Tailoring Social Marketing Strategies for Patients Facing Multiple Health Risk Factors: The LIFE Framework

Background Patients living with chronic disease often face multiple and interacting health risk factors, such as smoking, sedentary lifestyles, psychological distress, or exposure to disruptive health crises. Yet prevention programmes frequently remain organised around single diseases or isolated behaviours. Addressing these complex situations requires patient-centred and behaviorally informed approaches that account for patients’ varying capacities to understand health information, mobilise resources, and act on recommendations. Focus of the Article This article introduces LIFE — Literacy & Individualized Framework for Empowerment — as a conceptual and empirically informed segmentation framework for social marketing. LIFE differentiates patients according to two complementary dimensions: health literacy and empowerment. It supports the upstream strategic phase of intervention design by helping practitioners move from broadly defined target audiences to more differentiated patient profiles with distinct barriers, resources, and support needs. Research Question The study explores two questions: (1) How do patients with diabetes or pre-diabetes perceive and manage multiple health-related demands when facing either a disruptive health crisis such as COVID-19 or a behavioural risk factor such as smoking?. (2) How can social marketing strategies be tailored by integrating health literacy and empowerment as segmentation dimensions, while using behavioral science frameworks to identify intervention priorities? Methods A hybrid deductive–inductive qualitative design was used, drawing on Interpretative Phenomenological Analysis. Thirty semi-structured interviews were conducted across two qualitative studies. The first examined diabetes management during the COVID-19 pandemic among 18 patients with diabetes. The second examined perceptions and management of smoking-related risk among 12 diabetic or pre-diabetic current or former smokers. Data were analysed through inductive coding, consolidation into meta-themes, cross-study thematic integration, and interpretation through health literacy and empowerment. COM-B and Chronic Illness Management Theory were used as complementary lenses. Results Findings show that patients often recognised isolated health risks but lacked an actionable understanding of how diabetes, smoking, pandemic-related vulnerability, treatment routines, and everyday constraints interacted. Health literacy gaps concerned not only information deficits, but also patients’ ability to evaluate credibility, interpret relevance, and translate information into practical decisions. Empowerment emerged as the hinge between knowledge and action, while also being shaped by social, emotional, and material opportunity structures. The analysis identified four patient profiles: vulnerable patients, overconfident autonomous patients, patients dependent on healthcare professionals, and effective autonomous patients. Importance to the Social Marketing Field The article contributes to social marketing by proposing a segmentation-oriented framework for patients facing multiple health risk factors. LIFE extends segmentation beyond biomedical risk or socio-demographic categorisation by focusing on patients’ capacity to understand health information and act upon it. It also clarifies the complementary roles of health literacy, empowerment, and COM-B: health literacy and empowerment provide the segmentation logic, while COM-B supports behavioural diagnosis. Recommendations for Research or Practice LIFE can help social marketers, healthcare professionals, and public health authorities tailor prevention and self-management strategies to heterogeneous patient needs. Low-literacy/high-empowerment patients require clearer guidance that preserves autonomy; low-literacy/low-empowerment patients require proactive outreach and supportive opportunities; high-literacy/low-empowerment patients need confidence-building and support for translating knowledge into action; and high-literacy/high-empowerment patients require maintenance, relapse prevention, and peer-support opportunities. Future research should test the relevance, reliability, and predictive validity of the four profiles and examine whether patients respond differently to tailored messages or support formats.