AUDIENCE
Overview
In health communication, the concept and practice of audience segmentation derives largely from its shared heritage with commercial and social marketing. There are 3 broad phases of segmentation, according to Philip Kotler (1989). First, an audience is divided into segments, and profiles of each of these segments are developed. Second, each segment is evaluated with respect to the goal of the communication campaign or other effort, and the specific segments are chosen as “target markets” or “target audiences”. Third, a detailed strategy of health communication/social marketing is developed for each of the target segments. Commercial marketing differs from social marketing largely with the former's emphasis on selling specific products while social marketing "sells" behavior and social change. In response to environmental and climate concerns, as Kotler (2022) notes, social marketing further diverges from its business roots in its greater move away from consumerism.
That the audience is the central feature of health communication may appear obvious. However, many campaigns seem to be developed with little regard for the target audience. Sources are chosen that may not have characteristics specifically desired by the target audience. Messages may not be understandable or may even prove offensive to individuals who receive them. Finally, channels may be chosen that don’t ‘find’ the audience (i.e., fail to reach them). Finding audience members “where they are” means using a wide variety of media (especially social media) that are developed very rapidly and become popular far more quickly than standard health communication planning and implementation processes can match. Therefore, audience segmentation always represents a major challenge as it will drive not only the development and selection of messages, but also of sources - and most importantly - of channels. Qualitative and quantitative research involved with developing profiles of the target audience and segments of this audience are a critical first step, without which the health communication campaign cannot possibly succeed.
Audience Research
Audience research, whether it is qualitative or quantitative, occurs in distinct phases.
1. At the very formative level, audience research emphasizes the concept that potential audience members have about a health issue or social topic and why they may or may not see this as an important issue to them. During this formative phase, the audience or audience segments will help determine the wording of the messages which will capture the issue from the audience’s perspective. Initial formative research should also help determine what the audience segments are with respect to the health issue. For instance, young children may not themselves be decision-makers with respect to whether they use a seat belt and would therefore be in a different segment than would their parents or older siblings. This does not mean that they comprise an unimportant segment; indeed, young children may not only be able to determine how to improve their own safety but may be helpful in reminding (or nagging) the parents about the importance of adults wearing seat belts or avoiding distracted driving as well (see this Ruff Ruffman example). Conversely, mothers and fathers may have different perspectives and may conceptualize or frame the issue of seat belt and passenger safety much differently from one another (as in this humorous example). Only qualitative research with a variety of audience members can determine this.
Research Activity 1
Answer the following about your experience as the audience of a product or brand and provide an example:
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Does a service seem to be ignoring a segment of its audience? Or, more specifically
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Have you personally experienced a brand that didn't pay attention to you for reasons of age group, gender identity, or other demographic or psychographic factors?
2. In the second phase of audience research, different alternatives for messages, sources, and channels may be pretested. Pretesting then takes the audience research to be next level. Initial conceptualizations that audiences may have about a health issue are used to mock up different messages and stories (Milanote provides excellent examples and free templates for storyboarding). Pretesting may also suggest different sources as well as channels, and display or share these initial ideas with future representatives of audience segments. The segments can then help choose which are the best alternatives for reaching and convincing people who share their demographic, psychological, or economic circumstances.
This process shows where commercial marketing and health communication may diverge. First, the public health approach can include an overall population appeal, which would correlate with the marketer’s approach to reaching the greatest possible number of buyers. However, this broad scope may not always be consistent with a health communication perspective, which may instead be designed to reach a smaller number of people at higher risk. Further, the concept of “reachability” brings to mind ethical concerns about health communication, which again diverge from those related to commercial marketing. Audiences that are classified as “hard-to-reach” are generally done so because the channels that we have available to us do not necessarily meet the audience where they are. For example, we cannot rely on social media or broadcast media to reach unhoused people. Such populations would not necessarily be a priority for any form of commercial marketing; however, in the realm of public health communication, we must work creatively to reach individuals who not only need access to our message, but may actually be in most need of it.
Figure 1 shows a typical normal curve where healthfulness and risk are arrayed across a population. This implies two approaches to public health communication: one that has been referred to as the “population attributable risk” approach (Figure 2) where we try to shift the entire curve of population risk to a lower risk level even though many individuals may not benefit from it (such as those at normal or average risk). This contrasts to approaches to a high risk targeting method (Figure 3), where we try again to shift the curve but this time by pushing people who are at the very high risk tail of the curve back toward a moderate or low level of risk. This can only be done by focusing our efforts on individuals who are often in the relatively less “reachable” category.
In the population attributable risk approach, the health communication program attempts to move almost everyone from high to moderate risk, or from moderate to low risk. In the high risk or screening approach, effort focuses on those at highest risk, moving them into a moderately or slightly higher-than-average risk level. The two are predicated on different assumptions and even different goals and philosophies of the sources or funders.
Elements of an Effective Segmentation Strategy
First, the segments should be specific and mutually exclusive. In other words: if our formative research determines that an individual belongs to one segment, that individual should not belong to a separate one as well. Whatever metric we use (qualitative, quantitative, or mixed methods research), we should be able to put an individual into one of our segments. From a different perspective, our segment should have both discriminative and convergent validity. Every person may have a different view of a health or social issue, but generally speaking, they all have some sort of profile related to that issue.
That leads directly to the need to have a metric to place individuals into a category, whether that category is based on a demographic, geographic, psychographic, or other characteristic. In any case, we should be able to operationalize how we decided that an individual or group belong to one specific segment and not to another.
Finally, the segment should have a functional meaning. In other words, the defined segment should be based not on whether an individual is, say, rich or poor, or Black or white, but whether that individual’s population category responds differentially to a health communication or marketing strategy.
Audience Segmentation Dimensions
Audiences can be segmented on a variety of dimensions. Most typically thought of are demographic approaches: what age groups, sex, gender identity, sexual orientation, income, education, religion, ethnicity, occupation, and family status segments does our population reach? Secondly, what are the geographic issues related to our segments? How do they vary by political entity (county, state, city, etc.), region of the country, urban, suburban or rural location, or other geographic entities? This is the subject of its own module, so we won't explore it in detail here.
Third, in health communication, what are the epidemiological or health segments of our population? Are we interested in individuals who are at risk for an illness, have recovered from an illness, or maybe in a position to protect others from an illness, accident, or other problem? Fourth, an important element often overlooked in “quick and dirty” marketing are psychographic issues. What are the beliefs and attitudes of our target audience members, regardless of their race, age, sex, etc.? Related to this are lifestyles, values, stages of change (McGuire’s “outputs”, Prochaska and DiClemente’s Transtheoretical Model, etc.) and other factors. Finally, what benefits do individuals seek from changing health behavior, buying a product, or other psychological and behavioral factors?
An interesting example of psychographic segmentation is provided by Edward Maibach and his colleagues (2009). Specifically, Maibach (an early graduate of the San Diego State University Masters of Public Health program!) was interested in looking at the development of social marketing approaches to change peoples’ attitudes toward global warming. Using survey research, he was able to define six largely psychographic segments: the audience types were labeled as "alarmed," "concerned," "cautious," "disengaged," "doubtful," and "dismissive." These categories had good discriminative validity and point to very different types of messages that would have to be developed for each of those six audience segments, as well as different channels and sources that might be used to best reach them and convince them.
Analysis Activity 1
Assume for a second the persona of a parent, grandparent, or other older person whom you know well. Then, as that person, take Maibah's Six Americas Segment quiz. Based on these questions, into what segment have you been placed? Do you agree with this placement? Why or why not? What are some of the message strategies recommended for your segment?
Research Activity 2
Identify one print, broadcast, or social media health or social communication piece that seems to carefully segment its audience, and contrast it with another one that seems to do a fairly inadequate job of audience segmentation.
Target Audience and Target Market Selection
Finally, it will be impossible to select all audience segments and target each and every one of them. Therefore, the following RICS dimensions tend to be prioritized in public health communication and social marketing: Risk, Influencers, Channels, and Size.
1. The proportion in a category that is deemed “at risk”. In other words, what bang for our buck will we get in terms of the number of people in the segment who can actually benefit from health communication or in terms of a secondary audience who can contribute most to change in the primary audience? Here, the concept of reach and frequency are paramount. Given a limited budget, how many individuals are we trying to reach overall, and how frequently do we need to reach those at higher risk? These concepts are critical not only in health communication, but in public health and epidemiology in general.
2. What role models, influencers, multipliers, and secondary audiences do we have available to us who can help communicate with a target audience? This is discussed more in the theory submodule as we describe the work of Everett Rogers in his groundbreaking “communication of innovation” model (see Theory module). In any case, early adopters and individuals in the neighborhood who are already approximating the prescribed goal can contribute to the success of our health communication campaign. Extending the concept to commercial marketing, individuals may be hired as influencers, endorsing a product purchase or behavior change primarily via social media.
3. Given the channels available to us, which audiences can we best reach, or alternatively, which additional channels can we use to reach the proposed target segments? Can we develop more social media and other skills to reach a lot larger audience?
4. The total number of people in or size of a segment: larger usually means higher priority (but not always).
Analysis Activity 2
Examine the This Free Life campaign. What segments and sub-segments do the creators target? From your perspective, how would you imagine they came up with these segments? With reference to the RICS dimensions, have they done so effectively and comprehensively with respect to the overall ‘destination’ of the campaign?
Analysis Activity 3
Examine these top Instagram influencers from 2021. Who is still popular and who is not, and who has now moved to the top of the list? Explain briefly why you believe this change has occurred.