Mass media campaigns and the 'file drawer problem': A mixed methods study of how to avoid campaign failure.

Mass media campaigns are frequently used to address public health issues. Considering the considerable cost, there has been little analysis of why campaigns sometimes fail. This study used a sequential mixed methods approach to explore the mechanisms that can lead to failure and to identify what can be done to avoid or overcome common mistakes in campaign planning, implementation, and evaluation. We conducted interviews and a survey with 28 public health social marketing and mass media campaign experts over three rounds of research and analysed the data thematically, generating themes inductively. We identified four systemic factors that drive success: long-term strategic thinking and commitment, understanding the campaign context, doing and learning from evaluation, and fostering strong relationships. The factors did not operate in isolation, rather good (or poor) execution in one area was likely to influence performance in another. The experts also emphasised that a change of political context could drastically affect one or more of the identified factors. Our analysis showed that campaign failures are not simply individuals making mistakes. Systemic issues throughout the planning, execution, and evaluation phases need to be addressed if campaign outcomes are to improve.

Social marketing and mass media interventions to increase sexually transmissible infections (STIs) testing among young people: social marketing and visual design component analysis.

INTRODUCTION: Globally, sexually transmissible infections (STIs) continue to disproportionately affect young people. Regular STI testing is an important public health strategy but remains low among this age group. Raising awareness of testing is an essential step and requires effective interventions designed for young people. To inform the development of effective interventions that promote STI testing among young people, we conducted a systematic literature review to describe the social marketing and visual design components commonly found in STI testing interventions and explore associations of these components with intervention effectiveness. METHODS: We used a systemic review methodology to identify peer-reviewed articles that met pre-defined inclusion criteria. Social marketing and visual component analyses were conducted using structured data extraction tools and coding schemes, based on the eight key social marketing principles and 28 descriptive dimensions for visual analysis. RESULTS: 18 studies focusing on 13 separate interventions met the inclusion criteria. Most interventions used photograph-based images, using conventionally attractive actors, positioned centrally and making direct eye contact to engage the viewer. The majority of interventions featured text sparingly and drew on a range of tones (e.g. serious, humorous, positive, reassuring, empowering and informative) and three interventions used sexualised content. Four articles explicitly stated that the interventions was informed by social marketing principles, with two explicitly referencing all eight principles. Around half of the articles reported using a formal theoretical framework, but most were considered to have theoretical constructs implicit in interventions materials. Four articles provided detailed information regarding developmental consumer research or pre-testing. All articles suggested segmentation and development of materials specifically for young people. Explicit consideration of motivation and competition was lacking across all articles. This study found that there were some design elements common to interventions which were considered more effective. High social marketing complexity (where interventions met at least seven of the 11 criteria for complexity) seemed to be associated with more effective interventions. CONCLUSIONS: Our findings suggest that the incorporation of social marketing principles, could be more important for intervention effectiveness than specific elements of visual design. Effective and systematic use of social marketing principles may help to inform future evidence-informed and theoretically based interventions and should be employed within sexual health improvement efforts.

Markets, incentives, and health promotion can improve family planning and maternal health practices: a quasi-experimental evaluation of a tech-enabled social franchising and social marketing platform in India.

BACKGROUND: Improving family planning and maternal health outcomes are critical to achieving the Sustainable Development Goals. While evidence on the effectiveness of government-driven public health programs is extensive, more research is needed on effectiveness of private-sector interventions, especially in low- and middle-income countries. We evaluated the impacts of a commercial social-franchising and social-marketing program - Tiko Platform - which created a local ecosystem of health promoters, healthcare providers, pharmacies, stockists/wholesalers, and lifestyle shops. It provided economic incentives through discounts and reward points to nudge health-seeking behaviors from enrolled women consumers/beneficiaries. METHODS: An ex-post facto evaluation was commissioned, and we employed a quasi-experimental design to compare outcomes related to the use of family planning, and antenatal and postnatal services between users and non-users who had registered for Tiko in three North Indian cities. Between March and April 2021, 1514 married women were surveyed, and outcome indicators were constructed based on recall. Despite statistical approaches to control for confounding, the effect of COVID-19 lockdown on Tiko operations and methodological limitations preclude inferring causality or arguing generalizability. RESULTS: We found a strong association between the use of the Tiko platform and the current use of temporary modern contraceptives [non-users: 9.5%, effect: +9.4 percentage points (pp), p-value < 0.001], consumption of 100 or more iron-folic-acid tablets during pregnancy [non-users: 25.5%, effect: +14 pp, p-value < 0.001], receiving four or more antenatal check-ups [non-users: 18.3%, effect: +11.3 pp, p-value 0.007], and receiving postnatal check-up within six weeks of birth [non-users: 50.9%, effect: +7.5 pp, p-value 0.091]. No associations were found between the use of the Tiko platform and the current use of any type of contraceptive (temporary, permanent, or rudimentary). Effects were pronounced when a community health worker of the National Health Mission also worked as a health promoter for the Tiko Platform. CONCLUSION: Commercial interventions that harness market-driven approaches of incentives, social marketing, and social franchising improved family planning and maternal health practices through higher utilization of private market providers while maintaining access to government health services. Findings support a unifying approach to public health without separating government versus private services, but more rigorous and generalizable research is needed. TRIAL REGISTRATION: NCT05725278 at clinicaltrials.gov (retrospective); 13/02/2023.

Pharmacist insights into antimicrobial stewardship: A social marketing approach.

BACKGROUND: Antimicrobial resistance is a worldwide public health problem. Antimicrobial stewardship programs (ASPs) optimize antimicrobial use within hospitals. The social marketing framework has been used in analyzing systems and devising best practices. OBJECTIVE: (s): To use the social marketing framework to explore pharmacist experiences and perceptions of structural, behavioral and interventional strategies that support ASPs. METHODS: A qualitative approach utilizing semi-structured individual interviews was utilized. A purposive sample of hospital pharmacists was invited to participate. An interview guide was constructed to describe participant experience and perceptions regarding ASPs in their institutions based on elements of social marketing: Behavioral goals; Customer Insight; Segmentation and Targeting; Competition; Exchange; and Marketing and Interventional mix. Interviews were recorded digitally and transcribed verbatim. Thematic analysis was conducted using deductive methods. A combination of case-based and code-based approaches allowed individual and holistic analyses respectively. Codes were collated into themes and subthemes. RESULTS: Saturation of themes occurred with 25 interviews from 17 hospitals. ASP metrics included: consumption of antibiotics using days of therapy and defined daily dose, rates of C. difficile and multidrug resistant organisms, resistance patterns, and provider adherence to the ASP. Active stewardship tools such as preauthorization, and prospective feedback/audit were preferred over passive tools such as order sets and automatic stop orders. A physician champion and a clinical pharmacist with infectious disease training were core elements in the multidisciplinary team. Despite certain areas being considered key for stewardship, participants emphasized a hospital-wide approach including outpatient departments; discharge stewardship emerged as a primary theme. Leadership supported ASPs with finances, rapid and novel diagnostics, Clinical Decision Support Systems, mobile technology, and continuous staff training. CONCLUSIONS: The social marketing framework has been used to explore pharmacist perceptions that inform successful qualities including metrics, restriction methods, personnel, benefits, barriers, training needs/modes, and promotional avenues that support ASPs in hospitals.

A reflection on the co-design approach to the development of the Medway Can campaign; a whole systems approach to obesity prevention using COM-B.

Obesity is one of the highest metabolic risk factors associated with morbidity and mortality in the UK, with two-thirds of adults in the UK classed as overweight or obese. Whole systems approaches can be effective in tackling this public health challenge through stakeholder and key partner engagement. This article describes the co-design process for a social marketing obesity prevention campaign taking a whole systems approach based on the COM-B model of behaviour change. Development of social marketing campaigns through Agencies is often hampered by rapid turnaround and short timescales; we highlight how drawing on existing knowledge and co-design with beneficiaries can support the design, delivery and implementation of a social marketing behaviour change campaign.

Recommendations for Improving Oral Pre-exposure Prophylaxis Implementation and Social Marketing in Ugandan Fisherfolk Communities: A Qualitative Exploration.

Background: HIV is hyperendemic among fisherfolk in Sub-Saharan Africa, especially around Lake Victoria, Uganda. Purpose/Research Design: We conducted cross-sectional semi-structured interviews about oral pre-exposure prophylaxis (PrEP) implementation with 35 Ugandan fisherfolk (15 women, 20 men) and 10 key stakeholders (healthcare providers, policymakers, community leaders). We used a directed content analysis approach based on implementation science and social marketing frameworks. Results: Participants showed high acceptability for PrEP. Anticipated barriers among fisherfolk included stigma (due to similar medications/packaging as HIV treatment); misconceptions; mobility, competing needs, poverty, and partner conflict. Anticipated provider barriers included insufficient staffing and travel support. Recommendations included: change PrEP packaging; integrate PrEP with other services; decrease PrEP refill frequency; give transportation resources to providers; train more healthcare workers to provide PrEP to fisherfolk; and use positively framed messages to promote PrEP. Conclusions: Results can inform policymakers and healthcare organizations on how to overcome barriers to PrEP scale-up in most at-risk populations with poor healthcare access.

Assessing the impact of a national social marketing campaign for antimicrobial resistance on public awareness, attitudes, and behaviour, and as a supportive tool for healthcare professionals, England, 2017 to 2019.

BackgroundPrevious United Kingdom campaigns targeting antimicrobial resistance (AMR) recommended running multimedia campaigns over an increased timeframe. The 3-year-long Keep Antibiotics Working (KAW) campaign was a mass media campaign in England targeting the public and general practitioners (GPs).MethodsEvery year, pre- and post-campaign questionnaire data were collected from the public, whereas post-campaign interview data were obtained from GPs. Data were weighted to allow pre- and post-campaign comparisons between independent samples. Significant changes in nominal and ordinal data were determined using Pearson's chi-squared (X2) and Mann-Whitney U tests, respectively.ResultsPrompted campaign recognition was high, increasing by 6% from 2018 to 2019 (2017: data unavailable; 2018: 68% (680/1,000); 2019: 74% (740/1,000); X2 = 8.742, p = 0.003). Knowledge regarding declining antibiotic effectiveness when taken inappropriately improved following the campaign (net true: pre-2017 = 69.1% (691/1,000); post-2019 = 77.6%; (776/1,000); X2 = 5.753, p = 0.016). The proportion of individuals reporting concern for themselves or for children (≤ 16 years) about AMR increased by 11.2% (Z = -5.091, p < 0.001) and 6.0% (Z = -3.616, p < 0.001) respectively, pre- to post-campaign. Finally, in 2017, reported confidence to say no to patients requesting antibiotics differed significantly between GPs who were and were not aware of the campaign (net agree: 98.9% (182/184) vs 92.4% (97/105) respectively; X2 = 4.000, p = 0.045).ConclusionA high level of prompted campaign recognition was achieved. The KAW campaign improved aspects of AMR knowledge and certain attitudes towards appropriate antimicrobial use. It increased awareness of and concern about AMR, supporting GP confidence to appropriately prescribe antibiotics. Future determination of measurable behaviour changes resulting from AMR campaigns is important.

The moderating influence of celebrity endorsement on intention to engage in infection prevention behaviours.

Although the use of celebrities for communication within social marketing to influence voluntary behaviour change has received significant attention, its application to promote infection preventive behaviours, such as frequent handwashing with soap, has received limited attention. Using the health belief model (HBM), the study examined the moderating effect of celebrity endorsement (CE) on the relationship between the predictors of HBM such as perceived severity, susceptibility, benefits, barriers, self-efficacy and target audiences' intention to avoid handshaking, frequently wash hands with soap and cover mouth with an elbow when coughing. Data from 562 respondents were analysed using PLS-SEM. The result shows that CE significantly moderate the relationship between target audiences' perception of severity, susceptibility, self-efficacy and cues to action and intention to perform the recommended infection preventive behaviours. Thus, when a celebrity is employed as a conduit for delivering a social marketing message, particularly about infection preventive behaviour, target audiences are more likely to take action to perform the recommended behaviour. Theoretically, the study shows that although the HBM has been extensively applied to explain health-related behaviours, using celebrities to endorse the various constructs of the HBM significantly enhances the predictive ability of the model.

Potential social marketing applications for knowledge translation in healthcare: a scoping review protocol.

INTRODUCTION: Knowledge translation has emerged as a practice and a science to bridge the gap between evidence and practice in healthcare. While the field has appropriately borrowed from other related fields to advance its science, there remain fields less mined. One such field with potential relevance to knowledge translation, but limited application to date, is social marketing. This review aims to determine elements of social marketing interventions that could be applied to knowledge translation science. Our objectives are to: (1) summarise the types of studies that have tested social marketing interventions in controlled intervention study designs; (2) describe the social marketing interventions and their effects; and (3) propose strategies for the integration of social marketing interventions into knowledge translation science. METHODS AND ANALYSIS: This scoping review will be conducted using the Joanna Briggs Institute Methodological Guidance. For the first and second objectives, all English-language studies published from 1971 onwards will be included if they (1) used a randomised or non-randomised controlled intervention design, and (2) tested a social marketing intervention as defined by five essential social marketing criteria. The research team will address the third objective through discussion and consensus. All screening and extraction will be performed independently by two reviewers. Variables extracted will include intervention details using essential and desirable social marketing criteria and the context, mechanism and outcomes of the interventions. ETHICS AND DISSEMINATION: This project is a secondary analysis of published papers and does not require ethics approval. We will disseminate our review outputs in knowledge translation journals and present at relevant conferences across the spectrum of the field. We will produce a short and long version of a plain language summary that will be tailored to various groups including implementation scientists and quality improvement researchers. REGISTRATION DETAILS: Open Science Framework Registration link: osf.io/6q834.

California's Supplemental Nutrition Assistance Program-Education (SNAP-Ed) Be Better social marketing campaign: mothers' fruit and vegetable consumption and facilitation of children's healthy behaviours.

OBJECTIVE: Evaluation of California Department of Public Health's three-year social marketing campaign (Be Better) to encourage healthy eating and water consumption among Supplemental Nutrition Assistance Program-Education (SNAP-Ed) California mothers. Andreasen's social marketing framework was used to outline the development and evaluation of the campaign. DESIGN: Quantitative, pre-post cross-sectional study with three cohorts nested within survey years. Generalised estimating equation modeling was used to obtain population estimates of campaign reach and changes in mothers' fruit and vegetable (FV) consumption and facilitative actions towards their children's health behaviours. SETTING: CalFresh Healthy Living (California's SNAP-Ed). PARTICIPANTS: Three separate cohorts of SNAP mothers were surveyed (pre, post) between 2016 and 2018 inclusive. A total of 2229 mothers (ages 18-59) self-identified as White, Latina, African American or Asian/Pacific Islander participated. RESULTS: Approximately 82 percent of surveyed mothers were aware of the campaign as assessed by measures of recall and recognition. Ad awareness was positively associated with mothers' FV consumption (R2 = 0·45), with the proportion of FV on plates and with behaviours that facilitate children's FV consumption and limit unhealthy snacks and sugary drinks (ßs ranged from 0·1 to 0·7). CONCLUSIONS: The campaign successfully reached 82 percent of surveyed mothers. Positive associations between California's Be Better campaign and targeted health behaviours were observed, although the associations varied by year and media channel (i.e. television, radio, billboards and digital). Most associations between ad awareness and outcomes were noted in years two and three of the campaign, suggesting that more than 1 year of campaign exposure was necessary for associations to emerge.

Implementation of a salt substitute intervention using social marketing in resourced-limited communities in Peru: a process evaluation study.

Objective: This study aimed to conduct a process evaluation of a salt substitute trial conducted in Peru. Methods: Through semi-structured interviews of intervention participants, we documented and analyzed process evaluation variables as defined by the Medical Research Council Framework. This study was a stepped wedge trial conducted in Tumbes, Peru in 2014. The intervention was a community-wide replacement of regular salt (100% sodium) with "Salt Liz" (75% sodium and 25% potassium) using social marketing strategies to promote the adoption and continued use of the salt substitute in daily life. The components of the social marketing campaign included entertainment educational activities and local product promoters ("Amigas de Liz"). Another component of the intervention was the Salt Liz spoon to help guide the amount of salt that families should consume. The process evaluation variables measured were the context, mechanism of action, and implementation outcomes (acceptability, fidelity and adoption, perceptions, and feedback). Results: In total, 60 women were interviewed, 20 with hypertension and 40 without hypertension. Regarding context, common characteristics across the four villages included residents who primarily ate their meals at home and women who were responsible for household food preparation. As the mechanism of action, most participants did not notice a difference in the flavor between regular salt and Salt Liz; those that did notice a difference took around 2 weeks to become accustomed to the taste of the salt substitute. In terms of implementation outcomes, the Salt Liz was accepted by villagers and factors explaining this acceptability included that it was perceived as a "high quality" salt and as having a positive effect on one's health. Participants recognized that the Salt Liz is healthier than regular salt and that it can help prevent or control hypertension. However, most participants could not accurately recall how the compositions of the Salt Liz and regular salt differed and the role they play in hypertension. Although the use of the Salt Liz was far-reaching at the community level, the use of the Salt Liz spoon was poor. Educational entertainment activities were well-received, and most participants enjoyed them despite not always being active participants but rather sideline observers. Conclusion: This process evaluation identifies key intervention components that enabled a successful trial. Seeking and incorporating feedback from the target population helps deepen the understanding of contextual factors that influence an intervention's success. Furthermore, feedback received can aid the development of the intervention product. Some factors that can be improved for future interventions are acknowledged. Clinical trial registration: NCT01960972.

Using the '4Ps' social marketing strategy to overcome vaccination hesitancy: COVID-19 vaccine coverage in a Chinese college as an example.

OBJECTIVES: To explore the role of the '4Ps' social marketing strategy on vaccine hesitancy and its impact on public vaccine coverage. The '4Ps' strategy (place, price, product and promotion) is a social marketing tool that had addressed many public issues and vaccinations. METHODS: This study was a retrospective before-after study. A total of 10795 people were enrolled. The routine COVID-19 immunization method was used for the first vaccination doses from 23 March to 11 April, 2021. Then we carried out a '4Ps' social marketing strategy for vaccination from 12 April to 1 May 2021. The vaccine hesitancy and the coverage rate of the first dosage of COVID-19 vaccine in the target population were collected and compared before and after the '4Ps' social marketing strategy. RESULTS: The coverage reached only 6.19% during routine immunization. However, vaccine hesitancy of the target population decreased (52% versus [vs.] 3.1%, before vs. after '4Ps' strategy) and degree of coverage (94.8%, vs. routine vaccination method, p<0.001) significantly increased after taking '4Ps' social marketing strategy. Furthermore, the '4Ps' social marketing strategy also consolidated the completion of the second dosage of COVID-19 vaccines. CONCLUSION: The '4Ps' social marketing strategy greatly reduced vaccine hesitancy and enhanced vaccination coverage and provided a more effective and reliable promotion method in the face of current virus mutations and new vaccination in the future.

An application of social marketing for promoting HIV testing in Iran.

BACKGROUND: It has been estimated that 60,000 Iranians have been infected with HIV/AIDS and only 36% of them are aware of their status. This study aimed to design, implement and evaluate a social marketing campaign to promote HIV testing in Boyer-Ahmad County, Kohgiluyeh, and Boyer-Ahmad Province, southwest of Iran. MATERIALS AND METHODS: This study was a quasi-experimental pretest-posttest without a control group, developed based on a social marketing assessment and response tool. To design the intervention formative research was conducted, comprised of four focus group discussion sessions with 42 participants of the target community along with seven in-depth semi-structured personal interviews with health care providers involved in the HIV/AIDS Program. Data analysis was done manually using content analysis and the main content was formulated for the campaign. Afterward, the slogan and messages of the campaign were developed. The campaign's materials including banners, posters, pamphlets, referral forms, and short messages were designed, pretested, and revised. Ultimately, the campaign was conducted for one month in October 2019. To determine the effectiveness of the campaign, the rate of referrals to the Center for Behavioral Health Counseling Services (CBHCS), for three months before and after the campaign, was compared. RESULTS: Qualitative findings identified that the majority of the interviewees mentioned that the main reasons for the low rate of referrals to get tested for HIV were lack of awareness and information about HIV/AIDS and its diagnosis as well as the free and confidential tests available from the CBHCS. Moreover, the stigma associated with HIV/AIDS was another important reason for low referrals for testing. The rate of referrals for HIV testing in the three months leading up to the campaign was 18, 32, and 23 people, and three months after the campaign was 64, 81, and 44 individuals; respectively. The results of the multivariate analysis demonstrated that the campaign had increased the rates of referrals for HIV testing through its significant influence on females, and individuals with academic degrees. CONCLUSION: It can be concluded that the social marketing campaign was successful in persuading people to get tested for HIV.

Targeted social marketing of PrEP and the stigmatization of black sexual minority men.

Disparities in HIV incidence and PrEP uptake suggest a need to prioritize Black sexual minority men (SMM) in PrEP social marketing initiatives. However, images linking Black SMM to HIV and PrEP may inadvertently reinforce stigma. We examined HIV-negative/status-unknown Black SMM's responses to targeted PrEP advertisements using mixed methods, including an experiment embedded in a longitudinal online survey (Time 1: n = 96; Time 2 [eight weeks]: n = 73) and four focus groups (n = 18). The full factorial experiment included between-groups and within-subjects comparisons. For between-groups comparisons, each participant was randomly assigned to view one of 12 advertisements, which varied by couple composition (Black SMM couple/Black heterosexual couple/multiple diverse couples/no couples) and campaign (PrEPare for the Possibilities/PlaySure/PrEP4Love). We examined couple composition, campaign, and interaction effects on: advertisement judgments (Time 1), PrEP stigma (Time 1), PrEP motivation (Times 1 and 2), and PrEP behavior (Time 2). For within-subjects comparisons, each participant viewed all 12 advertisements, and we examined couple composition, campaign, and interaction effects on advertisement judgments (Time 2). Focus group participants discussed advertising preferences and responded to the same set of advertisements. For between-groups and within-subjects comparisons, we found significant couple composition effects but no or limited campaign and interaction effects on advertisement judgments. Advertisements featuring Black SMM exclusively were judged as more stigmatizing than advertisements without couples. Advertisements with diverse (vs. no) couples were considered more eye-catching and motivating. There were minimal effects of couple composition and campaign on PrEP stigma, motivation, and behavior. Focus group participants corroborated concerns about the potential for PrEP advertisements to be stigmatizing, suggesting advertisements featuring Black SMM exclusively could be alienating and fuel conspiracy theories. Focus group participants generally favored diverse and less sexualized advertisements, particularly for public spaces. Findings collectively highlight the potential for targeted PrEP advertisements to stigmatize Black SMM and support diverse representation.

Designing an eSports intervention for middle-aged and older adults in Hong Kong: Social marketing approach.

This study examined the perceptions and experiences of middle-aged and older adult participants in electronic sports (eSports) in Hong Kong (HK), China, by using the social marketing (SM) approach. This qualitative study applied SM approach to the design of a center-based eSports intervention for middle-aged and older adults in HK. Interviews were conducted with 39 adults stratified in terms of age (i.e., 45-64 vs. ≥65 years) and experience with eSports. Ten administrators working in community elderly centers were invited for semistructured interviews. Thematic analysis was performed on the data by incorporating SM. Main findings are presented in terms of five P's. The product component of an eSports intervention includes the foundation of eSports (e.g., safety, eSports training), suitable games for older adults, and professional equipment (e.g., large-screen devices and motion-controlled Nintendo Switches). The price component comprises affordability and the frequency and duration of each eSport session, and the place component includes accessibility and spaces to play eSports. The promotion component should be educational in nature and can incorporate free trials and gaming days, short films about older adults playing eSports, promotional channels, physical evidence and annual eSports competitions. The people component consists of support from administrators and the center in charge, the availability of skilled program instructors and staff, and appropriate partnering, team sizes and instructor-to-participant ratios. The 5P's enhance the design of future center-based eSports interventions and can help researchers and practitioners determine which aspects encourage middle-aged and older adults to participate in eSports.

A downstream social norms approach for curtailing e-cigarette waste: Promising social marketing interventions from consumer interactions.

Irresponsibly disposed electronic cigarette (e-cigarette) waste poses significant public health and environmental harm. This study explores downstream social marketing interventions that can be used to curtail the growth of e-cigarette waste in South Africa through the lenses of the social norms approach. This study harnesses the power of social marketing to identify downstream interventions that can be used by marketers to curb the problem of e-cigarette waste. An exploratory research design and a qualitative method were employed. Six virtual focus groups were conducted to collect cross-sectional data from South African electronic cigarette users. Reciprocal altruism, social orientation value, moral licensing and ecological beliefs were found to be the main normative influences that characterise e-cigarette waste. The results support the proposition that social marketers should employ a downstream approach to develop interventions to curtail the growth of e-cigarette waste. Such measures are envisaged to complement upstream initiatives. This study offers new insights on how to manage e-cigarette waste in the context of an emerging market.

The Role of Graphic Design Semiotics in Environmental Awareness Campaigns.

This work aims to explore the usefulness of graphic design in awareness campaigns promoting sustainable tourist destinations and to identify their contribution to the success of the campaigns in terms of their generating increased protection of the natural and socioeconomic resources of the destination. The study applies semiotics to the field of social marketing to build a conceptual model that relates the graphic design of a campaign to public environmental awareness, and to the destination's preservation. In order to test the conceptual model, the campaign "Que la montagne est belle!" of the "Parc Naturel Régional des Pyrénées catalanes" in the French Pyrenees is taken as a case study for analysis, as it aims to preserve the park's natural environment and pastoral activities. The data are analysed using the partial least squares structural equation modelling technique (PLS-SEM), and the results are studied for different segments of the sample. The findings show that the graphic design semiotics influence public environmental awareness and destination preservation by generating in the audience a sensitive, emotional, and cognitive reaction towards the campaign. This innovative framework on graphic design can be adapted to other branding or marketing campaigns to improve destination images.

Effectiveness of Prevention Interventions Using Social Marketing Methods on Behavioural Change in the General Population: A Systematic Review of the Literature.

In an effort to encourage people to adopt healthy behaviours, social marketing is increasingly used in disease prevention and health promotion. This systematic review aimed to evaluate the effect of prevention initiatives that use social marketing techniques on achieving behavioural change in the general population. We conducted a systematic review of PubMed, Embase, Science Direct, Cochrane, and Business Source Complete. Among 1189 articles identified across all databases, 10 studies met the inclusion criteria (six randomized controlled trials and four systematic reviews). The number of social marketing criteria used varies according to the studies. The results showed positive effects overall, albeit not always statistically significant. The quality of the studies was mixed: 3/4 of the systematic reviews did not meet the methodological criteria, and four out of six randomized trials had at least a high risk of bias. Social marketing is not fully exploited in prevention interventions. However, the greater the number of social marketing criteria used, the more positive the effects observed. Social marketing thus appears to be an interesting concept to bring about behavioural change, but it requires rigorous monitoring to ensure maximum effectiveness.

Educational material for social marketing and behaviours linked to early detection of breast cancer.

BACKGROUND: Social marketing is an effective tool to ensure a populationbased behaviour change for a healthy lifestyle. AIM: The aim was to investigate the effects of breast cancer-related printed educational materials on women's behaviours related to early detection and diagnosis of breast cancer within the framework of social marketing. METHOD: This pre-post test one-group study was conducted with 80 women in a family health centre. An interview form, printed educational materials and follow-up form were used to collect the study data. The data were collected at the baseline and through phone calls at the third month. RESULTS: Of the women, 36% had never performed breast self-examination (BSE), 55% had never had clinical breast examination (CBE), and 41% had never had mammography. There were no differences between the measurements made at the baseline and at the third month in terms of performing BSE, and having CBE and mammography. CONCLUSION: The importance of expanding social marketing approaches in terms of global health investments is emphasised. Adoption of positive health behaviours will lead to improvements in health status, as assessed through measures of morbidity and mortality status in cancer.