should be trying to “sell” to youth and teens in Boston is not increased helmet use to reduce injury. They should be trying to sell the idea that wearing a helmet makes you part of a popular campaign that you would want not only to be a part of, but to promote among your friends and family as well. Youth should be a part of the Campaign process, from designing the slogan, to creating a logo to “brand” the Campaign (8). Social Cognitive Theory says that the perceived social norms of a group can influence individuals to act in accordance with those norms, even if the truth is that the majority of the individuals in the group would not choose to act in line with these norms if they were outside of social influence, for example many teens believe that all teens have sex before college, yet most teens wish they had waited to have sex (9). Therefore, the Play Safe Campaign should focus on shifting the perception of the norm to that of regular helmet use.
One effective way to shift perceptions of the norm is through TV and promotions involving young, popular people in youth culture. The YouTube videos on the Campaign website showed young, attractive teens wearing helmets in their videos, but they were not widely distributed and, as previously mentioned, did not portray teens wearing helmets in realistic situations. Young people spend 3 to 4 hours a day watching TV, and gain self-efficacy in performing activities they see actors perform with success through programming (9). This means that the Boston Public Health Commission should craft a public service announcement (PSA) to be aired in the evening, at a time when youth are most likely to be watching TV, that features a local sports figure or actor promoting helmet use. Another alternative would be to feature a popular BMX biker or skateboarder who wears a helmet, although there is the risk that youth would not connect their bike riding behavior to that of a professional BMX rider, and therefore decide that a helmet is not necessary for them.
If airing a TV spot with a famous actor is out of the budget for the Boston Public Health Commission, another alternative would be to share personal stories of youth who have survived serious bicycle accidents because they were wearing their helmet. Social Cognitive Theory tells us that individuals learn through the stories of others (10). The videos currently on the Campaign website are not real stories. However, there are a few videos on the Boston Trauma website of patients sharing their true stories of survival due to their helmet use (4). These types of stories should be in a prominent location on the Campaign website.
The Engaging Medium
The “place” for finding Campaign information was not visually appealing or easy to interact with. In order for an audience to feel like they are involved in the Campaign, they need to be able to interact with the Campaign material and media. As youth are a target audience, it makes sense to use Facebook to connect and to promote the messages of the Campaign. However, information on the Campaign should be easy to find, share, and interact with. There should be an easy way to submit questions on helmet use, locations, and styles. As three of the top reasons for not wearing a helmet among youth and adults are that it is uncomfortable, hot and ugly (5) there should be a section to exchange pictures and suggestions for comfortable, cool and fashionable helmets that Campaign viewer’s have purchased and had success with. Contests, such as the free bike giveaway, could be made a more regular part of the Campaign, but on a smaller scale to enable more frequent giveaways and to keep the target audience engaged. A contest to find and post a picture of someone wearing a helmet in their community, or to find a clip of someone wearing a helmet on TV or in a movie, on the Facebook page would encourage the target audience to find out for themselves what the true norm is in their community, and to shift their attention to seeking out examples of positive behavior in their environment. In Social Cognitive Theory this is the concept of “situational perception,” or how the individual perceives what is happening in their environment (10).
Increased Methods
The Play Safe Campaign is actively partnered with Boston Medical Center to provide discounted helmets in their gift shop. While this is positive, the Campaign would have more success by partnering with organizations that youth and teens find more accessible and that they are more likely to find positive role models that they can relate to (8). Bike shops have more variety in the types of helmets they carry, and youth and teens would have the freedom to express their personality by not being forced to buy a generic helmet from the hospital gift shop. This freedom of choice will lessen the possibility for psychological reactance to take hold. They may also be encouraged to learn more about biking in general, find bike maps, learn about bike maintenance and safety, and to see bike shop employees naturally promote helmet use (8). Furthermore, by bringing the Campaign to more neighborhood bike shops throughout Boston, the self-efficacy of the target audience is increased; they will believe that it is possible to get a helmet because it is physically accessible to them, rather than having the barrier of taking public transportation or asking for a ride to the Boston Medical Center, a large intimidating structure in what may be an unfamiliar part of town.
In addition to partnering with bike shops, the Play Safe Campaign should shift a part of its resources to encouraging parents to wear helmets themselves, not just to impose compliance with the law by making their children wear helmets. According to Social Cognitive Theory, individuals watch the actions and behavior’s of those they admire (both those in their lives, such as parent, teacher’s and friends, and actors on TV) and use what they see to inform their own actions (9). Other than the 11-19 year old age group, 30-39 year olds have one of the smallest percentages of helmet use out of all age groups (5). Studies have shown that their reasons for not wearing them are similar to those of children and youth; they don’t own one, they find them hot, they find them annoying (5). These 30-39 year olds could potentially be the parents of 11-19 year olds, and as previously mentioned, teens are influenced by the behavior of theiparents (5). Therefore it makes sense to target parents helmet wearing behavior directly, even though they are considered “secondary” targets of the intervention.
Conclusion
In summary, the Play Safe Campaign of the Boston Public Health Campaign fails to adequately market helmets and increased helmet use to the parents of children and to the teens and youth of Boston. While elements of Social Marketing Theory are applied (teen actors in videos, a Facebook page), the Campaign appears piecemeal and incomplete. The risks of injury from not wearing a helmet are over-emphasized, while the benefits of being a part of a greater social campaign are overlooked. With a few adjustments, utilizing insights from Social Marketing and Social Cognitive Theories, the Campaign could see success; however, it will require the feedback and input from Boston youth themselves, a reworking of the Campaign web pages, and a wider net of partnerships with local bike shops and local or national teen figures.
REFERENCES
1. Bicycle Helmet Safety Institute. Bicycle Helmet Statistics.
2. Boston Bikes. Safety Campaigns. Boston, MA.
3. Boston Public Health Commission. Play Safe-Bicycle and Sports Safety. Boston, MA.
4. Boston Trauma. Boston Medical Center Injury Prevention. Boston, MA.
5. Finnoff J., Laskowski E., Altman K. and Diehl N. Barriers to bicycle helmet use. Pediatrics 2001. 108(4): 1-7.
6. Insurance Institute for Highway Safety. Research: Fatality Facts 2009.
7. Lin C. and Hullman G. Tobacco-prevention messages online: social marketing via the web. Health Communication 2005. 18(2):177-193.
8. Ludwig T., Buchholz C. and Clarke S. Using social marketing to increase the use of helmets among bicyclists. Journal of American College Health 2005. 54(1):51-58.
9. Martino S., Collins R., Danouse E. et al. Social cognitive processes mediating the relationship between exposure to television’s sexual content and adolescent’s sexual behavior. Journal of Personality and Social Psychology 2005; 89(6):914-924.
10. Sharma M. and Romas J. Theoretical Foundations of Health Education and Health Promotion. Sudbury, MA: Jones and Bartlett Publishers, 2008.
11. Thompson DC., Rivara F. and Thompson R. Helmets for preventing head and facial injuries in bicyclists. Cochrane Database of Systematic Reviews 1999.
According to the Institute for Highway Safety a total of 630 bicyclists were killed in crashes involving motor vehicles alone in 2009, the most recent year that data from the U.S. Department of Transportation’s Fatality Analysis Reporting System was analyzed (6). Of those killed, over 91% were not wearing helmets (6). At Boston Medical Center, New England’s busiest trauma center, only 10 of the 60 patients treated for bicycle related injuries were wearing helmets (4). Riders under the age of 21 account for the majority of the 500,000 bicycle accidents occurring yearly in the United States, and this age group also has one of the lowest proportion of bicycle helmet use among all age groups (5).
The Boston Public Health Commission introduced the Play Safe Bicycle and Other Sports Safety campaign (the Campaign) to encourage helmet use in children and youth in the city of Boston (3). It is widely known that head injury is the most reported type of injury sustained by bicyclists, and the most likely to cause death (11), thus helmet use would be an appropriate intervention to reduce injury in children and youth in Boston.
The Campaign used aspects of social marketing to target two groups: parents of children under age 17 (when a child is legally required by Massachusetts law to wear a helmet) and youth over the age of 17. The message aimed at parents focused on increasing awareness of i) the injuries caused by bicycle accidents, ii) how the use of helmets can decrease or prevent injury, iii) the law requiring helmet use for children under age 17 and iv) the discounted helmet program offered in conjunction with the Boston Medical Center Emergency Department.
The message aimed at youth, centered around three short videos promoting “three reason’s you’d be cooler in a helmet (3).” The first video “You’d be cooler in a helmet. Literally!” shows a group of sweaty youth sitting on a bench wiping their brow, with the final person wearing a helmet and smiling. The second, “Helmet romance,” shows a girl in a coffee shop turning away a potential suitor (sans helmet) followed by the successful approach of a young man wearing a helmet. The final video, “The intervention,” features a group of peers holding an “intervention” for a non-helmet wearing friends about the dangers of riding without a helmet. The videos ended with a link to the Healthy Boston Facebook page, where viewers could register to win a free bike.
Using insights from Social Marketing Theory and Social Cognitive Theory, this paper will explain how the Play Safe Campaign failed in its design in three distinct ways: through a misguided message, a non-engaging medium, and missed methods of reaching its target . Once the shortcomings of the Campaign have been established, this paper will offer explicit ways in which this Campaign can apply the understandings of Social Marketing and Social Cognitive Theories to improve the outcomes of the Campaign.
Frameworks for Health Intervention
Social Marketing Theory presents a framework for promoting a health intervention to a media-receptive public. It employs the same concepts of corporate marketing, Product, Price, Place and Promotion, and then adds a few of its own, Publics, Partnership and Policy (10). According to Social Marketing Theory, these different elements of a marketing campaign must match the needs, desires and abilities of your target population in order to have an effective campaign and “sell” your product (10). This paper will show that while the Campaign applied aspects of this theory, it did so inadequately and inconsistently, thereby reducing the potential impact of the campaign.
Social Cognitive Theory is a way of explaining behavior that incorporates environmental and personal factors (10). The premise behind Social Cognitive Theory is that individual behavior is influenced by more than just personal preference; it is shaped through interactions with an individual’s physical and social environment and through self-efficacy, or their belief that they can undertake and succeed with a new behavior within their environment (10). The following critiques demonstrate how the Campaign did not utilize insights from Social Cognitive Theory that would aid in achieving increased helmet use.
The Misguided Message
One critique of the design of the Play Safe Campaign is the messaging the Campaign chose. Specifically, the Campaign lacked coherent or relevant products and pricing to appeal to its target audience, children and teens. Social Marketing Theory emphasizes that a successful campaign should offer a “product” that is appealing and relevant to the target populations.
Product: The Play Safe Campaign videos attempted to promote helmets as a product that makes teens “cooler”, both physically and socially. They miss their mark by portraying actors in situations that, although humorous, are unrealistic. Helmets generally do not cool your head, it is far-fetched to believe that wearing a helmet indoors makes you more attractive, and a group of friends are unlikely to get together to have an intervention about your helmet use. These types of unrealistic portrayals have been shown to have a limited effect on behavior change (7). The “Intervention” video has five friends sitting in a living room when their friend bikes over, without a helmet, and enters the room. His friends then proceed to have a serious talk using very mature language about their “intervention” to get him to use his helmet, because they care about him. Apart from being unrealistic, the video could induce psychological reactance, which is when the audience reacts negatively to a message that they feel threatens their sense of freedom (10). The Campaign poster, which states, “Use Your Head! Wear a Helmet!” could also cause reactance with youth and teens averse to the authoritarian tone of the message.
Price: The material price of the helmet for in the Play Safe Campaign is $5, when purchased at Boston Medical Center (BMC). For users, the actual “price” of the helmet is more than monetary. For parents, it is also the expense of taking the time to travel to BMC and to measure their child’s head for the helmet. Furthermore, a parent may not want a discounted helmet for their child, because they may see it as being of inferior quality because of the decreased cost. For teens, the “price” of wearing a helmet could be their social status and standing, if they do not already have a social group that supports helmet use. The Campaign attempts to persuade its audience, parents of children, and teens, that the price of not wearing a helmet is serious injury and possible death, by listing statistics and facts on their website. While this may be affective in appealing to a core value of parents, protecting their children, it does not appeal to the core values of teens, which is to be respected by their peers.
The Non-Engaging Medium
The second critique of the Campaign was the ways in which the city attempted to reach the target. This includes where the Campaign promoted and advertised the campaign, as well as what the how interactive and engaging their campaign materials were.
Place: The “Place” is where the audience will be exposed to the campaign message (3). In the Play Safe Promotion the Campaign messages were advertised on posters at BMC (where the helmets are sold in the gift shop for $5) and on the internet through the Boston Public Health Commission website, Boston Medical Center Trauma webpage, and Facebook. It has been suggested by analyzing user data that online-health seekers are typically college-educated with higher incomes (7)-not the demographic in need of discounted helmets. Therefore, limiting the Campaign to promotion on the internet (especially on a page that was not easy to find) limited the exposure to the Campaign’s target audience.
The Campaign website is dominated with information about bicycle injury statistics, the rules of the road, how to play safe, and bicycle fit and maintenance, with information about discounted helmets bolded and the three teen-oriented videos embedded towards the bottom of the page. Much of this information is written for the parent who will make their child wear a helmet, not to the teen that will likely be making the decision about helmet use on their own. In order to engage the teen audience, the information relevant to them-the videos and the Facebook page, should be prominently located and easy to find, which it is not. Otherwise they will click out of the webpage (7). The Campaign page is not immediately accessible from the home page of the Boston Public Health Commission, and the link to the Healthy Boston Facebook page is only visible at the end of the videos. In order for a Social Marketing Campaign to be effective, the audience should be able to interact easily with agents delivering the message, either a person or a webpage (7). Other than on Facebook, there is no space to leave comments or to ask questions on the page, only a phone number, e-mail and fax for a general Injury Prevention Program.
Promotion: Social Marketing Theory also highlights the use of promotions, either in the form of discounts or free products, to encourage behavioral change. The Campaign utilized a promotion, but the promotion offered was inadequate. The main Promotion used in the Play Safe Campaign is discounted helmets offered through a partnership with Boston Medical Center, and the Free Bike Giveaway offered on their Facebook page (although no information on the giveaway could be found at the time of writing). The problem with these offers is that they are one-off activities; they fail to engage the audience in the Campaign in a sustained way (8). Once the teen or parent has the helmet, or wins the free bike, they have no incentive to return to the website or to stay connected to the Campaign, or to the Campaign goal of increased regular helmet use.
The Missed Methods
Finally, the Campaign failed to fully utilize all the methods central to both Social Marketing and Social Cognitive Theories. The final three “Ps” of Social Marketing Theory, public, partnerships and policy, recognize the impact of two key Social Cognitive Theory concepts: the role of environment and self-efficacy on behavior (10). An effective Social Marketing campaign would incorporate these concepts into its campaign, yet the Play Safe Campaign does not succeed in using the Public or Partnerships to their full potential.
Public: This aspect of Social Marketing Theory refers to the influence of those who comprise the wider social circle of the individual whose behavior the campaign is trying to change (10). In the Play Safe Campaign the influence of a child or teen’s parent is thought of only as a resource for providing a helmet, and as an authoritarian figure who “insist that children wear” their helmets when cycling, according to the Campaign website (3). By only focusing on a child’s helmet use, and not directly promoting helmet use by parents themselves, the Campaign neglects an important environmental source for modeling behavior.
Simply providing information about the “Rule of the Road,” “Sports Safety,” and “Bicycle Fit and Maintenance” on the Campaign website is not going to cause a teen to adopt and follow all the recommendations, and it is not going to give them the self-efficacy, or confidence, to believe that they can adopt those behaviors and successfully maintain them. Studies have shown that parents and peers influence helmet use behavior (5). Teens need to see a role model have success with helmet use and bicycle safety in order to feel confident in his or her own ability (9).
Partnerships: The Play Safe Campaign also failed to exploit the power of partnerships in their campaign to promote helmet use. The only partnership advertized on their website was with Boston Medical Center, who sold the $5 helmets in their gift shop and provided information on safe helmet use on their Boston Trauma blog (4). Although it is accessible by public transportation, the Boston Medical Center gift shop is not in an ideal location. There is limited free parking in the South End neighborhood of Boston, it is near a very busy intersection, and it is in a hospital, not an environment generally associated with safety. Furthermore, there is no additional incentive or benefit for the parent, child or teen to go to the hospital. They cannot provide additional information about safe biking, or be a source for peer role models in biking and helmet use in the way that a bike shop could (8).
Policy: The final “P” in Social Marketing Theory, is for Policy. Policies enacted by governments, schools and communities can have a profound effect on the environment that an individual acts within, and can work to increase the self-efficacy of the targeted individuals. But policies can also be over-emphasized, and the effect of a policy can be diluted if it is not regularly enforced. The helmet law in Massachusetts requires that all residents under the age of 17 wear a helmet while riding a bicycle, and the Play Safe Campaign does discuss the law on their website. Highlighting the law on the website may actually cause psychological reactance, discussed earlier, in some teens who see the law as an infringement of their personal freedom, and to exercise that freedom they may choose to not wear a helmet.
Articulation of Proposed Intervention
The Play Safe Campaign of the Boston Public Health Commission has many serious flaws, as outlined above, that prevent it from effectively increasing helmet use in children and teens in Boston. Although the Campaign appears to be based on Social Marketing Theory, it provides a misguided message, uses a non-engaging medium, and does not utilize all possible methods of reaching its target audience, thereby limiting the ability to build a strong Campaign to increase helmet use in youth and teens. Additionally, the Campaign failed to fully incorporate insights from Social Cognitive Theory, which have clear applicable benefits to a public campaign such as this.
What could they have done better? The three sections below describe ways in which the Boston Public Health Commission could adjust their current Campaign to better incorporate the tenets of Social Marketing Theory and by incorporating aspects of Social Cognitive Theory.
A Direct Message
The “product” that the Play Safe Campaign should be trying to “sell” to youth and teens in Boston is not increased helmet use to reduce injury. They should be trying to sell the idea that wearing a helmet makes you part of a popular campaign that you would want not only to be a part of, but to promote among your friends and family as well. Youth should be a part of the Campaign process, from designing the slogan, to creating a logo to “brand” the Campaign (8). Social Cognitive Theory says that the perceived social norms of a group can influence individuals to act in accordance with those norms, even if the truth is that the majority of the individuals in the group would not choose to act in line with these norms if they were outside of social influence, for example many teens believe that all teens have sex before college, yet most teens wish they had waited to have sex (9). Therefore, the Play Safe Campaign should focus on shifting the perception of the norm to that of regular helmet use.
One effective way to shift perceptions of the norm is through TV and promotions involving young, popular people in youth culture. The YouTube videos on the Campaign website showed young, attractive teens wearing helmets in their videos, but they were not widely distributed and, as previously mentioned, did not portray teens wearing helmets in realistic situations. Young people spend 3 to 4 hours a day watching TV, and gain self-efficacy in performing activities they see actors perform with success through programming (9). This means that the Boston Public Health Commission should craft a public service announcement (PSA) to be aired in the evening, at a time when youth are most likely to be watching TV, that features a local sports figure or actor promoting helmet use. Another alternative would be to feature a popular BMX biker or skateboarder who wears a helmet, although there is the risk that youth would not connect their bike riding behavior to that of a professional BMX rider, and therefore decide that a helmet is not necessary for them.
If airing a TV spot with a famous actor is out of the budget for the Boston Public Health Commission, another alternative would be to share personal stories of youth who have survived serious bicycle accidents because they were wearing their helmet. Social Cognitive Theory tells us that individuals learn through the stories of others (10). The videos currently on the Campaign website are not real stories. However, there are a few videos on the Boston Trauma website of patients sharing their true stories of survival due to their helmet use (4). These types of stories should be in a prominent location on the Campaign website.
The Engaging Medium
The “place” for finding Campaign information was not visually appealing or easy to interact with. In order for an audience to feel like they are involved in the Campaign, they need to be able to interact with the Campaign material and media. As youth are a target audience, it makes sense to use Facebook to connect and to promote the messages of the Campaign. However, information on the Campaign should be easy to find, share, and interact with. There should be an easy way to submit questions on helmet use, locations, and styles. As three of the top reasons for not wearing a helmet among youth and adults are that it is uncomfortable, hot and ugly (5) there should be a section to exchange pictures and suggestions for comfortable, cool and fashionable helmets that Campaign viewer’s have purchased and had success with. Contests, such as the free bike giveaway, could be made a more regular part of the Campaign, but on a smaller scale to enable more frequent giveaways and to keep the target audience engaged. A contest to find and post a picture of someone wearing a helmet in their community, or to find a clip of someone wearing a helmet on TV or in a movie, on the Facebook page would encourage the target audience to find out for themselves what the true norm is in their community, and to shift their attention to seeking out examples of positive behavior in their environment. In Social Cognitive Theory this is the concept of “situational perception,” or how the individual perceives what is happening in their environment (10).
Increased Methods
The Play Safe Campaign is actively partnered with Boston Medical Center to provide discounted helmets in their gift shop. While this is positive, the Campaign would have more success by partnering with organizations that youth and teens find more accessible and that they are more likely to find positive role models that they can relate to (8). Bike shops have more variety in the types of helmets they carry, and youth and teens would have the freedom to express their personality by not being forced to buy a generic helmet from the hospital gift shop. This freedom of choice will lessen the possibility for psychological reactance to take hold. They may also be encouraged to learn more about biking in general, find bike maps, learn about bike maintenance and safety, and to see bike shop employees naturally promote helmet use (8). Furthermore, by bringing the Campaign to more neighborhood bike shops throughout Boston, the self-efficacy of the target audience is increased; they will believe that it is possible to get a helmet because it is physically accessible to them, rather than having the barrier of taking public transportation or asking for a ride to the Boston Medical Center, a large intimidating structure in what may be an unfamiliar part of town.
In addition to partnering with bike shops, the Play Safe Campaign should shift a part of its resources to encouraging parents to wear helmets themselves, not just to impose compliance with the law by making their children wear helmets. According to Social Cognitive Theory, individuals watch the actions and behavior’s of those they admire (both those in their lives, such as parent, teacher’s and friends, and actors on TV) and use what they see to inform their own actions (9). Other than the 11-19 year old age group, 30-39 year olds have one of the smallest percentages of helmet use out of all age groups (5). Studies have shown that their reasons for not wearing them are similar to those of children and youth; they don’t own one, they find them hot, they find them annoying (5). These 30-39 year olds could potentially be the parents of 11-19 year olds, and as previously mentioned, teens are influenced by the behavior of theiparents (5). Therefore it makes sense to target parents helmet wearing behavior directly, even though they are considered “secondary” targets of the intervention.
Conclusion
In summary, the Play Safe Campaign of the Boston Public Health Campaign fails to adequately market helmets and increased helmet use to the parents of children and to the teens and youth of Boston. While elements of Social Marketing Theory are applied (teen actors in videos, a Facebook page), the Campaign appears piecemeal and incomplete. The risks of injury from not wearing a helmet are over-emphasized, while the benefits of being a part of a greater social campaign are overlooked. With a few adjustments, utilizing insights from Social Marketing and Social Cognitive Theories, the Campaign could see success; however, it will require the feedback and input from Boston youth themselves, a reworking of the Campaign web pages, and a wider net of partnerships with local bike shops and local or national teen figures.
REFERENCES
1. Bicycle Helmet Safety Institute. Bicycle Helmet Statistics.
2. Boston Bikes. Safety Campaigns. Boston, MA.
3. Boston Public Health Commission. Play Safe-Bicycle and Sports Safety. Boston, MA.
4. Boston Trauma. Boston Medical Center Injury Prevention. Boston, MA.
5. Finnoff J., Laskowski E., Altman K. and Diehl N. Barriers to bicycle helmet use. Pediatrics 2001. 108(4): 1-7.
6. Insurance Institute for Highway Safety. Research: Fatality Facts 2009.
7. Lin C. and Hullman G. Tobacco-prevention messages online: social marketing via the web. Health Communication 2005. 18(2):177-193.
8. Ludwig T., Buchholz C. and Clarke S. Using social marketing to increase the use of helmets among bicyclists. Journal of American College Health 2005. 54(1):51-58.
9. Martino S., Collins R., Danouse E. et al. Social cognitive processes mediating the relationship between exposure to television’s sexual content and adolescent’s sexual behavior. Journal of Personality and Social Psychology 2005; 89(6):914-924.
10. Sharma M. and Romas J. Theoretical Foundations of Health Education and Health Promotion. Sudbury, MA: Jones and Bartlett Publishers, 2008.
11. Thompson DC., Rivara F. and Thompson R. Helmets for preventing head and facial injuries in bicyclists. Cochrane Database of Systematic Reviews 1999.
Introduction
According to the Institute for Highway Safety a total of 630 bicyclists were killed in crashes involving motor vehicles alone in 2009, the most recent year that data from the U.S. Department of Transportation’s Fatality Analysis Reporting System was analyzed (6). Of those killed, over 91% were not wearing helmets (6). At Boston Medical Center, New England’s busiest trauma center, only 10 of the 60 patients treated for bicycle related injuries were wearing helmets (4). Riders under the age of 21 account for the majority of the 500,000 bicycle accidents occurring yearly in the United States, and this age group also has one of the lowest proportion of bicycle helmet use among all age groups (5).
The Boston Public Health Commission introduced the Play Safe Bicycle and Other Sports Safety campaign (the Campaign) to encourage helmet use in children and youth in the city of Boston (3). It is widely known that head injury is the most reported type of injury sustained by bicyclists, and the most likely to cause death (11), thus helmet use would be an appropriate intervention to reduce injury in children and youth in Boston.
The Campaign used aspects of social marketing to target two groups: parents of children under age 17 (when a child is legally required by Massachusetts law to wear a helmet) and youth over the age of 17. The message aimed at parents focused on increasing awareness of i) the injuries caused by bicycle accidents, ii) how the use of helmets can decrease or prevent injury, iii) the law requiring helmet use for children under age 17 and iv) the discounted helmet program offered in conjunction with the Boston Medical Center Emergency Department.
The message aimed at youth, centered around three short videos promoting “three reason’s you’d be cooler in a helmet (3).” The first video “You’d be cooler in a helmet. Literally!” shows a group of sweaty youth sitting on a bench wiping their brow, with the final person wearing a helmet and smiling. The second, “Helmet romance,” shows a girl in a coffee shop turning away a potential suitor (sans helmet) followed by the successful approach of a young man wearing a helmet. The final video, “The intervention,” features a group of peers holding an “intervention” for a non-helmet wearing friends about the dangers of riding without a helmet. The videos ended with a link to the Healthy Boston Facebook page, where viewers could register to win a free bike.
Using insights from Social Marketing Theory and Social Cognitive Theory, this paper will explain how the Play Safe Campaign failed in its design in three distinct ways: through a misguided message, a non-engaging medium, and missed methods of reaching its target . Once the shortcomings of the Campaign have been established, this paper will offer explicit ways in which this Campaign can apply the understandings of Social Marketing and Social Cognitive Theories to improve the outcomes of the Campaign.
Frameworks for Health Intervention
Social Marketing Theory presents a framework for promoting a health intervention to a media-receptive public. It employs the same concepts of corporate marketing, Product, Price, Place and Promotion, and then adds a few of its own, Publics, Partnership and Policy (10). According to Social Marketing Theory, these different elements of a marketing campaign must match the needs, desires and abilities of your target population in order to have an effective campaign and “sell” your product (10). This paper will show that while the Campaign applied aspects of this theory, it did so inadequately and inconsistently, thereby reducing the potential impact of the campaign.
Social Cognitive Theory is a way of explaining behavior that incorporates environmental and personal factors (10). The premise behind Social Cognitive Theory is that individual behavior is influenced by more than just personal preference; it is shaped through interactions with an individual’s physical and social environment and through self-efficacy, or their belief that they can undertake and succeed with a new behavior within their environment (10). The following critiques demonstrate how the Campaign did not utilize insights from Social Cognitive Theory that would aid in achieving increased helmet use.
The Misguided Message
One critique of the design of the Play Safe Campaign is the messaging the Campaign chose. Specifically, the Campaign lacked coherent or relevant products and pricing to appeal to its target audience, children and teens. Social Marketing Theory emphasizes that a successful campaign should offer a “product” that is appealing and relevant to the target populations.
Product: The Play Safe Campaign videos attempted to promote helmets as a product that makes teens “cooler”, both physically and socially. They miss their mark by portraying actors in situations that, although humorous, are unrealistic. Helmets generally do not cool your head, it is far-fetched to believe that wearing a helmet indoors makes you more attractive, and a group of friends are unlikely to get together to have an intervention about your helmet use. These types of unrealistic portrayals have been shown to have a limited effect on behavior change (7). The “Intervention” video has five friends sitting in a living room when their friend bikes over, without a helmet, and enters the room. His friends then proceed to have a serious talk using very mature language about their “intervention” to get him to use his helmet, because they care about him. Apart from being unrealistic, the video could induce psychological reactance, which is when the audience reacts negatively to a message that they feel threatens their sense of freedom (10). The Campaign poster, which states, “Use Your Head! Wear a Helmet!” could also cause reactance with youth and teens averse to the authoritarian tone of the message.
Price: The material price of the helmet for in the Play Safe Campaign is $5, when purchased at Boston Medical Center (BMC). For users, the actual “price” of the helmet is more than monetary. For parents, it is also the expense of taking the time to travel to BMC and to measure their child’s head for the helmet. Furthermore, a parent may not want a discounted helmet for their child, because they may see it as being of inferior quality because of the decreased cost. For teens, the “price” of wearing a helmet could be their social status and standing, if they do not already have a social group that supports helmet use. The Campaign attempts to persuade its audience, parents of children, and teens, that the price of not wearing a helmet is serious injury and possible death, by listing statistics and facts on their website. While this may be affective in appealing to a core value of parents, protecting their children, it does not appeal to the core values of teens, which is to be respected by their peers.
The Non-Engaging Medium
The second critique of the Campaign was the ways in which the city attempted to reach the target. This includes where the Campaign promoted and advertised the campaign, as well as what the how interactive and engaging their campaign materials were.
Place: The “Place” is where the audience will be exposed to the campaign message (3). In the Play Safe Promotion the Campaign messages were advertised on posters at BMC (where the helmets are sold in the gift shop for $5) and on the internet through the Boston Public Health Commission website, Boston Medical Center Trauma webpage, and Facebook. It has been suggested by analyzing user data that online-health seekers are typically college-educated with higher incomes (7)-not the demographic in need of discounted helmets. Therefore, limiting the Campaign to promotion on the internet (especially on a page that was not easy to find) limited the exposure to the Campaign’s target audience.
The Campaign website is dominated with information about bicycle injury statistics, the rules of the road, how to play safe, and bicycle fit and maintenance, with information about discounted helmets bolded and the three teen-oriented videos embedded towards the bottom of the page. Much of this information is written for the parent who will make their child wear a helmet, not to the teen that will likely be making the decision about helmet use on their own. In order to engage the teen audience, the information relevant to them-the videos and the Facebook page, should be prominently located and easy to find, which it is not. Otherwise they will click out of the webpage (7). The Campaign page is not immediately accessible from the home page of the Boston Public Health Commission, and the link to the Healthy Boston Facebook page is only visible at the end of the videos. In order for a Social Marketing Campaign to be effective, the audience should be able to interact easily with agents delivering the message, either a person or a webpage (7). Other than on Facebook, there is no space to leave comments or to ask questions on the page, only a phone number, e-mail and fax for a general Injury Prevention Program.
Promotion: Social Marketing Theory also highlights the use of promotions, either in the form of discounts or free products, to encourage behavioral change. The Campaign utilized a promotion, but the promotion offered was inadequate. The main Promotion used in the Play Safe Campaign is discounted helmets offered through a partnership with Boston Medical Center, and the Free Bike Giveaway offered on their Facebook page (although no information on the giveaway could be found at the time of writing). The problem with these offers is that they are one-off activities; they fail to engage the audience in the Campaign in a sustained way (8). Once the teen or parent has the helmet, or wins the free bike, they have no incentive to return to the website or to stay connected to the Campaign, or to the Campaign goal of increased regular helmet use.
The Missed Methods
Finally, the Campaign failed to fully utilize all the methods central to both Social Marketing and Social Cognitive Theories. The final three “Ps” of Social Marketing Theory, public, partnerships and policy, recognize the impact of two key Social Cognitive Theory concepts: the role of environment and self-efficacy on behavior (10). An effective Social Marketing campaign would incorporate these concepts into its campaign, yet the Play Safe Campaign does not succeed in using the Public or Partnerships to their full potential.
Public: This aspect of Social Marketing Theory refers to the influence of those who comprise the wider social circle of the individual whose behavior the campaign is trying to change (10). In the Play Safe Campaign the influence of a child or teen’s parent is thought of only as a resource for providing a helmet, and as an authoritarian figure who “insist that children wear” their helmets when cycling, according to the Campaign website (3). By only focusing on a child’s helmet use, and not directly promoting helmet use by parents themselves, the Campaign neglects an important environmental source for modeling behavior.
Simply providing information about the “Rule of the Road,” “Sports Safety,” and “Bicycle Fit and Maintenance” on the Campaign website is not going to cause a teen to adopt and follow all the recommendations, and it is not going to give them the self-efficacy, or confidence, to believe that they can adopt those behaviors and successfully maintain them. Studies have shown that parents and peers influence helmet use behavior (5). Teens need to see a role model have success with helmet use and bicycle safety in order to feel confident in his or her own ability (9).
Partnerships: The Play Safe Campaign also failed to exploit the power of partnerships in their campaign to promote helmet use. The only partnership advertized on their website was with Boston Medical Center, who sold the $5 helmets in their gift shop and provided information on safe helmet use on their Boston Trauma blog (4). Although it is accessible by public transportation, the Boston Medical Center gift shop is not in an ideal location. There is limited free parking in the South End neighborhood of Boston, it is near a very busy intersection, and it is in a hospital, not an environment generally associated with safety. Furthermore, there is no additional incentive or benefit for the parent, child or teen to go to the hospital. They cannot provide additional information about safe biking, or be a source for peer role models in biking and helmet use in the way that a bike shop could (8).
Policy: The final “P” in Social Marketing Theory, is for Policy. Policies enacted by governments, schools and communities can have a profound effect on the environment that an individual acts within, and can work to increase the self-efficacy of the targeted individuals. But policies can also be over-emphasized, and the effect of a policy can be diluted if it is not regularly enforced. The helmet law in Massachusetts requires that all residents under the age of 17 wear a helmet while riding a bicycle, and the Play Safe Campaign does discuss the law on their website. Highlighting the law on the website may actually cause psychological reactance, discussed earlier, in some teens who see the law as an infringement of their personal freedom, and to exercise that freedom they may choose to not wear a helmet.
Articulation of Proposed Intervention
The Play Safe Campaign of the Boston Public Health Commission has many serious flaws, as outlined above, that prevent it from effectively increasing helmet use in children and teens in Boston. Although the Campaign appears to be based on Social Marketing Theory, it provides a misguided message, uses a non-engaging medium, and does not utilize all possible methods of reaching its target audience, thereby limiting the ability to build a strong Campaign to increase helmet use in youth and teens. Additionally, the Campaign failed to fully incorporate insights from Social Cognitive Theory, which have clear applicable benefits to a public campaign such as this.
What could they have done better? The three sections below describe ways in which the Boston Public Health Commission could adjust their current Campaign to better incorporate the tenets of Social Marketing Theory and by incorporating aspects of Social Cognitive Theory.
A Direct Message
The “product” that the Play Safe Campaign should be trying to “sell” to youth and teens in Boston is not increased helmet use to reduce injury. They should be trying to sell the idea that wearing a helmet makes you part of a popular campaign that you would want not only to be a part of, but to promote among your friends and family as well. Youth should be a part of the Campaign process, from designing the slogan, to creating a logo to “brand” the Campaign (8). Social Cognitive Theory says that the perceived social norms of a group can influence individuals to act in accordance with those norms, even if the truth is that the majority of the individuals in the group would not choose to act in line with these norms if they were outside of social influence, for example many teens believe that all teens have sex before college, yet most teens wish they had waited to have sex (9). Therefore, the Play Safe Campaign should focus on shifting the perception of the norm to that of regular helmet use.
One effective way to shift perceptions of the norm is through TV and promotions involving young, popular people in youth culture. The YouTube videos on the Campaign website showed young, attractive teens wearing helmets in their videos, but they were not widely distributed and, as previously mentioned, did not portray teens wearing helmets in realistic situations. Young people spend 3 to 4 hours a day watching TV, and gain self-efficacy in performing activities they see actors perform with success through programming (9). This means that the Boston Public Health Commission should craft a public service announcement (PSA) to be aired in the evening, at a time when youth are most likely to be watching TV, that features a local sports figure or actor promoting helmet use. Another alternative would be to feature a popular BMX biker or skateboarder who wears a helmet, although there is the risk that youth would not connect their bike riding behavior to that of a professional BMX rider, and therefore decide that a helmet is not necessary for them.
If airing a TV spot with a famous actor is out of the budget for the Boston Public Health Commission, another alternative would be to share personal stories of youth who have survived serious bicycle accidents because they were wearing their helmet. Social Cognitive Theory tells us that individuals learn through the stories of others (10). The videos currently on the Campaign website are not real stories. However, there are a few videos on the Boston Trauma website of patients sharing their true stories of survival due to their helmet use (4). These types of stories should be in a prominent location on the Campaign website.
The Engaging Medium
The “place” for finding Campaign information was not visually appealing or easy to interact with. In order for an audience to feel like they are involved in the Campaign, they need to be able to interact with the Campaign material and media. As youth are a target audience, it makes sense to use Facebook to connect and to promote the messages of the Campaign. However, information on the Campaign should be easy to find, share, and interact with. There should be an easy way to submit questions on helmet use, locations, and styles. As three of the top reasons for not wearing a helmet among youth and adults are that it is uncomfortable, hot and ugly (5) there should be a section to exchange pictures and suggestions for comfortable, cool and fashionable helmets that Campaign viewer’s have purchased and had success with. Contests, such as the free bike giveaway, could be made a more regular part of the Campaign, but on a smaller scale to enable more frequent giveaways and to keep the target audience engaged. A contest to find and post a picture of someone wearing a helmet in their community, or to find a clip of someone wearing a helmet on TV or in a movie, on the Facebook page would encourage the target audience to find out for themselves what the true norm is in their community, and to shift their attention to seeking out examples of positive behavior in their environment. In Social Cognitive Theory this is the concept of “situational perception,” or how the individual perceives what is happening in their environment (10).
Increased Methods
The Play Safe Campaign is actively partnered with Boston Medical Center to provide discounted helmets in their gift shop. While this is positive, the Campaign would have more success by partnering with organizations that youth and teens find more accessible and that they are more likely to find positive role models that they can relate to (8). Bike shops have more variety in the types of helmets they carry, and youth and teens would have the freedom to express their personality by not being forced to buy a generic helmet from the hospital gift shop. This freedom of choice will lessen the possibility for psychological reactance to take hold. They may also be encouraged to learn more about biking in general, find bike maps, learn about bike maintenance and safety, and to see bike shop employees naturally promote helmet use (8). Furthermore, by bringing the Campaign to more neighborhood bike shops throughout Boston, the self-efficacy of the target audience is increased; they will believe that it is possible to get a helmet because it is physically accessible to them, rather than having the barrier of taking public transportation or asking for a ride to the Boston Medical Center, a large intimidating structure in what may be an unfamiliar part of town.
In addition to partnering with bike shops, the Play Safe Campaign should shift a part of its resources to encouraging parents to wear helmets themselves, not just to impose compliance with the law by making their children wear helmets. According to Social Cognitive Theory, individuals watch the actions and behavior’s of those they admire (both those in their lives, such as parent, teacher’s and friends, and actors on TV) and use what they see to inform their own actions (9). Other than the 11-19 year old age group, 30-39 year olds have one of the smallest percentages of helmet use out of all age groups (5). Studies have shown that their reasons for not wearing them are similar to those of children and youth; they don’t own one, they find them hot, they find them annoying (5). These 30-39 year olds could potentially be the parents of 11-19 year olds, and as previously mentioned, teens are influenced by the behavior of theiparents (5). Therefore it makes sense to target parents helmet wearing behavior directly, even though they are considered “secondary” targets of the intervention.
Conclusion
In summary, the Play Safe Campaign of the Boston Public Health Campaign fails to adequately market helmets and increased helmet use to the parents of children and to the teens and youth of Boston. While elements of Social Marketing Theory are applied (teen actors in videos, a Facebook page), the Campaign appears piecemeal and incomplete. The risks of injury from not wearing a helmet are over-emphasized, while the benefits of being a part of a greater social campaign are overlooked. With a few adjustments, utilizing insights from Social Marketing and Social Cognitive Theories, the Campaign could see success; however, it will require the feedback and input from Boston youth themselves, a reworking of the Campaign web pages, and a wider net of partnerships with local bike shops and local or national teen figures.
REFERENCES
1. Bicycle Helmet Safety Institute. Bicycle Helmet Statistics.
2. Boston Bikes. Safety Campaigns. Boston, MA.
3. Boston Public Health Commission. Play Safe-Bicycle and Sports Safety. Boston, MA.
4. Boston Trauma. Boston Medical Center Injury Prevention. Boston, MA.
5. Finnoff J., Laskowski E., Altman K. and Diehl N. Barriers to bicycle helmet use. Pediatrics 2001. 108(4): 1-7.
6. Insurance Institute for Highway Safety. Research: Fatality Facts 2009.
7. Lin C. and Hullman G. Tobacco-prevention messages online: social marketing via the web. Health Communication 2005. 18(2):177-193.
8. Ludwig T., Buchholz C. and Clarke S. Using social marketing to increase the use of helmets among bicyclists. Journal of American College Health 2005. 54(1):51-58.
9. Martino S., Collins R., Danouse E. et al. Social cognitive processes mediating the relationship between exposure to television’s sexual content and adolescent’s sexual behavior. Journal of Personality and Social Psychology 2005; 89(6):914-924.
10. Sharma M. and Romas J. Theoretical Foundations of Health Education and Health Promotion. Sudbury, MA: Jones and Bartlett Publishers, 2008.
11. Thompson DC., Rivara F. and Thompson R. Helmets for preventing head and facial injuries in bicyclists. Cochrane Database of Systematic Reviews 1999.
Labels: Adolescent Health, Health Communication, Yellow
posted by Melanie Pennison @ 2:18 PM
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