A social marketing approach to increasing enrollment in a public health program: A case study of the Texas WIC Program

Human Organization, Fall 2001 by Bryant, Carol, Lindenberger, James, Brown, Chris, Kent, Ellen, Et al

The Texas WIC Program used social marketing to recruit new program participants and improve participant and employee satisfaction with the program. This article focuses on research conducted by anthropologists and public health researchers to identify target populations who were eligible, but had not enrolled in the program, and discusses the role research played in developing a comprehensive, multifaceted outreach plan. Systematic observations, in-depth interviews, focus groups, and a survey were used to identify factors that motivate and deter eligible families from enrolling in the program. Research results revealed that most eligible families had positive attitudes about the WIC program but were unfamiliar with the program's benefits. Women were deterred by a number of barriers: confusion about eligibility guidelines; reluctance to accept government assistance; problems signing up for WIC; and fear they would be treated disrespectfully by program staff or grocery store cashiers. Research findings were used to develop a social marketing plan to increase enrollment in WIC, improve program satisfaction, and enhance service delivery. Evaluation results point to significant growth in the program and suggest that social marketing can be helpful to program planners who want to improve their delivery of services and motivate new groups to utilize their services.

Key words: social marketing, WIC program, program utilization, program participation, audience segmentation, Texas

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) was established by the United States government in 1972 to provide target populations of women, infants, and young children with nutrition education, supplementary nutritious foods, and referral to appropriate health and social services. During ensuing years, numerous studies have documented WIC's positive impact on pregnancy outcomes and early childhood growth and development (Abrams 1993; Brown, Watkins, and Hiett 1996; Kennedy and Kotelchuck 1984; Metcoff et al.1985; Rush et al 1988a, 1988b, 1988c). WIC's costeffectiveness has been demonstrated by the reduced incidence of infant mortality (Moss and Carver 1998), small-forgestational-age births (Buescher et al. 1993), and low birthweight babies born to women receiving WIC services (USGAO 1992).

As a result of these achievements and the fact that the program serves only a portion of eligible women, infants and children, Congress has continued to appropriate additional funding to increase WIC enrollment. With increased funding, state programs were challenged to design outreach strategies that motivate eligible women to enroll and fully participate in this beneficial public health program.

To meet the challenge of increasing enrollment and improving service delivery, Texas WIC public health administrators contracted with a social marketing firm, Best Start Social Marketing, to develop marketing strategies to increase enrollment among the state's diverse, rapidly growing population. With the state's rapid growth, Texas WIC had been unable to reach many families in need of its services; only 40 percent of the eligible population was served during fiscal year (FY) 1993 (Texas Department of Health 1994), when this project was initiated. The major objectives of the Texas WIC Marketing Project were to: increase enrollment among target groups of eligible families not currently being served; enhance service delivery; and raise participant and staff satisfaction.

This paper summarizes research conducted to determine why eligible families were not enrolling in the Texas WIC Program and how research findings were used to develop a comprehensive social marketing plan designed to motivate families to enroll in Texas WIC. In addition, this article demonstrates how anthropologists can assist program planners to understand the values, needs, and expectations of potential program participants and develop culturally appropriate strategies to encourage use of health and social services. (See Bryant et al. 1998 for a more detailed discussion of the other study components.)

The Social Marketing Approach

Social marketing offers a consumer-based approach to promote socially beneficial behavior change in specific populations. According to Andreasen (1995:7):

Social marketing is 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 society.

Social marketing is distinguished from other management approaches by its adherence to six basic principles: 1) a consumer orientation; 2) the use of marketing's full conceptual framework to design behavior change interventions; 3) recognition of competition; 4) reliance on formative research to understand consumers' desires and needs; 5) segmentation of populations and careful selection of target audiences; and 6) continuous monitoring and revision of program tactics to achieve desired outcomes (Andreasen 1995; Coreil, Bryant, and Henderson 2001).