African American STD Health Disparities: Implications for Message Constructs and Bundling for Health Communication Campaigns

Theoretical Background and research questions/hypothesis: This exploratory formative research study explores the development of a health communication campaign to address the high rates of STDs and HIV among African Americans.  One main study objective was to explore whether audience members react better to prevention messages that focus on (1) an individual non-HIV STD, (2) the bundling of multiple non-HIV STDs, (3) a combination of HIV and other STDs, or (4) a complete reframing of the message that focuses on desired attributes and behaviors, rather than disease.

Methods: The study sample (n=158) included English-speaking, African American men and women aged 18 to 45 who reported being heterosexual and having sex in the past 6 months. We segmented the triads/interviews by age (18 to 29 and 30 to 45), gender (male/female), and urban/rural residence to create eight audience groups. A brief 44-item questionnaire was administered prior to the start of each triad/interview to capture STD-related knowledge, attitudes, beliefs and perceptions, personal risk reduction strategies, risk behavior, and prior STD testing behavior.

Results: Participants were asked how they would feel about receiving STD information combined with information about HIV. Most participants stated that all STDs, including HIV, should be combined in the same campaign. However, they should be addressed separately (within the same campaign) because they can be contracted differently, they have different symptoms, and they have different levels of severity. Overall, participants felt that more of a risk-based, fear-appeals approach was best for communicating information about STDs, particularly for youth and young adults. For example, they suggested that pictures of the physical effects of the diseases be provided for a harsh reality check. Participants suggested that factual information about symptoms, statistics, how STDs are treated, and if they are curable (i.e., not a death sentence) should be conveyed. In particular, they stated that facts on how STDs affect the black community more than whites would be effective. A minority of participants stated that using a positive, empowering approach would be more beneficial than using scare tactics.

Conclusions: Most participants stated that it would be acceptable to combine information on HIV with other STDs. However, unanswered is the question of whether they should be combined. We did not identify a compelling reason for keeping them separate or combining them. 

Implications for research and/or practice: Future research should consider whether there is a strategic goal for message bundling and may depend on combining messages by different age and gender groups, where HIV/AIDS was seen as much more distinct from other STDs among males and younger research participants. Participants' stated reasons for messaging about individual STDs separately (e.g., transmitted differently, have different symptoms, have different levels of severity) also suggests potential ways to group STDs when messaging. Ultimately, more testing will be required to determine the most efficacious way to present the information to the target audience.