healthy bones australia - section b

Section B – Individual Section Chi-‐Loong Ho 10289825

Analysis and Interpretation of Findings

Focus Group Findings To reiterate, the purpose of the qualitative study was to:

1. Gain initial insights on young adults’ attitudes and behaviours towards the set of eight health issues.

2. Gauge evaluative methods employed by young adults when assessing various health issues.

3. Observe positive/negative reactions to health messages by competitive organizations.

4. Gather the target market’s thoughts on bone health practices and how it is

relevant to them. As the focus group was conducted in 3 sections, it will be addressed in that order. Section 1: Health Issues In the first section, questions were ask with regard to the group members’ attitudes and behaviours towards the 8 health issues identified: (Drug/Alcohol Addiction, Obesity, Heart Attack, Breast Cancer, Prostate Cancer, Mental Health, Osteoporosis and Skin Cancer). As a warm up exercise, the focus group were asked to write down words that they associated with the health issues. Concerning Osteoporosis, 2 of the 8 members did not known what it was. The rest associated words such as, bones, old/elderly and fragility/brittle. Interestingly, the respondents knew osteoporosis to be concerned with bones and that the other words were associated with vulnerability. When asked to rank the top three health issues of personal importance and explain why they were in that order, the majority of respondents ranked mental

health the highest, followed by obesity and heart attack. The focus group shared common reasons for ordering the health issues:

1. The health issue was a known case in the family 2. Knowing people outside the family, such as friends and acquaintances,

who have or had the health issue. 3. The issue was considered common.

Their responses further suggested that being personally connected to the health issue had greater weight than the issue being of importance to the wider community. The focus group generally ranked skin cancer and obesity the highest, in terms of health issues that were considered of national importance, followed by mental health and drug/alcohol addiction. Health Issues of national importance were evaluated based on what ‘the media’ (TV, social media, online, advertising of health issues) told them and also from friends’ personal experiences. Further, there was emphasis on organizational messages on health issues and the statistics and facts that were used to justify their importance. One group member said, ‘they show us the statistics, that’s how we know’. This indicates that messages supported and evidenced by an authority, have more meaning to the target market. Group members noted that national health issues were also evaluated based on which health issues had the potential to lead to other health issues, “for example, if you have mental instability, that could lead to obesity or heart conditions because of your stress. It could also lead to other things like alcohol addiction and even cancer maybe”. Several observations were made with regard to the group’s analysis of the organizational health messages and how they evaluate health issues. First, empathy plays a role in the target’s evaluation of a health issue messages. Strong empathic connections to the subject in an ad, for example, a drunken teenager on a night out, can evoke feelings, such as shame, disgust, pity, concern, etc. Further, images that evoke negative emotions generally discourage willingness to engage in health risk behaviour. This is similar to the juxtaposition of dissimilar prototypes, proposed by Lane et al (2011), to reduce willingness to engage in health risk behaviour. Second, images that evoke happiness and that didn’t offend, tended to be more encouraging and serve to promote good health practice and maintenance. Health messages that were offense, such as the mental health ad that had disturbing

images and was interpreted to stigmatize mental health suffers, resulted in the group recoiling from the main message. This relates back to the observation that the young adult members were empathizing with the actors in the image. Where the use of disturbing images was suitable for getting young adults to avoid health risk behaviour, in this case it seems to disassociate the viewers when the core message is about raising concerns over mental health. Thus there is a potential difference in perception over health risk issues, such as excessive alcohol consumption or exposure to UV rays, as opposed to maintaining ones health. Third, consistency between the mood of the message and the seriousness of the health issue is a factor in the successful communication of the health issue. In the case of Pink Ribbon day, a female member noted, “Something needs to come before the happiness like, ‘I treated it early’.” In addition, the ideal representation of the health issue depends on how the viewer wants to see it. A male member commented, “It’s about representation. Would I want to see someone sad or would I want to see someone overcoming to the issue? … If they want me to support it, than I’d rather see people overcoming it, than succumbing to it when attempting to garner support a person noted”. He suggested using a dichotomy to show someone succumbing to, and someone overcoming, the health issue. Finally, in the case of Movember, a female member was attracted to the peculiar moustaches used to promote the event. Interest was spurred when male friends posted on Facebook about the cause. This encouraged her to lookup Movember and ultimately led her to become aware of prostate cancer. This relates back to being personally connected to a health issues through friends and family, and is consistent with the work of Brennan et al (2010) who indicated that normative beliefs play a large role in shaping the attitudes and intentions of young people towards health practices. In this case, her friend’s belief towards supporting prostate cancer research encouraged her to investigate and ultimately become aware.

Section 2: Questions on Health and Wellbeing Practices The focus group was questioned on three health practices that were general in nature, but were connected with good bone health practices. These practices were, fitness, food consumption and sun exposure. The group members were generally aware of the importance of fitness. Again, facts and figures backed by some authority were the source of their belief, “I think we are the second fattest nation in the world” and “It should be important, considering a large amount of the population are considered obese”. When queried on how they new this, “Media… you see all the weight loss ads… they’re selling supplements but they are also complimenting it with exercise”.

Further, the group expressed that people exercise because they want to “lose weight”, “look good”, “stay healthy” and “live longer” They agree that fitness is important but more for aesthetic reasons than for good health itself. While it is considered important, they consider it difficult to actually exercise, “It’s hard”. One female member noted that when considering the many ads promoting fitness, she felt fat. “I’m setting here watching TV, them telling me to exercise… yeah I should be out there, not here watching people exercise”. She followed up her comment with, “It doesn’t help you get off the couch”. This has implications for health messages encouraging exercise, which is applicable to good bone health. It may be that while fitness messages make people aware that exercise is important, such messages do not shift the targets’ intention to engage in fitness activities. A final comment on fitness indicated that a young adult’s sense of responsibility to the future generations could be a factor in evaluating health issues. “…And what leads on to the next generation… because they look up to us as an example and if we sit around they will be like, ‘well I’m not going to do that [exercise]’.” In terms of how the target market purchases of food, the focus group mainly focused on eating out as opposed to buying groceries. In addition, taste and cost were the most important factors when deciding on a food purchase. Though we had framed the question in terms of nutritional value, only one member noted that she was concerned about fat content. However, even that was described as, “if I feel like I want to be healthy… like I’ll buy a sushi roll at a food court if I felt like eating healthy”. Finally, the group’s comments on exposure to sunlight focused mostly on the harmful effects of sunlight. Though words such as ‘beach’ and ‘warmth’ were used, the group commented more on the words and phrases that held negative associations, such as ‘skin cancer’, ‘hate the sun’ and ‘don’t want to get tanned’. While this could be because of the group’s exposure to skin cancer advertising, there are implications for bone health messages. Focus should be placed on promoting positive associations with sun exposure to penetrate negative associations already in place. Section 3: Bone Health With regard to bone health specifically, the focus group expressed that is was important for the future, but it wasn’t currently a health concern. Most associated it with illness suffered by the elderly. A male member stated that, “It doesn't apply to me now but it will later” and “it’s something that I will be worrying about further along the line or when I start seeing signs of significant bone issues”.

When questioned on their ability to maintain their both health, the general response was that they weren’t confident on their ability to consume the adequate daily calcium intake, attain the level of sun exposure and most importantly exercise. “It’s easier to drink milk then to exercise”, one female member said. This represents an important area in the shaping of intentions of young adults towards bone health. According to Brennan et al (2010), if a young adult’s self-‐efficacy were low, then they’d be less likely to engage in the health practice. In this case, the group assessed their ability to exercise and get adequate sun exposure, as low. A final word on the matter was, “Like a combination of all three, it’s doable, but in terms of us remembering to do it… I mean if you could drink milk, exercise and stay in the sun at the same time… but yeah… it just comes down to being lazy”. This implies that bone health messages should prioritize lifting the self-‐efficacy of young adults and empowering them to engage in the health practice. Finally, in terms of how a bone health message could best address the target market, the group members made a few suggestions. With regards to video formats on the Internet, a male member said, “Not many young people watch TV or TV on the Internet… perhaps more social media?” at which a female participant commented that she generally ignored ad videos on YouTube, anticipating the ‘skip’ button or browsing on another ‘tab’ till the ad was finished. This is similar to the notion of ‘zapping’ that is a shortcoming suffered by Television advertising. As a way to overcome this issue, a male participant suggested, “keep ads short, like 15 seconds”. Another female member proposed, “forced advertising”, by which she meant advertising where you have few options available to avoid looking at the ad. She gave the example of bus transit advertising, where as a person waits for a bus, they can observe the ad message. Another female participant provided at the last, that she had noticed health messages advertised in doctor’s surgeries and absorbed the messages, while she awaited her appointment.

Questionnaire Survey To reiterate, the questionnaire was design for a number of purposes:

1. To measure the knowledge of young adults regarding bone health and its maintenance.

2. To measure the attitudes, beliefs and habits of young adults towards good bone health practices.

3. To measure young adults awareness of Osteoporosis Australia and Healthy Bones Australia.

4. To rank existing health issues and determine where bone health ranks

amongst them.

5. To find which sources of health information are most frequently used and trusted.

45 young adults aged 18 – 24, responded to the questionnaire survey. 20 were male and 25 were female. 32 were full time students and 3 were part time students. 11 were in full time employment and 18 were employed part time. As it is the simplest to address, young adults awareness of Osteoporosis Australia proved to be very low, with only 22.2% of respondents indicating that they had heard of the organization. Further, only 6.7% of respondents had heard of Healthy Bones Australia. However, this was expected and supports the fact that the target market has very little exposure to the organization, let alone its messages on bone health. A weighted average was used to determine the overall ranking of a set of 8 health issues. These issues are ranked in accordance to which the target market believe are most relevant to them.

Figure 1: Order of Personal Relevance Heart

Attack: Mental Health Issues:

Skin Cancer:

Obesity: Breast Cancer:

Bone Health Issues:

Drug/Alcohol Addiction:

Prostate Cancer:

Rank 1 2 3 4 5 6 7 8

Sum 155 178 179 197 203 215 244 249 The higher sums are indicative of more respondents ranking the health issue at the lower end of the range of 1 to 8. As indicated in Figure 1, Bone Health ranks as 6th in terms of personal relevance to young adults. This was expected, as during the focus group, members mentioned that bone health wasn’t a current

health issue. To confirm if this was the case, respondents were asked to sort the above health issues into two categories, Immediate Health Importance and Future Health Importance. The findings showed that 68.9% of respondents considered Bone Health to be of future importance. 80% of respondents were aware of osteoporosis, but only 52.8% indicated that it was a future health concern. To further test the targets knowledge of osteoporosis, respondents were asked to indicate which risk factors they were aware of.

(Figure 2) From this table (Figure 2), it can be observed that most respondents (86.1%) recognized low calcium levels as a risk factor of osteoporosis. Yet, only 66.7% recognized low levels of physical activity as risk factor. Of concern, is that only 50% recognized low vitamin D levels and 36.1% associated low sun exposure as risk factors. A test regarding vitamin D indicated only 46.7% of respondents could identify it to be of importance to bone health, while 40% indicated that they did not know. There were also 23 people who incorrectly associated other vitamins to be of help. This indicates that while most young people are aware of the importance of calcium to bone health, exercise and especially exposure to sunlight represent areas requiring further education.

Figure 3 How important is your bone health to you?

Count How important is your bone health to you? Total

Of Little Importance

Moderately Important

Important Very Important

Please select your gender

Male 1 5 5 9 20 Female 5 3 10 7 25

Total 6 8 15 16 45

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Approximately 31 (68.9%) respondents considered bone health to be of importance (Figure 3). When asked to rank the reasons why (acquired from the focus group), functional reasons and personal long-‐term health ranked the highest (see appendices). This supports findings that bone health is considered of future importance. 91.1% of respondents indicated that calcium was important for their bone health. The reason for the higher percentage is because all respondents (including those who did not know what osteoporosis was) participated.

Figure 4 Which statement best describes how often you consume calcium products (i.e. milk, yoghurt, broccoli, sardines, cheese, ice cream, tofu)?

Count Which statement best describes how often you consume

calcium products (i.e. milk, yoghurt, broccoli, sardines, cheese, ice cream, tofu)?

Total

Everyday Several times a week

Once a week Once a month


Male 8 9 2 1 20 Female 7 14 4 0 25

Total 15 23 6 1 45 What is the likelihood of you consuming at least 1000mg of calcium a day? Note: 2 x 250ml cups of milk, 2 single serves of yoghurt or 5 slices of cheese are the equivalent of 1000mg of calcium

Count What is the likelihood of you consuming at least 1000mg of calcium a

day? Note: 2 x 250ml cups of milk, 2 single serves of yoghurt or 5 slices of cheese are the equivalent of 1000mg of calcium

Very Unlikely

Unlikely Neither Likely nor Unlikely

Likely Very Likely


Male 4 3 3 3 4 Female 1 7 4 7 2

Total 5 10 7 10 6 38 (84.4%) respondents indicated that they consumed calcium products at least several times a week, of which 15 indicated daily consumption (Figure 4). Yet, only 16 of the 38 (42.1%) indicated that they’d be likely to consume the equivalent of 1000mg of calcium a day. Further, 25 of the 45 respondents indicated it would be difficult for them to do so (see appendices). These findings imply that while calcium is recognized as of importance to bone health, motivating young adults to consume the required amount of calcium should be an objective of bone health messages.

Figure 5 How important is exposure to direct sunlight for your bone health?

Count How important is exposure to direct sunlight for your bone

health? Total





Male 0 10 6 4 20 Female 1 10 9 5 25

Total 1 20 15 9 45 On average, how much time do you spend in direct sunlight a day

(i.e. walking in the street, outdoor exercise, etc.)? Count On average, how much time do you spend in direct sunlight a day (i.e.

walking in the street, outdoor exercise, etc.)? Less than or equal to 5 minutes a

day

6 - 10 minutes a

day

11 - 15 minutes a

day

16 - 20 minutes a

day

Greater than 20 minutes a

day


Male 0 3 4 5 8 Female 1 3 9 7 5

Total 1 6 13 12 13 Figure 5 shows that 24 (53.3%) of respondents understood direct sunlight was important to bone health. These findings were higher than the previous findings because this question was open to respondents who indicated osteoporosis wasn’t of importance to them. This indicates that almost half of the target market is still unaware of the importance of direct sunlight to bone health. However, despite their lack of knowledge, 38 (84.4%) of the respondents are receiving adequate daily exposure to direct sunlight. In addition, 29 (42.2%) of respondents felt it took effort on their behalf to get the required direct sun exposure of at least 5 – 10 minutes a day. Since the majority of the target market is inadvertently practicing good bone health, there is an opportunity to reinforce the behaviour by educating the market on its importance.

Figure 6 How important is exercise for your bone health?

Count How important is exercise for your bone health? Total





Male 0 4 10 6 20 Female 1 6 9 9 25

Total 1 10 19 15 45 How often do you exercise?

Count How often do you exercise? Total

Everyday

Several times a week

Once a week

Once a month

Not at all


Male 4 5 7 0 4 20 Female

2 5 8 5 5 25

Total 6 10 15 5 9 45

Figure 6 indicates that 34 (75.6%) respondents consider exercise of important to bone health. Yet, 29 (64.4%) indicated that they exercised less than once a week. This supports comments made by the focus group members and is reinforced by the fact that 30 (66.7%) of the respondents indicated that exercising 30 minutes, 4 – 6 days per week, would be difficult. This suggests that efforts should be focused on encouraging the target market in engaging in exercise, with educating them on the importance of exercise taking second place. With regard to education, it was found that the target market was under misconceptions with which exercises promoted good bone health.

(Figure 7)

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Swimming and Walking, which are low impact exercises, hold the highest ranked positions (Figure 7). Further, high impact exercises such as martial arts and tennis held the lowest positions. Thus, bone health messages should communicate that high impact exercises promote bone health, as opposed to low impact exercises. Finally, results on most frequently used and most trusted health message sources were mostly similar to the findings of Brennan at al (2010).

(Figure 8) A difference with Brennan et al (2010) is that in Figure 8, Internet is ranked 2nd in terms of trustworthiness. A comment made during the focus group gives this credence. The male participant noted that it was because of his ability to ‘parse’ the information that justified this ranking. This is consistent with Pardee’s (2010) suggestion that Generation Y is a tech savvy age group. Another difference is that this questionnaire included Medical Centers/Doctors and Pharmacies as sources of exposure to health messages, where Brennan et al (2010) did not.

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Interpretations with Regard to the Research Objectives In conducting this research project, the following research objectives were fulfilled:

R1. Discover the market’s recognition of bone health in relation to prevention of future osteoporosis health issues later in life.

From the qualitative and quantitative studies conducted, a better understanding of the target market’s recognition of bone health was discerned. First, young adults view Bone Health as a future health issue. They realize its importance for maintaining an active lifestyle in the future, such as playing with grand children. Despite this, only 52.8% of respondents indicated that Osteoporosis was a concern for them in the future. In terms of their knowledge regarding risk factors to osteoporosis:

• 86.1% recognized low calcium as an issue • 66.7% recognized low physical activity as an issue • 50% recognized low vitamin D as an issue • Only 36.1% recognized low sun exposure as an issue

Further analysis raised several concerns with regard to the knowledge and attitudes of young adults towards bone health practices. While majority of young adults are aware that calcium is important for bones, 64.4% of young adults indicated that they would be unlikely to consume the required 1000mg of calcium a day, and 52.5% found it difficult to do so. In terms of exposure to direct sunlight, the majority of young adults surveyed receive the adequate daily exposure to sunlight. However, 53% of respondents were aware of its importance to bone health. Lastly, while 75.6% of respondents recognized the importance of exercise towards good bone health. Yet, 64.4% indicated they exercised less than once a week. To compound this issue, the findings indicate that young adults believe low impact exercise, such as walking and swimming are more beneficial to bone health maintenance than high impact exercises.

R2. Determine how the target market ranks bone health against other

health issues. Bone Health is considered 6th in terms of importance against the set of health issues: Heart Attack, Mental Health, Skin Cancer, Obesity, Breast Cancer, Drug/Alcohol Addiction and Prostate Cancer.

R3. Establish a set of evaluative criteria by which the target market evaluates between competing health issues.

The developed set of evaluative criteria draws upon findings from the literature review, qualitative study and quantitative study. The criteria are based on what constitutes ‘personal relevance’ to a young adult, with regards to the evaluation of health issues. The following criteria are ranked in terms of importance.

1. Personal Connection: Being related to or knowing someone who has suffered from a health issue was one of the main reasons why a health issue is of importance.

2. Health Advertising Messages are Supported by a Trusted Authority: Health messages backed by statistics and an authority, gives credence to health issues. Further, health communications serve as a powerful tool that raises the target market’s awareness over a health issue, thus raising the importance of the health issue.

3. Normative Beliefs: Findings from Brennan et al (2010) showed that young

adults intentions towards health could be affected by the beliefs of their peers and family members. Therefore, a young adult’s evaluation of a health issue could be based upon what a person important to them believes. For example, “mum believes that I should drink more milk for my bones to become strong.”

4. Self-‐Efficacy: If a young adult perceives their ability to carry out health

behaviour is low, their intention towards engaging in the health practice will be low (Brennan et al, 2010). Survey findings suggest that the target market’s self-‐efficacy towards bone health practices is quite low, which helps to explain why bone health ranks 6th.

5. Potential for Escalation: This implies that a health issue can be seen as a

cause/precursor to other health issues. An example given was Mental Health, as it was perceived to lead to obesity, heart conditions or drug/alcohol addiction.

6. Immediate vs. Future Health Concern: The target market was found to

view immediate health issues as of more importance. However, their long-‐term health is still important to them. For example, Heart Attack was considered as a future health concern and ranks first in terms of personal relevance. The fact it holds first place is attributed to Personal Connection and Health Advertising Message.

7. Health Risk Behaviour vs. Good Health Behaviour: The findings indicate that young adults see a difference between health issues and categorize them as health risks behaviour or good health behaviour. This is supported by:

a. The P/W Model (Lane et al, 2011) that can be used to reduce

willingness to engage in health risk behaviour. b. The Integrative Model of Behavioural Prediction and Change

(Brennan et al, 2010) that can be used to shape intentions towards good health behaviour.

R4. Identify potential mediums of communication with the target market,

regarding health issues. The questionnaire survey indicated that the Internet, Medical Centers/Doctors, and Friends and Family are among the most frequently trusted and used sources by the target market. Further, secondary research has indicated that frozen yoghurt dessert cafes could be partnered with to deliver bone health messages. This is attributed to the growing popularity of the stores and the fact that young adults are one of their primary targets.

Recommendations

Positioning Healthy Bones Australia should position its Brand as playful and active.

Findings had suggested that young adults, aged 18 – 24, would not respond well to brand positioning with a serious tone. This is because the health issue is not perceived as current and not considered a health risk. However, bone health is still important to the target market, so it would be beneficial to adopt a playful image to encourage adoption of preventative behaviours. Further, the main preventative areas that the target market was found to be lacking in were physical activity and sun exposure. Thus, an active brand image would assist in communicating the importance of both outdoor and physical activities. Finally, this will help keep the brand image consistent across target markets, as the current brand positioning is similar. This position serves to help further separate it from its nearest competitor, Dairy Australia’s Healthy Bones. This competitor’s organizational image is a playful one, but doesn’t emphasize the importance of exercise or sun exposure. Indeed, its main focus is communicating the importance of dairy products to bones. As the research indicates, young adults knowledge in that area is not lacking. However, it is known that Osteoporosis Australia and Dairy Australia have partnered in the past, as the two organizations have similar goals with regard to bone health. So it is possible that future partnership maybe possible.

Active Passive

Playful

Serious

Healthy Bones Australia

Red – Dairy Australia: Healthy Bones Lime – Movember Pink – Pink Ribbon Purple – Swap It! Don’t Stop It! Orange – Headspace.org.au Black – Heart Foundation: I Wish I Had My Heart Attack Again Grey – Know When to Say When Brown – Cancer Institute: The Dark Side of Tanning

In addition to the brand positioning, the following strategies have been proposed to promote awareness of Healthy Bones Australia.

Strategy 1: Advertising Campaign An advertising campaign, scheduled for release during summer, could serve to promote Healthy Bones Australia and its new image. The advertising messages should focus on encouraging physical activity, in the form of high impact exercise, and spending time in the sun, so as to produce vitamin D in the body. As a secondary goal, these activities can also be associated with calcium-‐rich food consumption. The messages should also highlight that the activities are specifically for good bone health, which leads to overall physical wellbeing now and for the future. Since the budget is $25,000, it stands to reason that the launch should take place where a larger population of young adults will be exposed to it. To these ends, it is suggested that the campaign target the beach areas of the two major cities in Australia, Sydney and Melbourne. Vespa/Scooter mobile billboard services should be employed to travel a route that intersects popular beach locations. The convoy should consist of 3 vehicles, manned by drivers dressed in skeleton suits, to draw attention and associations with bones. Further, each vehicle is to display one of three posters. These posters need to communicate the importance of physical activity, sun exposure and calcium intake. The images supplied by Landor depicting a tennis racket, the sun and a milk carton with cheese could be used. On the opposing side of the billboards, the Healthy Bones Australia brand should be displayed, with a slogan, “Youthful Bones, Youthful Life” to specifically target young adults. It is reasonable to include a Facebook symbol to indicate that the organization can be found on the social network site. The vehicles, which are typically hired out for 6 – 7 hours of a day, should be organized to conduct routes during early and mid summer. They should also be hired to do this on weekends as more people, will be at the beaches. The estimated cost to hire 6 scooters for the two cities, and schedule them for 4 Saturdays during summer, is $13,440. The remaining $11,560 should be used to develop Healthy Bones Australia’s online activates. Landor’s images could be reworked to fit into banner ads that are displayed during long Internet videos, or as a flash based ad on a webpage. The ads should communicate the same message of physical activity and sun exposure. Healthy Bones Australia’s branding and slogan “Youthful Bones, Youthful Life” should be displayed. Finally, on clicking the ad, the user should be forwarded to either the Healthy Bones Australia website or Facebook page. It is

estimated to cost $11,000 to reach 50,000 people through banner ads on YouTube. Overall, this strategy is quite orthodox and there is concern that it might not generate enough ‘hype’ and ‘chatter’ around the issue of bone health. To truly form a community around bone health, a strategy needs to draw people together and make the message of bone health more personal. The second proposed strategy aims to achieve this.

Strategy 2: Obstacle Run Event An outdoor event should be used to launch the Healthy Bones Australia program for the 18 – 24 year old market. An Obstacle Run, similar to Tough Mudder and Warrior Dash, would be ideal for several reasons. First, such an event can draw many people of the target market to it. Those who take part in it can be quickly established as the first ‘ambassadors’ of the cause. At the very least, they can promote the event, which should be identified with the Healthy Bones Australia organization, and consequently draw more people’s attention to the organization’s message and future events. From this, a community can be built around the event, thereby serving as a platform to deliver bone health messages and promote the use of the bone health calculator tool. Further, there is now an object of interest to draw young adults together on a social media network, such as Facebook. Second, by running an outdoor sports activity, the main thrust of Healthy Bones Australia’s message, to engage in fun, regular exercise and to enjoy regular sun exposure, remains consistent with the marketing activity. Further, the nature of the activity means that young adults will be engaging in good bone health practices. Thereby, they show themselves that exercise and exposure to the sun can be fun and that they are capable of managing their own bone health. This serves to raise the self-‐efficacy of the individual towards bone health. Also, the organization’s marketing messages will become more personal. Third, the event not only serves as a platform to engage the target market in bone health practices, but also as a potential generator of funds needed to further bone health research. It is possible to structure the event so that it can generate profits or even have a donation/sponsorship system in place. The event could be called ‘Mud’n’Bones’ with a slogan, ‘Stress the Structure’. This name keeps the event consistent with the gritty names of other obstacle runs and the message of Healthy Bones Australia. It should be scheduled for a long weekend in spring or summer, making it more accessible to all segments of the

target market, for example, students and full time employees. As the required funding is significant, efforts should be focused and the event should be launched in Sydney, as it is the largest city in Australia. In terms of funding, Tough Mudder required an initial investment of $20,000 to start its first competition that accommodated 4500 (Money-‐Freedom, 2013). It is expected that a similar initial outlay will be required to run the event around the Sydney area. Additional funds can be acquired through sponsorships and partnerships from businesses and other organizations. Further, ticket prices can range between $50-‐$110 (Obstacle Racers, 2013). It is recommended that prices be kept in the lower to mid end of the price range, as the majority of the target market does not have access to high amounts of money. Potential sponsors could be businesses or organizations that hold a stake in Healthy Bones Australia’s message or even with the target market. It is suggested that frozen yoghurt business, such as Yogoberry, or fitness companies such as Fitness First, be approached for sponsorships. Further, Osteoporosis Australia and Dairy Australia have partnered in the past on National Healthy Bones Week (NTG Department of Health, 2013). This represents a way to increase the funding, as well as the strength of the overall marketing message. However, caution is advised, as confusion between the similar brands, Healthy Bones and Healthy Bones Australia, may occur. The image of the ‘Mud’n’Bones’ race should be fun, gritty and exciting, as opposed to grueling and test of strength, like Tough Mudder. However, it should adopt the teamwork structure, whereby people join and complete the race as a team (Tough Mudder, 2013). This will help to enhance the sense of ‘community’. Finally, participants should be allowed to seek sponsors of their own, since the race is to champion the cause of bone health. Benefits should be provided for people who can acquire a certain amount of sponsors. For example, should a participant acquire a value of $50 in sponsorships, they receive a 30% rebate on their ticket. Finally, the remaining $5,000 on the budget can be put towards promotion over social networks, or combined with funds acquired from sponsors to promote on a greater scale, such as Strategy 1’s Advertising Campaign.

Strategy 3: Partnerships with Businesses that are Popular with Young Adults This final strategy is to build relationships with food businesses such as Yogoberry and Boost Juice, which use dairy products as a main ingredient. During the summer, Healthy Bones Australia can use the $25,000 to establish promotional teams that take the business partners products, for example, frozen

yoghurt or smoothies, directly to beaches. The promotion-‐sized products will be used to promote the partners, as well as distribute promotional messages regarding bone health. In exchange for taking the products ‘to the streets’, the businesses can help distribute Healthy Bones Australia’s messages in their stores. This can be in the form of posters or cups and containers, bearing the organizations logo, a short message on bone health and even the Bone Score rating for the product sold.

Final Words Regarding a Long Term Strategy When considering all the strategies, it is recommended that Strategy 2 be adopted, as it directly involves the target market. Further, it should be conducted every year to continue generating awareness, funds for bone health research and ‘chatter’ surrounding bone health on social networks. Strategy 1 serve as an excellent avenue for the future promotion of ‘Mud’n’Bones’ and Strategy 3 will help consolidate future partners and distributed Healthy Bones Australia’s message across a wider set of communication mediums. By using these three strategies over the long term, Healthy Bones Australia will be able to successfully:

1. Raise knowledge regarding the role of high impact exercise, sun exposure and calcium consumption in maintaining bone health.

2. Build their self-‐efficacy with regard to bone health maintenance. 3. Create a community around bone health that helps supports young adults. 4. Promote ‘chatter’ around bone health and develop the community’s

positive normative beliefs towards bone health. 5. Deliver a more personal message regarding bone health. 6. Shift the attitudes and intentions of young people towards bone health.

Limitations and Future Research Avenues First, due to time constraints, a deeper analysis of what constitutes ‘personal relevance’, for a young adult, could not be conducted. Qualitative studies could help uncover deeper reasons for a young adult’s perception of a health issue. For example, focus group members had responded quite sensitively to the Mental Health ad. While it was discovered that they were empathizing with potential mental health suffers, it was never ascertained why they empathized with them in the first place. Second, the exact weight of each criteria identified could not be ascertained. This was largely due to time constraints and being unable to conduct a second questionnaire survey to gather that information. Of particular interest would be the importance of Immediate vs. Future Health Concerns. As mentioned, Heart Attack ranked first in terms of personal relevance, yet is a future health concern. Most of the higher-‐ranking health issues were considered an immediate health concern. Third, the factors that determine if a health issue is perceived as a health risk vs. a good health practice, begs further investigation. For example, what associations do young people draw between risky-‐behaviour and excessive exposure to the sun or drug/alcohol addiction? Fourth, no conclusive information was found with regard to the use of P/W Models (Lane et al, 2010). Future research should explore potential health risks behaviours that are associated with bone health. Through this, P/W Models could be used to reduce the willingness to engage in behaviour that poses risks to bone health. It should be noted however, that the recommended strategies involve building associations with good health behaviour and work well with the brand’s image. By taking a P/W Model approach, strategies would involve disassociating oneself from dissimilar prototypes and would require a brand image change. Finally, the sample size of the questionnaire survey (n = 45) was too small to conduct hypothesis testing. Thus, it couldn’t be ascertained if there was a difference between the knowledge, attitudes and behaviours of men and women. Since Osteoporosis messages have focused mainly on older women, it was expected that the knowledge would have trickled down more to young females, as it would be of future importance due to menopause.

Bibliography

1) Brennan R., Dahl S., Eagle L., 2010, Persuading young consumers to make healthy nutritional decisions, Journal of Marketing Management, vol. 26, no. 7-‐8, p 635 – 655

2) Lane D., Gibbons F., O’Hara R., 2011, Standing Out From the Crowd: How Comparison to Prototypes Can Decrease Health-‐Risk Behaviour in Young Adults, Basic and Applied Social Psychology, vol. 33, p. 228 – 238

3) Money-‐Freedom, 2013, Tough Mudder’s Easy Money: How Pain Combined a $75m Business, Money Freedom, 08 April 2013, viewed 12 May 2013 http://money-‐freedom.net/tough-‐mudders-‐easy-‐money-‐how-‐pain-‐created-‐a-‐75m-‐business/

4) NTG Department of Health, 2013, National Healthy Bones Week, viewed 15 May 2013 http://www.health.nt.gov.au/Agency/Events/View_All/index.aspx?itemDetails=1462&objectType=kms

5) Obstacle Racers Australia, 2013, Obstacle Racers, viewed 13 May 2013

http://www.obstacleracers.com.au/

6) Tough Mudder, 2013, Tough Mudder, viewed 13 May 2013 http://toughmudder.com.au/

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