Committing to Continuous Improvement Audience Testing 10 Years in

Theoretical Background and research questions/hypothesis:  The Centers for Disease Control and Prevention (CDC) initiated the Learn the Signs. Act Early. (LTSAE) program to improve the likelihood that the 1 in 6 children in the United States with a developmental delay or disability are identified early enough to be connected with early intervention (EI) services (services typically provided before age 3 years). In most cases, children with delays are not identified before school entry, so they do not receive EI services likely to improve long-term outcomes. LTSAE provides tools to aid parents and providers in regular developmental monitoring, helping to identify developmental delays earlier and providing the opportunity to “act early” when concerns arise.

Methods:  LTSAE conducted an evaluation to assess relevance, comprehension, and motivating quality of currently used and newly developed messages among parents and healthcare providers (HCPs). Phase 1 focus groups examined parents’ (N=32) opinions about current “act early” messages and their knowledge of early intervention. Most parents said they did not know about their state’s EI program. Parents preferred empowering messages, such as “you know your child best” and wanted more information on how to act early. Findings were then adapted and recommended changes were made to materials, which were then evaluated again by parents and HCPs to assess the impact of the revised “act early” messages.

Results:  Phase 2 of materials testing included focus groups with parents (N=18), interviews with pediatricians (N=8), and intercept surveys with parents (N=64) in pediatric offices. Revised materials provided action steps to take if parents are concerned about their child’s development, including sharing concerns with their doctor and contacting EI for assessment. Overall, responses to materials and messages were positive. A majority of intercept survey respondents reported feeling more confident about taking action, and most said they would be more likely to act early if necessary. However, some parents in focus groups expressed reluctance to call EI and were skeptical about how it could help their child. Additionally, the action messages did not always grab attention; a few parents and pediatricians said their attention was drawn more strongly to the developmental milestones and not the “act early” messages.

Conclusions:  Findings showed which messages were more likely to increase parents’ confidence and likelihood to take action, and these revised messages will be integrated into the materials. In addition, clarifications will be made to areas where parents missed the calls to action.

Implications for research and/or practice:  A commitment to continuous improvement through regular audience testing is key to ensuring that health communication messages and materials continue to resonate with the target audience and increase the likelihood that the audience can take recommended action. Testing the call to action is an important consideration during audience testing. Our testing resulted in modifications to the “act early” messages, which likely led to participants’ overall positive response to the materials, high perceived self-efficacy toward the action messages, and a high degree of confidence for taking action.