Social Marketing Recommendations For COVID-19 Vaccine

STEP 10SUMMARY OFFINDINGSAre We There Yet?Create an Evaluation Plan.The campaign should be measured in terms of inputs (budget, stafftime, partnership contributions) and outputs (impact and reachof strategies). But ultimately success should be measured by theoutcomes (changes in awareness, receptivity and vaccinationbehavior) and impact (curve flattening; reduction in serious illnessand death).WASHINGTON STATE DEPARTMENT OF HEALTH SOCIAL MARKETING RECOMMENDATIONS FOR COVID-19 VACCINE8

Social MarketingOverview

The practice of social marketing is built on a significant base of research that showsawareness and education alone rarely change behaviors. Instead, strategies that aimto overcome barriers and provide people with personal, relevant motivators must beused to create meaningful, sustainable behavior change. This approach will increasethe efficiency and effectiveness of marketing efforts by identifying the specificbehaviors that must change to achieve a program’s goals, segmenting audiencesbased on who has the highest probability of changing the desired behavior (or whois not yet participating), and addressing the barriers to behavior change while alsoensuring that an audience is sufficiently motivated to act.The following recommendations describe how community-based social marketing canbe used to overcome barriers and motivate people to get the COVID-19 vaccine. This10-step process, used in developing social marketing campaigns, was followed by theteam to create this recommendations document.Step #1: Identify project purpose, goals and objectives. Develop a road-mapfor the project, with a focus on defining what success looks like, includingmeasurable objectives.Step #2: Identify desired behavior changes. Determine the specific desiredbehavior changes that are the most direct path to achieving the program’s goals.This is often done by mapping which behaviors have the highest impact on thegoal and the highest probability of change.Step #3: Define priority audiences. Define the priority audiences that are likely tobe most receptive to changing their behaviors.Step #4: Research. Good campaigns and materials are grounded in research.Research should be used to understand priority audiences’ current actions andidentify what they think and feel about the subject matter and behaviors.Step #5: Identify barriers, benefits and motivators for the desired behaviorchanges. Once you know what behaviors you want people to adopt, the nextstep is to analyze the barriers that are preventing them from doing the desiredbehaviors, and the possible benefits and motivators that could overcome thosebarriers. Motivation can be increased in several ways including incentives or byspeaking to what people find beneficial (e.g., protecting those we love, beinga good citizen). This is a key part of the process and one that often provides areality check. If the motivators for a particular behavior change are not strongenough to overcome the barriers, it may be necessary to re-think that behaviorchange. The goal here is to set the program up for success—pick the achievablebehaviors and focus efforts there.WASHINGTON STATE DEPARTMENT OF HEALTH SOCIAL MARKETING RECOMMENDATIONS FOR COVID-19 VACCINE10

Step #6: Create a messaging strategy. A succinct and compelling messagestrategy is critical to help ensure the success of social marketing efforts. We livein a world where the average person is exposed to between 2,000 and 3,000marketing messages each day. We have about three-to-five seconds to catchsomeone’s attention so that they continue reading or viewing to learn more. In thisstep it is important to identify key value propositions and messaging to motivatethe desired change.Step #7: Social marketing intervention. This step is the culmination of the processwhere we prioritize and choose what social marketing tools will work best toinfluence behaviors among the priority audience groups. Sample tools are listedand explained later in this section.Step #8: Identify partners. Partnerships can help create demand for a programby providing access to a larger audience, incentives for program participants andadding credibility to the cause. Good potential partners have a complementarymission and audiences that overlap with the campaign’s priority audiences.Step #9: Develop a marketing plan. A fully developed marketing plan is crucial tothe success of social marketing efforts. This plan shares how to operationalize thesocial marketing tools, deliver the program’s message to the priority audiences,and define the outreach strategies and tactics that will deliver on the program’sgoals and objectives. It is often advised to launch a social marketing programwith a pilot campaign so that feedback on effectiveness can be gathered prior tobroad-scale implementation.Step #10: Create an evaluation plan. The evaluation plan is designed to track theprogram’s progress, celebrate successes and make necessary changes along theway. It includes measurements of campaign inputs, outputs, outcomes and overallcampaign impact.WASHINGTON STATE DEPARTMENT OF HEALTH SOCIAL MARKETING RECOMMENDATIONS FOR COVID-19 VACCINE11

Based on research in psychology and other social sciences, community-based socialmarketing has identified a set of tools for promoting behavior change. These tools aremost effective when they address barriers, benefits and motivators that have beenidentified through audience research. The tools include:Commitments – Making a commitment to change a behavior makes itmore likely that people will follow through.Social Norms – People will change their behaviors if they believeeveryone else has done so.Social Diffusion – Peer and referent groups spread behavior changethrough conversations, interactions and observation of each other.Prompts – Placing reminders to act as close to the location of behavioras possible (for example, floor signage showing six feet of distance inpublic, or mobile/text prompts).Communication – Seeks to capture attention, overcome barriers withmotivators and highlight benefits. Disseminate through channels thatreach priority audiences.Incentives – Providing a tool or discount that helps overcome a barrierto trying the behavior.Convenience – Making it easy to do the behavior (for example,providing free masks and sanitizing stations in public locations).Recognition/Feedback – People want to know that their behavior ismaking a difference. Report back with messages like, “XX% of peopleor groups have committed to do the behavior” or “Thank you, youhelped flatten the curve.”The process described above is scaled to the scope of each program. No matterthe scale or scope of the campaign, the essence of the planning process is to clarifyobjectives and how we will measure success, identify the priority audiences mostlikely to act, create messaging that cuts through the clutter, and create a plan todeliver that messaging at the right time, in the right place. These basic steps ensurethat outreach and communications efforts have the maximum impact possible for theresources invested.WASHINGTON STATE DEPARTMENT OF HEALTH SOCIAL MARKETING RECOMMENDATIONS FOR COVID-19 VACCINE12

Background

DOH has been conducting a suite of comprehensive strategies to address theCOVID-19 pandemic. These strategies have included policies, partnerships, localsupport and a statewide education campaign. The education campaign waslaunched in March of 2020 and continues today. The goal of the campaign has beento educate people about COVID-19 and encourage behaviors that protect peopleand the community. Throughout this effort, DOH has employed social marketingprinciples when possible in the creation of materials, messaging, communicationchannels and community engagement in addition to employing principles fromcommunity engagement and risk communication.With COVID-19 vaccines now becoming available, DOH launched an effort this fall toconduct research and plan a comprehensive social marketing approach to supportvaccine distribution. This report is the culmination of that social marketing planningprocess which included six weekly planning sessions with core members of the socialmarketing team (including DOH experts Kristen Haley and Morgan Jade, and industrysocial marketing experts Doug McKenzie-Mohr, Nancy Lee and Julie Colehour).WASHINGTON STATE DEPARTMENT OF HEALTH SOCIAL MARKETING RECOMMENDATIONS FOR COVID-19 VACCINE14

Step 1:Purpose, Goals &Objectives

PURPOSEGOALOBJECTIVESThis purpose statement answersthe questions,Save Lives andReduce SeriousIllness Relatedto COVID-19“What is the potential impact ofa successful campaign?”Build receptivity,intention andactionto get aCOVID-19 vaccineThis goal statement expresses,more concretely, the positiveimpact the campaign isintended to achieve. For thiscampaign, the goal is toultimately drive COVID-19vaccination by buildingreceptivity and intent.Most Washingtonianscomplete therecommendeddoses of aCOVID-19 vaccine Vaccination objectivesto be set by phase Percentage of peoplethat get both doses Curve flattens“Why are we doing this?”Social marketing campaignsare designed to have animpact by identifying andinfluencing behaviors that willcontribute to achievingcampaign goals. For thiscampaign, specificobjectives will be set as thevaccine distribution phasetiming and audiences aredetermined. Due to the levelof unknown factors related tothe COVID-19 vaccine, weexpect that objectives mayshift over the course ofimplementing this plan.WASHINGTON STATE DEPARTMENT OF HEALTH SOCIAL MARKETING RECOMMENDATIONS FOR COVID-19 VACCINE16

Step 2:Behavior Change

The effort will be broken into three communications veto gettingthe COVIDVaccineAudienceplans to getthe vaccineand knowshow theprocess worksAudiencegets recommendeddoses of aCOVID-19vaccineBehavior Change ContinuumEach of these stages can be mapped on the behavior change continuum. Thecontinuum shows how an audience moves through the process to make a decisionabout changing their behavior.Behavior Change ContinuumAudience becomes loyaladvocate; influencespeers; social normdevelops (action stagedrives intent in others)Audience is satisfied withvaccine experience;feedback drives long-termloyalty (action stage drivesintent in others)Audience gets the vaccine(action stage)Audience becomesaware the vaccine(education stage)Audience developsunderstanding aboutthe vaccine(education stage)Audience developspersonal connection;motivators overcomebarriers (intent stage)WASHINGTON STATE DEPARTMENT OF HEALTH SOCIAL MARKETING RECOMMENDATIONS FOR COVID-19 VACCINE18

Behavior Chain MapsThe behavior outlined for each stage are complicated when broken down into thespecific non-divisible steps that need to occur in order to get vaccinated. The behaviorchain below illustrates each step and indicate the types of social marketing tools thatcan help move the audiences through the vaccine decision making process.Education & Intent: ADULTSPURPOSE: Learn about the vaccine so you can make an informed choice (do research; have knowledge pathways open; understand this is in their power)BEHAVIOR: Build audience receptivity to get the COVID-19 vaccineDo moreindependentresearchKnow the facts(need element ofcuriosity to getthere and access togood information):Educatethemselves-How does it work?-How is thevaccine made?IDEA: Create and sharea list of essential questionsfor consumersTalk tohealthcareproviderRemindersand promptsHealth provideror insurancereaches out(chat, mail etc.)Maintenance ofcommitmentCommit intentto get vaccine(Potentiallyprolonged forphases 3&4)Continuedmediamessaging-Is it safe?-What phaseam I in?IDEA: Consider ways to preparehealthcare professionals to bewilling to get the vaccineSign up forhealth alertson phoneIDEA: Prepare audiences for thefacts. Partner with naturopathsand chiropractors, etc. topromote vaccines and myth bustagainst outliers within their field.Attend virtualpanels/Q & AIDEA: Consider the powerand influence of socialnorms to promote intentover time.KEY:CommitmentPromptSocial DiffusionCommunicationsIncentiveSocial Norms & FeedbackWASHINGTON STATE DEPARTMENT OF HEALTH SOCIAL MARKETING RECOMMENDATIONS FOR COVID-19 VACCINE19

Intent: ADULTSPURPOSE: Friends and family are trusted sources of information and powerful drivers of behaviorBEHAVIOR: Talk to friends and family and be an advocateIntentGather yourthoughts/talking points:-How do you feelabout vaccines?Identifythe person(who doyou want totalk with?)-Do you plan toget the vaccine?Reach out:In-personVia phoneEmail/social-What other infodo you need?-How can Ihelp you?HaveconversationSendmessage:Writemessage-Here is what myprovider said to me.Make afamily plan/decision tovaccinateKeep theconversationgoing/follow-upLead tosocialnormingVia emailTextSocialmediaIDEA: Use a guide (how to be an advocate/how to have conversations about thevaccine) – this could be our strategy or an add-on. Possible channel: direct mail.IDEA: Support thefamily conversationIDEA: Model the conversations,weave in “myth busting”KEY:CommitmentPromptSocial DiffusionCommunicationsIncentiveSocial Norms & FeedbackWASHINGTON STATE DEPARTMENT OF HEALTH SOCIAL MARKETING RECOMMENDATIONS FOR COVID-19 VACCINE20

Action: HEALTH CARE PROVIDERSPURPOSE: Friends and family are trusted sources of information and powerful drivers of behaviorBEHAVIOR: Talk to friends and family and be an advocateReceive talkingpoints/ FAQ fromDOH, workplace,association,peer-reviewedjournal, etc.EducationStudymaterialsMaster thecontentWork for ahealthcareemployer thatdistributes vaccinePersonally getCOVID vaccineUse ascreeneror tool tedemails, letters,VO calls, etc.Proactivelytalk topatientParticipatein statewidecampaignor hospital/healthsystempromotionRole play/practiceadvocatingfor thevaccinewithpatientsEmployerencouragespromotion topatientsIDEA: Promote convenience, e.g. DOH establishesrobocall system that is secure to send info to patientdistribution list. Provide clear scripts and pathways tomake this easy.PatientvaccinatedMake partof routineoffice visit;embed inintake formIn officematerial(handouts/posters)Use ascreeneror tool tofacilitateconversationScripts for callhealthcaresystem mptSocial DiffusionCommunicationsIncentiveSocial Norms & FeedbackWASHINGTON STATE DEPARTMENT OF HEALTH SOCIAL MARKETING RECOMMENDATIONS FOR COVID-19 VACCINE21

Action: Adults (by Phase)PURPOSE: Drive vaccinationBEHAVIOR: Get the recommended doses of a COVID-19 vaccineTravel stand your phase(look up online, providerinforms, media informs)IntentDeterminequalificationfor phaseonsiteLook uplocationTravelto clinic,pharmacy,pop-uplocationAgree toget thesecondvaccineIf delay:Willing towait?Willingto comeback?Get thevaccineMobileclinicarrives atwork, school,or housinglocationSign upfor SMSreminderfor seconddoseTell others;encouragethem to getvaccinatedKEY:CommitmentPromptSocial DiffusionCommunicationsIncentiveSocial Norms & FeedbackWASHINGTON STATE DEPARTMENT OF HEALTH SOCIAL MARKETING RECOMMENDATIONS FOR COVID-19 VACCINE22

Step 3:Priority Audience

A full list of priority audiences for the COVID-19 vaccine campaign are listed below.We have delineated general audiences, in-language audiences, audiences in eachvaccine distribution phase and influencer audiences. It is important to note that theaudiences by phase may shift as the vaccine roll-out progresses.General Population Audiences: A dults 18 Hispanic/Latinx Adults African American/Black Adults Pacific Islander/Native Hawaiian Adults LGTBQ Adults College Students Asian American Adults Rural Adults Disabled Adults Native American/Tribal NationsIn-language Audiences (* indicates education stage audiences): H ispanic/Latinx* Punjabi* Urdu Russian* Tagalog* Burmese Vietnamese* Arabic* Lao Simplified Chinese* Cambodian (Khmer)* Nepali Traditional Chinese* Amharic* Tamil Korean* Afaan Oromo Farsi Ukrainian* Tigrinya Hmong Hindi* Japanese* Karen French Telugu* Chuukese Romanian* German Mixteco Bajo Português - Brazil Swahili Marshallese Somali* Thai SamoanWASHINGTON STATE DEPARTMENT OF HEALTH SOCIAL MARKETING RECOMMENDATIONS FOR COVID-19 VACCINE24

Audiences by Phase:Phases indicate when certain populations will be eligible to get the vaccine. This list willbe modified as the state finalizes these recommendations:Phase 1 Audiences: H ealthcare workers F irst responders P eople with two comorbidities P eople age 65 living in congregate settings C ritical workers in congregate settings P eople who smokePhase 2 Audiences: K -12 & childcare staff C ritical workers high risk settings P eople with one comorbidity R esidents of homeless shelters & group homes for the disabled D isabled people that are unable to adopt protective measures I ncarcerated people and staff P eople age 65 Phase 3 Audiences: Y oung adults C hildren E ssential workersPhase 4 Audiences: All others (adults 18 )Influencer Audiences: D octors and Healthcare Workers P harmacists T rusted Messengers S ystems & InstitutionsThese audience groups can be mapped by the three planned stages of thecampaign: Education, Intent and Action. Within each stage we have delineatedgeneral market audiences, in-language audiences, audiences in each vaccinedistribution phase and influencer audiences.WASHINGTON STATE DEPARTMENT OF HEALTH SOCIAL MARKETING RECOMMENDATIONS FOR COVID-19 VACCINE25

StageEducationIntentActionTiming (Tentative)Nov. 2020 March 2021Jan. - June 2021Start Q2 2021until most people inWA vaccinatedDesired BehaviorAudiencebecomes receptiveto getting theCOVID VaccineAudience plansto get the vaccine

Table of Contents Executive Summary 1 Social Marketing Overview 9 Background 13 Step 1: Purpose, Goals & Objectives 15 Step 2: Behavior Change 17 Step 3: Priority Audience 23 Step 4: Research 27 Step 5: Barriers, Benefits & Motivators 39 Step 6: Message Strategy 41 Step 7: Social Marketing Intervention 49 Step 8: Partnerships 55 Step 9: Mark