Demand generation increases awareness of, and demand for, health products or services among a particular target audience through social and behavior change communication and social marketing techniques.
What is Demand Generation?
Demand generation increases awareness of and demand for health products or services among a particular intended audience through social and behavior change communication (SBCC) and social marketing techniques. Demand generation can occur in three ways:
- Creating new users - convincing members of the intended audience to adopt new behaviors, products or services;
- Increasing demand among existing users - convincing current users to increase or sustain the practice of the promoted behavior and/or to increase or sustain the use of promoted products and services;
- Taking market share from competing behaviors (e.g. convincing caregivers to seek health care immediately, instead of not seeking care until their health situation has severely deteriorated or has been compromised) and products or services (e.g. convincing caregivers to use oral rehydration solution (ORS) and zinc instead of other anti-diarrhea medicines).
Demand generation programs, when well-designed and implemented, can help countries reach the goal of increased utilization of the commodities by:
- Creating informed and voluntary demand for health commodities and services;
- Helping health care providers and clients interact with each other in an effective manner;
- Shifting social and cultural norms that can influence individual and collective behavior related to commodity uptake; and/or
- Encouraging correct and appropriate use of commodities by individuals and service providers alike.
In order to be most effective, demand generation efforts should be matched with efforts to improve logistics and expand services, increase access to commodities, and train and equip providers in order to meet increased demand for products and/or services. Without these simultaneous improvements, the intended audience may become discouraged and demand could then decrease. Therefore, it is highly advised to coordinate and collaborate with appropriate partners when forming demand generation communication strategies and programs.
Who are the Audiences of Demand Generation Programs for the 13 Life Saving Commodities?
Reducing maternal and child morbidity and mortality through increased demand for and use of RMNCH commodities depends on the collaboration of households, communities, and societies, including mothers, fathers and other family members, community and facility-based health workers, leaders, and policy makers. Some of the commodities are more provider-focused in terms of demand and utilization, but all depend on care-seeking by women and families.
Key Concepts and Definitions in Demand Generation
SBCC promotes and facilitates behavior change and supports broader social change for the purpose of improving health outcomes. SBCC is guided by a comprehensive ecological theory that incorporates both individual level change and change at the family, community, environmental and structural levels. A strategic SBCC approach follows a systematic process to analyze a problem in order to define key barriers and motivators to change, and design and implement a comprehensive set of interventions to support and encourage positive behaviors. A communication strategy provides the guiding design for SBCC campaigns and interventions, ensuring communication objectives are set, intended audiences are identified, and consistent messages are determined for all materials and activities.
Social Marketing seeks to develop and integrate marketing concepts (product, price, place, and promotion) with other approaches to influence behaviors that benefit individuals and communities for the greater social good.
Mass media reaches audiences through radio, television, and newspaper formats. Traditional media is usually implemented within community settings and includes drama, puppet shows, music and dance. Media campaigns that follow the principles of effective campaign design and are well executed can have a significant effect on health knowledge, beliefs, attitudes, and behaviors.
Community mobilization is a capacity-building process through which individuals, groups, or organizations design, conduct and evaluate activities on a participatory and sustained basis. Successful community mobilization works to solve problems at the community level by increasing the ability of communities to successfully identify and address its needs.
IPC is based on one-to-one communication, including, for example, parent-child communication, peer-to-peer communication, counselor-client communication or communication with a community or religious leader.
Entertainment education is a research-based communication process or strategy of deliberately designing and implementing entertaining educational programs that capture audience attention in order to increase knowledge about a social issue, create favorable attitudes, shift social norms, and change behavior.
ICTs refer to electronic and digital technologies that enable communication and promote the interactive exchange of information. ICTs are a type of medium, which include mobile and smart phones, short message service (SMS), and social media such as Facebook and Twitter.
Advocacy processes operate at the political, social, and individual levels and work to mobilize resources and political and social commitment for social and/or policy change. Advocacy aims to create an enabling environment to encourage equitable resource allocation and to remove barriers to policy implementation.
Behavior Change Theories
Why is theory important to demand generation?
Increasing evidence suggests that demand generation interventions that are based on social and behavioral science theories are more effective than those without a theoretical base, especially when multiple theories and concepts are considered.[1] A strong theory can help design, implement and evaluate effective programs by providing an understanding of the influencing factors on behavior, the way in which behavior change occurs and potential entry points for behavior change interventions.
The key to using theory effectively is to identify one that seems to fit with the initial understanding of what currently influences behavior and social norms and to use that theory to explore in more detail the impetus for change.
A few of the theories and frameworks most often used in social and behavior change communication programming include:
Health behavior is determined by personal beliefs or perceptions about the health issue and the strategies available to improve the situation. Behavior change is influenced by: perceived severity; perceived susceptibility; perceived benefits; and perceived barriers. These perceptions can be modified by other variables, such as culture, education level, past experiences, skill, and motivation. Behavior is also influenced by cues to action, which are events, people, or things that can motivate behavior change and self-efficacy, which is the belief in one’s own ability to do something.
Behavior change is a process, not an event, and a person attempting to change a behavior may follow through five stages: 1) pre-contemplation, 2) contemplation, 3) preparation, 4) action, and 5) maintenance. The stages are not linear, and people do not necessarily progress systematically from one stage to the next but rather may move back and forth between the five until maintenance is sustained.
Focuses mainly on individual decision-making as a function of (1) what you believe the consequences of a behavioral choice will be and whether those consequences are positive or negative (i.e., beliefs and attitudes about the intended behavior) and (2) what you think other people who are important to you believe about the behavior (subjective norms).
People learn from each other through observation, imitation, and modeling. Behavior change is also determined by environmental, personal, and behavioral factors, which interact and affect each other. These reciprocal interactions help determine behavior change so a change in one factor can determine changes in the others. The outside environment is where a person can observe an action, understand its consequences, and become motivated to repeat and adopt it. In a programmatic application, this is called modeling, where the desired behavior can be demonstrated and popularized by “role models.” Modeling can come from real or fictional characters depicted in mass media and on-line media.
Examines how new ideas, concepts, and behaviors spread within a community or from one community to another. The theory identifies five subgroups which define an audience’s propensity to accept and adopt the innovation: 1) Innovators, 2) Early adopters, 3) Early majority, 4) Late majority, and 5) Laggards. The theory was later modified to change the focus from a persuasion approach where information was transmitted between individuals and groups to a process where information is created and shared in order to reach a mutual understanding. The rate of diffusion is related to the audience; environmental constraints and facilitators; communication system; and attributes of the innovation. These attributes include:
- Relative advantage – Does the new behavior offer any advantage over the current behavior?
- Compatibility – Is the new behavior compatible with current behaviors, beliefs, and values?
- Complexity – How difficult is the new behavior to perform?
- Trialability – Can it be tried without too much risk before making a decision?
- Observability – Are there opportunities to see what happens to others who adopt this behavior?
Behavior change is influenced by cognitive (knowledge, attitudes, beliefs), emotional (self efficacy), and social interaction factors (peer support and influence) as well as skills and environmental support and constraints. These elements operate synergistically and together are called ideation. The likelihood of adopting a behavior is much higher when the person has gained sufficient knowledge about it, has developed a positive attitude towards it, has talked to others about it, and feels right about doing it. The more ideational elements that apply to an individual, the greater the probability that he/she will adopt the behavior.
The social ecological model recognizes that behaviors related to demand for care and treatment take place within a complex web of social and cultural influences. This perspective views individuals as nested within a system of socio-cultural relationships - families, social networks, communities, nations - that are influenced by and have influence on their physical environments. Within this framework, individuals’ decisions and behaviors are theorized to depend on their own characteristics as well as the social and environmental contexts within which they live.
This model emphasizes the motivating power of a perceived health threat, such as the idea that malaria is a potentially deadly disease, to which one may or may not be susceptible. If you believe (correctly or incorrectly) that you are susceptible to a serious threat, then you are motivated to act. EPPM also emphasizes efficacy, which refers to what people feel they are able to do in response to a perceived threat. For example, if you believe that using insecticide-treated bed nets can prevent malaria (response efficacy) and also believe that you can successfully use a bed net each night (self efficacy), then you are more likely to try and use a bed net to prevent malaria.
For more information on theories used for social and behavior change communication refer to the additional resources provided.
[1] Glanz, K. & Bishop, D. (2010) . The Role of Behavioral Science Theory in Development and Implementation of Public Health Interventions. Annual Review of Public Health, 30:399-418. doi: 10.1146/annurev.publhealth.012809.103604.
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