National studies have shown that physical inactivity is more prevalent among African American adults than non-minority adults . These findings have led to an increasing national priority for increasing knowledge about the determinants and mediating factors of physical inactivity, especially among minority communities [2–5]. Previous research has demonstrated that underserved communities (low-income, predominately minority) have a number of environmental barriers that limit their engagement in walking, including concerns about safety, stray dogs, lack of group participation, and lack of available facilities and opportunities for physical activity (PA) [6–16]. This study describes the formative development of a social marketing campaign that targeted improving perceptions of safety, access, psychosocial and social environmental barriers related to walking among residents living in low-income, high crime communities as part of the Positive Action for Today’s Health (PATH) trial .
Social marketing is an approach which targets specific audiences with marketing strategies to improve personal health and quality of life, such as increasing walking . In general, there are five major components of developing social marketing strategies, which include the “5 Ps:” (1) product, (2) price, (3) place, (4) promotion, and (5) positioning. Product refers to the target behavior, such as increasing walking. Price refers to the social, economic, and psychological costs involved in adopting the behavior such as walking. Place refers to the setting, community context, or distribution channels for the product (walking behavior). Promotion includes all actions designed to make the audience aware of the ideas, behaviors, and benefits of walking that may include interpersonal communication, media messages, grassroots approaches, special events and incentives. Positioning (also known as exchange), refers to the framing of the product (walking behavior) so that the perceived benefits are maximized and the perceived costs are minimized. Additional principles of social marketing include an understanding of (1) audience segmentation, including the creation of tailored messages, incentives, and opportunities that appeal to community subgroups, (2) channel analysis, which entails identification of communication pathways most likely to reach identified community subgroups, (3) identifying target markets through consumer research and (4) process tracking for documenting adherence to planned strategies [18–22].
Social marketing is a widely accepted approach in the field of health promotion [23, 24]. Research on social marketing and the promotion of walking and physical activity has been reviewed by Alcalay and Bell . Previous investigators have typically failed to have measurable objective outcomes, apply behavioral theory, use audience segmentation beyond basic demographics, conduct consumer research about the audiences of interest, and pre-test concepts and health communication messages. Whereas other social marketing approaches for increasing PA have placed greater emphasis on the individual-level , the present social marketing campaign also highlights the social and community-wide benefits of walking. This study specifically expands on past qualitative work by using principles based on Social Ecological Theory [25, 26] and Social Cognitive Theory [27, 28] to explore social environmental barriers and facilitators for improving motivation and self-confidence for walking and exercising regularly. Compared to studies reviewed by Alcalay and Bell , those reviewed by Yancey and colleagues , which targeted ethnic minority communities, were more heavily focused on community norms and activities. The current social marketing campaign specifically targeted community norms by focusing on family and community connectedness in the overall approach. In addition, the PATH trial addressed previous limitations by using a formative evaluation process that incorporated behavioral principles, audience segmentation, and consumer audience input to create a social marketing strategy to promote community walking.
A growing body of evidence suggests it is important to tailor social marketing approaches to increase social environmental supports for walking. Previous research has focused on improving key social environmental factors including community connectedness, collective efficacy, social networks, and social support in developing social marketing approaches [30–40]. Specifically, previous investigators have examined these factors to more fully understand the relation between social factors and walking and PA outcomes [30–38, 40]. In a review of interventions for promoting walking, it has demonstrated that social support was strongly and positively associated with increased levels of walking and PA [30, 32, 35, 37, 39, 41]. In a study by McNeil et al.  both social and physical environmental supports had indirect effects on PA, and social support influenced PA through increasing motivation. Fisher et al.  found that community connectedness was significantly associated with increased levels of neighborhood walking and PA and positive social interactions for PA in adults. The social marketing approach in this study targeted intrapersonal level variables such as beliefs, motivation, and self-efficacy related to walking as well as social environmental factors such as perceptions of neighborhood safety, social support, and community connectedness.
The overall goal of the PATH trial was to develop and evaluate the efficacy and cost-effectiveness of a walking intervention for increasing PA in low-income, high crime communities . Three communities were randomized to receive one of three programs: a police- patrolled walking program plus social marketing campaign (full intervention), a police-patrolled walking only program (walking only intervention), or no walking, general health education program (comparison program). This article describes the formative work to develop a social marketing intervention that targeted determinants of walking, neighborhood safety and access for walking, as well as psychological and social factors related to increasing walking in the full intervention community in South Carolina (SC) that specifically targeted older African American women and men.