Integrating Quantitative and Qualitative Methods in Social Marketing Research

Introduction
Traditionally, research in the field of health promotion has followed in the footsteps of its "older brother," medicine. However, the reductionistic model of disease causation cannot adequately describe the complex mechanisms that influence health behavior. Social marketers working to promote health have learned that rigorous quantitative research surveys do not necessarily provide all of the data needed to develop effective communications. Consequently, qualitative methods such as focus groups and in-depth interviews, as well as less precise but useful semi-quantitative approaches, such as intercept surveys, have emerged as part of their research repertoire. In an ideal social marketing program, researchers use both quantitative and qualitative data to provide a more complete picture of the issue being addressed, the target audience and the effectiveness of the program itself. The purpose of this paper is to look at how these two different research approaches can be integrated to inform the development of an effective social marketing program.

Qualitative and Quantitative Methods: A Comparison
An examination of the quantitative and qualitative paradigms will help to identify their strengths and weaknesses and how their divergent approaches can complement each other. In most cases, researchers fall into one of the two camps--either relying exclusively upon "objective" survey questionnaires and statistical analyses and eschewing warm and fuzzy qualitative methods, or using only qualitative methodologies, rejecting the quantitative approach as decontextualizing human behavior. However, social marketing researchers recognize that each approach has positive attributes, and that combining different methods can result in gaining the best of both research worlds.
Quantitative research uses methods adopted from the physical sciences that are designed to ensure objectivity, generalizability and reliability. These techniques cover the ways research participants are selected randomly from the study population in an unbiased manner, the standardized questionnaire or intervention they receive and the statistical methods used to test predetermined hypotheses regarding the relationships between specific variables. The researcher is considered external to the actual research, and results are expected to be replicable no matter who conducts the research.
The strengths of the quantitative paradigm are that its methods produce quantifiable, reliable data that are usually generalizable to some larger population. Quantitative measures are often most appropriate for conducting needs assessments or for evaluations comparing outcomes with baseline data. This paradigm breaks down when the phenomenon under study is difficult to measure or quantify. The greatest weakness of the quantitative approach is that it decontextualizes human behavior in a way that removes the event from its real world setting and ignores the effects of variables that have not been included in the model.
Qualitative research methodologies are designed to provide the researcher with the perspective of target audience members through immersion in a culture or situation and direct interaction with the people under study. Qualitative methods used in social marketing include observations, in-depth interviews and focus groups. These methods are designed to help researchers understand the meanings people assign to social phenomena and to elucidate the mental processes underlying behaviors. Hypotheses are generated during data collection and analysis, and measurement tends to be subjective. In the qualitative paradigm, the researcher becomes the instrument of data collection, and results may vary greatly depending upon who conducts the research.
The advantage of using qualitative methods is that they generate rich, detailed data that leave the participants' perspectives intact and provide a context for health behavior. The focus upon processes and "reasons why" differs from that of quantitative research, which addresses correlations between variables. A disadvantage is that data collection and analysis may be labor intensive and time-consuming. In addition, these methods are not yet totally accepted by the mainstream public health community and qualitative researchers may find their results challenged as invalid by those outside the field of social marketing.

Social Marketing Research
The traditional health promotion professional conducts research at the beginning of a project to develop an intervention, and again at the end to evaluate the effectiveness of the intervention. In contrast, social marketers utilize research throughout the planning, development, implementation and evaluation phases of the program; social marketing is a process of continuous development and testing. Many of the tools used to develop social marketing programs--focus groups, consumer marketing databases, intercept surveys--have their origins in the field of commercial market research, and are based on "what works" for gathering various types of needed data. Social marketing relies upon consumer-focused research to learn as much about the target audience as possible by looking at their lives from many different angles--both quantitatively as part of a larger group and qualitatively to investigate individual attitudes, reactions, behaviors and preferences.
Social marketing programs use research throughout the life of a project. Research in social marketing is conducted specifically to help make better decisions at key points in the process (Andreasen, 1995). These decisions may include which target audience, messages and media to choose; whether to make changes in program strategy during implementation; and whether to continue the program. Pinpointing the facts needed to make these decisions will help to identify the best methods for subsequently collecting this data. Some types of information may require quantitative data collection methods, such as detecting any measurable differences in knowledge or behaviors once the program has been implemented. Soliciting audience reactions to a selection of program messages, on the other hand, may be best done through qualitative methods. An effective and responsive program requires a combination of research approaches in order to have the data needed for decision making.
Professionals who come to social marketing from a traditional health promotion background may have a difficult time in reconciling their notion of "what research is" with some of the methods that social marketers have appropriated from the commercial marketing tool kit. Even those who are committed to using a mix of research methods may encounter institutional resistance to deviating from the quantitative paradigm, particularly when the proposed research will occur in a governmental or academic setting. However, as the field of health promotion evolves from a focus on individual lifestyles and risk factors to a broader concept of social and environmental factors influencing morbidity and mortality, researchers must employ a variety of methods to reflect this new perspective.

Toward an Integrative Social Marketing Research Model
As a useful starting point, Steckler et al. (1992) have delineated four possible models of integrating qualitative and quantitative methods in health education research. In the first approach, qualitative methods contribute to the development of quantitative instruments, such as the use of focus groups in questionnaire construction. The second model consists of a primarily quantitative study that uses qualitative results to help interpret or explain the quantitative findings. In the third approach, quantitative results help interpret predominantly qualitative findings, as when focus group participants are asked to fill out survey questionnaires at the session. In the fourth model, the two methodologies are used equally and in parallel to cross-validate and build upon each other's results. Social marketers may operate under one or more of these models; the approaches are not mutually exclusive.
A social marketing model for integrating methods must include quantitative and qualitative methods at each stage of the process for formative research, process evaluation and outcome evaluation. While each program is unique, the model proposed here can be adapted based on available resources. See Figure 1, Integrative Social Marketing Research Model.

Integrating Formative Research
During the formative research stage, in which the goal is to learn as much as possible about how the target audience thinks and behaves in relation to the issue being addressed, a host of research methods provides many different data "viewpoints" for seeing the big picture. Exploratory research conducted at the beginning of the project reviews previous research involving both quantitative and qualitative data and can include interviews with those who have previously attempted to address the issue. This research will help in the initial development of the project strategy to delineate the parameters of the project, steer the selection of the target audience, specify the potential behaviors to be promoted and identify lessons learned and potential pitfalls. Focus groups conducted for exploration also yield valuable qualitative data regarding the target audience, providing insights into their language, issues and obstacles they identify, and meanings attributed to beliefs and behaviors.
Information learned from the initial focus groups can then be used to inform questionnaire construction for a population survey to collect hard numbers for baseline data. The survey will also help to segment the target audience based upon its distribution across the stages of behavior change, as described by the Transtheoretical Model of Behavior Change (Prochaska and DiClemente, 1983), or other characteristics. In addition, commercial marketing databases, while quantitative in nature, provide highly detailed profiles of target audience segments for message development and channel selection.
The messages and materials developed based upon the exploratory research should be pretested using both qualitative and quantitative methods so that the results provide depth of understanding as well as generalizability. Focus groups provide a valuable means to pretest messages and materials, for audience members can provide spontaneous reactions and explain their responses. This method, however, can only indicate trends and cannot yield hard quantitative data needed for definitive decision making. If enough focus groups are conducted and participants are considered representative of the target audience, a survey questionnaire may be administered either before or after the focus group to collect numerical data as well.
A central-site intercept survey, in which potential audience members are approached in a public area and asked to respond to a quick questionnaire, provides another method of pretesting materials. The fast turnaround nature of this method and high volume of responses makes it ideal for testing draft executions of materials such as print or television ads prior to production and implementation. This method is considered semi-quantitative because respondents are not selected from a random sample, but questions are usually closed-ended and tabulated statistically. Final decisions, such as choosing from among several possible ads, can be made based on the numbers this method yields.

Integrating Process Evaluation
Upon implementation of the program, process evaluation helps to keep the project on track and signals when changes are needed in the program strategy. The most common data collection activity in this phase involves counting--materials distributed, number of people attending activities, broadcasts of the television or radio ads, media coverage of events, phone calls to the organization--to ensure that the project proceeds as intended. Other quantitative tracking mechanisms, such as consumer surveys, identify whether the program's message is reaching the target audience and is getting its attention and motivating action. In an ongoing multi-year project, this may be a repetition of the population survey conducted at the beginning; for a shorter-term project, a survey may target a very specific audience segment.
Qualitative process evaluation methods can include periodic interviews or focus groups with target audience members to assess their progress toward behavior change. Through these activities, participants may inform program administrators of unforeseen barriers or opportunities to adopting the behavior that need to be addressed to increase chances of success. Observations of audience members may also provide clues to needed changes in program strategy or messages in case they are using the product in an unsafe manner or performing the target behavior incorrectly. The quantitative and qualitative process research can be conducted simultaneously to collect and react to data.

Integrating Outcome Evaluation
Both types of research are instructive in identifying the program outcomes. A repeat of the quantitative population survey will provide an indication of whether the program realized its objectives in raising awareness, changing attitudes and initiating behavior change. Related decreases in morbidity and mortality or other major indices will be more difficult to claim without also conducting a matched community intervention study, with the only difference between the communities being the presence of the social marketing program.
In the end, the quantitative data emerging from the survey are generally used as the final arbiters of success. However, qualitative research can point out successes that may have occurred on a more human scale through anecdotes about how the social marketing program made a difference in someone's life. Focus groups, interviews and other methods of collecting individual people's stories and responses to the campaign are valuable in learning which components of the program were successful and how the next project can be improved. Both types of research are necessary to assess the full extent of the program's impact upon the target audience.

Conclusion
Integrating quantitative and qualitative research methods lends depth and clarity to social marketing programs. This combination of approaches is necessary because of the wide range of data needed to develop effective communications. However, the potential for problems exists when attempting to combine such divergent research paradigms; one may end up not doing either type of research well. This integrative approach therefore requires a research team with expertise in both types of methods. Using multiple approaches can also be time-consuming, labor-intensive and expensive. Another obstacle, which will likely change as social marketing gains in usage, is that combining multiple methods is still not widely accepted as a viable research strategy--at least in mainstream public health circles. As social marketers demonstrate that such research is necessary to fully understand and address many health-related issues, the research norms and scientific dogma regarding appropriate methods may shift to a new, more integrative paradigm.