A presentation to the US Institute of Medicine's Food Forum workshop on food literacy on 4 September 2015. We need to think about solving for the micro-macro problem when designing programs. This means using diffusion of innovation theory and research to segment and characterize population groups and direct address the innovation chasm in program design in order to have successful programs 'at scale.' New research methods are needed to overcome depth deficits and the say-mean gap. One approach is to learn from positive deviants (or innovators) - people who have already adopted 'food literate' behaviors. These insights then need to be transformed into webs of change that focus on making change observable (estimates are that 90% of of what people learn is through watching others), intervening with social networks, and being sure to connect across the innovation chasm the early adopters with the early majority. One person's experience with eating on $4.20/day (the SNAP challenge) is explored to show how new insights and discovery can be made regarding these behaviors. Social marketing is then used to design and implement programs at scale, and a summary of lessons learned from social marketing research on improving nutrition lays out guide rails for program design. Finally, marketing means expanding from 1P approaches, whether they are Place-based or Promotion ones, and food literacy programs need to make science practice-based - that is, grounded in people's realities, their needs, problems to solve and dreams.

1. Marketing to Expand the Practice
of Behaviors Associated with Food
Literacy
R. Craig Lefebvre, PhD
Lead Change Designer, Center for Communication
Science
RTI International
@chiefmaven
Institute of Medicine’s Food Forum. Workshop on Food Literacy:
How do communications and marketing impact consumer knowledge,
skills, and behavior? 4 September 15, Washington, DC.

2. Some Personal Experiences

3. The Micro-Macro Problem
Our desire to achieve macro
outcomes, ones that involve
changes among large
numbers of people, or in
society as a whole, are driven
by the micro actions of
individuals.
 Changes at different levels of
organization are emergent,
not simply an adding up of the
components.
“Social change programs need to
consider more than one scale of
reality at a time.”

4. Diffusion of Behaviors Associated
with Food Literacy

5. Characteristics of Segments
Innovators Early Adopters Early Majority Late Majority Laggards
Venturesome Respect Deliberate Skeptical Traditional
High tolerance
of risk
Opinion leaders Very local
perspective
Sensitive to
peer pressure
and norms
The
traditionalists –
tried and true
Fascinated with
novelty
Well-connected
socially and
locally
Very engaged in
peer networks
Cautious Keepers of the
wisdom
Willingness to
travel to learn
Resources and
risk tolerance to
try new things
Rely on
personal
familiarity
before adoption
Usually scarce
resources
Near isolates in
their social
networks
Seen as
mavericks, not
opinion leaders
Self-conscious
experimenters
How does this
help me?
Minimize
uncertainty of
outcomes
Suspicious of
innovation and
change agents
Social networks
transcend
geographic
boundaries
They are
watched by
others – and
they know it
Want to see the
proof locally
Adoption will not
fail

6. Attributes of Food Literacy
Behaviors
 How is this better than
what
I currently do?
 How is it relevant to the
way I go about my
everyday life?
 Is it simple enough for
me
to do?
 Can I try it first?
 Can I watch others and
see what happens to
them when they do it?

7. The Innovation Chasm
Source: Moore, G.A. Crossing The Chasm. Capstone Publishing, 1998.

8. Research Objectives in Social
Marketing Program Development
 Understanding who the
important or priority groups
are.
 Developing insight into
each one of them.
 Understanding their
motivations and the value
current or proposed
behaviors might create for
them.
 Generating possible
solutions to meeting needs,
solving problems or
achieving dreams.

9. The Depth Deficit
 What people tell us in focus
groups and interviews is not the
same as their thoughts and
experiences.
 There is a great gap between the
way consumers experience and
think about their world and the
methods most researchers use to
collect this information.
 We need to assess the emotional
as well as the rational or
functional value people place on
specific products, services and
behaviors.

10. The Say-Mean Gap
 We need to use research
methods that allow people to
tap into their unconscious
processes.
 We need to understand shared
mental models.
 We need to tap into the stories,
archetypes, and core
metaphors people use to create
memories and coherent
meanings about food, the
organizations we represent, and
the behaviors we want them to
change or adopt.

11. Insights change how we view the world.

12. “If you want to catch a fish, first learn to think like a
fish.”

13. Learn from Positive Deviants

14. Creating Webs for Change

15. Social Networks Frame the Opportunities and
Constraints for Change
Social
Networks
Opinion
leaders
Groups
Adding or
removing
members
Bridging
groups
Rewiring
groups
Network
weaving

16. Adolescent Obesity and Social
Networks
 Intervene with the family
system, rather than with
the individual.
 Tailor family-based
interventions to the
structure of the family.
 Design support
mechanisms for parents
and adult family
members on the basis of
their social ties within the
community.
 Use peer networks to
encourage increased
physical activity.
Source: Koehly LM, Loscalzo A. (2009). Adolescent obesity and social networks. Preventing Chronic Disease;
6(3):A99

17. Learning is a Social Process
[and the 1% Rule]
Modeling: People learn from what they see others doing
and observing the consequences of those actions.

18. New Technologies Expand The Scope
and Capacity for Food Literacy

19. Social Marketing

20. Designing products, services and
behaviors that fit people’s reality
Eating Well on $4.30 a Day
Our columnist lives for six weeks as if he is on
the Supplemental Nutrition Assistance
Program, and learns something he didn't
expect.
Brett Arends, The Wall Street Journal
14 December 2013
Eating reasonably well on $4.30 a day turned out to be a bit
like a Rubik's Cube puzzle: It seemed impossible until I
worked out the trick. Then it became surprisingly
manageable, if monotonous.

21. Positioning Behavior Change
What relevant behavior can
we ask people to engage in
rather than the one they are
currently doing?
How can we make this
behavior more
compelling, relevant, and
potentially more valuable
to people
when they practice it, in
comparison to the
alternatives?

22. Brett’s Tricks
 I didn't eat out.
 I didn't eat any packaged or
processed foods.
 I didn't try to live on energy
bars.
 I avoided cheap carbohydrates,
like white bread and noodles.
 I abandoned buying coffee out.
For my caffeine needs I carried
tea bags instead.

23. Costs of Change
Financial
Energy
Geographical distance
Opportunity
Social
Psychological
Physical
Structural

24. Brett’s Costs
 Peanuts and peanut butter
(which cost around $2.50 a
pound).
 Eggs (20 cents each).
 Pulses or legumes, like split
peas and lentils, which can
cost not much more than $1
a pound.
 I rarely ate meats or fish.
They were too expensive.
 Milk is expensive, but I had
a cup—about 25 cents—a
day.
 Healthy carbohydrates:
oatmeal, whole-wheat pasta,
brown rice, baked potatoes
and sweet potatoes, and
whole-wheat bread - which I
made at home and cost a
little more than $1 for a 1½-
pound loaf.
 I ate plenty of bananas
(sometimes just 20 cents
each), and I bought frozen
peas, corn and other mixed
vegetables for around $1.30
a pound.
 I took a cheap multivitamin a
day.

25. Creating equitable opportunities and
access
Where can we locate a service,
distribute a product, or create
opportunities for members of
our priority group to engage in
healthier behaviors?

26. Where Did Brett Go?
 I took the subway to
the bigger
supermarkets.
 And I hunted
aggressively for
deals.
 What's on sale is
what's on the menu. I
found the food aisles
at downtown
drugstores
sometimes had
surprisingly good
deals.

27. Communicating change in linguistically,
culturally relevant and ubiquitous ways

28. How Effective are Health
Communication Campaigns?
5%
5%
5%
5%

29. Brett’s Message
My experience has changed how I eat. I am amazed at
how cheaply one can eat well—and mortified at how much
I have spent needlessly over the years. I suspect I am not
alone.

30. Keys to increasing healthy eating
behaviors using social marketing
Behavioral objective Evaluate healthy eating using multiple behaviors
Tackle single behaviors serially over time
Audience
segmentation
Identify different groups
Serve each group with a unique solution
Formative research Conduct formative research
Research must be consumer oriented
Exchange Offer salient benefits – short-term benefits can be more
salient than long-term benefits
Consider trials, rewards and prizes to stimulate trial and
repeated behavior
Marketing mix Move beyond communication – interventions must be
multifaceted (e.g. more than promotion and
communication)
Efforts need to be directed at initiating new behavior and
encouraging repeat behavior
Competition Undertake competitive analysis
Know your direct and indirect competition

31. Other Options
 “Relatively few residents in the intervention neighborhood in
our study adopted the new supermarket as their main food
store. This indicates that simply providing new food retail
stores is insufficient to encourage the adoption of the new
stores as residents’ main food stores. Complementary
initiatives to encourage the adoption of the new stores are
therefore required.” (Cummins, Flint & Matthews, 2014).
 “Concurrent availability of and access to key services and
products are crucial to persuade individuals motivated by
media messages to act on them.” (Wakefield, Loken, & Hornik,
(2010).
 “We conclude from this review that applied health sciences
research would have a much enhanced probability of
influencing policy, professional practice, and public responses
if it turned the question around from how can we make practice
more science based to how can we make science more
practice-based?” (Green, Ottoson, Garcia & Hiatt, 2009).

32. Resources
 Carins JE, Rundle-Thiele SR. (2013). Eating for the better: A
social marketing review (2000-2012). Public Health Nutrition;
28:1-12.
 Cummins, S., Flint, E. & Matthews, S.A. (2014). New
neighborhood grocery store increased awareness of food
access but did not alter dietary habits or obesity. Health Affairs;
33:283-291.
 Green, L.W., Ottoson, J.M., Garcia, C. & Hiatt, R.A. (2009).
Diffusion theory and knowledge dissemination, utilization, and
integration in public health. Annual Review of Public Health;
30:151-174.
 Lefebvre, R.C. & Bornkessel, A. (2013). Digital social networks
and health. Circulation; 127:1829-1836.
 Snyder, L. (2007). Health communication campaigns and their
impact on behavior. Journal of Nutrition Education and
Behavior; 39(Suppl.):S32–S40.
 Valente, T.W. (2013). Network interventions. Science;337:49–
53.
 van Mierlo T. (2014). The 1% Rule in Four Digital Health Social
Networks: An Observational Study. Journal of Medical Internet
Research; 16(2):e33 URL: http://www.jmir.org/2014/2/e33/
doi:10.2196/jmir.2966
 Wakefield, M. A., Loken, B., & Hornik, R. (2010). Use of mass
media campaigns to change health behaviour. Lancet;
376:1261–1271.