EXPLORING SOCIAL MARKETING POLICIES: THE USE OF POSITIVE AND NEGATIVE EMOTIONAL APPEALS IN HEALTH ADVERTISING IN FOUR EUROPEAN COUNTRIES Doctoral Thesis in Business and Management Studies -Specialisation in Marketing and Strategy by Beatriz da Graỗa Luz Casais Supervised by Professor Doutor Joóo F Proenỗa Porto, August 2014 ii Authors Biography Beatriz da Graỗa Luz Casais was born in Porto, Portugal, on July 9th 1983 She has taken her higher education pathway at University of Porto with a degree in Journalism and Communication Sciences at Faculty of Arts (2005), a post-graduation in Health Communication at Faculty of Medicine (2007), and a MSc in Marketing at Faculty of Economics – FEP (2009) In February 2011 she finished the curricular course of the doctorate in Business and Management Studies at FEP, with the approval of the doctoral proposal in Marketing and Strategy, which made her PhD candidate Beatriz Casais teaches marketing and communication at University of Minho and Polytechnic Institute of Viseu as teaching assistant In the past, she collaborated with Polytechnic Institute of Viana Castelo, Polytechnic Institute of Porto and Porto Business School, in the same field She also did teaching mobility at Tallinn University of Technology (Estonia) under Erasmus Programme Beatriz Casais is also Marketing Manager and Communication Specialist at Five by Five Consulting and Research, Lda Between 2006 and 2011, Beatriz Casais was the manager of marketing and communication at the National Coordination for HIV/AIDS Infection, an organism from the Portuguese Ministry of Health In 2011, she integrated, for six months, the marketing and communication office of FEP Her professional career started in 2004/ 2005, when she was journalist trainee at Diỏrio Econúmico and Rỏdio Renascenỗa Her research interests focus on social marketing, social advertising, health marketing, public policies and management of non-profit organisations Beatriz Casais has published in Health Marketing Quarterly, Journal of Macromarketing and Advances in Advertising Research She has presented papers at AMA Marketing and Public Policy Conference, AMA Summer Educators’ Conference, Macromarketing Conference, International Conference in Research in Advertising (ICORIA), European Social Marketing Conference, International Conference of the International Association on Public and Nonprofit Marketing and International Colloquium on Nonprofit, Arts, Heritage, and Social Marketing, a special interest group from Academy of Marketing – where she won the best conference paper award provided by Journal of Social Marketing and Emerald Group iii Acknowledgments This thesis is a result of a personal effort and perseverance that would not be possible without the collaboration of several people to whom I want to express my gratitude The first acknowledge goes to my supervisor, Professor Doutor Joóo F Proenỗa He provided me an important learning process to conduct academic research I want to manifest my profound recognition for his professionalism, availability, rigour and constant demanding, as well as for his friendship and motivational support Professor, thank you for believing in me I want to thank the people that, in different ways, gave specialised assist to the research: professionals from institutions working on HIV/AIDS prevention that showed their campaigns and allowed confidence on the data collection process; translators of data from French, German and Italian to English; and the independent coders I also give my recognition to the academics that reviewed and discussed this topic with me, giving criticisms, suggestions and showing paths to follow Those contributions happened both at FEP, during the discussion of the thesis’ proposal, and in the international scientific meetings where I presented papers Finally, but not less important, I express my deep acknowledge to my family and my friends They supported me in several levels with love, friendship, care, comprehension and motivation My thankfulness is, at the same time, an apologising for my distance and absence in all those moments that I knew I was expected Thank you for your sense and for always being with me iv Abbreviations AIDS – Acquired Immunodeficiency Syndrome API - AIDS Programme Effort Index CDC –Center for Disease Control and Prevention ECDC – European Center for Disease Control and Prevention EPPM - Extended Parallel Processing Model EU – European Union GDP - Gross Domestic Product HIV – Human Immunodeficiency Virus IDU - Injection Drug Users MBA – Master in Business Administration MSc – Master of Science MSM – Men who have sex with men NCPI - National Composite Policy Index NGO - Non-Governmental Organisation OECD - Organisation for Economic Co-operation and Development OPM - Ordered Protection Motivation PEH - Public Expenditure on Health PhD – Doctor of Philosophy PLWHIV - People Living with HIV PMT - Protection Motivation Theory PRL - Proportional Reduction in Loss TV – Television UN – United Nation Orgnisation UNAIDS - Joint United Nations Program on HIV/AIDS WHO – World Health Organisation v Abstract The objective of this thesis is to understand the use of positive and negative appeals in the practice of health-related social marketing, since the theoretical knowledge about the effectiveness of appeals is inconsistent in the literature The research proposes to analyse the prevalence of positive and negative appeals in social marketing in a longitudinal overview, characterising their form and the context where they are used The thesis examines whether the use of positive and negative appeals fit with the theoretical knowledge of the conditions that differentiate their effectiveness - the target audiences and behavioural change messages, the type of institutional sources, the policy and cultural context, as well as the epidemic dynamics The researchers analysed 375 social advertisements preventing HIV/AIDS in four European countries developed by governmental or non-governmental organisations and broadcasted on television since the beginning of infection in 1981 until the end of 2011 The thesis contributes with a content analysis model to identify and characterise positive and negative appeals in health-related social advertisements and to classify ads according to the proportion of appeals verified in their different components Results indicate that positive appeals have expressive and higher proportional use all the period under analysis This is an unexpected result, suggesting that social marketing practices not follow the theoretical evidences and predominance in the literature regarding the effectiveness of negative appeals Public health advertisements are essentially targeted to general people, with general messages, and commonly framed by public policies in a reactive response to health dynamics The research showed sensitiveness between the use of positive and negative appeals and countries’ profiles and epidemic rates vi Resumo O objetivo da tese consiste em compreender o uso de apelos positivos e negativos nas práticas de marketing social em saúde, considerando que o conhecimento teórico sobre a eficácia desses apelos é inconsistente na literatura A investigaỗóo propừe-se a analisar a prevalờncia dos apelos positivos e negativos no marketing social numa perspetiva longitudinal, caracterizando a sua forma e o contexto em que são usados A tese verifica se o uso de apelos positivos e negativos está em conformidade com o conhecimento teórico das condiỗừes que diferenciam a sua eficỏcia o segmento alvo e as mensagens de mudanỗa comportamental, o tipo de fonte institucional, o contexto político e cultural, bem como a dinõmica epidemiolúgica Os investigadores analisaram 375 anỳncios publicitỏrios de prevenỗóo VIH/sida em quatro paớses europeus desenvolvidos por organizaỗừes governamentais ou nãogovernamentais e exibidos na televisão desde o início da infeỗóo em 1981 atộ ao final de 2011 A tese contribui com um modelo de análise de conteúdo para identificar e caracterizar os apelos positivos e negativos nos anúncios publicitários de promoỗóo da saỳde e para classificar os anỳncios de acordo com a proporỗóo de apelos verificados nas suas diferentes componentes Os resultados indicam que os apelos positivos têm um uso expressivo e proporcionalmente maior em todo o período de análise Trata-se de um resultado inesperado, que sugere que as práticas de marketing social não seguem as evidências teóricas nem a predominância na literatura relativamente eficácia dos apelos negativos Os anỳncios de saỳde pỳblica sóo essencialmente dirigidos populaỗóo geral, com mensagens generalistas, e sóo frequentemente enquadrados em aỗừes de políticas públicas numa resposta reativa às dinâmicas de sẳde A investigaỗóo mostra uma sensibilidade entre o uso de apelos positivos e negativos e os perfis dos paớses e situaỗóo epidemiológica vii Contents Author’s Biography iii Acknowledgments iv Abbreviations v Abstract vi Resumo vii Contents viii List of Tables x List of Figures xi CHAPTER - INTRODUCTION 1.1 Motivation for the Research Topic 1.2 Introduction 1.3 Research Purpose 1.4 Structure of the Thesis by Papers 1.5 Methodological Approach 10 CHAPTER - SOCIAL MARKETING POLICIES FOR PUBLIC HEALTH AND EPIDEMIC DYNAMICS: A STUDY BASED ON HIV/AIDS PREVENTION TELEVISION ADVERTISEMENTS IN FOUR EUROPEAN COUNTRIES 15 2.1 Introduction 17 2.2 Literature Review 18 2.2.1 Health-Related Social Marketing Interventions within Public Policies and NGOs 18 2.2.2 Social Marketing Effectiveness 20 2.2.3 Challenges and Barriers for Effective Health Social Marketing Programmes 21 2.3 Research Methods 24 2.3.1 Data Collection 25 2.3.2 The Database 25 2.3.3 Data Analysis 26 2.4 Discussion 30 2.4.1 Social Marketing as a Public Policy Intervention 30 2.4.2 Longitudinal Appropriateness of Health-Related Social Marketing to Epidemic Profiles 31 viii 2.4.3 Appropriateness of Targeting Policies and Behaviour Change Messages 34 2.4.4 Adequacy to the Environment 37 2.4.5 Social Marketing and Policy Ambivalences 40 2.5 Conclusion and Research Implications 42 2.6 Limitations and Further Research 43 CHAPTER - A CONTENT ANALYSIS MODEL TO CLASSIFY SOCIAL ADVERTISEMENTS ACCORDING TO THEIR USE OF POSITIVE OR NEGATIVE APPEALS 45 3.1 Positive and Negative Appeals in Social Marketing 47 3.2 A Content Analysis Model to Classify Social Advertisements 50 3.3 Methodology 51 3.3.1 The Model 51 3.3.2 The Empirical Research .52 3.3.2.1 The sample data .52 3.3.2.2 The analysis of categories 53 3.3.2.3 The comparison of classifications 54 3.4 Results 55 3.4.1 Categories 55 3.4.2 Reliability 59 3.5 Conclusion and Research Implications 60 3.6 Limitations and Further Research 61 CHAPTER - THE USE OF POSITIVE APPEALS IN SOCIAL MARKETING: FOCUSED ON TELEVISION ADVERTISING FOR PREVENTING A RESEARCH HIV/AIDS IN FOUR EUROPEAN COUNTRIES 63 4.1 Introduction 65 4.2 Literature Review 66 4.2.1 The Persuasiveness of Negative Appeals 66 4.2.2 Positive Appeals: an alternative to fear control .68 4.2.3 Factors Influencing the Efficacy of Positive and Negative Appeals .69 4.3 The Research Design 72 4.4 Methodology 73 4.4.1 The Database 74 4.4.2 Data Analysis .75 ix 4.5 Results and Discussion 77 4.5.1 What are the most prevalent appeals in social advertising? 77 4.5.2 When are positive and negative appeals used in social advertising? 78 4.5.3 How are positive and negative appeals used in social advertising? 79 4.6 Conclusion and Research Implications 90 4.7 Limitations and Future Research 92 CHAPTER - 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Classify Social Advertisements According to their Use of Positive and Negative Appeals? ?? Paper - ? ?The Use of Positive Appeals in Social Marketing: a research focused on television advertising for... proportional use in advertising components Analyse the use of positive and negative appeals in social marketing in a longitudinal overview in order to discuss what are their prevalence over time, how they