Using Social Marketing to Reduce Cold and Flu Transmission On a University Campus

Theoretical Background and research questions/hypothesis: Influenza transmission risks in universities are similar to those in other closed communities as they host a large number of students and staff daily; these students and staff use shared facilities and spend time indoors in classrooms, libraries and offices. Evidence suggests that university students are not aware of, or not following, basic procedures to reduce the transmission of these illnesses even in situations of heightened alert and anxiety. Perhaps most notable in the Australian context is the tendency to cough or sneeze directly into the air, or into their hands, rather than into their sleeve/armpit or a disposable tissue. A social marketing approach was adopted in this project as an effective strategy to engage the population in the appropriate responses to reduce the transmission of infection requires a careful consideration of the 4Ps, not just ‘promotion’. 

Methods: In 2011 we developed and implemented a campus based social marketing intervention, to reduce the spread of cold and flu among the university population. The campaign consisted of six stages including a review of previous campaigns, formative research with university staff and students, development of campaign materials, pretesting materials with the target audience, campaign implementation and a comprehensive evaluation. The key objectives of the campaign were to: raise awareness of the importance of preventing the spread of colds and flu; and provide clear messages to students and staff concerning actions they could take to reduce their risk.  As well as a communication campaign, the intervention addressed the barriers to behavior change identified in the formative research (the ‘other 3 Ps’). Strategies included: desktop hygiene centres distributed across campus; flu booths with branded merchandise, information resources, and ongoing activities for staff and students.

Results: Unprompted recall of the campaign was high (70.3% of students and 82.6% of staff). The campaign reinforced existing beliefs about hand washing and staying home when sick, and significantly increased beliefs about the efficacy of ‘cough and sneeze into your sleeve’. Pre-post analysis showed statistically significant and meaningful increases in the number of staff and students reporting coughing and sneezing into their sleeve; the number of staff staying home if they are sick; and the number of students washing their hands regularly while on campus.

Conclusions: Our intervention was able to change not only attitudes and beliefs, but actual prevention behaviors. The campaign reinforced the ‘wash your hands’ behavior, promoted discussion of the ‘stay at home if you are sick’ behavior, and convinced many to adopt a new behavior (‘cough and sneeze into your sleeve’). The latter two are particularly notable given the existing social norms which are contrary to the promoted behavior.

Implications for research and/or practice: Key to the success of this intervention was the conduct of formative research to identify barriers and facilitators, and the use of multiple strategies – addressing all of the 4Ps – rather than a single-strategy communication campaign.