Lessons from social marketing with Pacific and Māori populations, key to understanding how to reach the target population, included:
- The importance of Māori and Pacific clinical and community leadership
- Early engagement with Māori and Pacific stakeholders/communities and strong involvement of Māori and Pacific peoples in campaign planning and development
- Use of existing Māori and Pacific community networks
- Recognition of motivators and emotional drivers specific to Māori and Pacific peoples
- Use of culturally-specific sites such as marae, kura kaupapa, or Pacific churches, with use of culturally appropriate processes.
The plan recommended a two-stage approach:
1.
Health Systems: Focusing on meeting with stakeholders and disseminating basic
campaign information such as key messages, PowerPoint presentations,
newsletters etc.
2.
Family/whānau and community/workplaces: Using a mix of paid advertising, public
relations, and community development approaches to reach target populations.
Ensuring that specific advertising and PR strategy is developed for each
audience.
Finally, the core principles underpinning the plan:
- Ensure that infants have the best possible start in life
- Ensure that outcomes from the campaign will be equitable, particularly among priority groups
- Facilitate Māori and Pacific health advancement
- Recognize that breastfeeding sits within a wider context of whānau ora (family health)
- Pragmatism: recognize small achievements (any shift towards improving breastfeeding rates is positive)
- Avoid stigmatizing women who do not breastfeed
The
Ministry’s Health Eating – Healthy Action campaign featured breastfeeding in
2008 through three initiatives (3):
- Breastfeeding Social Marketing Campaign – this mass-media and advertising campaign featured television, radio, and magazine advertising that disseminated messages encouraging family and friends to support their women to breastfeed for as long as possible (3).
- Developing Breastfeeding Action Plans for District Health Boards – The action plans developed included ways to support and advocate the Baby Friendly Initiative, as well as how to facilitate and coordinate an infant feeding health promotion strategy in their respective regions (3).
- Breastfeeding Workforce Development – Previous research indicated the dire need for trained healthcare professionals to give breastfeeding advice, as well as ensuring the training was consistent and addressing common problems and solutions. Once the Ministry of Health updated training guidelines, courses would be developed for health care professionals, specifically Māori and Pacific health care practitioners and workers (3).
The
New Zealand Ministry of Health’s independent breastfeeding social media campaign began in
2009 by creating television, radio, and magazine advertisements to help build
awareness of the benefits of breastfeeding. The following year after initial
success, they strove to maintain this newfound connection with breastfeeding
mothers, extending into the home and growing community support (8). This second
phase of the program included images of breastfeeding women on billboards,
online and print advertising, promotion and distribution of an informational
DVD, and, most importantly, the use of social media outlets such as Facebook,
Twitter, and YouTube (8).
Focusing
on the Facebook campaign, the page managers were breastfeeding experts who were
also skilled in social media use. They were instructed to respond to questions
posted on the Facebook page regarding breastfeeding, as well as informational
facts about breastfeeding (8). In addition, using the information gained from
the formative research, particularly with the engagement with stakeholder
groups, the Ministry of Health compiled a list of topics for the community
managers to post on the page (8). These posts “further stimulated discussion
and feedback from the target audiences”, and importantly, kept people
revisiting the page, building the sense of an online community and
disseminating knowledge at a rapid pace (8).
To
increase the action on the page, a competition called, “Looking Good Baby,”
called for mothers to post photographs of them breastfeeding with the babies
(8). Mothers posted across the country and eight regional winners were selected
by members of the page (8). After the first two years of the Facebook launch,
the page had developed a strong community.
Evidence of Implementation Strategy
A 2009 report to update the government on the status of Healthy Eating Healthy Action states the National Breastfeeding Promotion Campaign had successfully completed phase one and was entering phase two, going beyond the mothers’ immediate family to focus on promoting and supporting breastfeeding in healthcare facilities and retail settings such as supermarkets (9). The report also states that under the guidance of the National Breastfeeding Advisory Committee, a three-part seminar series was developed and presented via videoconference facilities that year. This seminar series provided HEHA managers the chance to bring together Pacific and Māori breastfeeding community stakeholders in order to hear from experts and community members on the best methods for the promotion and support of breastfeeding (9). Specifically in Southland, the report gives three different instances of breastfeeding promotion materials in regional newspapers (9).
Cost and Cost-Effectiveness
HEHA
was funded by the government of New Zealand. In 2007, HEHA reported that $12.45
million was approved for funding HEHA Community Action Projects, breastfeeding,
workforce development, and public health units and non-government organizations
for nutrition and physical activity services (3). Not all of the $12.45 million
went to breastfeeding but the proportion that did (not reported) went to fund
their three breastfeeding initiatives:
(3).
The use of mass media for health advocacy and promotion purposes has been reported as cost-effective in changing health behaviors (10). The MoH reported spending less than $200,000 a year on the Breastfeeding NZ Facebook campaign (8). This includes the salary of the page managers and many other resources developed alongside the Facebook page to support breastfeeding mothers including promotional material such as informational DVDs (8). In fact, the most expensive part of a promotion campaign may be the formative research done beforehand to inform the campaign; financial resources will be needed to hire research consultants, host meetings, and for the collection of in-country data through surveys, interviews, and other methods. However, the return on these investments is high, as using an evidence-based approach ensures proper targeting.
Perceptions and Experiences of Interested People
A case study by the New Zealand Government Information Services on New Zealand’s use of social media for breastfeeding promotion states the Facebook page was successful (8):
“The
Facebook page works because it supports women in their own environment and
according to their own time constraints. It offers credible content, support
from other breastfeeding women and celebrates their shared experiences”
Feedback
on the page was very positive–posts by community members were grateful for the
breastfeeding advice given and support from other women members (8). An article
from a parenting website on the New Zealand national breastfeeding promotion
campaign praised the ads displaying mothers breastfeeding in public settings,
agreeing with the campaign’s statement of purpose that breastfeeding gives
babies a healthy start in life and is perfectly natural (6).
The case study reported key lessons learned; they reported an “excellent relationship” with their contracting company, GSL, and cited contracting outside expertise as an effective way to add to the success of the campaign (8). Monitoring, such as by full-time page managers on the Facebook page, was crucial to keeping the social media sites active (8). These page managers were also key in disseminating breastfeeding information and initiating conversations among community members (8). A final lesson learned reported was to commit to the promotion campaign in the long-run, something New Zealand failed to do. For instance, the Breastfeeding NZ Facebook page was able to gain a strong following over a period of four years, but unfortunately, it is not continued today (8).
Benefits and
Potential Damages and Risks
- There is a risk in contracting with an outside actor because at the end of the contract, the promotion methods will not be sustained. This appears to be the case in New Zealand, as the Facebook Page and Blog are dormant or deleted. The Ministry of Health’s contract with GSL ended in 2013 (4). Individuals must be employed to continue/maintain the promotion methods, assuming responsibility from the external contracting company.
- There is risk of failure in reaching the intended audience depending on the avenues of communication in the country. This may have happened in New Zealand, whose target populations, the Māori and the Pacific communities, did not see an increase in exclusive breastfeeding rates while the nation as a whole did. Furthermore, these stagnant breastfeeding rates occurred despite formative research to develop the campaign to target these populations. Thus, countries must consider multi-faceted approaches to increase target population breastfeeding rates; alongside promotion through media, direct community outreach through community health workers may be better if the target population is a minority or rural group.
- As evidenced in New Zealand, the country can lose support and strength for a breastfeeding promotion campaign if the promotion is a subset of another campaign, such as HEHA in New Zealand’s case.
- There is a risk of failure of the mass media campaign in promoting the uptake of the intended message and thus behavior change in the target audience due to the campaign’s content, style, or other factors such as the belief in the credibility of the media. In addition, promotion campaigns that utilize social media must ensure constant monitoring so all posts by the public are appropriate and in-line with the goal of the campaign to promote breastfeeding.
- Resources for a professional,
commercial-style campaign could be scarce (ie skilled personnel to undertake
formative research, technical professionals to develop the material, lack of
personnel to serve as social media managers that also have expertise in
breastfeeding topics).
Scaling Up Considerations
- It is essential that any mass media health message be pre-tested and based on formative research to ensure uptake by the target population. The message should be culturally appropriate and specific to the target population.
- It is good to note the wide array of media the New Zealand national breastfeeding promotion campaign utilized–print ads, Facebook, Twitter, YouTube, and blogs. It is important for a country to survey its main modes of communication, as well as the target population’s main mode of communication (which may be different than the national), and disseminate promotional material appropriately to reach the target population. For instance, television was not a mode of communication used widely by the New Zealand national breastfeeding promotion campaign, while the Internet and social media was clearly targeted.
- As mentioned, it is important for the promotion campaign to commit to the long-term. There is a risk in contracting with an outside actor because at the end of the contract, the promotion methods will not be sustained. This appears to be the case in New Zealand, as the Facebook Page and Blog are dormant or deleted. The Ministry of Health’s contract with GSL ended in 2013 (4). Individuals must be employed to continue/maintain the promotion methods, assuming responsibility from the external contracting company.