How to enhance the Social Ecological Framework by incorporating Bronfenbrenner s Process, Person, Context and Time Model.

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1 How to enhance the Social Ecological Framework by incorporating Bronfenbrenner s Process, Person, Context and Time Model. Introduction. Social marketing is a process designed to improve the welfare of individuals and society (Lazer & Kelley, 1973 and Andreasen, 2002). At the turn of the century, its growth was hampered by a lack of understanding on how it could facilitate social change (Andreasen, 2002). There is a concern that many scholars and practitioners only focus on the interaction with the individual (Rothschild, 1999; Collins, Tapp & Presley, 2010 and Helmig & Thaler, 2010). This failing in social marketing was first identified in the early nineties when Wallack et al (1993) stated that social marketers should incorporate wider environmental issues. Such a gap may potentially be bridged by incorporating some form of ecological model to the concepts of social marketing. It should also give scholars and practitioners a wider perspective of the problems they face. There is a long history of researchers utilising ecological models: it is particularly prevalent in education, health, social and behavioural studies. Researchers in this field include Lewin (1935), Barker (1968), Bronfenbrenner (1977, 1979, 1994, 1999), Moos (1980), Stokols (1992), Cohen et al (2000), Collins Tapp & Pressley (2010) and Lynch and Batal (2011). The primary proposition for an ecological theory is that it must have multiple levels of interaction, which include (but are not limited to) the individual, society, governments and non-governmental organisations (Sallis, Owen & Fisher, 2008): figure 1 is a graphical illustration of an ecological model. Figure 1: A graphical illustration of an ecological model (adapted from Bronfenbrenner, 1979). The ecological researchers (highlighted above) have all produced slightly differing frameworks. The Social Ecological Framework (SEF) developed by Collins, Tapp & Pressley (see Appendix1) is a model designed specifically for social marketing. They acknowledge that the SEF is still in its infancy and that "considerable further work will be needed to test the SEF against a wider variety of available social marketing activities" (Collins, Tapp & Pressley, 2010, p1193). They hope that further improvements will enhance the SEF into a strategic management tool. This doctoral research project will take up Collins, Tapp & Page 1

2 Presley s call to action by testing it against the possibility of changing the health behaviours of people living with diabetes. The doctoral research project will also explore if there is a possibility of enhancing the SEF by incorporating Bronfenbrenner's Process, Person, Context and Time (PPCT) Model (which will be discussed later in this document). The Social Ecological Framework. The SEF (see appendix 1) takes its main foundations from Bronfenbrenner's (1979) Ecological Theory. The framework is represented in table 1 and focuses on those factors that can potentially impact on the behaviour of an individual through the various levels of the ecological system. Ecological System Impact Factor Macrosystem Exosystem Mesosystem Microsystem What impact will cultural differences have on a social marketer s ability to instigate behaviour change? What impact will factors outside of an individual s control have on a social marketer s ability to instigate behaviour change? An example could be changes in government or health policy. What impact will an individual s wider sphere of interaction have on a social marketer s ability to instigate behaviour change? An example could be the restrictions they face by having to work for a living. What impact will an individual s immediate sphere of interaction have on a social marketer s ability to instigate behaviour change? An example could be the pressures experienced from their immediate family or friends. Table 1: Impact Factors Along The Ecology System (adapted from Bronfenbrenner, 1979) The main premise of the framework is to identify how many positive and negative forces (related to behaviour change) occur at each level. This creates a path along the framework (see figure 2) to one of sixteen possible scenarios. The methods for dealing with each scenario are highlighted in appendix 1. Figure 2. The SEF's Theoretical Scenario Pathway (Collins, Tapp and Presley, 2010). Page 2

3 Bronfenbrenner's Ecological Theory. Bronfenbrenner's Ecological Theory has been in a constant state of evolution (Tudge et al, 2009). The nested system (the micro, meso, exo and macro model as illustrated in table 1) was his first iteration and is probably his most recognised (Bronfenbrenner 1979). It is this version that the SEF was built on. Tudge et al (2009) believe that the key differentiator between Bronfenbrenner's earlier and latter work was the introduction of the concept of "process" and how it varied by "context". This lead to the creation of the "proximal processes" (Bronfenbrenner 1994, 1999 and Bronfenbrenner & Ceci, 1994) which can be defined as the enduring forms of interaction within an environment. In social marketing terms it can be seen as the campaign elements (the mix) adopted to encourage behaviour change. At about the same time Bronfenbrenner introduced the Process Person Context Time Model (Bronfenbrenner & Morris, 1998) which is the operational research design that permits the simultaneous investigation of the proximal process against the targeted person through every context (ie environment) over a specified time. Bronfenbrenner posited that "human development (and thus behaviour changes) takes place through processes of progressively more complex reciprocal interaction between, evolving biopsychological human organism and the persons, objects and symbols in its immediate external environment. To be effective, the interaction must occur on a fairly regular basis over extended periods of time" (Bronfenbrenner & Morris, 1998, p996). These new developments are missing from the SEF, their inclusion could add value to the SEF's application as I believe that they would provide clarity to: 1. The social marketing campaign: the proximal process. 2. The market segments: the biopsychological human organism. 3. The social marketing campaign timing. It should be noted that social marketing currently utilizes a range of other theories, these should be considered before any final conclusions are made. The Ecological Impact Of Theories Supporting Social Marketing. Social marketing is made up of four components; health, environment, social and health and safety (Kotler, Reberto & Lee, 2002). The diversity and potential complexities of social marketing campaigns should mean that no single behavioural theory will dominate the social marketing arena. This hypothesis is backed by recent studies (Helmig & Thaler, 2013) demonstrating that 80% of the theories adopted by researchers in social marketing are attributed to the Theory of Reasoned Action (Ajzen & Madden, 1986), Social Cognitive Theory (Bandura, 1986), the Health Belief Model (Rosenstock, 1974), the Theory of Planned Behaviour (Ajzen, 1991), Protection Motivation Theory (Rogers, 1975) and the Transtheoretical Model of Change (Prochaska & DiClemente, 1983). Using theory should provide researchers with an insight as to whether the required behavioural change is determined by a function of an individual's attitudinal, normative, selfefficacy, environmental or any other additional social concerns (Fishbein & Yzer, 2003). My interpretation of this is, social marketers need to adopt multiple campaigns that have a much wider holistic view of the problem if they are to capture as many of their targeted customers as possible. Using the SEF may provide social marketers with the mechanism needed to Page 3

4 identify these wider issues, it may also reinforce the fact that single campaigns are unlikely to be inclusive and that additional work would be required to maximize reach. Finally, it is worth noting that this doctoral research does not believe that the SEF will supersede all other theories, it should merely be introduced to support social marketers design the right intervention(s), which could mean utilising one or many theories. Research Questions. The primary question for this research is: How can I enhance the SEF by incorporating the PPCT model as described in Bronfenbrenner's bio-ecological theory? As this study will be based on an actual social marketing intervention it will also ask: 1. Should the NHS change the way it manages social marketing campaigns? 2. What processes and procedures are needed to apply it to a social (health) marketing intervention? 3. How should social marketers prioritise the importance of each element of the nested system (individual, micro, meso, exo and macro) when designing social (health) marketing interventions? Research Methodology. The scope of this study is limited to the "Health" element of social marketing. It will focus specifically on the process, person, context and time factors associated with a behaviour change. Implicit within this statement is the need to include a proximal process which can be considered as the primary social marketing campaign. The study must have a contrast between a minimum of two settings and between two groups of subjects distinguished by differing personal characteristics (Bronfenbrenner, 2005, p89). The case review will be the social marketing intervention related to health education programmes for individuals living with diabetes. This is because these health education programmes provide an excellent means for testing the proximal processes and the majority of diabetes cases are either type 1 or type 2: giving the study a means of comparing two groups that are genetically different. The scope of the research will be limited to individuals (adults with type 1 or type 2 diabetes) living in England: this ensures that comparisons can be made against a range of settings, namely the different Primary Care Trusts (PCTs) / Clinical Commissioning Groups. This document has already stated that the research hopes to enhance Collins, Tapp and Pressley s SEF by incorporating the missing elements of Bronfenbrenner s latest model. This is an important point as 84% of the published studies on Bronfenbrenner s models have relied on outmoded versions of the theory (Tudge et al, 2009, p198). Tudge et al (2009, p198) also stated empirical studies that do not properly represent the theory on which it is based will mislead individuals and provide a flawed heuristic tool. A mixed method approach will be used to examine the various environments, they include semi-structured qualitative interviews on individuals living with diabetes (type 1 and type 2) and a quantitative census analysis of the 152 Primary Care Trusts (PCTs) in England (note the new Clinical Commissioning Groups would not have the required historical data). Diabetes Page 4

5 UK have also agreed to support the programme by providing access to individuals living with diabetes who have agreed to take part in research. All the appropriate ethics requirements were also completed. Results To Date. There is a significant difference in the adoption of the required positive behaviour changes between those living with Type 1 and Type 2 diabetes. This demonstrates that the consideration of the Person is key. The PCTs had differing policies and options for their patients: the quality of the service and types of diabetes health education programmes varied by location. This causes great confusion amongst individuals living with diabetes. There was also a large variation in the percentage of completion rates demonstrating that the Process utilised could determine the campaigns success rate. It was also identified that cultural differences play an important part in determining if the positive behaviour changes would be adopted: the most significant is the ability to attend a language specific course, yet not all of the PCTs provided this option. Finally there were many complaints that it was difficult to assimilate the required information in just a day: some PCTs ran courses for just one day, others had them over six weeks. The findings demonstrate that Bronfenbrenner s PPCT model is significant in designing a social marketing campaign. The next phase of this doctoral research project is to establish how the SEF can be enhanced by incorporating the elements of the PPCT model into it. Conclusion. It is well established that many social marketing researchers only focus on the individual (Rothschild, 1999; Collins, Tapp & Presley, 2010 and Helmig & Thaler, 2010). There is a need to adopt a wider environmental perspective of all social marketing research (Wallack et al 1993). This constitutes a gap in the current theory and knowledge of social marketing: a gap that this doctoral research hopes to bridge. To achieve this, the research will build on the work of Collins, Tapp and Presley (2010) using their SEF. This framework is still in its development phase and requires considerable more work to enhance it: this will be the primary contribution of this doctoral study, although it will only focus on the health category of social marketing. The methodology employed will be a mixed methods approach focusing specifically on how health education programmes can be used to influence individuals living with diabetes to change their health behaviours. The study will be working in partnership with Diabetes UK who will provide access to individuals living with diabetes who are interested in supporting research projects. The initial findings demonstrate that the PPCT model can have a significant impact in the design of a social marketing campaign. The next phase is to develop a means of incorporating it into the SEF because as this report has shown, the SEF has the potential of becoming a strategic planning tool for social marketers. It could also have a significant impact in designing better social marketing campaigns. Page 5

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8 Appendix 1: The SEF Scenarios (Collins, Tapp & Presley, 2010, p ). Page 8

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