Introduction 1 3 before 4 product price promotion place 1 5 Table 1 Theories and frameworks applicable to guiding research on the 4 P’s of social marketing preconception care services Marketing component Theory or framework Focus of the theory or framework Relevant constructs or concepts Product Social marketing The application of marketing techniques to the design, implementation, and evaluation of programs designed to facilitate voluntary exchanges of mutual benefit and improved personal well-being and societal welfare Formative research; Market segmentation; Competitive analysis  Diffusion of Innovation The spread of new ideas, products, or services within a society or from one society to another; focus on innovation Relative advantage; Compatibility; Complexity; Trialability; Observability Price Social cognitive theory The interaction between personal factors, environmental factors, and human behavior Reciprocal determinism; Behavioral capability; Expectations; Self-efficacy; Observational learning; Reinforcements  Health belief model The perceptions of threat posed by a health problem, the benefits of avoiding the threat, and factors influencing the decision to act Perceived benefits; Perceived barriers; Cues to action; Self-efficacy Promotion Diffusion of innovation The spread of new ideas, products, or services within a society or from one society to another; focus on diffusion Communication channels; Social systems/networks  Precaution adoption process model The journey from lack of awareness to action and maintenance in dealing with hazards; acknowledge inherent risk Unawareness; Unengaged; Decision-making; Acting Place Communication theory The different types of communication that affect health behavior Media Exposure; Media effects; Agenda setting; Framing Note. Viewing health care services as a business, and using language such as “marketing” and “sales,” may be uncomfortable to some who prefer to view the process of having a baby as a natural, emotional and deeply personal part of the human experience. However, the notion of providing preconception care as a service could very well benefit from a well-conceived and constructed social marketing research plan and execution that acknowledges and embraces the emotions of the patient and her partner. Thus, thinking about developing a social marketing plan to support preconceptional health care could help to ensure that babies are born with the best start in life. 6 7 Product product 1 8 9 10 11 1 12 13 14 15 18 2 19 21 22 23 24 25 Price price appealing easy 26 The pricing for a health care organization is more complicated. Cost-effectiveness studies and business case studies need to document how the organization’s PCC service costs compare with treatment of preventable health conditions. Balancing financial overhead and time pressures in these times of managed care may be a real challenge—and particularly so for reaching women who may have unplanned pregnancies. The greatest challenge may be weighing the intangible costs and benefits against the financial costs: How much preconceptional folic acid counseling is worth a child being born without a lifelong disability like spina bifida? How many smoking cessation sessions balance out the costs of a premature/low birth weight baby who might spend his first months of life in the NICU? How many fewer patients might a health care professional have time to see and bill for when pregnancy counseling they do for people with genetic conditions takes up more time? And what additional patient education messages, addressing chronic or acute health issues, are not being delivered during a regular well visit because the health care professional’s time is being used discussing preconception health issues? The health care provider medical office may well not be the best and/or most efficient way to market preconception care services to consumers in many cases. The practicing physician may also not be the first or best person to deliver the preconception care message. The goal of a good pricing strategy is to find an effective and innovative way to reach the target market while reducing the costs to both the health care delivery system and the consumer. Promotion promotion 27 2 13 28 29 Table 2 Sample social marketing questions for selected stakeholders of preconceptional care services  Consumers Health care providers Insurers Product What action must be taken by each audience (e.g., product, behavior, or policy) What does PCC services need to look and feel like for consumers to want/use/demand them? What does PCC services need to look and feel like for busy health care providers to want to offer them? What does PCC services need to look and feel like for health insurers to want to cover this service? Pricing – Why would they want to do it? What is the value of PCC services and what would they be willing to pay for them? What is the value for offering PCC services to patients and what would it cost to offer them? What is the return on investment for including PCC services as a covered service? Promotion – How will each audience be told about the what, why, where, and how? How will PCC services be publicized and made available to consumers in a way that they are attractive, affordable, and accessible? How will PCC services be presented to health care providers so that they are willing and able to offer them? How will PCC services be presented to insurers so that they are willing and able to reimburse for them? Place – Where can they do the action needed? What settings/locations are most acceptable, appropriate, and accessible for providing PCC services? What settings/locations are most acceptable, appropriate, and accessible for offering PCC services? What forums or conferences can instigate productive discussions about including PCC services as a covered expense? Place placed 30 2 31 32 33 34 Conclusion experiencing experience 35