Abstract

 Pakistan is signatory of Sustainable Development Goals (SDGs) where promoting good health is at the heart of achieving various goals. Social marketing has earned its credit worthiness quite convincingly in influencing behavior change. It is, however, pertinent to see nature of the challenges that social marketing program tend to address are quite complex and each social problem need to size up with broader social context rather merely using conventional approaches.  Number of scholars has questioned approaches that have been barely successful in bringing perceptible improvement. This gap quite pervasive as most of the techniques employed used one way communication, persuasive techniques of communication. The paradigm of participation in social marketing has shown better results in bringing about sustained behavior change. This study uses broad categorization of fear appeals elements using the explanatory power of participatory paradigm to induce behavior change. Study participants were randomly selected from a Public Sector University. The participants were randomly assigned to study intervention. Study participants were given treatment based on fear appeals in groups, based on activity theory. The qualitative data drawn was analyzed using NVIVO. The different themes were explored were grouped into four categories using activity theory like activities produced by artifacts, activities produced by subjects, activities produced by rules and transformational activities. The participatory paradigm using systematic interaction proved key factors to reinforce fear appeals that enhanced the value for social marketing program to achieve sustainable behavior change.   

Key Words

Participatory Paradigm, Fear Appeals, Systematic Interaction, Social Marketing

Introduction

Social issues function as impediment in development and they also undermine common people’s ability to be an enterprising workforce and have decent level of living which is a constitutional right of the common man. In this regard Kotler and Achrol (2015) questioned the existing methodologies and interventions used by social scientist have barely successful in bringing perceptible improvement. In this regard the authors have forcefully argued the significant of marketing, particularly social marketing role that it could play in addressing these problems.

Pakistan is signatory of Sustainable Development Goals (SDGs) and promoting good health is the heart of achieving and delivering on 2030 sustainable development goals; goal 3 says “Ensure healthy lives and promote well-being for all at all ages. Every year due to Non-communicable diseases (NCDs) around 4 million people kills globally which is equivalent to 70% of global deaths and more than 70% occurring in developing countries. In Pakistan, out of 1.3 million per annum deaths, about 50% are due to NCDs and about 21% are accounted for premature deaths due to NCDs (WHO report on NCDs 2014).  The major reasons for NCDs are physical inactivity, tobacco use, and use of alcohol (GBS 2015). Lazer (1969) convincingly argued that “marketing must serve not only business but also the goals of society; it must act for broad public interest” (p.3). The article by Foote (1963) highlighted that “In the future consumption and consuming activities will occur in a society suffering from obesity and not hunger; in a society emerged from a state of chronic scarcity, one confronting problems of satiation, full stomachs, garbage’s, closets and houses”  Prior to this, Wiebe (1950) questioned the importance of marketing in selling the social ideas and thoughts through his famous notion, “why can’t we market brotherhood like we sell soap through marketing technique”. 

Since its inception the efficacy of social marketing has widely been recognized by many developed countries in behavioural change programs. There are also some valuable explanations of the social marketing tools to address social issues in developing countries like Pakistan (Khan, 2005). In context of Pakistan effective use of social marketing is vital for the effectiveness of various programs and to address social problem and to achieve 2030 SDGs and many social problems badly effecting health and wellbeing goals of people of the Pakistan. No doubt, to some extent persuasive communication, have been successful to influence individual behaviour change, but it has failed to bring sustained behaviour change (Brewer, Chapman, Gibbons, et al., 2007 and Witte & Allen, 2000). Notwithstanding the fact the tools used in commercial marketing has successfully been used in social marketing (Kotler & Zaltman 1971; Evan, et al., 2014) however, the paradigm of participation in social marketing have shown better results to bring about sustained behaviour change (Khan, 2005) as compared to conventional approaches which were based on more of one way communication to induce behaviour change at individual level. Participatory paradigm using systematic interaction based on activity theory where participants provided the opportunity to participate based on equality and principles of fairness to resolve societal common problems has proved to be an effective strategy to induce sustainable behaviour change (Khan, 2014). 

Literature Review

Social Marketing 




Marketing got attention in the overall paradigm of marketing by the work of Kotler and Levy (1969a) in their article titled, “Broadening the scope of marketing”. This has triggered the debate to whether marketing should only focus on commercial aspects or it also extends towards advancing the good of the society through addressing social issues. In their pioneer work Kotler and Zaltman (1971) propounded the idea of social marketing to advance social marketing as an emerging area of inquiry in the overall field of marketing. The concept was propounded by Kotler and Zaltman (1971), in their work titled Social marketing: an approach to planned social change. Prior to this work Wiebe (1950), questioned the importance of marketing in selling the social. Moreover, Kotler and Levi had expanded the concept of marketing through an article titled, Broadening the concept of marketing 1969. In this article they have forcefully argued that the time has come to reorient our ways of thinking and appreciate the scope marketing to enhance the value of public and civic services. In context of sustainability and resource constrained environment there is a possibility that two marketing perspectives one is de-marketing and social marketing will affect the quality of future environment (Kotler, 2011). This research attempted to examine the approaches, which have been used in social marketing programs to bring about desired behaviour change. Social marketing, a practice using marketing tools which provides valuable support to develop social communication campaigns to influence behaviour for prosocial reasons like betterment of society (Andreasne, 1994; Kotler & Zaltman, 1971). Social marketing employ marketing techniques and tools to influence volunteer behaviour change of the target audience.




Fear Appeals in Social Marketing




People are daily exposed to various social marketing messages that strive to change their attitude and behaviour.  This may tend to create conflicting attitudes and behaviour. The researches in social marketing have used fear appeals and guilt extensively. The results are quite impressive as far as effectiveness of the messages which were focused on the target audience emotions (Antonetti et al, 2015).  It has been argued that the fear appeals likely to achieve the desired goals and do curtail undesired actions of the target segment in the campaign of social marketing programs (Donovan & Hanley, 1997). Moreover, a good number of researches have empirically studied the influence of guilt and fear appeals and its impact in change of behaviour towards the pro-social (Antonetti & Baines, 2014). Sheeran et al. (2013) have reported in their empirical findings that fear appeals tend to desperate the target group from those stories that aptly design to project frivolous act of people and tendency towards denying the recommended steps to prevent from a dreaded disease. The impact of persuasive messages was also studied in laboratory condition to examine the changes in behaviour in different contexts across a variety of behaviour as a function fear inducement in each set of designed control. (Witte and Allen 2000). 

Ruiter, Abraham and Kok, (2001) have concluded by studying cases where fear based persuasive communication did provoke fears that had significantly helped to achieve health and wellbeing goals and to encourage for protective actions. From these studies, they have also concluded that content of threat in fear appeals tend to modify behaviour like e.g. obesity increase the chances of cardiovascular disease and at the same time recommend actions i.e. participate in physical activity behaviour daily (Loewenstein, Weber, Hsee, & Welch, 2001). 

Fear as a communication appeals presents threat and motivate people to follow the recommended behaviour to keep oneself away from the harm or danger due to current behaviour (Keller & Lehmann, 2008). A powerful model proposed by Maddux & Rogers in 1983 is the Protection Motivation Model (PMM) and the same has quite extensively been used in marketing discipline (Pechmann, Zhao, Goldberg, & Reibling, 2003). It explores various dimensions of compliance for assessment of the audience. This model identifies four variables: I) threat severity; II) threat susceptibility; III) response efficacy; and IV) self-efficacy to opt proposed recommendations. However, Past literature and meta-analyses identifies a weaker link between threat severity and intention and behaviour & susceptibility on intention / behavioural direct linkages (Milne, Sheeran, & Orbell, 2000). Notwithstanding the fact that above-mentioned models are being employed that are underpinned with conventional techniques of intra-individual processing, one way communication and persuasive techniques of persuasion. These techniques have focused on individual cognitive process and neglected the social contexts, and underestimate the impact of interactive paradigm and social contexts to bring about sustained desired behaviour change (Morris et al., 2012).   




Systematic Interaction




There are biases like ethnic, linguistic, economic and stratification, quality of interaction if conducted likely to offload these prejudices. This interaction if continued will likely to be transformed into systematic interaction. It tends to develop respect for each other every member has equal opportunity, Interaction phenomenon could also be predicted through activity theory. Efficacy of the mechanism could also be enhanced using activity theory. The impact of interaction tends to reinforce the commitment to engage in physical activity, the notable work that tested the interaction viable technique to advance the filed by Schein (1996; 1999; 2009). Paradigm shift the prognosis of interaction is viable mechanism to bring about desired behaviour change compared to conventional approaches such as planned behaviour changes, reasoned action theory, health belief model, social learning theory, and social influence theories. 

Human behaviour, attitudes and actions are affected due to social interaction in the society and that also help to build social norms and offload deep seated prejudices from the society. Due to this interaction people see word both social and individual perspectives due to this participatory paradigm the decision of individual members are influenced by the other group members (Tomasello, 2014). Since human actions are in congruence with what other are doing in the society and contingent with ideas and norms of other members too. They also pointed out that to achieve common and shared goals related to development then there is need to increase quality of interaction among community members. Increasing social ties is also a focus of health researchers who have explored how relationships help shift health behaviour (Mansuri & Rao, 2013). Yet increasing social ties with the aim of transforming civic culture can be challenging for policy makers. For instance, an analysis of a field experiment in a World Bank program in Sudan aimed at increasing civic participation in the wake of a civil war found that the intervention did not increase altruistic and cooperative behaviour in lab-in-the-field experiments nor did it increase social network density (Avdeenko & Gilligan, 2014). Researchers suggested that CDD programs too often involve social mobilizers telling citizens about the benefits of participation while failing to increase social interactions. Both theory and empirical research suggest that for CDD programs to be effective, practitioners must find ways to help citizen to engage with one another and ways to help those interactions after project incentive disappear (Mansuri & Rao, 2013). 

Systematic interaction is progeny of group dynamics. Group dynamics is metatheory which tells how to develop a theory. Group dynamics helps to build a system for group interaction. Systematic interaction can also improve health literacy programs. A study in health literacy program reported that increase in attitude leads to decrease in health-related behaviour because lack of motivation towards the application of knowledge into action and reported that conventional conservative careless thoughts are possible reasons for knowledge-action gaps and this study recommended to improve innovative health literacy strategies (Gautam, Bhatta, & Aryal, 2015). Systematic interaction can narrow down this gap through attitudinal reconstruction. Social issues or problem can be solved based on social interaction of the community members, where even ordinary people’s power of reflective thoughts has good meanings to society to reaching to decision or conclusions. 

Methodology

Research design 




To conduct this study verbal approval was obtained from the university to conduct there with students. The researcher used personal contacts to get approval from the university. In order to approach the participants, ethical approval was obtained from the management of the university after getting consent from the head of university, the students were directly approached to get their willingness to participate in the study. Baseline study was conducted and all those participants who were found physically inactive were considered for study intervention. To measure the stage of physical in activity the Prochaska (1992) model “the stage of behaviour change” was used. All those participants who were at the stages of pre-contemplation, contemplation and preparation were considered for further study. To conduct group activity, the Activity Theory by Vygotsky 1978 and propounded by Engeström 1987 was operationalized as guiding principle and tool to conduct group activity by breaking down group work into six dimensions. A growing body of knowledge propounded that ideas that group, not individuals, are the key sources for learning (Strijbos, 2011). 

As by Vygotsky (1978), due to inter-psychological processes, or group learning, first high level cognitive function to be appeared, and only later as intra-psychological learning, which results from the social participation and internalization. The activity model propounded by Engeström (1987) consists of six interacting components. These six components are depicted in figure: 1 below; namely subjects, tools, rules, community, division of labour and objects. In our experiments, subjects are the students, and through using intervention i.e. print advertisement and systematic interaction they are performing together as a working social system to achieve certain goals by following set rules for activity. The aim of this group activity to achieve transformation that may be group learning and knowledge to attain goals of sustained behaviour change over time.



Description of activity theory operationalization for group activity

Subject: Students efforts to achieve certain goals related to health and wellness.

2. Rules of systematic interaction (developed using expert’s feedback & literature) 

a. Everyone will read the advertisement but not in groups (individually), may use Google using smart phone to explore more about topic (10 minutes)

b. Comeback in groups and one by one discuss the issue

c. Identify and discuss problem discussed in the ad – all will participate and no one will block the information; will listen to each other  carefully

d. Everyone will work out towards Possible solution to address the problem 

e. And way forward how to implement i.e. action plans 

f. Group discussion of 7-10 people to continue for 45 minutes to one hour. 

g. Presence of group observer to self-regulate social interaction of group members (Kislev, 2015)   

3. Tools: intervention and group interaction, environment of experiment site. 

4. Community: Direct and indirect communication between members of the group 

5. Division of labor:  participation based on principles of fairness and equality

6.   Object: shared goal to achieve solution to the problem  




Group interaction was conducted following activity theory protocols as mentioned in descriptions above. Interaction process was recorded and notes were taken.  The group activity as described was carried out with the participants ranging from 7-10 participants. Multiple interaction with study participants to measure long term impact of the group activity/ experiments were taken place. To check the long-term impact of the group activity conducted, participants were selected randomly to know about long term impact of the group activity.     




Development of Communication Material




To conduct this research, study a print advertisement was developed. Print media was used because it permitted to adapt different treatments simultaneously. A print advertisement was developed employing fear appeals. A doctor from the well-known private sector hospital based in Islamabad was enlisted to endorse on intervention advertisements. In the advertisements, the doctors present the factual data / information related to fear appeals and how inactivity badly affects health. Similarly, the doctor presented data / information regarding evidence linking colon cancer and exercise behavior (e.g., “research suggested that exercise reduce colon cancer risk by as much as 40%) and as a call to action to provide some suggestions to engage in physical activity/ exercise (e.g. options are available for you to engage in physical activity in your life to meet the recommended guidelines of 30 minutes a day of moderate to vigorous physical activity/ exercise. For example, drive less walk more to go to diary, shopping etc. go to walk / hiking with your friends. 

Data Collection

As the objective this study was to explore gross attitudinal / behaviour changes because of systematic interaction among study participants. To measure the attitudinal and gross behavior changes because of systematic interaction among those study participants who engage in group activity and multiple interactions were arranged with study participants. The activity theory was used a theoretical foundation to conduct the group activity. Data was collected randomly selected participants, the qualitative data thus came from four different types of sources like phone calls, personal interviews, through email and through focus group discussion and hand written story. The key question asked from the participants was “Share your experiences / stories after participating in group activity. 




Data Analysis 




NVivo 10 has been used to analyse the data of which is good software to analyse the qualitative data, Text analysis using Nvivo helps to explore themes from the textual data that comes from different sources. Text search query was used to analyse the pattern of talk among all studied cases. Different tools like word tree map, tag cloud, and matrix coding query were used to analyse the textual data and themes explored from the textual data. 

Results

Figure-5 depicts main finding of study, the different themes were explored as depicted in figure 1 like “transformation” “Barriers to activity”, “Concern for others for physical activity”, “conscious for healthy living”, “bring me close to nature”, “continuous signals needed”, motivational videos”, “opportunity to spend time with family and friends”, “reduce stress”, “feeling the importance of physical activity”, “need actions now”, “sharing and motivating other”, and “spiritual boost’. Due to more references in the respective nodes, some factor themes are most critical as and some themes are less critical as deposited in the figure 5. Figure 1 represents the themes explored as a result of group activity

Themes explored as a result of intervention




Larger the size of rectangle mean more it’s important than those have smaller size of boxes. 

Table: Matrix coding query

 

Name	Barriers to physical activity	bring me close to nature	concern for others for physical activity	Conscious about health living	Continuous signals needed	Feeling the importance of Physical activity	Opportunity to see self	Need actions now	Opportunity to spend time with family and friends	Reduce stress	Sharing and motivating others too	Spiritual boost	Transformation
A	-	-	-	-	-	-	-	-	-	-	-	-	-
B	1	-	3	2	-	-	-	-	-	-	-	-	7
C	2	1	4	5	-	7	-	-	1	1	1	1	1
Table Continued on Next Page
Table Continued from Previous Page
D	2	1	-	-	1	-	1	2	-	-	-	-	1
E	1	-	2	-	-	-	-	-	-	-	-	-	2
F	1	-	1	2	-	-	-	-	-	-	-	-	1
G	-	-	-	-	-	-	-	-	-	-	-	-	-
H	-	-	-	-	-	-	-	-	-	-	-	-	-
I	-	-	-	1	-	-	-	-	-	-	-	-	1
J	-	-	-	-	-	-	-	-	-	-	1	-	-
K	-	-	-	-	-	-	-	-	-	-	-	-	4

 

The findings of study of phase two provide ample support our hypothesis that “participation in group discussion can motivate participants to healthy lifestyle.  Participation paradigm created dynamism and study participants set direction to achieve their health and wellbeing goals. The members who participated in groups and interacted systematically felt a sense of ownership with health and wellbeing goals for themselves as well as they served as change agents among other members of university class fellows and their colleagues.  In the transformational activity the participants acquired new knowledge and wisdom and question their exiting pattern of life and behavior.  The group activity produced requisite dynamism to generate development initiatives by the group members as a function of systematic interaction which is pre-requisite to enhance the quality of life of community members. 

Relationship among activities

Normally, success or failure tends to attributed to individual. However, in broader paradigm individual actions are part of a team play. Activity theory broadens our understanding from individual action into team play. In our society, large number of activities exists, some are independent from, and some are dependent on one another.  Relationship among various activities can be classified into four categories  i.e. I. activities produced by artifacts, II. Activities produced by subjects, III. Activities produced by rules and IV. Transformational activities. The most important in all four is the last activity i.e. transformational activity. 

In figure, the role of artifact producing activity is presented. The participants who had participated in group activity acquired new knowledge related to the role of physical activity in preventing diseases and to improve social and health indicators. They participants used this news knowledge or learning as an artifact to engage in physical activity. Therefore, group activity to learn new knowledge and engaging in physical activity are related as an artifact of engage in physical activity is produced by group activity.    




Artifact producing activity

Figure

Artifact producing activity: 



In artifact producing activity, study participants pointed out that: 

“I downloaded speedometer aps for my smart phone, I used to count 10,000 steps daily and continued this with passion and commitment. I also shared the link of this apps with my friends and time to time I have shared my progress of daily steps with them”

“Regular physical activity in park especially in the morning is an opportunity to get closer to the nature which puts my soul at peace”

“After this interaction I bought new joggers and purchased rocket and shuttles to play badminton in the park.  We also used to play badminton in the park”

“After interaction, I started visiting shoes stores to purchase good quality branded shoes which should give me peace of mind and relaxation while walking”

“This exercise created fear in me that I have started avoiding junk foods (although not finished completely yet”

“I am fully convinced that physical wellness (fitness, nutrition, personal care, and safety) are essential to a happy and healthy living over the period one’s life. Physical activity cannot be rather must not be ignored if healthy living is a priority”

“Despite a preliminary awareness of the benefits of physical activity, I spent almost last 15 of my life in physical inactivity” 

It was fantastic exercise that we had earlier. Now I woke up at 4 in the morning and things are improving. Previously, I feel laziness now I go to walk early in the morning and take healthy foods and now I feel fresh. 

After group activity, I now start better feel. After a group discussion, I have quit smoking as well I as felt that it has negative effect on health. 

The above statements clearly highlighted that due to artifact producing activities, there was overall improvement in behavior of those who participated in the group activity. They adopted overall healthy life style and healthy habits and they acquired improved knowledge because of systematic interaction and collective mechanism. Due to systematic interaction, they have also extended the knowledge to the family members and friends. This collective paradigm could provide many opportunities for the field of marketing as well. Systematic interaction and collective mechanism helped internalization of good values, character building and commitment to learning new things. Through this process of group activity based on systematic interaction, the study participants engaged in physical activity, and shared information with family members and friends and they also discussed impediments towards engaging in physical activity like time constraints, over occupied with official and university tasks, exams etc. Besides positive changes in behavior, there were some positive attitudinal changes also reflected like attitude towards fresh fruits and vegetables, avoidance of junk foods, searching for new branded joggers etc. As the above statements highlighted they also served as change agents to promulgate the benefits of overall health and wellbeing with their family members and peer groups. Overall, due the collectivity and systematic interaction improved attitude and behavior of the participants. 

Observed Behavioral changes:

1. Engaging in physical activity

2. Download speedometer aps for smart phone and measuring daily steps

3. Visiting shoe stores to purchase joggers 

4. Purchasing tools like joggers and sports material 

5. Playing badminton in the park




Attitudinal changes: 

1. Discussing benefits of physical activity with family members and other friends 

2. Sharing progress on activity with others 

3. Avoiding and Disliking junk foods

4. Realizing the importance of health and wellness

Although one way communication and lecture methods on health and life style used but created less impact on behavior change, however, systematic interaction showed better results to augment behavior change. The findings of study of phase two provide ample support our hypothesis that “participation in group discussion can motivate participants to adopt healthy lifestyle.




Subject Producing Activities




In figure 3 the role of subject producing activity is presented.  The participants who participated in the group activity now know the benefit of physical activity and its linkages with disease prevention. Now as subjects they are aiming improving life of others and showing concerns for others too also participate in physical activity by using their new learning acquired through group activity and systematic interaction. Here, group activity and support activity for showing concern for others are in the relationship where a subject of the latter activity is produced by the former

Figure 3

Subject Producing Activity:




In subject producing activities, participants pointed out that:

I also used to download speedometer aps for my smart phone, I used to counts 10,000 steps daily and continued this with passion and commitment. I also shared the link to these apps with my friends and time to time I have shared my progress of daily steps with them. They also start sharing their daily steps with me.

I also shared this information with my colleagues about the link of exercise with health and wellbeing and often my colleagues were also accompanied with me to top in nearby parks like rose and Jasmine Park

We told other people in university especially to our friend who was not part of activity about the benefits of physical activity. 

I started morning walk along with my wife and children in a nearby park. I also motivated my friend to join me at Rose & Jasmine Park for walk in the evening after office hours. I have been enjoying a wonderful time with family in the morning and on weekends since I participated in group activity.

The statement clearly pointed out that that the participants who have participated in group activity and systematically interacted with each other are now supporting others too for adopting healthy life styles.  The study revealed that systematic interaction and participatory paradigm created sense of urgency towards achieving social and wellbeing goals of the community.  The participants who were part of group have gained new knowledge about the benefit of physical activity and its linkages with disease prevention. They are now served as change agents for those who were not part of group activity. The subjects (who participated in activity) are adding more people in their circle and this way helping their family and friends towards this community development program. The continuous interaction energizes the study participants to thinks about the involvement of others members of the community. 




Rule Producing Activities 




In figure 4 the role of rule producing activity is presented.  The participants who participated in the group activity now show more concern for health living to achieve health and wellbeing goals. Now they are setting goals and timing for daily physical activity and encouraging each other to follow schedules to engage in physical activity as well as giving priority to health and natural foods Here, group activity and support activity for setting rules are in the relationship where a rule of the latter activity is produced by the former (see Figure 4)

Figure 4

Rule producing activity




In rule producing activity, study participants pointed out that: 

“We decided not to use junk foods as it increases our body weights. Take healthy foods and now feel fresh. It has given a boost up to my personal and family health. We are more conscious about healthy living”

My friend supported the ideas that we must purchase old cycles and we visited nearby market in Aabpara and bought old cycles and now on cycling we normally cover 7-8 km daily

We used to download speedometer aps for my smart phone; we used to counts 10,000 steps daily and continued this with passion and commitment

“We have also avoiding chicken and avoiding eating unhygienic food and foods especially from the market. We have also reduced our daily tea consumption”

The above-mentioned statements clearly highlighted that the participant’s actions are more connected with each other i.e. colleagues, friends and family members as the way team player cooperate and not merely individual own actions. This team has division of labor i.e. different members are performing different roles and they are following keeping rules in their minds e.g. some are sharing mobile aps (speedometer; mobile aps) and encouraging others to install on their mobile phones to gauge progress and other are asking and monitoring schedules for daily targets.    




Transformational Activities 




Activity theory is not only describing three activities mentioned above i.e. artifact producing, subject producing and rule producing activities. Activity theory also helps the people in creation more vibrant new activities to get rid of conventional activity.  The new activity is called learning activity as originally proposed by Engestrom but this activity is called transformational activity .  The transformational activity of this study is depicted in figure 5.  As highlighted in object of transformation activity is irregular pattern of participation in physical activity and more focus on individual actions that have been implemented for a long period. In transformational activity, it challenges such a conventional activity and created a new and improved way of participating in physical activates using mobile apps and sharing progress with each other. Often go for walk in team. Participants who engaged in group activity have also arranged same group activities in their respective community to create new knowledge and wisdom to improve health and wellbeing of other community members. The transformational activity provide valuable opportunity to off load deep seated prejudices prevails in the society and excel with vibrant and forward looking new activity.  

Figure 5

Transformational activities



Participants pointed out that: 

“When I started discussion, initially we all took it as just joke but later on that discussion converted into serious discussion we explore new ways to engage in physical activity.

Experiment created good awareness for us. In next week there was debate initially it wasn’t a serious but later it converted into serious debate. In group we shared that there must be seminar on this topic in the university.

We all decided walk is important and we must start walk regularly and to avoid too much bike riding. Someone pointed that we must shift from motorbike to bicycle. 

We thought there is need to arrange workshops and seminar in the university and duration must not be more than 30 minutes and need to start activity with fun to grab the attention of the audience. There is need to give certificates to the participants at end of activity because they value it.  

We will also develop Facebook page on this topic.  We will make this a “movement “in Pakistan to save many people”




Long Term Impact of the Activity 




Behavior Changes as Result of Interactions: Findings During Follow-Up Interactions

1. At least I started thinking about myself after today “where I stand today” in term of physical activity

2. We should start taking 10,000 steps daily

3. Using stairs not elevators since the time we had   

4. Started eating fresh vegetables, fruits and avoid chicken and have banned chicken in my house totally.

5. Such type of exercises must continue as it motivates to take steps 

6. I know always park our cars away from market 

7. I have started offering 5 time prayers daily in mosque

8. Have downloaded speedometers to count daily steps 

9. I have also encouraged my various friends for combine hiking

10. We have started eating fruits in office at least once in week instead of heavy lunch  

11. Group discussion give me push to take action, from that I never use office elevators, I always visit Shalimar ground in the evening and walk for about 2 hours daily during working days. I have reduced eating chicken in my house. 

12. I am now more conscious about my health that ever before and I have started eating fruits in as my lunch on working days. Discussion gives me sense as I have getting over weight and need to control it on urgent basis.    

13. This gives push, although intention was already there, but information and group discussion provide new energy and direction to take actions.  

14. For the last six months, I never used elevators always use office stairs. I have been doing physical activity after office hours and every day achieved 10,000 steps daily. 

Discussion

It is rightly said that people are dying not merely because they don’t have access to health services rather it is the ignorance that causes a number incidents of death and causalities. This situation quite alarming in developing countries like Pakistan. One of the important reasons is the weak institutions and lack of policies to resolve such issues at grass roots level. It has been argued that the spirit of is to resolve such issues using concept, tools and techniques of marketing as supportive communication system ( Stidsen & Schutte, 1972) to resolve such issues. World health Organization (WHO 2014) in their report  aptly highlighted that non-communicable diseases (NCDs) kills around 4 million people, which is equivalent to 70% of global deaths. The major reasons for NCDs are physical inactivity, tobacco use, and use of alcohol (GBS 2015). This alarming situation should be focus of attention for policy makers, health professionals, professionals of marketing engage in social communication and development programs, district government, politicians, researchers and academicians and social scientists. In this age of information where knowledge and access to communication devices are quite pervasive. It is, however, quite unfortunate that people are dying with hunger, malnutrition, and non-communicable diseases. We would have prevented such tragedies if we had well positioned our prevention and behaviour change program using requisite social mechanism rather lamenting on planned behaviour and other conventional models in social change program initiatives. Use of science and rigour can only earn credibility if it has human face. It is a matter of great challenge for social scientist, who have yet to develop effective social mechanism that tend to address these social issues. Social marketing is a valuable tool to facilitate social and development reforms, both at macro and micro level interventions using interactive paradigm based on group dynamics. This way it tends to broad the social context using interactive and participatory paradigm that bring about desired social and behaviour change among the target segment, audience, community or society.

The study supported the idea that  if people are interacting on the basis of equity and equality then they come across with new information and knowledge during the discussion to resolve any social issues it tend to dilute the conflicting attitudes on the basis of rationality and resolve it in a befitting manner compare to conventional marketing techniques which were employed in social marketing using one way communication, persuasive techniques that likely to create polarization among the members due to lack of social mechanism that synchronize communication among members. On the other hand systematic interaction overcome this vacuum that conventional marketers have inadvertently ignored as they were quite sold to the method, which is a mean not an end. that tend give them an opportunity to compare with existing practice this comparison method tend to realize the meaning and usefulness of the product , service or idea as a function of social interaction among the group member. In other words social interaction if carried out in a systematic way it tend to generate new knowledge that induces new insight and understanding. Social marketing using group dynamics provide quite effective social mechanism as a supportive system to bring about desired behaviour change. 

Keeping in view the magnitude of the social issues and social safety net in developing countries in Pakistan. It is deemed desired that policy makers, practitioners, although one way communication using fear appeals up to some extent were successful. However, this study uses group as unit of analysis, and highlights that systematic interaction in group along with fear appeals generates dynamism in the groups to achieve desired goals. In social marketing, this method is not taking into consideration by the conventional approaches of social marketing that focus on individual behavioural change approaches to get desired results of the program.  Moreover, personality trait approaches have also emphasized intra-individual processing aspects as essential and prerequisite for expansive learning. Uncertainty prevails, both in developed and developing countries because addressing the question related to social issues could hardly be answered with conventional approaches. There is need to have a look for new mechanism which empower group though continues dialogue based on principles of fairness and quality of interaction to answer the growing concerns social marketing like non-communicable diseases, antismoking, family planning (FP), obesity, HIV/AIDS, sustainable consumption, energy conservation, water conservation, civic sense etc.

The main objective of this research study was to uncover the power of group dynamics using systematic interaction and social norms as moderating mechanism and intention as mediating mechanism between fear appeals and behavioural modification using group as unit of analysis. In past literature, many theories interpret fear appeals as tools to determine decisions and actions and most of studies were correlational in nature (Sheeran, Harris, & Epton, 2013). However, these studies, to best of my knowledge, did not explain anything about group interaction and social norms as moderating mechanism to influence gross behaviour change using group as unit of analysis. Secondly, to best of my knowledge for the last fourty year literature on the fear appeals; only two studies used risk perception, anticipated emotions and perceived severity (Cho& Salmon, 2006; Croyle, Sun, & Louie, 1993) as predictor to augment behaviour change.  The current study attempts to explain the moderating mechanism of systematic interaction and social norms on fear appeals and exercise intention using group as unit of analysis rather focusing on individuals. 

Research Contribution

This study has several contributions to expand body of knowledge in context of fear appeals literature. This study used group as unit of analysis and this study uses activity system propounded by Engeström (1999), who advanced the idea innovative learning through activity system, which mainly hinges on activity theory propounded by Vygotsky (1985). This study supported that systematic interaction is a viable option for group action to determine the predictive value of the fear appeals and ability to manage change as function of continuous interaction, the relationship is not one way which is cognition and action rather two ways. This study used Activity Theory as a strategic tool to bring about desired behavior change which has not been used extensively used in the domain of consumer behavior, the underlying assumption of using Activity theory is that social and desired behavior change is a result of continuous interaction and discussion, which use to take place in every stratum of society, with vary degree of social interaction. This research provided new thought to the marketing discipline i.e. marketing as an engagement activity. Because social norms as moderators on fear appeals-outcome relationships, it is important to highlight that many marketers, public policy advocates use the persuasive power of social norms to encourage consumer to engage in healthy behavior. 

Limitation of Study

There are number of limitation in the current research study.  The first limitation is related to generalizability of results because study was conducted with students.  

Managerial Implications

The research revealed that systematic interaction with fear appeals is an effective mechanism to augment behaviour change in social marketing, particularly in community based social marketing program. It provides opportunity for the group members to interact with each other based on principles of fairness and equality. This, in turn, leads to explore some innovative ideas to solve common social problems. The effective utilization of activity theory to generate systematic interaction can help towards community development program.  The programmatic use of positive deviance strategies centers not on adopting “best practices” from abroad but identifying the local practices on the basis of observed successes and encouraging their adoption by others through local communities of practice. 

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