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About The Heart Truth
Using Social Media to Reach Women with The Heart Truth® - 2009 Update

Using Social Media to Reach Women with
The Heart Truth® - 2009 Update

Terry Long1
Ann M. Taubenheim, Ph.D., M.S.N.2
Jennifer Wayman, M.H.S.3
Sarah Temple4
Emily Yu5


1Former Communications Director, National Heart, Lung, and Blood Institute
2Public Health Advisor, National Heart, Lung, and Blood Institute
3Executive Vice President, Ogilvy Public Relations Worldwide
4Senior Vice President, Ogilvy Public Relations Worldwide
5Account Supervisor, Ogilvy Public Relations Worldwide

Corresponding Author:
Terry Long: 4521 Middleton Lane, Bethesda, Maryland 20015. Email: longt21@comcast.net.

Based on a presentation at the Symposium on New Media in Health Communication and Marketing, George Washington University School of Public Health and Health Services; February 3, 2009.

Suggested Citation: Long T; Taubenheim A; Wayman J; Temple S; Yu E. Using Social Media to Reach Women with The Heart Truth® - 2009 Update. Cases in Public Health Communication & Marketing. 2010; 4:55-68. Available from: www.casesjournal.org/volume4.

Abstract

The power of social media to effect change is becoming recognized by social marketers and health educators as an important strategy, and campaigns are increasingly using social media strategies to expand the reach to their target audiences. In 2002, when the National Heart, Lung, and Blood Institute launched The Heart Truth - the first federally-sponsored national campaign aimed at increasing awareness among women about their risk of heart disease - many of today's social media hardly existed. At the outset, the campaign team developed and tested a women's heart disease brand - the Red Dress - and sought to promote it through a wide variety of means, including the Internet marketing approaches that were current at that time. The online approaches supported the three main campaign implementation strategies, that is, partnership development, media relations, and community action. As the campaign matured and new media approaches evolved, the campaign increasingly promoted its products, messages, and events through social media channels and Internet marketing techniques, including e-mail promotions, blogs targeted to women, Facebook, Twitter, public service banner advertisements, and outreach to online mainstream news sites. The social media effort began as a small pilot project in 2007, and was expanded in subsequent years based on lessons learned. This article describes the approaches used and the results achieved, and discusses the advantages and limitations of social media in the context of the larger campaign. With a combined impact of many millions of additional audience impressions through social media, the campaign team concluded that these channels provide an effective, low-cost means of further extending the reach of The Heart Truth to its core audience and beyond.

Overview

Twitter, blogs, Facebook, Flickr, and the next thing just a keystroke away - new media are changing the way commercial marketing is done, and making a profound impact on the world of health communications and social marketing as well. The Symposium convened by The George Washington School of Public Health and Health Services in February 2009 explored ways in which new media are shaping health communications strategies and showcased practical examples of campaigns and programs that are using these new channels to reach their audiences.

In September 2002, when many of today's social media hardly existed, the National Heart, Lung, and Blood Institute of the National Institutes of Health launched The Heart Truth - the first federally-sponsored national campaign aimed at increasing awareness among women about their risk of heart disease. From the beginning, the campaign used a multi-faceted approach based on social marketing principles, including an extensive formative research phase which informed the campaign planning and development. With the creation of The Red Dress® as the national symbol for women and heart disease awareness, the campaign integrated a branding strategy into its traditional social marketing approach. The aim was to develop a women's heart disease brand that would have a strong emotional appeal to women, and promote it through a wide variety of means, including the Internet marketing techniques that were current at that time. The online approaches were designed to support the three main campaign implementation strategies - partnership development, media relations, and community action. By 2009, the campaign showed substantial successes, including an increase in women's awareness of heart disease as their leading cause of death - up from 34% in 2000 to 68% in 2009.

From the outset, The Heart Truth sought to create and use online resources and marketing strategies. This included developing a web site that became the workhorse of the campaign, providing tools to support partners, showcasing events, and offering program materials, links, and resources. As the campaign matured and the online world evolved, The Heart Truth increasingly promoted products, messages, and events through a variety of social media channels and Internet marketing techniques. These approaches and the initial results (for 2007 and 2008) were published in the journal Social Marketing Quarterly as part of a special section on The Heart Truth ( "Using Social Media and Internet Marketing to Reach Women with The Heart Truth®," Social Marketing Quarterly, Vol XIV, No. 3, Fall 2008.) This article summarizes key points from the full article, with permission of the journal, and updates it with information and results from the campaign's social media activities for 2009 (Ogilvy Public Relations Worldwide 2009).

Integrating Social Media and Internet
Marketing into The Heart Truth

Beginning in 2007, The Heart Truth campaign sought to use social media marketing (SMM) as a means of expanding the reach of its existing marketing and promotion tactics as a potentially low-cost means of reaching millions more women with heart health messages. (The campaign's full array of strategies and tactics is described in the special section of Social Marketing Quarterly noted above.) SMM has been defined as ''a way of using the Internet to instantly collaborate, share information, and have a conversation about ideas or causes we care about'' (Wilcox and Kanter, 2007). It has been described as a form of Internet marketing for the purpose of building brand awareness, increasing visibility, and achieving marketing communication goals in various online social networks (MySpace, YouTube, Facebook), social web applications (Wikipedia, ePinions, Flickr), and 3D virtual worlds (Second Life, Active Worlds) (Wikipedia, 2008). SMM is a tool that allows people to share information with each other and build dialogs, instead of passively receiving information, through online platforms such as blogs, widgets, video and photosharing, social networks, and virtual worlds (Weinreich, 2006).

The power of SMM in effecting change is increasingly recognized by social marketers and health educators as an important strategy (Wilcox and Kanter, 2007.) As such, the campaign team set out to augment existing campaign marketing and promotion strategies by creating and testing selected online communication approaches for reaching The Heart Truth's core target audience (women ages 40-60). The aim was to use social media strategies to help achieve the campaign's ultimate goals-raising awareness of heart disease among women, increasing awareness that having risk factors can lead to heart disease, and increasing the number of women who talk to their health professionals about risk factors and take action to lower them.

Objectives

Online communication strategies were chosen that would help to achieve the following objectives:

  • Increase visibility of The Heart Truth, The Red Dress®, and key campaign messages.
  • Further achieve campaign branding and marketing communication goals in various online social networks.
  • Target an audience that is actively seeking information, and expand the campaign's core audience of women ages 40-60 to reach younger women, who also need to know about heart disease risk factors.
  • Promote two key Heart Truth activities - National Wear Red Day® (NWRD) and the Red Dress Collection (RDC) fashion show. Both events occur annually in February, which is American Heart Month.
  • Provide heart health information in an atmosphere of social support and motivation through online social networks.
  • Humanize the issue of women's heart disease by encouraging women to hold online dialogs to talk about heart disease and reach out to other women on the issue.
  • Create a more trusted relationship with the target audience by participating in forums they have created.

Social Media and Internet Marketing
Strategies and Results

The team used the same basic set of SMM and Internet marketing strategies and tools in 2007 and 2008 (Table 1), and repeated them in 2009, with the addition of a new tactic - live coverage of the Red Dress Collection fashion show via Twitter. In 2008 and 2009, the team used the lessons learned from the previous year(s) to refine the approach, with the main change being a phased implementation of the tactics from November to January.

Overall, the various SMM approaches achieved a wider reach each year. In 2009, the Internet and social media promotions substantially extended and enhanced the results of the previous two years, netting gains in audience impressions and again creating wide visibility for The Heart Truth's messages and signature event, the Red Dress Collection fashion show. The following is a description of the main tactics used and the results for each.

Table 1. The Heart Truth campaign's social media marketing and internet strategies.
Targeted e-mail communications
Social network outreach (blogger outreach, Facebook, YouTube)
Social web applications (Wikipedia, Flickr)
Public service announcement online banner campaign
Pay-per-click campaign
Paid banner ad campaign (Blogher.com)
National Wear Red Day® countdown widgets/gadgets
Heart Truth photo gallery (Flickr)
Outreach to online mainstream news sites
The Heart Truth profile on social bookmarking site (Del.icio.us.com)

 

Blogs

As part of the social networking strategy, the team contacted hundreds of social networks, message boards, and high-influence bloggers who focus on women, health, motherhood, fashion, and entertainment. Several high-influence bloggers were invited to attend the Red Dress Collection fashion shows in New York. The team discovered that although approaching many relevant bloggers is the key to success, carefully identifying influential, active bloggers-and monitoring and supporting their coverage over time- holds great promise for leveraging social media. Identifying appropriate bloggers involved a multi-step process, including researching relevant pieces posted on the blog; confirming that the blogger's intended audience is a good match for the campaign's target audience; and assessing the blogger's influence relevant to the subject matter by reviewing comments posted on the blog, noting outbound and incoming links to the blog, and assessing the frequency of posts. The process for developing and maintaining relationships with relevant bloggers included crafting individualized emails to each one; giving them photos, fact sheets and other materials that make it easy for them to create posts; and creating extensions for them to post such as Web banners, links, and other campaign-related information and tools.

Using this approach, the team discovered one particular blogger each year who, because of the right combination of audience, theme, and placement, sent a large volume of traffic to The Heart Truth web pages. In January and February 2007, 16% of all traffic to The Heart Truth web pages came directly from the blog: Dr.Helen. com - a clinical psychologist who has significant reach to women online. In 2008, a blogger who reaches young mothers and attended the Red Dress Collection fashion show-Designmom.com- was responsible for more than 11% of all traffic in February. In addition to the tremendous power of individual bloggers, the combined effect of blogs was substantial, and the number of blogger entries increased each year. In 2007, outreach to 40 bloggers led to 300 posts, and the 2008 outreach to 137 bloggers resulted in 536 posts which mentioned the campaign and/or its February events.

In 2009, outreach was expanded to 235 blogs, social networks, and message boards in the categories of health and fitness (e.g., WebMD and About.com), parenting/ motherhood (e.g., Modern Mom, Manic Mommies), ages 55+ (e.g., AARP, Boomer Women Speak), caregivers (e.g., caregiver. com, GenBetween), and fashion/style (e.g. Fashionista, Hip Candy.) As in the previous years, the team provided information about the campaign and specific calls to action around upcoming events such as National Wear Red Day® and the fashion show. Bloggers were also encouraged to become a Facebook fan of The Heart Truth and join The Heart Truth photo stream on Flickr.com. The effort generated more than 3,000 blogger entries in January-February 2009, a substantial increase in social media coverage over the previous year. The most discussed topics - the campaign itself and the Red Dress Collection fashion show- comprised 67% of the online social media conversation.

Social Media and Internet Marketing
Strategies and Results

In 2009, the team added live coverage of the Red Dress Collection fashion show event via Twitter. Twitter is a "microblogging" platform composed of brief (140 characters) answers to the question, "What are you doing?" Its users post updates (known as Tweets), as well as read and respond to other user’s Tweets. As in past years, a selection of high-influence bloggers who reach women were invited to attend the Red Dress Collection fashion show. In addition to covering the event on their blogs and posting images on Flickr, the guest bloggers were asked to contribute to the live coverage of the event using Twitter. The real-time ability to connect with others and share experiences made Twitter an ideal platform for gaining attention for The Heart Truth’s major national events. Prior to the show, the team also reached out to relevant Twitter users who expressed interest in the campaign and fashion topics, as well as to those who were already planning to attend New York’s Fashion Week. Twitter users were informed of the #hearttruth hashtag that the team created specifically to use during event coverage, and were encouraged to follow and share the stream of conversation with others. Live event coverage via Twitter using the #hearttruth hashtag generated 66% of all Heart Truth-related Twitter conversations on the day of the fashion show. With more than 370 posts by 173 people, the conversation around the campaign and the fashion show reached more than 141,000 people (known as "followers" on Twitter), with substantial spikes in the conversation on the day of the show and on National Wear Red Day®

Facebook

The team launched a Heart Truth Facebook fan page in 2008, and expanded efforts in 2009 to unite the online Heart Truth community across platforms, promote the Facebook page, and increase the fan base and engagement on the page. The page was restructured, and event listings and new content, including photos and videos, were added. Relevant Facebook groups were then contacted and encouraged to join the campaign fan page, and the page was cross-promoted via Twitter and bloggers. The Facebook fan base grew from 76 fans in 2008 to more than 400 fans by February 2009.

Healthy Action Community

In 2009, a "Healthy Action Community" page was added to The Heart Truth web site to facilitate audience interaction with the campaign and encourage sharing the campaign’s messages with others. The community page connected users with a variety of multi-media resources and tools, including The Heart Truth Facebook fan page and Flickr, as well as heart healthy action "badges" for users to post on their blogs or personal profiles, and links to the National Heart, Lung, and Blood Institute’s extensive information on reducing the risk of heart disease.

Public Service Banner Placements

For 2008, The Heart Truth team created public service announcement (PSA) banners featuring The Red Dress® and core campaign messages, which drove traffic to The Heart Truth web pages. Staff contacted more than 125 influential online media outlets that reach a large number of American women. Outreach efforts resulted in more than 3,604,480 audience impressions (that is, the number of people estimated to have seen the banners while posted.) The most prominent PSA placements include Hearst Media, which donated 2 million impressions on five women’s magazines’ web sites; Mayo Clinic, which posted three PSA bannersthroughout February (resulting in more than 1 million impressions); and USAToday, which provided 200,000 impressions. For the February 2009 campaign events, the team contacted 75 online media outlets focusing on women, health, entertainment, parenting/family and national news. Banner placements again included prominent placements, with the Mayo Clinic placement alone garnering about 15 million impressions, a considerable increase over 2008. In total, the 2009 PSA banner effort generated more than 100 million audience impressions on dozens of web sites.

Internet Search Engine Advertising

The team also initiated low-budget "pay-perclick" advertising campaigns, creating short ads using key terms such as "women’s heart disease" that were placed on Google and other search engines, as well as content network sites such as www.mayoclinic.com. When users clicked on the ads, the campaign was charged a small fee (about .60 per click). For 2009, this strategy resulted in 5,557 clicks, and a "click through" rate of 11%. (that is, the percentage of viewers who "clicked through" the ad to reach the campaign web site.) The industry click-through rate for the Government sector is about 2% (MailerMailer 2008.) Audience impressions totaled more than 1.4 million. Compared with 2008, clicks increased 100%, and audience impressions increased 36%.

Other results included:

  • Email campaign to partners/professionals: Distributed more than 300,000 emails with an average open rate of 13%.
  • Nearly 30 million unique monthly visits from the 49 web sites engaged by The Heart Truth team to participate in American Heart Month activities.
  • Visits to The Heart Truth web pages featuring campaign educational materials increased by 74% compared with same period in 2007/2008.
  • Overall, in 2009, there were an estimated 64 million total unique monthly visitors from postings generated by online outlets and users, both "organically" and through outreach by the campaign team.
  • Corporate partners such as Diet Coke and Johnson & Johnson also contributed to the online media impact. Their many online offerings, including advertisements, e-newsletters, microsites, web banners, and blogs, highlighted the campaign and resulted in millions of additional audience impressions, although the exact number is not available.

Implications and Discussion

The Internet marketing and social media strategies carried out in 2007 through 2009 exceeded the team’s expectations for promoting The Heart Truth and its messages. There was a demonstrated increase in the effectiveness of the new media tactics each year, which complemented and amplified the campaign’s other marketing and promotion activities. The social media tools and tactics were well integrated into the campaign’s ongoing activities and each served to promote and extend the other. For example, the campaign’s signature event, the Red Dress Collection fashion show, was promoted pre- and post-show on Facebook, links and photos from the show were posted, and fans were sent messages and new information to keep the interactive communication alive and fresh.

The 2009 activities again showed the value of involving selected bloggers. The viral impact of campaign messages on blogs that reach women greatly extended the campaign reach. The addition in 2009 of live coverage of the fashion show on Twitter made good use of this medium’s ability to make a real-time connection with audiences. The combined effect of the online activities was also noteworthy, with the various elements working together synergistically; for example, the guest bloggers who attended the fashion show also contributed to the live coverage via Twitter and posted images on Flickr. Although many of the audience impressions were the direct result of the campaign team’s outreach efforts, much of the impact was also generated "organically" as the issue of women and heart disease and the Red Dress Collection fashion show generated a presence on the Internet and web sites picked up information from one another. Furthermore, outreach to online mainstream news sites served as a good complement to the social media strategies, providing effective outreach to the existing users of these news sites.

For a federal government initiative without an advertising budget, the use of social media and Internet marketing strategies was a relatively low-budget means of raising the visibility of the campaign by substantially increasing the number of audience impressions, thereby potentially exposing many more millions of women to The Heart Truth.® Furthermore the "viral" impact of spreading the campaign message across many web sites, blogs, and social networking sites meant that far more people were reached than would have been possible through "traditional" channels alone.

The positive results of each year’s coverage led to the expansion of tactics, such as the use of Facebook beginning in 2008, and Twitter in 2009. With visibility increasing each year, it is expected that the yield will continue to grow over time, and that the campaign will be required to set its own benchmarks and track the trends as the effort continues in the future. An important measure of The Heart Truth’s success is the results of national surveys that measure women’s awareness of heart disease as their leading cause of death. (As stated previously, awareness increased from 34% in 2000 to 68% in 2009.) Given the limits of campaign evaluation resources, what is not known is the relative contribution of social media strategies to this key indicator. However, the combined impact of many millions of additional audience impressions through social media has almost certainly contributed to greater awareness of heart disease in women.

Overall, the Internet marketing and social media tactics that The Heart Truth has used for three consecutive years have provided an effective means of further extending the reach of the campaign to its core audience. In fact, these techniques have become not only mainstream marketing communication channels, but also integral to the success of The Heart Truth campaign’s marketing and promotion strategies. Similar efforts, no doubt, would prove to be a useful component of virtually any substantive health communications campaign.

References

MailerMailer LLC, Email Marketing Metrics Report, November 2008. http://www.mailermailer.com

Ogilvy Public Relations Worldwide, American Heart Month 2009 Web Marketing and Social Media Promotion Final Results Report , April 2009, unpublished report.

WEINREICH, N. 2006. Social marketing vs. "social marketing" smackdown. http://www.socialmarketing.com/blog/2006/09/social-marketing-vs-social-marketing.html

WIKIPEDIA. 2008. http://en.wikipedia.org/wiki/Social_marketing

WILCOX, D., and B. KANTER. 2007. Demystifying web 2.0 for volcom groups: blogs, rss, tagging, wikis and beyond. Slide set for UK Circuit Rider Conference, January 15, 2007. http://beth-typepad.com/beths_blog/2007/01/demystifying_so.html

®The Heart Truth and The Red Dress are registered trademarks of U.S. Department of Health and Human Services (HHS). National Wear Red Day is a registered trademark of HHS and the American Heart Association.

Author Information

Terry Long served as the Communications Director of the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health where she directed media relations, education campaigns, and product marketing for NHLBI’s research and education programs. She was the senior manager of The Heart Truth, NHLBI’s national campaign to increase awareness about women and heart disease. Before joining NHLBI, she managed media relations, campaigns, and prevention programs for other agencies of the U.S. Department of Health and Human Services. She retired from the National Institutes of Health in 2007, and is now a consultant in health communications.

Ann M. Taubenheim, PhD, MSN, is the Chief, Health Campaigns and Consumer Services Branch, Office of Communications at the National Heart, Lung, and Blood Institute. She serves as project director for The Heart Truth campaign, overseeing strategic program planning and development, implementation, and evaluation. She also serves as the project officer for the NHLBI Health Information Center and leads the Center’s work in developing new technologies for responding to public inquiries and marketing and promoting the Institute’s health information to patients, health professionals, and the public.

Jennifer Wayman, MHS, is an Executive Vice President with Ogilvy Public Relations Worldwide, and co-director of Ogilvy’s Social Marketing Practice in Washington, DC. She specializes in the strategic development, implementation, and evaluation of national social marketing and health communications campaigns, with an emphasis on women’s health. Currently, Jennifer serves as corporate monitor for Ogilvy’s work on the National Heart, Lung, and Blood Institute’s The Heart Truth campaign, after serving as the project director for the campaign’s first five years.

Sarah Temple is a Senior Vice President with Ogilvy Public Relations Worldwide, where she specializes in strategic health communications planning, public/private partnership development, and corporate social responsibility programming. Currently, Sarah serves as the project director for Ogilvy’s work on the National Heart, Lung, and Blood Institute’s The Heart Truth campaign, and also serves as partnership director for the campaign, guiding outreach and engagement of all partners in the corporate, media, and nonprofit sectors.

Emily Yu is an Account Supervisor with Ogilvy Public Relations Worldwide, and supports several national social marketing campaigns focusing on public health. Currently, Emily manages the development of social media tools and outreach strategies on behalf of the National Heart, Lung, and Blood Institute’s The Heart Truth campaign. In addition, Emily manages select corporate partnerships and facilitates the development of print, broadcast, and online materials for this campaign.

The Heart Truth, its logo, The Red Dress, and Heart Disease Doesn't Care What You Wear—It's the #1 Killer of Women are registered trademarks of HHS.
Red Dress and Red Dress Collection are service marks of HHS.
National Wear Red Day is a registered trademark of HHS and AHA.

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