Citation: van Hierden, Y.;
Rundle-Thiele, S.; Dietrich, T.
Improving Well-Being in Young
Adults: A Social Marketing
Proof-of-Concept. Int. J. Environ. Res.
Public Health 2022, 19, 5248. https://
doi.org/10.3390/ijerph19095248
Academic Editor: William
Douglas Evans
Received: 14 March 2022
Accepted: 20 April 2022
Published: 26 April 2022
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International Journal of
Environmental Research
and Public Health
Case Report
Improving Well-Being in Young Adults: A Social Marketing
Proof-of-Concept
Yannick van Hierden *, Sharyn Rundle-Thiele and Timo Dietrich
Social Marketing @ Griffith, Griffith Business School, Griffith University, Nathan, QLD 4111, Australia;
[email protected] (S.R.-T.); [email protected] (T.D.)
* Correspondence: [email protected]
Abstract: Approximately 1 in 5 Australians experience a mental disorder every year, costing the
Australian economy $56.7 billion per year; therefore, prevention and early intervention are urgently
needed. This study reports the evaluation results of a social marketing pilot program that aimed to
improve the well-being of young adults. The Elevate Self Growth program aimed to help participants
perform various well-being behaviors, including screen time reduction, quality leisure activities, physical activity, physical relaxation, meditation and improved sleep habits. A multi-method evaluation
was undertaken to assess Elevate Self Growth for the 19 program participants who paid to participate in
the proof-of-concept program. Social Cognitive Theory was used in the program design and guided
the evaluation. A descriptive assessment was performed to examine the proof-of-concept program.
Considerations were given to participants’ levels of program progress, performance of well-being
behaviors, improvements in well-being, and program user experience. Participants who had made
progress in the proof-of-concept program indicated improved knowledge, skills, environmental support and well-being in line with intended program outcomes. Program participants recommended
improvements to achieve additional progress in the program, which is strongly correlated with outcome changes observed. These improvements are recommended for the proof-of-concept well-being
program prior to moving to a full randomized control trial. This paper presents the initial data arising
from the first market offerings of a theoretically mapped proof-of-concept and reports insights that
suggest promise for approaches that apply Social Cognitive Theory in well-being program design
and implementation.
Keywords: well-being; health promotion; behavior change; social marketing; evaluation; theory;
intervention; social cognitive theory
1. Introduction
For decades, mental disorders have been leading causes of the health-related burden
world-wide [1,2]. Approximately 1 in 5 Australians experience mental disorders, costing
the Australian economy $56.7 billion per year [3,4]. Prior to the COVID-19 pandemic,
between 1980 and 2004, the prevalence of anxiety and depression in young people in
the United Kingdom increased by 70% [5]. Recent studies have demonstrated a further
significant increase in anxiety and psychological distress as a result of the COVID-19
pandemic [2,6,7]. The greater increase in anxiety and depression will add substantially
to an already significant and costly problem. Given many psychological problems (e.g.,
stress, anxiety and depression) are preventable [8,9], enhancing well-being for young adults
through prevention is urgently needed.
Scholars and experts are asking for new health interventions to support individuals’
mental well-being [10]. Existing well-being interventions generally target health behaviors, including nutrition, physical activity, deep breathing exercises, relaxation exercises,
mindfulness, meditation, gratitude practices (e.g., letter writing, journaling, three good
things) and goal setting [11–18]. In a previous review of 13 health interventions, eight
Int. J. Environ. Res. Public Health 2022, 19, 5248. https://doi.org/10.3390/ijerph19095248 https://www.mdpi.com/journal/ijerph
Int. J. Environ. Res. Public Health 2022, 19, 5248 2 of 16
claimed that their intervention was informed by theory; however, only four interventions
specified the use of theory-based behavior-change methods, and only one intervention
specified exactly how such behavior-change methods were mapped to the theory listed.
Further, many health interventions are not based on theory, despite the fact that behavioral
and social science disciplines recommend using theory in the design and implementation
thereof. Evaluations of behavior-change interventions have demonstrated improved effects
when theory use was reported [19–21]. Therefore, mapping theory to a behavior-change
intervention is expected to improve effectiveness [21–23], yet theories are still underused in
behavior-change intervention development, and application of social marketing to enhance
well-being is underreported [24–26]. Of the interventions that claim to be theory-informed,
many have failed to report how theory was mapped and make it difficult to assess the
effectiveness of the theory base. Further, health interventions require the involvement
of program participants in program design, implementation and evaluation. However,
interventions are often developed in a ‘top-down’ manner without the involvement of
program participants [26]. Considering the need for new co-created, theory-based health
interventions, a well-being program based on Social Cognitive Theory (SCT) [27] was
developed and implemented. The paragraphs hereafter describe how this theory-based
well-being intervention was co-created.
Social marketing is distinct from other behavior-change approaches which tell rather
than sell. In 2002, Andreasen [28] outlined core characteristics of social marketing, aiming
to contrast social marketing from other behavior-change approaches such as public health.
More recently, Rundle-Thiele et al. [29] provided an explanation of the strategic process
demonstrating how people are placed at the center of program creation, demonstrating
when and where core marketing functions were applied in first-time program development.
The well-being program was co-created and built prior to engaging people. Co-creation is a
critical element of social marketing [29,30]. During co-creation, consideration of competition
is given by examining how other programs deliver intended outcomes. Ideas gathered are
considered by potential program users during participatory design. This intervention was
theoretically informed, and formative research was undertaken prior to developing a program
featuring marketing mix elements that was sold (exchange). The only social marketing element
initially described by Andreasen that is missing is segmentation.
1.1. Co-Creating the Well-Being Program
Co-creation is the first phase in first-time application of social marketing [29]. A
participatory design (PD) process was applied to ensure the program was designed with
(and not for) young people. To understand what young adults aged 18–35 years preferred
in relation to improving well-being, the team undertook a PD study with 57 university
students. A full description of how the PD sessions were conducted can be found in research
by van Hierden et al. [26]. For the participants, well-being was defined as “the state of
being healthy and happy, and experiencing purpose and meaning”. The PD process led to
three insights that informed the program design of Elevate Self Growth. First, participants
preferred to have a focus on positive language (e.g., speaking of mental health rather
than mental illness) and increasing positive outcomes rather than decreasing negative
outcomes (e.g., increasing resilience rather than reducing anxiety and depression). Second,
participants made it clear that they wanted to have opportunities for active learning (e.g.,
assessments, habit builders, trackers, challenges, tools, etc.). Third, people expressed a
need for social interaction and connection through social gatherings, group workshops
or online communities. During the PD sessions, intervention components were designed,
evaluated and improved and, ultimately, a final proof-of-concept organized into five core
program modules emerged.
1.2. Applying Theory to the Well-Being Program
The five-step BUILD process was applied to map theory onto the proof-of-concept
well-being program [31]. The program sought to improve five areas of well-being: namely,
Int. J. Environ. Res. Public Health 2022, 19, 5248 3 of 16
resilience, positive relationships, mindfulness, stress management and purpose and meaning. Informed by the PD research, it was expected that these areas of well-being could be
improved by focusing on 10 behaviors: namely, screen time reduction, quality leisure activities, physical activity, physical relaxation, meditation, improved sleep habits, breathwork,
meditation, acts of kindness, community and social service and reflective journaling. This
evaluation only reports the six well-being behaviors that formed the focus of modules completed by program participants (screen time reduction, quality leisure activities, physical
activity, physical relaxation, meditation and improved sleep habits).
As a part of the five-step BUILD process, a theory selection process identified SCT
as the most suitable theory to underpin the intervention. The pilot program was developed using a novel theory-mapping process that mapped behavior-change methods and
intervention components to SCT constructs [27]. The theory-driven intervention aimed
to improve well-being behavior, from a theory-informed standpoint. According to SCT,
knowledge, skills and environment are three aspects that need to be considered within an
intervention. For example, to enable participants to reduce their screen time (behavior),
various intervention components were created to improve knowledge and skills related to
screen time reduction, while other intervention components focused on facilitating environmental change to deliver support that enabled participants to reduce their screen time. At
least one intervention component was designed to address each individual SCT construct.
Given that the intervention aimed to improve 10 behaviors, this process was repeated
10 times, leading to more than 30 intervention components. A full description of how SCT
underpinned the intervention design can be found in research by van Hierden et al. [31].
SCT was used to evaluate the intervention, specifically measuring changes in knowledge,
skills and environmental support before and after with follow-up timelines ranging from 8
to 12 months. Then, knowledge, skills and environmental support were measured against
targeted well-being behaviors: namely, screen time reduction, quality leisure activities,
physical activity, physical relaxation, meditation and improved sleep habits.
1.3. Implementing the Well-Being Program
The proof-of-concept program was designed at the end of 2019 and was intended to
be delivered in person. However, the COVID-19 pandemic restricted in-person gatherings;
therefore, the proof-of-concept was built and trialed online. During the trial, 24 people
received free access to the program, and they provided feedback to improve material
and delivery format. The free trial was followed by the initial market offering for the
proof-of-concept Elevate Self Growth program, which aimed to engage people who were
interested in improving their well-being. The Elevate Self Growth program offers videos,
assessments, tools and a community to build healthier habits. This study examines data
derived from delivery of the proof-of-concept Elevate Self Growth program, which occurred
over a 12-month period. The primary objective of this study is to evaluate the utility of
using SCT in a social marketing program that aims to improve well-being. This article
describes the lessons learned from delivery of the proof-of-concept, theory-driven social
marketing intervention.
2. Materials and Methods
A multi-method evaluation was conducted using self-report surveys from two waves
of data collected before and after participation in Elevate Self Growth. Several areas of
well-being were measured pre- and post-program implementation using a repeated measures
design. Baseline data was collected prior to participation in the Elevate Self Growth program
(n = 15). After participation in Elevate Self Growth program, a follow-up survey was
conducted (n = 11).
2.1. Baseline Survey
After enrolment in the Elevate Self Growth program, participants were assessed on
several well-being areas (i.e., resilience, positive relationships, mindfulness, stress man
Int. J. Environ. Res. Public Health 2022, 19, 5248 4 of 16
agement, and purpose and meaning), participants’ knowledge, skill and environmental
support related to well-being behaviors and performance of the specific well-being behaviors that underpinned the intervention (i.e., screen time reduction, quality leisure activities,
physical activity, physical relaxation, meditation and improved sleep habits). Due to the
small sample size, analysis was limited to descriptive statistics only. Comprehensive statistical tests were not performed due to the limited sample size and insufficient power. Online
surveys were included in the first lesson of Elevate Self Growth.
The Brief Resilience Scale (BRS) was used to measure resilience [32]. While Windle et al. [33]
deemed the 6-item BRS useful, to avoid survey fatigue, the 6-item BRS scale was considered, and 3 items were selected. Positive relationships were measured using the Positive
Relationships subscale of the Psychological Well-Being questionnaire [34]. The Positive
Relationships subscale has previously demonstrated reliability in assessing positive relationships [35]. Mindfulness was measured using a shortened MAAS scale [36]. MAAS was
originally designed by Brown and Ryan [37], however, Osman et al. [36] deemed a 5-item
MAAS useful. To stay in line with the survey structure, the 5-item scale was considered,
and 3 items were selected. Stress was measured using the shortened Perceived Stress
Scale [38], which has previously been validated by Vallejo et al. [39]. Purpose and meaning
were measured with the presence subscale of the Meaning in Life Questionnaire [40]. Again,
to stay in line with the survey structure and avoid survey fatigue, the 5-item scale was
considered, and 3 items were selected. The scales were measured through the question
“To what extent do you agree or disagree with the below statements?”. For each statement,
respondents rated themselves using a 5-point Likert-type scale where 1 is ‘totally disagree’
and 5 is ‘totally agree’.
Knowledge, skill and environmental support were measured through direct statements
related to each factor. For example, knowledge was measured through the statement
“I know the benefits of (well-being behavior)”, skills were measured through the statement
“I have the skills to (perform well-being behavior)”, and environment was measured
through the statement “My environment enables me to (well-being behavior)”. Finally, the
extent to which respondents were performing the well-being behaviors was measured by
asking how many minutes they currently spent performing each behavior. A full list of
questions can be found in Appendix A. Of the 19 people who enrolled in the Elevate Self
Growth program, 15 completed the baseline survey, representing a response rate of 71%.
2.2. Follow-Up Survey
The follow-up survey was sent to participants who completed at least 25% of the
proof-of-concept Elevate Self Growth program. Eleven people completed the follow-up
survey, representing a response rate of 57% of all Elevate Self Growth participants.
2.3. In-Depth Interviews
In-depth interviews were conducted to better understand peoples’ unique experiences
with the Elevate Self Growth program. People who completed the follow-up survey were
invited to participate in a phone call to discuss their experiences and provide feedback to
improve Elevate Self Growth. Interviewees were asked to share their opinions about what
they liked, what they didn’t like and how they thought the program could be improved.
The questions were asked according to a feedback grid [41]. Everyone who completed the
follow-up survey was willing to complete an in-depth interview (n = 11).
3. Results
On average, participants in the sample completed 61% of the program material available to them online (see Table 1). Analysis indicates that three people completed the full
program, two people almost completed the online program, and the remaining six people
made some progress, but stagnated at some point.
Int. J. Environ. Res. Public Health 2022, 19, 5248 5 of 16
Table 1. Evaluation of well-being areas (per individual).
Program
Progress
Average Pre- and
Post-Program Change
Rates Reported
Resilience Positive
Relationships Mindfulness Management Stress Purpose and Meaning
Baseline Follow-Up Baseline Follow-Up Baseline Follow-Up Baseline Follow-Up Baseline Follow-Up
23-year-old, British female,
working part time 100% 68% 2.3 4.7 2.7 5.0 1.7 3.7 2.3 4.0 4.3 5.0
28-year-old, Dutch male,
working full time 100% 45% 3.3 4.0 3.3 4.7 1.7 4.0 2.8 3.8 2.3 3.0
29-year-old, Finnish
female, student 90% 26% 3.3 3.7 4.3 5.0 1.7 3.3 3.3 4.3 3.0 3.3
30-year-old, Dutch female,
unemployed 87% 36% 3.3 4.0 3.7 5.0 2.0 3.0 1.7 3.0 4.0 5.0
31-year-old, Spanish
female, working full time 65% 24% 1.7 2.7 3.3 4.0 2.0 3.0 3.0 3.8 4.0 4.0
34-year-old, Australian
female, self-employed 55% 28% 3.7 3.3 4.3 4.7 1.0 2.3 2.3 3.8 3.7 5.0
24-year-old, Australian
Male, working full-time 50% 17% 4.0 4.3 5.0 4.3 2.7 3.3 1.7 2.6 3.0 4.5
29-year-old, Australian
male, self-employed 43% 18% 3.7 3.7 3.7 4.3 1.7 2.3 2.3 3.5 4.0 4.3
33-year-old, Australian
female, working part time 33% 24% 3.3 4.0 1.3 3.3 3.0 3.0 4.0 4.3 3.3 4.0
42-year-old, Australian
female, working full time 33% 14% 1.0 1.0 2.0 2.0 1.0 2.0 2.0 2.0 1.0 1.0
47-year-old, Dutch male,
working full time 28% 7% 3.7 4.0 3.3 3.7 3.7 4.0 3.8 4.0 4.0 4.0
Mean values 61% 28% 3.0 3.6 3.4 4.2 2.0 3.1 2.6 3.5 3.3 3.9
Int. J. Environ. Res. Public Health 2022, 19, 5248 6 of 16
3.1. Evaluation of Changes in Knowledge, Skill and Environmental Support
Figure 1 depicts the changes in knowledge, skills and environmental support related
to the behaviors targeted with the intervention. Overall, the charts indicate that knowledge
only changed slightly, whereas skills and environment improved more notably. Participants’
knowledge of the benefits of targeted well-being behaviors was already high and improved
only moderately. Participants’ skills related to targeted well-being behaviors improved
notably after engaging with the program, especially for physical relaxation and reducing
screen time. Similarly, the extent to which participants’ environment was conducive to
performing targeted well-being behaviors was considerably higher after engaging with
the program, especially for reducing screen time, engaging in quality leisure activities and
achieving high-quality sleep.
Int. J. Environ. Res. Public Health 2022, 19, x FOR PEER REVIEW 7 of 18
Figure 1. Changes in knowledge, skills and environment pre- and post-program. Figure 1. Changes in knowledge, skills and environment pre- and post-program.
Int. J. Environ. Res. Public Health 2022, 19, 5248 7 of 16
3.2. Evaluation of Well-Being Behavior Change
Figure 2 depicts the changes in well-being behavior before and after the program.
Each chart depicts how much time individuals spent on each behavior, except for the
‘quality sleep’ chart, which displays how confident participants felt in maintaining healthy
sleep habits. Overall, the charts indicate that participants’ well-being behavior improved
post-program. After engaging with the program, participants spent fewer hours on their
screens and more hours on quality leisure activities, physical activity, physical relaxation
and somewhat more time meditating. In addition, participants believed their behavior
around maintaining healthy sleep habits had improved. However, the change in time spent
on meditation was not significant, perhaps due to the relatively low levels of completion
of these lessons (i.e., content related to meditation was featured only in the last 40% of
the course).
Int. J. Environ. Res. Public Health 2022, 19, x FOR PEER REVIEW 9 of 18
Figure 2. Changes in well-being behavior pre- and post-program.
Figure 2. Changes in well-being behavior pre- and post-program.
Int. J. Environ. Res. Public Health 2022, 19, 5248 8 of 16
3.3. Evaluation of Well-Being Areas
Both surveys measured well-being areas, including resilience, positive relationships,
mindfulness, stress management and purpose and meaning (see Figure 3). The repeated
outcome measures used in the surveys indicated that all well-being areas improved between
the baseline (2021) and follow-up survey (2022) waves.
Int. J. Environ. Res. Public Health 2022, 19, x FOR PEER REVIEW 10 of 18
3.3. Evaluation of Well-Being Areas
Both surveys measured well-being areas, including resilience, positive relationships,
mindfulness, stress management and purpose and meaning (see Figure 3). The repeated
outcome measures used in the surveys indicated that all well-being areas improved between the baseline (2021) and follow-up survey (2022) waves.
Figure 3. Evaluation of well-being areas (a higher number indicates a better score).
Figure 4 depicts participants’ progress and changes reported pre- and post-program
participation. Program progress was provided by the eLearning portal and measures the
percentage of course material each participant completed. Change rates were measured
as a percentage increase between the baseline and follow-up phases. Specifically, the following calculation was used to measure the proportional growth per participant: the sum
of all baseline scores minus the sum of all follow-up scores divided by the sum of all baseline scores. The figure indicates that, on average, the more progress each participant made,
the higher their proportional growth on well-being measures they reported. A Pearson
correlation coefficient was computed to assess the relationship between program progress
and program change rates. A significant and strong positive correlation was indicated
between the two variables: r (9) = -0.82, p = 0.002, suggesting that progress within the
program is associated with the rates of change observed in intended outcome variables.
This relationship further indicates the importance of increasing program progress for participants. The individual results used to populate Figure 4 are reported in Table 1.
3
3.4
2.0
2.6
3.3
3.6
4.2
3.1
3.5
3.9
5 4 3 2 1
Resilience Positive
relationships
Mindfulness Stress
management
Purpose and
meaning
Well-being outcomes (pre- and post program)
Baseline Follow-up
Figure 3. Evaluation of well-being areas (a higher number indicates a better score).
Figure 4 depicts participants’ progress and changes reported pre- and post-program
participation. Program progress was provided by the eLearning portal and measures the
percentage of course material each participant completed. Change rates were measured as a
percentage increase between the baseline and follow-up phases. Specifically, the following
calculation was used to measure the proportional growth per participant: the sum of all
baseline scores minus the sum of all follow-up scores divided by the sum of all baseline
scores. The figure indicates that, on average, the more progress each participant made,
the higher their proportional growth on well-being measures they reported. A Pearson
correlation coefficient was computed to assess the relationship between program progress
and program change rates. A significant and strong positive correlation was indicated
between the two variables: r (9) = –0.82, p = 0.002, suggesting that progress within the
program is associated with the rates of change observed in intended outcome variables.
This relationship further indicates the importance of increasing program progress for
participants. The individual results used to populate Figure 4 are reported in Table 1.
3.4. Evaluation of Participant Experiences
This section provides a summary of qualitative feedback from the well-being program’s participants in three categories: likes, dislikes and ideas and improvements.
Likes. First, participants were asked what they liked about the Elevate Self Growth
well-being program. The most common aspect that people liked was the mix between
science and practicality. Participants mentioned that the presentation of a mix of scientific
evidence and real-life stories, followed by practical action points, enabled them to adopt
the suggested principles. The scientific approach helped people to see the importance of
Int. J. Environ. Res. Public Health 2022, 19, 5248 9 of 16
the concepts, whereas the personal stories made the concepts relatable to one’s life. Some
participants mentioned that the action points were concrete, practical and simple to apply.
Int. J. Environ. Res. Public Health 2022, 19, x FOR PEER REVIEW 11 of 18
Figure 4. Well-being program progress versus reported change rates on well-being areas pre- and
post-program (listed in percentages).
3.4. Evaluation of Participant Experiences
This section provides a summary of qualitative feedback from the well-being program’s participants in three categories: likes, dislikes and ideas and improvements.
Likes. First, participants were asked what they liked about the Elevate Self Growth wellbeing program. The most common aspect that people liked was the mix between science
and practicality. Participants mentioned that the presentation of a mix of scientific evidence and real-life stories, followed by practical action points, enabled them to adopt the
suggested principles. The scientific approach helped people to see the importance of the
concepts, whereas the personal stories made the concepts relatable to one’s life. Some participants mentioned that the action points were concrete, practical and simple to apply.
“I thought it was really cool to see that the content was based on scientific resources, as
well as being taught by someone who had experienced everything himself.”—28-yearold, Dutch male, working full time.
The second most frequently mentioned aspect that people liked was the delivery format of the program. Participants commented on the combination of recorded videos and
assignments in a workbook and how that enabled them to apply the ideas in their life.
Specifically, participants liked the relatively short duration of the videos (between 2 and
15 min), which made it easy for them to consume. Some participants thought the videos
communicated clear messages and found the use of captions and graphics engaging,
which aided the learning process.
“I liked the structure of the course and that it includes a video, and then an exercise to
really implement the teachings.”—28-year-old, Dutch male, working full time.
“I love how short the lessons are and that it’s broken up with the little clips. I really can’t
think of any tips to better your delivery so far.”—34-year-old, Australian female, selfemployed.
Figure 4. Well-being program progress versus reported change rates on well-being areas pre- and
post-program (listed in percentages).
“I thought it was really cool to see that the content was based on scientific resources, as
well as being taught by someone who had experienced everything himself.”—28-year-old,
Dutch male, working full time.
The second most frequently mentioned aspect that people liked was the delivery
format of the program. Participants commented on the combination of recorded videos
and assignments in a workbook and how that enabled them to apply the ideas in their life.
Specifically, participants liked the relatively short duration of the videos (between 2 and
15 min), which made it easy for them to consume. Some participants thought the videos
communicated clear messages and found the use of captions and graphics engaging, which
aided the learning process.
“I liked the structure of the course and that it includes a video, and then an exercise to
really implement the teachings.”—28-year-old, Dutch male, working full time.
“I love how short the lessons are and that it’s broken up with the little clips. I really
can’t think of any tips to better your delivery so far.”—34-year-old, Australian female,
self-employed.
The third most frequently mentioned aspect that people liked was that the program
enabled participants to be more present and intentional.
“I catch myself when this device [smartphone] is distracting me. And I know how to alter
it, so it serves me rather than I serve it.”—30-year-old, Dutch female, unemployed
“I was able to spend less time online, and more time in the real world.”—29-year-old,
Australian male, self-employed.
The fourth most frequently mentioned aspect that people liked was the use of practical
tools, including the mobile application, the digital declutter, the full body relaxation audio
track and the habit tracker.
“I can study whenever, wherever I want”—31-year-old, Spanish female, working full
time [about the mobile app].
Int. J. Environ. Res. Public Health 2022, 19, 5248 10 of 16
“The lessons helped me to manage my time and control my habits. I engaged in a digital
declutter and already started to regain my focus.”—28-year-old, Dutch male, working
full time [about the digital declutter].
Additional proof-of-concept program components that people liked included lessons
related to meditation, sleep and building habits. Some believed the techniques were
versatile and applicable to multiple facets of their life. Some participants mentioned the
usefulness of having ‘lifetime’ access to the program, so they could return whenever they
wanted. Finally, some people noticed a positive transformation in their life as a result of
the program.
“I could really see a transformation. I’ve become more compassionate and kinder towards
others, and I try to be more nurturing and caring toward other people.”—29-year-old,
Finnish female, Student.
“Now I have a morning routine, which has helped me be regular in my meditation practice,
which is one of the things I value most. This transformation has affected not just my
morning but my whole day. I feel I have more energy than before. I get more done in my
day and I feel more fulfilled in my life.”—23-year-old, British female, working part time.
Dislikes. When participants were asked what they disliked about the proof-of-concept
program, 3 items emerged. First, two people mentioned that having lifetime access reduced
the urgency to complete the program.
“It would’ve been better if access to the program would be revoked after a while, so I’m
more pushed to engage with the material.”—33-year-old, Australian female, working
part time.
The proof-of-concept was self-paced to enable flexibility in the learning process. However, two people mentioned that the lack of a set timeframe may have prevented them from
making regular progress.
“Nobody chased me to complete the course and that’s why I probably didn’t feel the urge
to continue at some point.”—31-year-old, Spanish female, working full time.
Third, one person wanted to be able to consume the content by listening (an audio
program), so they could study while running or driving.
Ideas and improvements. When participants were asked what could be improved in
the well-being program, 4 distinct topics emerged. First, some participants suggested a
clear timeline to complete the course should be set, to prevent participants from dropping
out. Second, participants recommended a ratio of online and offline, and pre-recorded and
live sessions and resources. Due to COVID-19 restrictions, the pilot delivery was entirely
online, and participants felt it would not have been as engaging as in-person events, which
is consistent with preferences indicated in the co-creation phase. Therefore, participants
recommend hosting sessions in-person where possible. One participant even recommended
hosting a live event to bring all participants together to foster a sense of community among
participants. Furthermore, most of the online resources were pre-recorded and did not allow
instant two-way communication and interaction. One participant mentioned that having
the ability to engage and communicate in real time could encourage people to ‘show up’
more frequently. Third, several participants suggested having regular one-on-one check-ins
with the program facilitator to keep them more accoun and increase their completion rates.
Fourth, one person would have liked to hear other participants’ stories to learn about their
experiences, which is now possible following delivery of the proof-of-concept program.
4. Discussion
Improving the mental well-being of individuals—especially now and in the future—
requires new, co-designed, theory-based health interventions. This paper detailed the
initial implementation and an additional explanation of how a theoretically informed
evaluation can be applied to consider if a proof-of-concept is achieving intended outcomes.
Int. J. Environ. Res. Public Health 2022, 19, 5248 11 of 16
The paper advances understanding of the potential utility of a theory-driven intervention
implementation in three ways. First, this paper details how an evaluation can be performed
following delivery of a proof-of-concept program to consider if intended outcomes may be
achieved. This paper provides a brief overview to explain how SCT was applied within the
proof-of-concept program and details how SCT core constructs can be applied in a repeated
measures design to gain insights to inform project planning. Second, this study provides
insights into the potential for SCT constructs to be used to change well-being behaviors.
This study reports that progress in Elevate Self Growth may change well-being behavior.
Further, participants provided feedback, delivering important insights that can be used to
further refine the program. Finally, the proof-of-concept indicates the value of dynamic
evaluation. Each of these contributions is discussed in turn.
4.1. Monitoring and Evaluating a Theory-Driven Social Marketing Intervention
This study reflects on the learnings following delivery of a proof-of-concept, theorydriven social marketing intervention that aims to improve young peoples’ well-being. The
program was underpinned by SCT and sought to improve well-being by changing three
theory-based constructs: knowledge, skills and environment. An ongoing debate on the
role of theory [42–44] is evident. This study provides an exploration of SCT to determine
if it offers the potential to improve well-being. Drawing from a small sample, our study
suggests that increases in knowledge and skills and changes in levels of environmental
support may lead to changes in well-being behavior (i.e., screen time reduction, quality
leisure activities, physical activity, physical relaxation, meditation and improved sleep
habits). The observed data patterns suggest that changing behaviors may contribute
to well-being improvement (i.e., resilience, positive relationships, mindfulness, stress
management and purpose and meaning). This study provides some preliminary support
for theory-driven intervention design; however, future research delivering a randomized
control trial and longitudinal evaluation design is needed to draw definitive conclusions
that can validate these preliminary findings.
4.2. Assessing the Utility of Social Cognitive Theory in Social Marketing Interventions
This study reports the evaluation of a proof-of-concept that aimed to identify if a
program designed to deliver components in accordance with three SCT constructs across
10 behaviors associated with well-being offers potential to improve well-being. This study
demonstrates that when a participant’s knowledge about well-being behavior is already
high, significant changes in knowledge may not be expected. Data insights indicate that
when participants’ skills and environmental support related to a well-being behavior
were lower at baseline, their scores did notably improve in those constructs following
engagement with the program. It seems that many people already know what behaviors
are conducive to better physical and mental health, yet they may not know how to integrate
those behaviors into their lifestyle. For example, most participants seemed to know that
excessive screen time was not conducive to their well-being, yet their skills to reduce screen
time and their ability to influence their environment to reduce screen time were significantly
lower prior to program participation. Ample evidence of this knowledge–behavior gap in
intervention science exists [45,46], demonstrating that there is an inconsistency between
what people know and their ability to act on that knowledge. Reflecting on the descriptive
analysis in this study, people may already know that excessive screen time is distracting
them, making them less productive and negatively impacting their mental health. However,
they may not have the skills to replace screen time behavior with another behavior that
is more beneficial for their well-being. Alternatively, they are not aware of the influence
of their environment on their excessive screen time, and they may not understand how
they can change their environment (i.e., their smartphone, computer, TV, etc.) to provide
them with the support they need to actively reduce screen time. In summary, this study
indicates the potential value of using SCT to influence participants’ knowledge, skills and
surrounding environment in order to support them to change behaviors known to improve
Int. J. Environ. Res. Public Health 2022, 19, 5248 12 of 16
well-being. Participants shared mostly positive feedback about their experience with the
intervention. Participants appreciated the tailored intervention components, and thus the
theory-driven intervention design. This indicates that SCT could be a useful framework to
design and plan interventions to change behavior for the greater social good.
4.3. Dynamic Monitoring and Agile Tweaking
Many program evaluations happen after interventions are completed [47–49]. The
insights from such post-program evaluations are limited only to a next round of program
implementation, which may never come if the results are not satisfactory. The need for
more dynamic monitoring from the start enables social marketers to identify the most
(cost-) effective methods to change behavior early on. Early insights into the effectiveness
of intervention components on participants’ knowledge, skills, environmental support and
behavioral outcomes enable social marketing professionals to assess what is working and
what is not. Such early insights can be used to maximize monetary and time investment,
thus ensuring that investments are placed behind the intervention components that deliver
the strongest performance. Agile tweaking enables professionals to adjust programs or
other market offerings more quickly and ensure that resources are used efficiently and
effectively. If early insights identify effective activities, available resources can be redirected
to save time and money and improve overall program effectiveness. Optimizing the
effectiveness of intervention components during an intervention will likely improve the
changes in knowledge, skills and behavior upon intervention completion.
4.4. Limitations and Future Research
This study is not without limitations. It only presents a descriptive analysis of
11 participants who engaged in a proof-of-concept well-being program. Few participants
completed the full program, and some enrolled participants had not started the program.
A longitudinal, controlled research design is needed with sufficient participants to deliver
a sufficient sample size to permit statistical testing and determination of effect sizes. Descriptive assessment indicates the potential for this proof-of-concept program, and funding
is needed to deliver a scaled test of the iterated program. Additional work is recommended
to assess other behaviors that this intervention targeted. Specifically, we recommend undertaking a three-arm randomized controlled trial to compare the current program with
other well-being programs that are not theory-driven, as well as a control condition. Then,
analytical methods, including hidden Markov modelling, can be applied to identify factors
driving change.
A series of recommendations were indicated in this study. Program participants who
failed to complete the program sought supportive mechanisms through online or in-person
contact. An iterated program that includes one or more recommended components can be
tested in a field trial delivering a similar sample size to permit a cost–benefit assessment. If
higher completion rates and potentially enhanced outcomes had been observed, the relative
costs of delivering a form of in-person support could be warranted. Finally, this paper describes a theoretically informed program’s potential to enhance well-being. Future research
testing the application of alternate theories in well-being is recommended, along with research that tests interventions informed by SCT in other health and environmental contexts.
5. Conclusions
This study presented an evaluation of a co-created, well-being proof-of-concept based
on theory. This study has contributed to understanding success and failures in applying
SCT to improve well-being. This research considered whether changes in knowledge, skills
and environmental support occurred, and it considered if observed changes may offer
potential to contribute to improvements in well-being for program participants. Program
improvements were identified. This study delivered further evidence that theory may
indeed offer potential to contribute to positive program outcomes. Social marketers are
advised to link intervention components to theoretical constructs and include theoreti
Int. J. Environ. Res. Public Health 2022, 19, 5248 13 of 16
cal measures in their evaluation to clearly determine the effectiveness of theory-based
intervention design.
Author Contributions: Conceptualization, Y.v.H., S.R.-T. and T.D.; formal analysis, Y.v.H., S.R.-T. and
T.D.; investigation, Y.v.H.; resources, Y.v.H.; data curation, Y.v.H., S.R.-T. and T.D.; writing—Y.v.H.;
writing—review and editing, Y.v.H., S.R.-T. and T.D.; visualization, Y.v.H.; supervision, S.R.-T. and
T.D.; project administration, Y.v.H. All authors have read and agreed to the published version of
the manuscript.
Funding: This research received no external funding.
Institutional Review Board Statement: The study was conducted according to the guidelines of the
Declaration of Helsinki and approved by the Ethics Committee of Griffith University (protocol code
2019/57, 12/9/2019).
Informed Consent Statement: Informed consent was obtained from all subjects involved in the study.
Data Availability Statement: The data presented in this study are available on request from the corresponding author. The data are not publicly available to safeguard the privacy of program participants.
Conflicts of Interest: The authors declare no conflict of interest.
Appendix A. Survey Measures
Appendix A.1. Well-Being Behaviors
Screen time reduction
• I know the benefits of reducing my screen time.
• I have the skills to reduce my screen time.
• My environment (including my smartphone, etc.) enables me to reduce my screen time.
Quality leisure activities *
• I know the benefits of engaging in quality leisure activities.
• I have the skills to engage in quality leisure activities.
• My environment enables me to engage in quality leisure activities.
Physical activity
• I know the benefits of doing moderate-to-vigorous physical activity.
• I have the skills to do moderate-to-vigorous physical activity.
• My environment enables me to do moderate-to-vigorous physical activity.
Physical relaxation
• I know the benefits of engaging in physical relaxation.
• I have the skills to engage in physical relaxation.
• My environment enables me to engage in physical relaxation.
Quality sleep
• I know the benefits of high-quality sleep.
• I have the skills to improve the quality of my sleep.
• My environment enables me to enjoy high-quality sleep.
Meditation
• I know the benefits of meditation.
• I have the skills to meditate.
• My environment enables me to meditate.
* Analogue leisure is free time that is spent not involving the use of a device or screen.
Int. J. Environ. Res. Public Health 2022, 19, 5248 14 of 16
Appendix A.2. Well-Being Outcomes
Resilience
• It does not take me long to recover from a stressful event.
• I usually come through difficult times with little trouble.
• I tend to bounce back quickly after hard times.
Positive relations with others
• Maintaining close relationships has been difficult and frustrating for me. (R)
• People would describe me as a giving person, willing to share my time with others.
• I have not experienced many warm and trusting relationships with others. (R)
Mindfulness
• I was finding it difficult to stay focused on what was happening.
• I was doing something without paying attention.
• I was rushing through something without being really attentive to it.
Stress management
• I felt unable to control the important things in my life. (R)
• I felt confident about my ability to handle your personal problems.
• I felt difficulties were piling up so high that I could not overcome them. (R)
• I felt that things were going my way.
Purpose and meaning
• I understand my life’s meaning.
• My life has a clear sense of purpose.
• I have a good sense of what makes my life meaningful.
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