Sally! A Case Study.


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Sally! A Case Study.

Sally works at the County public health department and has been given the assignment of conducting a social marketing campaign about STDs in the community. Her supervisors have chosen to implement a social marketing campaign because they would like to reach a larger population than they have traditionally met with group-level interventions.

Sally is not an expert on social marketing and her budget is very limited. As is often the case, the social marketing campaign has been assigned to her as part of a grant requirement. By focusing on the fundamental concepts of social marketing and relying heavily on community input, Sally will pull together a successful local campaign

You will see the process that Sally goes through to develop, implement and evaluate her social marketing campaign. You can either read the entire page here or use the navigation bar at the left to read about different steps in the process and then link back to Sally's story as she goes through the same steps. 

   Data and Background
   Assessing the Community
   Goals and Objectives
   Theory Informs the Message
   Creating the Message
   Strategy/Implementation
   Evaluation

Define the Problem - Data and Background

Sally is familiar with the STD data in her community, but she studies the data again to see which communities are most affected by STDs. She contacts the epidemiologists within the County and they give her the STD rates by zip code. They are also give her age, racial and ethnicity data about STDs and teen pregnancy rates in the county. From the data, it is clear that 15 - 24 year-olds in the African-American community in Springfield are disproportionately affected by Chlamydia. And, the same community is dealing with a high incidence of teen pregnancy. The local rates for these health outcomes are higher in Springfield compared with national data, and both national and local data sources reflect racial disparities in STD rates.  

Based on this information, Sally decides to focus this campaign on the most impacted community. This is her priority population: 15 - 19 year old, African-American youth in Springfield.

Assessing the Community

 

Now that Sally knows what the data are saying about STDs in the community, it's time to take this information back to the priority population to find out what they think.

 

Sally coordinates her efforts with the health teachers she works with in Springfield. With their help, she is able to visit three different schools at the lunch period, and secures a small amount of money to provide pizza for students. During these lunch sessions, she uses the SHOWED method with the students and presents a personal story abourt a local teen who got an STD and didn't know it.  She also presents the data showing local Chlamydia rates by zip codes.  During the session, students are asked what they think about the issue. 

The students in Springfield are surprised to hear that the rates of the Chlamydia are higher in their area of town than in nearby neighborhoods. Many of them are surprised that untreated Chlamydia can lead to infertility. This seems to be a running theme among the discussions. The students (with Sally's facilitation) decide to focus on this aspect when crafting the campaign message. Based on what the students say, they are going to focus on:

 

   Knowledge - Chlamydia can cause infertility if untreated
   Attitude - Condoms and birth control pills offer the best 
   protection to prevent unplanned pregnancy and STDs

   Belief - The pill does not protect against STDs
   Behavior - Youth who are having sex should be using condoms 
   and pills for the best protection

 

Go to the SHOWED description to see how a student driven message is developed.

.

Goals and Objectives

 

Sally meets with her team of health educators and supervisor. They are going to start the campaign in January of the next year, so they have created some program objectives to match their anticipated timeline. This is also the time when the team is thinking about the evaluation, since this goes hand in hand with setting objectives.

Impact objective

One year after the campaign is completed, the overall Chlamydia incidence rate for 15 – 19 year old African American youth in priority zip codes in Springfield will decrease from 1150 to 900.

The team discusses the possibility that testing increases might make the incidence rate appear higher, but this objective seems realistic when viewed as part of a community-wide effort to tackle this issue. This objective is also chosen because these data are already collected by the county. Sally can easily elicit the help of the epidemiologists in her department to help her better understand and more clearly report on the data.
 
Process objective
By June of the next year, staff (with youth) will have posted at least 20 posters in each of 5 local schools and clinics and distributed at least 1,000 palm cards and 1,000 stickers with the media campaign messageto local youth in Springfield.

The group decides on this process objective with some assumptions about the materials they will create (with the youth), but they all agree that once the campaign materials are printed they will revisit this objective. The process objective will help to guide the implementation of the campaign and help the team stay on task in terms of distributing materials.

Outcome objective - media saturation

By January, at least 20% of surveyed 15 - 19 year old African American patients in Springfield clinic, will report having seen the media campaign.

The team spends a great deal of time trying to figure out how to best measure the campaign outcomes. Sally and the health educators struggle to figure out a realistic measure for such a broad type of intervention. Initially they wanted to show increased condom use among youth who saw the campaign. They realize through discussion that one of the best ways to determine this is through a pre and post test to establish a baseline of condom use in order to measure an increase.

 

They all eventually agree that the saturation of the campaign and the possibility that students would go to the clinic as a result would be something worth recording and focusing on to match the intent of the campaign. 

 

Sally negotiates with the County clinic managers who agree that she will be allowed to collect waiting room surveys. She is going to use a Youth Sexual Behavior Questionnaire (YSBQ) that has already been developed and add a question about the campaign. Since Sally and her team are working within their own clinic system, her supervisors allow her to collect behavioral data without submitting a proposal to the Institutional Review Board (IRB). (Normally, research with human subjects has to go through an IRB to verify this issue before collecting behavioral data, especially when working with minors.)

Outcome objective - KABB change 

The clinic survey shows that of those who report having seen the media campaign, at least 60% will report intent to use a condom the next time they have sex.  

Sally and the team have also decided to set a benchmark about condom use within the clinic survey. They are hoping that the people who see the campaign will report an increase in intent to use a condom. Not everyone in the group is happy with this objective; Sally's supervisor is critical because there is no baseline to compare the 60% reporting use. However, they decide to move forward with this objective because it reflects a goal that  over half of respondents reporting intent to engage in healthy behaviors. They may be able to draw further conclusions if the surveys show that the people who see the social marketing campaign are reporting stronger intent to use a condom than their counterparts who did not see the campaign.

It's not perfect, but Sally is satisfied that, as a group, everyone is on the same page. When considering all of the objectives, their plan is solid enough to move forward with the campaign. Social marketing evaluation is a challenging piece for any campaign and compromise is necessary in order to move forward with a project. 
 

Theory Informs the Message 

 

The team has looked at the research and data in Springfield and decided to address the high Chlamydia rates by encouraging condom use. After talking to the community, it's clear that some of the youth in the area don't know that untreated Chlamydia could lead to Pelvic Inflammatory Disease (PID), which could lead to infertility. The groups of youth with whom they spoke are concerned about their fertility and were somewhat shocked to know that a treatable STD could have such serious outcomes.

The team has decided to use the Health Belief Model to address the perception of severity around acquiring Chlamydia. By addressing the possible severe outcomes of untreated Chlamydia, they hope to encourage more youth to use condoms if they are having sex. 
 

Creating the Message

 

Sally has a brainstorming meeting with the staff health educators to create some messages. As a group, they think of the following list of messages to convey the idea of the severe consequences of untreated Chlamydia and to promote condom use for the high-risk youth of Springfield:

Protect your future, protect yourself.

Protection is the key to your future.

Want babies? Wear a condom.

The group knows these aren’t the greatest ideas but they will be a starting point for the youth to figure out what they do and do not like in a message.

They meet with the kids who feel that the messages don’t make sense or they are not interesting or exciting enough. The kids themselves come up with messages that keep the campaign focused on condom use and gambling with the future.

The slogan they all seem to like is "Don't gamble with your future!" with images of gambling activities (dice, poker, spinning wheel of chance) paired with condoms. Overwhelmingly the youth think that the campaign needs to be a little edgy and that the gambling theme will attract the attention of their peers. They agree to include some simple information about untreated Chlamydia as a sub-headline.

Sally's team is a little nervous about using the gambling theme in a campaign at schools. It will take a lot of effort to convince administrators that the campaign needs to represent the voice of the youth. They agree to move forward with the "Don't gamble..." message even though they may have to omit some of the more conservative schools.

  

Strategy and Implementation 


Sally gets to work on creating the plan for her team. First, she generates a budget. She is only working with $5,000, which is a very small budget for a social marketing campaign. See Sally's projected budget
here.

The campaign will run for one year, from January to December to coincide with the duration of a small grant the County recently received.

Based on the feedback from focus groups and projected costs, the team has decided to print small posters to be distributed at schools in the priority area. Sally begins meeting with school administrators right away to build support for implementing a program. The high cost of the posters means there will not be stickers; Sally changes her process objective to:

 

Process objective

By June, staff will have distributed at least 200 posters and 1,000 palm cards with the media campaign message in local schools in Springfield.

One of Sally's colleagues recruits a student from a local high school who is interested in graphic design and is an excellent artist. He creates the poster designs in exchange for a gift card and the idea that he will get a resume boost by working with the local health department. They asked if he could create multiple variations of the poster so they can pre-test the design. Working together they assist him with changing colors and modifying text to come up with three different versions.

Sally works with the local schools in Springfield to recruit two more focus groups to pre-test the posters. During the focus group, Sally shows the youth all of the options. She asks them questions about the colors, what they think the message is, the images, how ledgable the text is, etc. The participants like two of the three posters, so Sally decides to print both. 

Once the posters are printed, Sally divides them up among herself and the health educators and assigns everyone to meet with school officials and work on putting them up around the schools. They decide to put up 10 posters in each school and distribute 800 palm cards in the first three months and then another 10 posters in each school and 200 palms cards by June in order to meet their objective. When possible, the team also asks the youth in the school for the best locations to hang posters and where they will be least likely to be torn down.

The posters are all finally up by June and Sally and the team continue to meet with school officials and check on the posters. Sally meets with the clinic staff and tells them about the campaign and that she is hopeful there will be new patients. During the entire implementation, Sally is meeting with people and reminding them about the activity in order to continue to build support. Social marketing is an ongoing process that requires maintenance. While seemingly simple to distribute materials, Sally is surprised at the energy and time it takes to convince people to display the posters and there are frustrating setbacks when some of the posters are torn down.

Near the end of the implementation year, Sally moves on to conducting  the outcome evaluation... 
 

Evaluation

 

Sally is relieved that she and her department spent so much time hammering out the objectives for the campaign since  the evaluation is MUCH easier to do when the objectives are carefully crafted.

Outcome objective - media saturation

By January, at least 20% of surveyed 15 - 19 year old African American patients in Springfield clinic, will report having seen the media campaign.

Sally negotiates with the clinic managers in the county to agree that she will be allowed to collect waiting room surveys. She is going to use a Youth Sexual Behavior Questionnaire (YSBQ) that has already been developed and add a question about the Don't Gamble... campaign. Since Sally and her team are working within their own clinic system, her supervisors allow her to collect behavioral data without submitting a proposal to IRB. (Normally, research has to go through an Institutional Review Board - verify this issue before collecting behavioral data.)

  

Outcome objective

Of those who report having seen the media campaign on the clinic survey, at least 60% will report intent to use a condom the next time they have sex.

 

Sally and the team have implemented the surveys throughout the clinic system. They are working with their epidemiologists to analyze the data and specifically to compare media exposure to sexual health behaviors.

 

Sally's campaign was modestly successful. The entire team works on a report at the end of the campaign that they share with the community. It's imperative that results from community research are shared back with the community. Sally and her team go back to the schools where they posted materials and presented the results. They also created some posters for the clinic patients and presented at in-service meetings of County clinic staff. They also thanked the youth who helped to develop the messages.

 

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