IMPROVING HEALTH:APPLYING QI TO PUBLIC HEALTH MESSAGING AND SOCIAL MEDIA

Presented byEileen R Daley RN, MPH

Black Hawk County Health Department, Iowa

December 6, 2012

Teams were organized around the six domains of the Iowa Public Health Standards

Group Process Strategies

Silent brainstorm Sorting and grouping of

issues to build an “Affinity Diagram” for each domain

Cross-walk of issue “headers” to the Iowa Standards to identify needs

Prioritizing statements of need through evaluation criteria and rank order

Consensus decision-making to identify priority need(s) for each group, and

Translating priority needs into goal statements

The process selected to improve is the lack of unified, timely, and culturally appropriate disease prevention messages to assist with the control of sexually transmitted infections (STI) in persons 15 – 24 years of age* Consistent with the health improvement plan to provide

clear, culturally appropriate, timely and effective education and information about prevention, management and control of communicable diseases to the public, and

Consistent with PHAB Standard 3.1, Provide Health Education and Health Promotion Policies, Programs, Processes, and Interventions to Support Prevention and Wellness

*Black Hawk County has one of the highest rates of combined Chlamydia, Gonorrhea and Syphilis in the state of Iowa

Sub-group of the Community Resources Uniting for Sexual

Health (CRUSH) Coalition with representation from: Allen Hospital Women’s Health (MCH contractor) Black Hawk County Board of Health Iowa Department of Public Health Black Hawk County Health Department (Lead

Agency) ME&V Healthcare Marketing Firm (contracted) Planned Parenthood University of Northern Iowa Student Health Services Wheaton Franciscan Healthcare Women’s Health

Clinic

By November 2012, [social marketing measure pending marketing consultant input] will occur with persons 15 – 24 years residing in Black Hawk CountyMarketing firm input needed to provide

measure of success in reaching the target population

Initial AIM addressed short term results (within the scope of the project period) and did not address the long term outcome necessary to improve public health practice

Affinity Diagram: What is contributing to the high rate ofSTIs in Black Hawk County?

CulturePersonal

ResponsibilityCondom Use

InterpersonalCommunication

Education Denial BarriersTreatment

(Client & Partner)

Pop ReligiousPartners Across

the Life span Stigma Access to Care

Hook-upculture mentality

Religiousbeliefs

More partnersthroughout

lifetime

Advocatingfor yourself

Not usingcondoms

Partnercommunicationon protection(or need of)

Lack of educationon transmission

of STI's

People thinkingthey are notat risk of STI

Scared toget tested

Access tohealthcare

People not gettingtreated when

STI test is positive

Thinking thathaving an STI

is not a big deal

Culturalbeliefs

Concurrentsex partners

PeerPressure

Not usingcondoms

every time

Individuals notcomfortable

talking about sex

People notknowing oraware of

S/S of STI's

Some may notview STI's as a

big deal

No one talksabout STI's

People not awareof where toget tested

Not gettingpartners treated

Cultural beliefs(won't usecondoms)

Talking aboutsex within faithorganizations

Early onset ofsexual activity

Lack ofresponsibility

for actions

Not usingcondomsproperly

People not wantingto talk about

sex/STI (youth)

Schools afraid toteach correct

and consistentcondom use

"It won't happento me"

No one to tell

Providers nottesting people

when theyhave the chance

Not tellingyour partner you

have a STI

It doesn'thappen on TV

Too easy to fixproblem (ratherthan prevent)

Not knowinghow/where toget condoms

Assumption thateveryone knowsabout prevention

Not aware ofsafer sex practices

Reality TV -it's not reality!

Influence!Fear of unknown Re-infection

Technology -meeting more

people they don't"really" know

Alcohol &Substances

Availabilityof condoms

Communicationbreakdown

betweenkids/parents

Lack ofconsistent info

Stigma withtesting

Impulsivebehavior

Not comfortablepurchasingcondoms

Have notpracticed theconversation

Misinformationregarding testing

or Tx of STI's

Alcohol &Substances

Cost of condomsPeople not knowingthey have an STI

Using anothercontraceptive - don'tneed any protection

Lack of knowledge/understanding

Young girls onbirth controlnot as likely

to use condoms

Lack of education

Alcohol &Substances

No symptoms,no STI

Certain factors incommunity provento increase STI's(CRUSH Summit)

REV 5-14-12

IF we undertake a targeted social IF we undertake a targeted social

media campaign, media campaign,

THEN we will decrease the THEN we will decrease the

incidence of STIs among men incidence of STIs among men

and women aged 15 – 24 in Black and women aged 15 – 24 in Black

Hawk CountyHawk County

By November 2012, social media click - through* will occur at a frequency of at least 0.01% for Facebook and 0.10% for YouTube, with persons 15 – 24 years residing in Black Hawk County (short – term measure)

By the end of 2013, an increase in STI testing and disease confirmation will occur as a result of greater awareness/disease risk (medium term measure)

By the end of 2014, a decrease in STI rates will begin to occur as a result of increased testing and disease confirmation (long term measure)

*Consumer “clicks” an advertisement impression for more information, i.e. STI education & link to testing sites

Research confirmed the Waterloo and Cedar Falls markets ranked highest in STIs in Black Hawk County

Facebook and YouTube were the two social marketing communication mediums recommended because they can pinpoint the target audience by: oAgeoGenderoGeography, andoType of music listened to

Facebook has rules and regulations when it comes to social media marketing on their site, including no sexual words in ads when targeting people under the age of 18

Research also showed that college age students, living in Cedar Falls, are high users of Facebook

“Test” and “prevention” campaigns targeted Men and Women 18 through 24 years of age, living in Cedar Falls

Facebook Survey Test Ad Statistics

Date Range 08/07/2012 – 08/24/2012

Target Audience Men and Women aged 18 through 24 living in the Cedar Falls zip code

Impressions 479,186

Clicks 87

Click through rate

0.01%

YouTube does not have any rules and regulations about using sexual terminology in a campaign ad

The City of Waterloo has an African American population of 15.5% (twice that of the County) and 76% of African American’s use YouTube (as compared to 50% of African American’s use Facebook)

The campaign targeted Men and Women 15 through 24 years of age, living in Waterloo

YouTube Survey Test Ad Statistics

Date Range 08/07/2012 – 08/24/2012

Target Audience Men and Women aged 15 through 24 living in any Waterloo zip code

Impressions 49,419

Key Words (creating the most impressions)

Call of Duty, Rihanna, Lady Gaga and Video games

Clicks 65

Click Through Rate

0.13%

YouTube Ad #1

YouTube Ad #2

Prevention Campaign: Facebook & YouTube

Date Range 09/06/2012 – 11/17/2012

Target Audience Men and Women ages 18 through 24 living in the 50613 Cedar Falls Zip Code; and ages 15 – 24 in any Waterloo zip code

Frequency of Visits to Website

998

Facebook Click Through Rate

Average of 0.019% (exceeded standard of 0.01%)

YouTube Click Through Rate

Average of 0.15% (exceeded standard of 0.10%)

YouTube Key Words Rihanna and Lil Wayne

Challenges Solutions

Determining a social marketing measure of success

Negotiating a budget to expand from an originalone month to a three month prevention campaign

o Negotiating with the marketing firm for a benchmark of success

o Pressure by community partners to justify the effectiveness and expense of social marketing when resources are scarce

o Bundling revenue sourceso Demonstrating gain to

community partners and Marketing Agency

Be respectful of what everyone brings to the process

Involve community partners that may have something to gain or learn from the process

Accept that progress may not happen as you expect; let the process work and use the results to strengthen public health practice and community partnerships

Keep your governing board informed of successes and limitations as the process may lead to new endeavors and organizational change

Funding for future social marketing ad campaigns and website expenseo Justify to external funders based on results of

process improvementoCollaboration with community partners to jointly

sponsor campaignsoBuild into FY2014 and beyond budgeting processes

Continue to work with CRUSH coalition to identify medium and long term benchmarks as well as monitor results

Share successes with public health partners

ME&V Healthcare MarketingGenerating Electrifying Results

6711 Chancellor Drive

Cedar Falls, IA 50613

319.268.9151

www.MEandV.com

Zanesville-Muskingum County Health Department

Zanesville, OhioBeverly Huth, Community Health Planner

Population 85,000

Combined city county health district

Y Bridge City Appalachian

County 65 Employees Accreditation

2013 or 2014

In 2011, 32.4% of ZMCHD media messages met desired criteria◦ Proactive health messages◦ Messages based on local health needs

By October 31, 2012, ZMCHD will increase:

The percentage of public health community messages based on local health need from 48.6% to 60% and increase the percentage of messages that are both proactive and based on local health need from 32.4% to 50%.

By October 31, 2012, ZMCHD will increase the % of public health messages based on local health need* and increase the % of public health messages initiated by HD and based on local health need as measured by media exposures.

Measure 1: Increase public health messages based on local health need from 48.6% to 60%.

Measure 2: Increase the percentage of public health messages initiated by the health department based on local health need from 32.4% to 50%.

Measure 3: Increase the number of message ideas generated by staff members (other than the PIO) from 1 to 5.

Proactive Messaging Based on Local Health Need - September & October 2012Date of Message Publication

Message Title Based on local health need Yes 1 No 0 (Target = 60% of Total Messages)

Initiated by Health Department Yes 1 No 0 (Target = 50% of Total Messages)

Initiated by staff (not PIO) Yes 1 No 0 (Target = 5/Qtr)

Initiated by Which Department

Method Used Target audience

9/2/12 Emergency Preparedness - Power Outage

1 1 1 EH Newspaper Community

9/7/12 WNV 1 1 0 PIO FB Followers

9/9/12 HD Inspections 1 0 0 Newspaper Newspaper Community

9/10/12 Lyme Disease 0 0 0 WHIZ WHIZ Community

9/11/12 Lyme Disease 1 1 0 PIO FB Followers

9/13/12 Emer. Prep. - Flu Exercise

1 1 1 EH WHIZ Residents 18+

9/15/12 Flu exercise 1 1 1 EH FB Followers

9/17/12 Flu exercise 1 1 1 EH FB Followers

9/17/12 Dirty Water 1 0 0 Newspaper Newspaper Community

9/17/12 Dirty Water 1 1 0 PIO FB Followers

Do: Design New Do: Design New Messaging ProcessMessaging Process

% of Messages Based on Local Needs Target of 60%

% of Messages ProactiveTarget of 50%

# of Messages Generated by HD Staff(other than PIO)Target of 5

Improved from 48.6% to 65% Exceeds target by 5% points

Improved from 32.4% to 73% Exceeds target by 23% points

Improved from 1 to 27 messages generated by staff Significantly exceeds target

Create new work flow process Educate staff PIO Trains Staff on News Advisory Report PIO Sends Quarterly Reminders Collect Data to Stay on Track and Maintain

Gains

AIM statement.Clear definitions and measures.

What is the intervention?Defining the “DO”.

Analyzing the data.Are we comparing apples to apples?

Follow the PDSA process Trust the team Keep pushing forward Build sustainability into the new process

Finally, don’t be surprised if your PDSA looks more like this………

DO

ACT

Thank you!

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