Testing Existing Zika Materials in Areas at High Risk in the Continental United States

Background: In emergency situations, effective communication can reduce mortality and morbidity. Audience characteristics, such as demographics, technical knowledge, and perceived risk affects how messages are received and willingness to act on them. Message testing is not typically performed during emergency responses because of time, funding, and other constraints.

Program background: For the Zika response, the Centers for Disease Control and Prevention (CDC) tested Zika materials and messages with pregnant women with low literacy skills in Miami, FL, and men and women ages 18-49 in Brownsville, TX. Primary research questions included whether messages and materials were understood as intended, culturally relevant, and acceptable and provided actionable information.

Evaluation Methods and Results: In 2016-2017, CDC engaged in formative research of Zika messages and materials to assess audience comprehension and ability to take action. Abt Associates facilitated data collection and analysis. In-person, in-depth interviews (IDIs) in English and Spanish were conducted in Miami with nine pregnant women to test four low literacy materials, two versions of the CDC travel guidance map for Miami-Dade County, one radio ad, and prioritization of five protective actions. In Brownsville, 14 online IDIs were conducted in English and Spanish to test two types of Zika community prevention materials and two Zika sexual transmission messages. Video interviews were observed in real-time by CDC researchers and transcripts were further analyzed using content analysis. In Miami, most respondents had awareness of Zika, but few knew it could be transmitted sexually, and risk perception was lower than anticipated. Maps were easy to read and understand, but certain words in Spanish appeared confusing and alternative language was suggested. Low literacy factsheets were generally clear, understood, and images were relatable. Wearing repellent was ranked most important and most able to be acted upon. Using screens was ranked least important and least able to be acted upon because it was seen as a man’s job or the landlord’s responsibility. In Texas, most respondents indicated that the fact sheets were effective, informative, and believable but were not aware of sexual transmission, and messages about suggested timeframes to wait before trying to get pregnant were sometimes misunderstood. Suggestions included bolder colors and examples of birth defects or repellent brands and avoidance of technical terms, such as microcephaly and permethrin.

Conclusions: CDC has developed and distributed several Zika prevention messages and materials. During testing, observing the IDIs allowed for real-time improvements based on what respondents were saying, thereby decreasing the lag time between research and application. Overall findings from testing were rapidly analyzed and used to make changes to existing messages and materials.

Implications for research and/or practice: Message testing of CDC materials resulted in a better understanding of what at risk populations knew, understood, and what actions were feasible. Having IDIs in English and Spanish also yielded important information on how translations could be more culturally appropriate for targeted audiences. Lessons learned will help improve messaging before the next U.S. mosquito season and give CDC a blueprint to use quickly for future responses.