Use of Social Marketing in Cardiometabolic Self-Management Education and Support Interventions: A Systematic Review

Background: Conventional self-management education and support (SMES) interventions for cardiometabolic disease (CMD) often fail to engage and retain recipients and have not demonstrated long-term impact. Social marketing applies marketing strategies to promote voluntary behaviour change and may enhance SMES effectiveness. While social marketing approaches been applied across a wide range of public health campaigns and notable chronic disease interventions, it is unclear how widely social marketing has been incorporated across cardiometabolic SMES interventions, or whether these approaches have been generally successful. Objectives: We aimed to investigate how cardiometabolic SMES interventions incorporate social marketing principles and evaluate whether these interventions improve self-management behaviours and cardiometabolic outcomes. Methods: A systematic review was conducted according to PRISMA guidelines. MEDLINE, Embase, CENTRAL, and CDSR were searched from inception to March 2026. Eligible studies included CMD SMES interventions for adult populations (18+ years) incorporating at least one social marketing principle. Risk of bias was evaluated using validated tools. Findings were synthesized narratively. Results: From an initial 1216 records screened, twenty-five studies involving 20,166 participants were included. A plurality of studies focused on type 2 diabetes (n=12/25, 48.0%) or smoking cessation (n=9/25, 36.0%), and 20/25 (80.0%) described randomized controlled trials. The most frequently incorporated social marketing principles were: motivational messaging (n=23/25, 92.0%), formative research with target population (n=17/25, 68.0%), branding (n=10/25, 40.0%), and mass personalization (n=10/25, 40.0%). Those who received interventions had positive outcomes including: smoking cessation, diabetes self-management behaviors, medication adherence, HbA1c, hypertension self-management, and less cardiovascular events. While most interventions incorporated only 1- 3 social marketing principles, several interventions reporting favorable behavioral and clinical outcomes employed more comprehensive social marketing approaches with 5+ principles. Few interventions targeted socially and structurally disadvantaged populations, with no studies focused on South Asian populations despite their high cardiometabolic risk and only one focused on younger adults.. Conclusion: CMD SMES interventions that incorporate social marketing principles may improve behavioral and clinical outcomes. There is a key opportunity in the field to develop interventions that more comprehensively integrate social marketing approaches and are targeted to socially and structurally disadvantaged populations. Corresponding Author: Dr. Calvin Ke, 12E-252, 200 Elizabeth Street, Toronto, Ontario M5G2C4, Canada. E-mail: calvin.ke@utoronto.ca Funding and Disclosures: This work did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Dr Campbell is a co-founder of Narra Technologies Inc., which creates self-management support products.