By Willa Seldon, Taz Hussein, and Matt Plummer
If you haven't seen MTV's hit TV show 16 and Pregnant, you're in for an experience. Each episode follows a teenager from pregnancy through the first challenging weeks of parenthood, when she must also grapple with stigma, adult decisions, and more--all in front of cameras. As one teen tweeted, "Seriously, watching @16andPregnant is birth control itself."
That teen was on to something. In the 18-month period after the show was introduced in 2009, teen pregnancies in the United States declined by almost 18 percent. A Brookings Institute report attributes a third of that decline to 16 and Pregnant and its popular Teen Mom spin-offs. "They created a show that teens wanted to watch--they weren't forced to watch it," says Brookings Senior Fellow Melissa Kearny. "Childbearing was something they [teens] took as a cautionary tale."
In fact, MTV did not set out to address issues surrounding teen pregnancy. However, by appealing to the interests of its teen demographic, the cable network drove change in a way that was much more persuasive than if this message had been more overt. The efficacy of this "stealth approach" warrants consideration for the nonprofit for whom recruiting participants for programs can feel like getting children to eat zucchini--an uphill battle that leaves everyone frustrated. Most parents learn that hiding zucchini in pasta, casserole, or, yes, even chocolate cake, can work much better than serving it up alone.
A stealth-based strategy might be one way to sell social change. When it comes to addressing challenges, hiding the intervention in an activity that beneficiaries desire--such as watching reality TV--offers a path forward for nonprofits trying to get people to participate in programs and services others have deemed "good" for them. Drawing from a Winter 2017 Stanford Social Innovation Review article, "Selling Social Change," here are four questions nonprofits might consider for getting results by going stealth.
Why go stealth?
Stealth approaches can help when motivation is lacking. Consider that, for many teens, the desire for sex outweighs the fear of getting pregnant. However, as the tweeting teen attested, seeing the real lives of teen moms flipped the desire-to-fear ratio.
If your program promises benefits that accrue somewhere down the road, as most education and prevention programs do, you may have a motivation problem. Some nonprofits and social change efforts are already applying MTV's stealth approach to their own endeavors.
• When London-based Marie Stopes International (MSI) was struggling to boost contraception usage in Zambia, it hired the human-centered design firm, IDEO, to help it understand why more teenagers weren't using readily available birth control. IDEO found that young women shied away from discussing or seeking contraceptives--and suggested that MSI open pop-up nail salons (Diva Centres) where manicurists, trained as counselors, would engage customers in discreet conversations about birth control options. MSI soon had crowds lining up outside its doors, as women got their nails done and picked up contraceptives.
• Meanwhile, Dr. Thomas Robinson, a professor of pediatrics and medicine at Stanford University School of Medicine--as well as the recipient of significant funding from the National Institutes of Health to develop weight-control programs for youth--is renowned for making weight loss fun. Robinson replaces the typical classroom-based, education-focused sessions with dance competitions and soccer tournaments, engaging his patients in activities far more fun than actually losing weight.
As MSI and Robinson have learned, motivation matters, both for boosting participation (and retention) and ultimately for improving outcomes. "Nothing can sell itself," says Sean Duffy, co-founder and CEO of Omada Health, which makes digital health-therapy programs for people with serious but potentially treatable diseases. "It doesn't matter how good the product is." This explains why a quarter of Omada's 200-plus staffers are devoted to sales.
What should we focus on?
At the end of the day, participation rates won't improve dramatically unless people feel motivated to join in. Nonprofits considering a stealth approach should identify what their beneficiaries want, not just what they need.
MTV is a master of determining what teens want to watch and then developing programming that appeals to those desires, which sometimes are at odds with what teens need (as most parents would attest). MTV emphasizes market research to learn about its teen audience, making an almost ethnographic study of what's important to them. Such careful listening gets results: each episode of 16 and Pregnant attracted more than two million viewers.
Likewise, when nonprofits and others dig deep into the desires of the people they are trying to serve, they can better meet people's real needs.
• MSI, for its part, spent months working hand-in-hand with IDEO to understand the real motivations of young Zambian women. After spending months talking with teenage girls in Zambia, MSI and IDEO developed "personality prototypes" to help staffers better understand how different young women would respond to contraceptive counseling. MSI was fortunate to receive a grant from Hewlett to do the important work of deeply listening to their beneficiaries' wants.
• Similarly, Dr. Thomas Robinson knows that most overweight kids don't want to listen to someone tell them to eat healthy and exercise more, even though eating healthier and exercising is precisely what they need. What do kids want to do? Dance and play sports--in a judgment-free environment where they aren't burdened by weight bias. Robinson appealed to their desire by designing dance competitions and soccer activities just for those who are overweight. "We've found that kids are intrinsically motivated to adopt healthful behaviors when the change is fun; it gives them a sense of choice and control, and provides challenges and a sense of accomplishment," Robinson said. Apparently, his approach works: 80 percent of the children in his program succeed in reducing excess weight.
What skills are required?
Appealing to beneficiaries' wants often involves a very different activity than delivering the effective intervention. As a result, nonprofits considering a stealth approach may also need to invest in capabilities that are foreign to their program staff. Consider that:
• MSI needed to build pop-up nail salons and hire a host of manicurists--or train their contraceptive counselors to do nails.
• Dr. Robinson needed to complement his nutrition and pediatric weight-control experts with youth sports and dance instructors.
When does going stealth make the most sense?
Nonprofits don't always need to go stealth so as to appeal to beneficiaries. Maybe the answer to beneficiaries' wants is already in your program, but you're just not promoting it. For example, if you're trying to sell older adults on a group-based, chronic-disease prevention program, you probably want to promote the program's community component as much as--or more than--the health benefits.
But if you're thinking, "I shouldn't have to use a stealth approach because there is such a big, real need for my program," then you may be falling prey to the "need=demand" fallacy. In a world where need doesn't always imply demand, MTV's stealth approach is yet another tool for nonprofits looking to sell social change.
For information on ways to reduce teen-pregnancy rates, please read The Bridgespan Group's report, "Billion Dollar Bets to Reduce Unintended Pregnancies."
Willa Seldon is a partner in The Bridgespan Group's San Francisco office. Taz Hussein is a partner and Matt Plummer is a manager in Bridgespan's Boston office.