FORMATIVE RESEARCH FOR SNORKEL-RELATED DROWNING IN HAWAIʻI: A SOCIAL MARKETING APPROACH
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2024
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Abstract
Abstract“Marketing has this sort of morbid power” (Lovato et al., 2007).
Snorkelers, mostly visitors, fatally drown in Hawaiʻi several times per month (Galanis, 2019). Despite this sobering statistic, successful marketing of Hawaiʻi has effectuated not only an increasing number of visitors to the state but also an increase in snorkel-related drowning. While a thorough understanding of the causes of snorkel-related drowning is still evolving, residence status, advanced age, and pre-existing medical conditions are identified as predisposing factors. While these factors are not modifiable, behaviors that may modulate risk include snorkeling with a buddy, being efficient with equipment, learning to perceive and react in adverse conditions, selecting beaches with a lifeguard presence and access to emergency services, and conditioning oneself for the strenuous activity of snorkeling. Social marketing, which adopts commercial marketing practices to address public health or social justice issues, may be affectively applied to snorkel-related drowning prevention. Framing this marketing strategy with established behavior change models such as the Theory of Planned Behavior (TPB) can enhance desired behavior change. Formative research to understand and message the target audience is a required first step in social marketing and is a centerpiece of this paper.
Study 1 derived and described snorkeling fatal, non-fatal, and pre-drowning incidents extracted from Hawaiʻi Emergency Medical System (EMS) patient care reports, including non-narrative (already coded) and narrative (post-coded) data. Of the 152 records reviewed, non-narrative data revealed that 77% of the snorkelers were visitors, 60% were male, mean age was 55.8 years old, and that 49% of the cases occurred in the county of Maui. Of the 27 deaths, 78% were male, 81% were visitors to Hawai‘i, and 96% received CPR by EMS responders. Although there were high proportions of missing data for some variables, non-narrative data showed the most frequent first intervenors for drowning snorkelers were bystanders/family members (61%), and the most common factor contributing to the drowning incident was exhaustion (44%), followed by issues with snorkeling equipment (22%).
Study 2 surveyed Hawaiʻi visitors (n=483) for information on the product behavior of "snorkeling with a buddy". TPB constructs of intention, social norms, perceived behavioral control (PBC), and attitudes about drowning and snorkeling alone were studied. Most visitors both preferred (94%) and intended (88%) to not snorkel alone, and most (94%) perceived it was important to their peers/family that they snorkel with a buddy. The odds of intending to snorkel alone among those who felt it would be challenging to adjust their schedule to snorkel with a friend or family member was over ten times the odds of those who reported it would be easy to do so. The predictive model explained 33% of the variance in response to intention to snorkel alone (Nagelkerke R2, p <0.001) and correctly classified 91% of cases.
Study 3 explored Maui County lifeguard observations, perceptions, and recommendations about snorkel-related drowning risk factors and prevention. Twelve lifeguards in three focus groups reported snorkelers were often ill-prepared for the hazards snorkeling presented, were often not open to lifeguard guidance, and that the visitor industry should clearly message the dangers of snorkeling to Hawaiʻi visitors.
Together these studies indicate several possible strategies to address and prevent snorkel-related drowning. To the extent possible within resources constraints, EMS and other first responders should be encouraged to provide more information on the rescuee’s level of snorkeling and swimming experience and skill, contributing intrinsic and extrinsic factors, and equipment types and issues. Snorkeling equipment vendors, commercial tour operators, and others who deal directly with visitors should be encouraged to provide education on snorkeling in Hawai‘i and encourage visitors to swim with a buddy and/or with or near tour or hotel staff that have been trained in supervising snorkelers. Visitor industry investment in strategies that move beyond individual behavior messaging and take on the responsibility of changing visitor social norms and culture are needed. Research, likewise, must balance use of theory with empirical application and evaluation of current practices, including application of social marketing concepts beyond the formative research highlighted in these studies, to address the prevalence of snorkel-related drowning in Hawaiʻi.
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Public health, Marketing, drowning, snorkel, social marketing
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137 pages
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