Targeting Promotion and Outreach to Meet the Needs of Special Populations

Background: CDC began to develop communication strategies to promote 2009 H1N1 influenza vaccination when the disease was first isolated in April 2009. As more was learned about the disease, the vaccine, and public perceptions of both, communication strategies and tactics evolved.

Program background: National vaccine recommendations included diverse life situations, age, racial segments, and ethnic groups. Some high priority groups included persons not normally recommended for vaccination (young adults) or persons who are reluctant to accept a medical intervention (pregnant women). CDC anticipated that vaccination rates would not reach optimal levels among persons with chronic medical conditions and their close personal contacts as well as newly recommended groups like children 6 to 18 years. While intense national and local media coverage of H1N1 raised its visibility, formative research suggested an increase in the use of personal protective behaviors rather than an intention to vaccinate. 

Evaluation Methods and Results: CDC held focus groups in June, September, and October 2009 to track changes in consumer knowledge, attitudes, and practices related to influenza prevention. The focus groups were used in conjunction with online surveys to test new messages and materials. The research revealed substantial concern about the disease but low perceived personal susceptibility. Moreover, participants expressed concerns that the vaccine was “rushed to market” and possibly unsafe, and that the vaccine was neither effective nor necessary. There was significant confusion about the difference between seasonal and H1N1 disease as well as the two vaccines. In addition to traditional and online media tracking, CDC also collected data through key media informants. Exposure to messages was tracked through media clipping services, online tracking tools, and data supplied by the outlets about audience reach. 

Conclusions: CDC created an overarching campaign theme (“The Flu Ends with U”) that resonated well across all English-speaking target groups. Executions under that theme were tailored to relevant behavioral determinants identified in the research. Campaign strategic and tactical principles included:

• Use trusted spokes persons and organizations to carry the message: Tom Joyner, WebMD, minority doctors, OB/GYNs, National Hispanic Medical Association, familydoctor.org 
• Depict recognizable situations where flu transmission is a concern to the target audience: workplace, public transit, restaurants, sporting events, feeding an infant; place materials and messages in such venues when possible
• Target the value proposition according to the audience: child will miss school/you will miss work; remind persons with risk conditions of their vulnerability; remind young adults of ugly flu symptoms
• Increase personal relevance with recognizable testimonials and situations related to the overarching theme
• Adapt cleared content for each population; repurpose it for different venues and formats
• Keep current on the dialog about the issue and prep spokespersons to respond to it
• Go local and customize; enable local partners
• Use non-government partners to say things in a way that government spokespersons cannot

Implications for research and/or practice: An overarching theme helps to give a large, multi-faceted campaign a coherent center that ties together the multiple activities and motivates stakeholders. Formative research with all the relevant sub-groups supports customization of generalized content and product offerings.