**1. Introduction**

More than 60 years ago, Wiebe asked a revolutionary question: "Why can't you sell brotherhood like soap?" He compared the principles and techniques for selling a tangible commercial product (soap) and promoting an intangible social idea (brotherhood) and concluded that key perspectives, principles, and tactics adapted from commercial marketing can be used in social behavior change [1]. In 1971, *social marketing* was born, when Kotler and Zaltman published their leading paper in Journal of Marketing and realized that the same marketing principles

© 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. © 2018 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

that were being used to sell products to customers could be used to "sell" ideas, attitudes, and behaviors [2]. Andreasen's defined social marketing as: "The application of commercial marketing technologies to the analysis, planning, execution and evaluation of programs designed to influence the voluntary behavior of target audiences in order to improve their personal welfare and that of their society" [3]. Rothschild believed that social marketing employs the principles of commercial marketing to influence consumer behavior and decision-making and attempts to influence voluntary behavior by offering or reinforcing incentives and/or consequences in an environment that invites voluntary exchange [4]. The Centers for Disease Control and Prevention (CDC) has introduced health marketing as an innovative approach that draws from traditional marketing theories and principles and adds science-based strategies to prevention, health promotion, and health protection. CDC defined health marketing as: "Creating, communicating, and delivering health information and interventions using customer-centered and science-based strategies to protect and promote the health of diverse populations" [5].

to potentially increase the impact of an intervention. Kotler and Lee explained some features of the social marketing approach: (1) focusing on understanding the perspectives of the full range of target audiences necessary to bring about change; (2) developing a research-based program, relying on formative research to develop and test concepts with members of the target audience; and (3) recognizing the need to include all elements of the marketing mix (i.e., product,

Social Marketing for Health: Theoretical and Conceptual Considerations

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The National Social Marketing Centre has developed a set of eight social marketing benchmark criteria to promote the understanding and use of core social marketing concepts. They are behavior, customer orientation, theory, insight, exchange, competition, segmentation, and methods mix [9]. According to Andreasen's benchmark criteria [10], for an intervention to be classified as social marketing, at least one of the following components is needed. They are

• Behavioral change: Determining the objective aiming to achieve behavioral change as the

• Formative research: Using audience research to understand target audiences, pre-test interventions and monitor their delivery; it is fundamental in social marketing interventions. • Segmentation: Dividing a general target audience into smaller and homogenous segments

• Marketing mix: Adopted from the commercial sector is the marketing mix, also known as the 4Ps: product, price, place, and promotion [11]. These four key elements of social marketing are central to the planning and implementation of an integrated marketing strategy. Each of these four components should be present in a marketing plan. However, it is the science of correctly using these elements in combination with one another that provides the effective "marketing mix." To have an effective social marketing program, we must have a product developed based on the consumers' wants, needs, and preferences, priced realistically, distributed through convenient channels, and actively promoted to customers. • Exchange: Social marketing programs aim to change behavior by establishing an exchange between the consumers and the program developer based on the consumers' wants and needs. In this exchange, consumers give up something of value and receive something of equal or greater value. Target audiences have opportunities to exchange their monetary and non-monetary resources for attractive tangible and/or intangible benefits. They are looking for the benefits of the product and have to pay its cost. Exchange forms voluntarily. Consumers want to fulfill their felt needs or desires and are ready to pay the costs and the social, economic, and physical costs (price). The costs must not be more than the perceived

• Competition: In a dynamic marketplace, commercial or social, there are different priorities and choices. So, competition is always present. If the target audience is not ready or willing to buy our promoted products, or we do not provide the products which the target audience wants, the marketing attempts will fail. In other words, the consumer will exit our market and go somewhere else. In case of social marketing, particular decisions are faced

price, place, promotion) to bring about behavior change [8]:

considered as the key concepts of the social marketing approach:

main focus of social marketing interventions.

based on the shared characteristics.

gains and benefits of the product.

Healthcare providers supply products (e.g., iron or multivitamin supplements for infants, condoms for sex workers, and contraceptives for teenagers) and provide services (e.g., pap smear testing for early detection of cervical cancer, mammography for diagnosis of breast cancer, and chest X-ray for patients suspected with tuberculosis). But, that is not all. In healthcare systems, the people as consumers or clients are encouraged to perform healthy behaviors and avoid non-healthy behaviors. We ask them have enough physical activity, reduce their salt intake, consume enough fruit and vegetables, and quit smoking.

Health behavior is a behavior directed at promoting, protecting, and maintaining health, as well as reducing disease risks and early death. It includes personal attributes such as beliefs, expectations, values, perceptions, prevention, behavior patterns, actions, and habits that relate to health maintenance, restoration, and improvement [6]. In public health, education, marketing, and law enforcement are three main approaches applied to achieve behavior change. For people who consider the behavior change but do not have the required knowledge or skills, education is effective. Enforcement of laws and regulation is appropriate for the entrenched people who have no desire to change and resist deliberately. Marketing can be useful to bridge the gap between these two approaches and will be a good solution for those who are aware of the need to change but have not considered changing [7].

Health can be considered as a real market in which consumers pay the monetary and nonmonetary costs and obtain the benefits of health products, services, or behaviors. If the marketing principles and techniques are applied, we can expect to be successful in selling our products, especially health behaviors. This chapter will address the theoretical concepts and practical steps for planning, implementing, and evaluating the interventions based on the social marketing approach for health.
