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Consumers tune in to multimedia marketing.

By Dawn lacobucci, Bobby J, Calder, Edward Malthouse, and Adam Duhachek

Many people who would benefit from wearing hearingaids don't use them, largely because they're put off by the negative imagesassociated with these products. No matter what their age, many potentialusers avoid purchasing a hearing aid because they believe that wearing onewould make them appear old, feeble, and incompetent. A July 1997 articlein the American Psychological Association's Monitor, a publication for practi-tioners and clinicians, described the denial and depression people associatewith hearing loss. It reported that people don't want to admit their hearingloss to themselves because it connotes aging. Nor do they want to admit it toothers, for fear of being viewed as incompetent.

in addition, hearing loss, if not assisted with hearing aids, can lead togreater dependence upon a spouse and/or withdrawal from social events.Many times family members, co-workers, or anyone secondarily affected bythe focal person's hearing loss may first diagnose the problem and recom-mend the impaired individual seek help.

Given the stigma associated with hearing aid products, it's perhaps notsurprising that when Business Week features a hearing aid manufacturer in itsannual design awards, it emphasizes that the product receiving acclaim istiny and will "nestle discreetly in the ear canal." Clearly, no one wants todraw attention to what's perceived as a malady of old age- When PresidentClinton publicly acknowledged wearing a hearing aid, these stigmatizedproducts saw a sudden surge in sales. Perhaps the devices were consideredmore acceptable because they were associated with the relatively young andpurportedly virile instead of the old and feeble.

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The negative image associated with hearing aids clearlypresents a challenge to marketers of these products. To findout what makes a person more likely to use a hearing aid,we explored the factors that encourage or discourage posi-tive attitudes toward their use and investigated how toenhance more favorable attitudes toward these stigmatizedproducts. !n particular, we were curious about the applica-bility and possible effectiveness of integrated marketingcommunications (IMCs), given their relative novelty andcurrent popularity. We thought that a stigmatized productmight best be approached through multi-modalityapproaches that reinforce the advertising message.

Integrated Marketing CommunicationsIntegrated marketing communications are growing more

popular as marketers coordinate advertising campaigns acrossdifferent types of media. For example, some campaigns willsupplement television advertisements with marketing mes-sages communicated via alternative media vehicles.Consumers might see print ads that capture a frame from thetelevision spot with a tag line that summarizes it. Anotherexample might be a radio airing of an excerpt of the dialogueand the announcer's product claims of that TV spot.

But how complementary are these media choices? Randompairings of media are not as elfective as more sensible pairingsof media—media that naturally go together; combinations thatmight make better sense for the sales of the particular productat hand; and media that convey the content of the advertisedmessage more precisely Specifically, we compared the mass(public) media of television and print advertisements to therelatively newer targeted (private) vehicles of direct marketingand telemarketing. Typically the former class is constructed formass appeal, whereas the latter is purportedly more cus-

We're not claiming that private media should always out-perlorm mass media. Rather, we're claiming that private ormass combinations of media may be more or less appropriatefor certain product categories. For example, in ads targeted toteens, a mass campaign may do a better job of appealing totheir need to fit in and belong. When it comes to sellinghearing aids, however, a personalized and more delicateapproach may be effective-

Finally, tbe media, the product category, and the content ofthe advertising message are all important- Our research foundthere could be optima! (and poorer) combinations of mediaand ad content. For example, poignant appeals make the needfor private consumption more salient- However, mass mes-sages that enhance universal empathy may make public vehi-cles perfectly acceptable persuasion tools. Thus, we haveinvestigated and can state with some confidence that the effec-tiveness of an ad depends on (1) the combination of media,(2) the product category, and (3) the combination of ad mes-sage and media.

We explored these three rules of thumb in a data set gath-ered from a large held experiment. The respondents comprisea sample drawn from the general public, contacted by a fieldmarketing researcb firm, and the actual advertisements in alltheir varying media forms. Hence, we have attempted to maxi-mize external validity to the extent possible, on both thedimensions of the sampling of respondents and the creation ofthe advertising stimuli.

The DetailsMarketFacts Inc- surveyed a national panel of 80,000

adults with a screener to identify respondents who had beenpreviously diagnosed by their general practice physician ashaving a hearing itnpairmem. Of the 59,828 cards returned

When President Clinton publicly acknowledged wearing a hearing aid,

these stigmatized products saw a sudden surge in sales.

tomized, even to the point of being the primary media fordeveloping and maintaining relationships and interactionswith customers. Combinations of private media (and of publicmedia) are processed by the consumer as more coherent andtherefore should typically be more persuasive than IMC effortsthat combine the public with private media.

The choice of media will likely depend on the productcategory being advertised. In our research, we've examinedwhether the public or private media are more effective atinducing favorable attitudes and purchase intentions towardhearing aids. These purchases involve no small amount ofconsumer embarrassment, so media that convey such deli-cate messages in the privacy of one's own home, with infor-mation that seems tailored for one's own personal needs, andthat can be studied at a leisurely pace may be more persua-sive than mass communications that emphasize an embar-rassment factor.

(for a 74.8% response rate), 7,955 respondents qualified. This10% rate approximates the prevalence of hearing difficulties inthe population. Those qualifying were sent an eight-pagequestionnaire (Wave 1). This survey provided baseline data onattitudes toward hearing aids, intentions to visit a physician todiscuss them, intentions to purchase a hearing aid, and severalindividual difference covariates- Usable questionnaires werereturned by 4,824 persons (60,6%).

Media exposures (advertising videos, print ads, direct mail,telemarketing) followed. A random sample of 4,344 partici-pants (of the 4,824) was assigned to receive one of threeadvertising messages attempting to enhance their attitudestoward hearing aids. Participants were mailed another eight-page survey (Wave 2) after the advertising exposures to meas-ure short-term change in attitudes and reactions to the adver-tisements. Returns came in from 3,351 persons (77,1%),Finally, a brief (four-page) follow-up questionnaire (Wave 3)

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was sent to the 3,351 parties three months later to obtainindices of moderately longer-term attitude change; 3,04y sur-veys were completed (91%).

The lollowmg profile describes what a cross-section of thegeneral public looks like who have an identified hearing prob-lem. Their mean age is 54 years, but the standard deviation islarge (10 years), confirming that hearing loss problems are notentirely concentrated among the elderly Our sample was com-prised of slightly more men (53.5%) than women. Very fewpeople in this sample, who are known to have hearing loss,have tried to use a hearing aid (5%), although 46% state theirwillingness to discuss the possibility of getting one.

Advertisements and the MediaIn our study, we used a panel of respondents as a test mar-

ket. We contacted the 4,344 participants at Time 1 prior to(he exposure to any marketing communications. At Time 2the attitudes of 3,351 participants were measured upon expo-sure to the persuasive materials. At Time 3 the attitudes of3,049 respondents were re-measured three months after themarketing efforts.

Advertising stimuli. Three advertising themes were testedin this study: "warm and emotional," "educational," and"wedge of douht." The warm and emotional print advertise-ment began with text at the top of the page, "Honey, can youpick up some nails?" A response of "Sure" was printed in themiddle of the page, with a photograph of a can of escargot.The tag line printed at the bottom of the page inquired, "Is itany wonder heanng loss can frustrate those around you?-,,Have your hearing checked. For you. For them."

The text for the educational message stated, "Use yourhead once a year" atop a photograph of headphones. The ad'sclosing text read: "Annual hearing checkups help you spotchanges in your hearing. ...Hear today. Hear tomorrow."

Is anyone listening?

The wedge-of-douht advertisement began with text thatwarned, "11 you think it's difficult admitting your hearing prob-lem, imagine admitting all the mistakes you've made becauseof it." At the bottom, the ad read: "When you can't hear clearly,it's easy to misunderstand someone. And before you know it,people start thinking you've lost your mental edge."

Privale and public media. These advertising messages weredelivered via varied media vehicles, to simulate a real-worldadvertising campaign. These included what we are calling "massmedia," namely print and television ads, and those we are call-ing "private media," which are customized to appeal to their tar-get, specifically telemarketing phone calls and direct marketingmailings. The experimental field design was a 3 (warm andemotional, educational and objective, and wedge of douht) x 2(telemarketing or no) x 2 (direct marketing mailing or no) x 2(print ad or no) x 2 (television or no) factorial design.

What Worked Best?We found that consistent combinations of media (both pri-

vate or both public) were more effective than mixed media.The two private media (telemarketing combined with directmarketing) outperformed any two mixed media (telemarketingand print, telemarketing and TY direct marketing and print,or direct marketing and TV).

In addition, the private media combination outperformedthe public media, which makes sense for this product catego-ry. U there's a stigma or embarrassment about a purchase, evenlearning more about the product prior to purchase mightrequire some delicacy and privacy

Finally, we also observed that the content of the messageinfluenced the preference for a particular class of media (pri-vate or public). The combinations of media and advertisingmessage that performed best are depicted in Exhibit 1 onpage 20. The integrated private media (telemarketing and

If you're talking about hearing aids, chances are most consumers

don' t want to hear it. Of adults age 18 and oider with impaired

hearing, 7 8 % do not own a hearing aid. Even among fhe hearing

impaired age 65 and older, 6 1 % do not wear hearing aids. As the

graph on the right shows, people reported they would readiiy

acquiesoe to wearing eyeglasses to help correct their vision (mean

response=6.40 of 7). Respondents also would have no problem

taking pain reiievers to alleviate aches (5.24). They would not even

mind terribly having to c i rcumambulate with a oane (4.98).

However, the thought of wearing a hearing aid is a far less attrac-

tive prospect (3.46).

wear take pain walk useglasses relievers with cane hearing aid

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Exhibit 1Performance of media and advertising message combinations

Performance Media

Best2nc] best

3rd worst2nd worstWorst

2 private (telemarketing and direct marketing)2 private (telemarketing and direct marketing)

Advertising message

wedge of doubtwarm and emotional

1 mass exposure (print or teievision) educational2 private (telemarketing and direct marketing) educational1 mass (print or television} wedge of doubt

direct marketing) performed best, first with the wedge ofdoubt and then with the warm and emotional ad content.Note that two private exposures were not always superior—the combination with the educational advertising message per-formed poorly Also note the wedge of doubt, which did thebest when delivered via the two private media, wasn't uni-formly superior either. In fact, it performed the worst whendelivered via a mass medium.

It's no secret that marketing health services can be compli-cated. As this investigation demonstrates, rarely can a mar-keter choose a medium or advertising message without con-sidering the big picture. That big picture needs to include aguess at the likely media plan (i.e., the multiple media thatwill be invoked), the complementarity of the media with thead message, and an understanding of the particular productcategory It should also include an informed guess or, betler.

data Irom a consumer pilot test as to which media and mes-sages might enhance attitudes and purchase intentions.

Strategic choices of media and messages can make ail thedifference. Media cannot simply be pasted together to achievesome seemingly cntical threshold of ad weight—many mixedmedia can perform worse than fewer exposures of sensiblyintegrated media. Similarly, the choice of media outletsdepends upon both the product and the content of the adver-tisements themselves- In our experience, thoughtful combina-tions of media and messages are more influential than hap-hazard collections of media and messages. Private mediamay also yield positive results for personal care productsand other product categories that, like hearing aids, carrysome stigma. MHS

About the Authors

Dawn lacobucci is a professor of marketing at theUniversity of Arizona, She may be reached at dawn@eller,arizona-edu. Bobby J. Calder is a professor of marketingat Northwestern University He may be reached atcalder@nwu.edu. Edward Malthouse is an assistant profes-sor at Northwestern Universit). Adam Duhachek is a doctor-al student at Northwestern University

Authors' Note: We are grateful to Sergei Kochkin ofKnowles Electronics, MarketFacts Inc., and Colle-McVoyAdvertising Agency for their assistance in this research

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