Formative and Message Concept Testing in the Domestic Zika Campaign

Background:  CDC’s Domestic Readiness Initiative for Zika Virus Disease is an “umbrella” campaign to tie U.S. communication efforts together and tailor and target Zika prevention messages in Puerto Rico and the continental United States. Target audiences are pregnant women, their partners, and women possibly exposed to Zika, with secondary audiences of U.S. adult travelers to affected areas and healthcare professionals (especially those caring for pregnant women.

Program background: Formative research has been a key component driving the development of advertising concepts in this campaign. Creative themes have been tested in both English and Spanish via social media using A/B digital testing of ads in Puerto Rico; online panel feedback; online focus groups with two final concepts (in English and Spanish); intercept interviews in Puerto Rico; and multiple interviews with Puerto Rican men in a relationship. 

Evaluation Methods and Results:  Evaluation involved media monitoring and three waves of telephone surveys. Within 2 weeks, the placement of billboards, metro/train stations and rural bus stop ads were initiated throughout Puerto Rico. Prevention messages were placed in grocery stores in aisle shopping displays, mall entrances, and in mall and restaurant bathroom ads. Public Service Announcements were created and used for live radio, internet radio streaming, webTV, and in movie theaters. The continental United States component focused on South Florida in Miami Beach and greater Miami-Dade County. Paid social media ads in English and Spanish were geo-targeted through Google AdWords/Display Network, Facebook, Twitter and Pandora, and radio PSA spots, when the first local cases were identified in South Florida. The campaign also included newspapers/news website ads and outdoor advertising on bus shelters, mobile digital ads on trucks, taxi tops, and an airplane banner. The campaign expanded to other parts of Florida, Brownsville, Texas, and other southeastern states at high risk for Zika. Estimated paid media impressions  for CDC’s Domestic Readiness Campaign for Zika has been approximately 190 million in Puerto Rico, equating to about 95 impressions per adult (18-64 yrs). In the United States, advertising created an estimated 423 million impressions. Campaign exposure among respondents (especially women who have been, are currently, or planning to get pregnant) was positively associated with actions taken to protect against Zika, correlated through surveys and repellent sales in grocery stores.  

Conclusions:  This has been a unique campaign initiated during an emergency response, where the need for expedient, credible information was crucial.  Advertising supplemented gaps in messaging carried through news media and focused on preventive actions. Innovative platforms put messages where people were at such as malls/restaurants, movie theaters, metro stops, or on the beach. The campaign structure allowed for message targeting within days of outbreaks in urban and rural areas in Puerto Rico, Texas, and in the Southeast, and has substantially amplified protective messaging while news focused on new cases.

Implications for research and/or practice:  The idea of having other media – in addition to “earned media or traditional media”- carry prevention messages during an emergency outbreak like Zika is critical. By using a paid approach, message delivery can be controlled and delivery tailored to the target audience in an expedited time period.