Writing to move a reader to act

Writing intended to change behaviour needs a specific action as its goal. Information and persuasion work alongside readers' motivations, choices and circumstances; knowledge alone does not ensure lasting change.

Behaviour as the goal

Social marketing aims to increase acceptance of a social idea, practice or product among specific groups, involving people who voluntarily exchange time and attention for help with needs as they perceive them. ¹ It focuses on behaviour change for good and on social, environmental and cultural influences, rather than treating every audience alike. ¹

Social marketing is distinct from social media: the former is a behaviour-change discipline, while the latter can provide channels for its work. ^{1, 2, 3} Audience segmentation and research into strategies suited to each group are central to the approach. ¹ Secondary research can help tailor content, or a project can gather new insights. ⁴

The approach developed from health education and promotion from the 1950s, applying commercial-marketing methods to public benefit without the need to return profits to shareholders. ¹ Its work has included family planning, clean water, immunisation, hunger and malnutrition, HIV prevention and girls' education internationally, and blood pressure, smoking, acceptance of neighbourhood facilities for people with cognitive impairment, diabetes and HIV in the United States. ¹

In 2007, Centers for Disease Control and Prevention (CDC) health marketing framed its task as turning research, science and evidence-based advice into action by health professionals, partners and the public. ⁵ Its intended result was people actively using accessible, accurate, relevant and timely information and interventions. ⁵ After the “Learn the signs, act early” autism campaign addressed parents' lower awareness of cognitive than physical signs, surveys examined how people searched for the information, how well they liked it and what actions they took, informing further communication products. ⁶

Social-marketing benchmarks and the four Ps

Eight benchmark criteria describe accepted social-marketing practice: ⁷

1. A clear focus on behaviour, with specific behaviour goals.
2. Consumer or market research.
3. A basis in theory.
4. Insight.
5. An exchange concept.
6. A competition concept.
7. Segmentation.
8. An integrated mix of methods, including the marketing mix of the four Ps and beyond.

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The four Ps are product positioning, combining attributes and benefits; price or cost; placement; and promotion. ¹ A teenage-vaping campaign illustrates them, in a 2019 setting when restrictions on sales to under-21s were still being proposed: ^{1, 8}

1. Product positioning: research both the appeal of devices and liquids and the social value of vaping within a peer group.
2. Price: consider tangible costs such as taxes and sales restrictions alongside the psychological costs and rewards of vaping or abstaining among peers; social marketers tend to work on the psychological side while regulators address policy.
3. Place: consider where vaping is permitted and whether restrictions might make it seem cooler, as well as where messages will reach teenagers.
4. Promotion: offer something valued more than vaping's perceived benefits, making the alternative fun, easy and popular through increased costs of the harmful practice, easier alternatives, non-vaping norms, other uses of time and appropriate messages, channels and media.

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An early illustration of reducing barriers was the 1943 Kate Smith war-bond campaign: patriotic motivation, a familiar radio voice, telephone purchasing, a dedicated line, acknowledgement of financial sacrifice and busy signals interpreted as evidence of others participating. ¹

Knowledge, motivation and practical barriers

Health-promotion tactics should fit the audience's needs. ⁹ Changing behaviour involves changing attitudes, which can be difficult amid health messages from media, family, friends and government; people may retain unhealthy habits despite having relevant knowledge. ⁹

Fear can motivate immediate change without sustaining it: people who stop smoking from fear of cancer may later resume. ⁹ Reliable information presented persuasively should help create conditions in which people want to alter their habits. ⁹ Practical recommendations are: ⁹

1. Keep messages simple and use appropriate media.
2. Encourage belief in the seriousness of the need for change.
3. Be convincing about the pros and cons of change.
4. Boost self-confidence through coaching to practise new health-choice skills.

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Encouragement towards simple changes and rewards such as living longer and seeing children and grandchildren grow up can make lifestyle change and its continuation more likely. ⁹

Barriers include readiness and social norms, conflicting values, cultural barriers, lack of insurance or access to healthcare, poverty and environmental factors. ⁹ Better nutrition is difficult without nearby fresh-food markets, as is a walking routine without pavements; campaigns need to consider these circumstances rather than information alone. ⁹

Six steps for motivating health content

Six steps can help general-public health content inspire and motivate change: ¹⁰

1. Be conversational. Use a warm, friendly tone, second-person address and language suitable for a casual acquaintance rather than clinical or technical language.
2. Keep the message simple and focused. Set clear objectives, concentrate on no more than three key points and repeat them in the wrap-up.
3. Promote confidence and choice. Make goals attainable and realistic, avoid shaming or finger-wagging and give readers control.
4. Give a reason to act. Show the benefit to the reader quickly and follow motivation with a call to action.
5. Include the unexpected. A positive account of benefits can offer an alternative to familiar warnings about dangers.
6. Invite reflection. Acknowledge the difficulty of change and ask thoughtful, nonthreatening questions that readers can consider and discuss with healthcare professionals.

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In a Healthwise smoking-cessation video example reported in 2016, 66% of viewers said they were considering quitting after watching progressive health benefits of stopping, rather than the usual emphasis on smoking's dangers. ¹⁶ Input from behavioural psychologists, other specialists and colleagues before finalising materials can help ensure sensitivity and accuracy. ¹⁸

Segmentation and message relevance

A diverse audience can be approached through one common-denominator message, a fundamental message varied for specific audiences, or distinctly different messages for different audiences; the last can be effective without always being practical. ¹⁸ Tailoring creates an individual message from personal circumstances and is often costly and time-consuming, whereas targeting or segmentation identifies subsets by age, sex, education, geography or psychographic characteristics and addresses their needs. ¹⁸

After choosing the audience, the message needs answers to five questions: ¹⁸

1. What is the best way to reach this audience?
2. What benefits would appeal to them?
3. What images should be conveyed?
4. What challenges or barriers must be overcome?
5. What actions can this audience take?

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An audience identifying with a message is more likely to be influenced by it. ¹⁸ One recommended framing for men emphasises social roles such as providers, protectors and players rather than wellness, fear or longevity. ¹⁸

Logical, emotional and ethical appeals

Classical rhetoric combines audience analysis, rhetorical appeals and organisation to build resonant health messages. ¹⁹ Its three appeals should be integrated: ²⁰

1. Logos, the logical appeal: concrete information and data, prominent in decision aids and package inserts; balanced information supports informed choices and knowledge of options.
2. Pathos, the emotional appeal: personal stories, conversational writing and compelling visuals can engage people not yet interested in a topic, as with warning photographs on cigarette packets.
3. Ethos, the ethical appeal: credibility rests on presenting the author as an authority, as with CDC.

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A draft can be checked against the rhetorical triangle: ²²

1. Logos: Is the message clear and specific? Is credible scientific evidence available? Does the story develop logically?
2. Ethos: Where does the writer stand with the audience? How is the writer connected to the topic? Is the vocabulary appropriate?
3. Pathos: What engages readers' emotions, imagination, beliefs and values? Can readers understand and identify with the examples and language?

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The recommended organisation begins with an emotionally engaging anecdote or story, establishes credibility, gives background, states the issue or argument and closes with emotional appeal. ²³ The writer should lead with the writer's argument when agreement is likely and with the other side's argument when it is not. ²³ Balanced arguments, clearly presented numbers and visuals can strengthen persuasion. ²⁴

Clarity, brevity, context, impact and value

Five principles refine persuasive science communication: ²⁵

1. Clarity: respect readers' time, intelligence and attention, making the message easy to understand.
2. Brevity: remove unnecessary information and put the most important content first, with details later, rather than requiring readers to reach the end for the message.
3. Context: account for audience biases and build positive associations by explaining relevance, including why the topic matters and why now.
4. Impact: adapt messages to different audiences, make implications memorable, provide a clear call to action and reinforce key points.
5. Value: balance clarity, brevity, relevance and impact to educate and empower the audience.

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Asking “So what?” throughout drafting can keep content concise and interesting rather than assuming readers will understand and agree because the project matters to its writer. ²⁵

Further guidance

Resources for health-message planning and audience-sensitive communication include: ²⁶

• The National Cancer Institute's Making Health Communication Programs Work: A Planner's Guide.
• CDC's Gateway to Health Communication and Social Marketing Practice.
• Johns Hopkins' The Gender Guide for Health Communication Programs.
• Helen Osborne's Talking Health to Men.

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