A 10-year systematic review of HIV/AIDS mass communication campaigns: Have we made progress?

The Association Between the We Can Do This Campaign and Vaccination Beliefs in the United States, January 2021-March 2022

Public health campaigns addressing COVID-19 vaccination beliefs may be effective in changing COVID-19 vaccination behaviors, particularly among people who remain vaccine hesitant. The "We Can Do This" COVID-19 public education campaign (the Campaign) was designed to increase COVID-19 vaccine confidence and uptake. This study aims to evaluate whether Campaign dose was associated with changes in vaccination beliefs related to COVID-19 vaccine concerns and perceived risks, the importance of COVID-19 vaccines, the perceived benefits of COVID-19 vaccination, normative beliefs about COVID-19 vaccination, and perceptions about general vaccine safety and effectiveness. The study linked data from four waves of a nationally representative longitudinal panel of U.S. adults (January 2021-March 2022) with Campaign paid digital media data (April 2021-May 2022). We used mixed-effects linear regressions to examine the association between Campaign paid digital impressions and changes in vaccination beliefs. The results provide evidence that Campaign digital impressions were significantly associated with changes in respondent beliefs regarding COVID-19 vaccine concerns and perceived risks, perceived benefits of COVID-19 vaccination, and perceptions about general vaccine safety and effectiveness. Findings suggest that public education campaigns may influence vaccine confidence and uptake by increasing positive vaccination beliefs and reducing vaccine concerns.

Increasing HIV Testing Among Sexual and Gender Expansive Men in Kazakhstan: A Stepped-Wedge Randomized Trial of a Community-Level Intervention

Importance

HIV transmission in Kazakhstan has increased among men who have sex with men (MSM) and transgender and nonbinary people who have sex with men (TSM), driven by low HIV testing rates.

Objective

To determine if the PRIDE in HIV Care intervention had a community effect of increasing HIV testing among MSM and TSM in Kazakhstan.

Design

We employed a stepped-wedge, cluster-randomized controlled trial with MSM and TSM community members recruited from three cities in Kazakhstan: Almaty, Astana, and Shymkent. We collected serial cross-sectional data where community members completed one assessment between 21 August 2018, and 30 March 2022.

Setting

We collected data from 629 MSM and TSM among the study cities. Community respondents were recruited from real-world (e.g., NGOs, bars, clubs) or virtual sites (e.g., social media, apps) where MSM and TSM in each of the three cities were known to frequent.

Participants

Eligibility criteria for community respondents were: (1) ≥18 years old; (2) identifying as male at any point in life or being assigned male at birth; (3) having consensual sex with another man in the past 12 months; (4) engaging in binge drinking (i.e., ≥5 drinks in a 2 hour period), illicit use of drugs, or both in the past 90 days; and (5) residing in one of the three study cities.

Intervention

The PRIDE in HIV Care intervention is a theory-driven "crowdsourcing and peer-actuated network intervention" designed to amplify community members' successes and resilience via "influencers" who can strengthen and impart benefit to their networks and community.

Main outcome measures

Received an HIV test in the prior six months.

Results

There was a statistically significant increase in odds of recent HIV testing for every additional month the intervention was implemented in a respondent's city (AOR=1.08, 95% CI=1.05-1.12; p<.001).

Conclusions

The PRIDE in HIV Care intervention appears to be efficacious in enacting a community wide increase-i.e., promoted HIV testing among those who did not go through the intervention itself-in HIV testing among MSM and TSM.

Trial Registration

This trial is registered with clinicaltrials.gov (NCT02786615).

Funding

National Institute on Drug Abuse (NIDA), grant number R01DA040513.

Benefit-Cost Analysis of the HHS COVID-19 Campaign: April 2021-March 2022

INTRODUCTION

This study estimated the benefits and costs of the U.S. Department of Health and Human Services' We Can Do This COVID-19 public education campaign (the Campaign) and associated vaccination-related impacts.

METHODS

Weekly media market and national Campaign expenditures were used to estimate weekly first-dose vaccinations that would not have occurred absent the Campaign, weekly Campaign-attributed complete vaccinations, and corresponding COVID-19 cases, hospitalizations, and deaths averted. Benefits were valued using estimated morbidity and mortality reductions and associated values of a statistical life and a statistical case. Costs were estimated using Campaign paid media expenditures and corresponding vaccination costs. The net Campaign and vaccination benefit and return on investment were calculated. Analyses were conducted from 2022 to 2024.

RESULTS

Between April 2021 and March 2022, an estimated 55.9 million doses of COVID-19 vaccines would not have been administered absent the Campaign. Campaign-attributed vaccinations resulted in 2,576,133 fewer mild COVID-19 cases, 243,979 fewer nonfatal COVID-19 hospitalizations, and 51,675 lives saved from COVID-19. The total Campaign benefit was $740.2 billion, and Campaign and vaccination costs totaled $8.3 billion, with net benefits of approximately $732.0 billion. For every $1 spent, the Campaign and corresponding vaccination costs resulted in benefits of approximately $89.54.

CONCLUSIONS

The We Can Do This COVID-19 public education campaign saved more than 50,000 lives and prevented hundreds of thousands of hospitalizations and millions of COVID-19 cases, representing hundreds of billions of dollars in benefits in less than one year. Findings suggest that public education campaigns are a cost-effective approach to reducing COVID-19 morbidity and mortality.

Motivating COVID-19 Vaccination through Persuasive Communication: A Systematic Review of Randomized Controlled Trials

Vaccination is a vital defense against COVID-19 infections and outbreaks, yet vaccine hesitancy poses a significant threat to pandemic response and recovery. We conducted a systematic review of published randomized controlled trials (N = 47) assessing the persuasive effects of COVID-19 communication on COVID-19 vaccine acceptance. Individual vs. collective appeals and gain vs. loss frames are among the most frequently assessed message features, but they generally do not make a difference in persuasion. Normative messages that highlight higher (vs. lower) prevalence of vaccine acceptance are more persuasive. Message sources overall have limited impact on COVID-19 vaccine acceptance, but sources that have a shared identity with the message receivers tend to be persuasive. More engaging message channels such as interactive chatbots and videos are promising communication tools but are generally under-utilized and under-studied. Compared to no communication or irrelevant communication, COVID-19 vaccine messages generally have a small advantage in increasing COVID-19 vaccine acceptance. Messages that include 1) vaccine safety and/or efficacy information; 2) collective appeals combined with embarrassment appeals; and 3) political leaders' vaccine endorsement are among the most effective messaging strategies. There is no evidence of any backfire effects of COVID-19 vaccine messages. We discuss the implications of our findings for persuasive message design in pandemic vaccine communication.

Knowledge of HIV transmission, prevention strategies and U = U among adult sexual and gender minorities in Brazil

INTRODUCTION

Although strong scientific evidence of the efficacy and effectiveness of treatment-as-prevention (TasP) is available, full endorsement of the "Undetectable = Untransmittable" (U = U) and "zero-risk" messages could be improved. Increasing knowledge about HIV transmission, prevention and treatment is a critical component of care efforts. The study assessed knowledge of HIV transmission and prevention strategies, and the perceived accuracy of the slogan U = U among sexual and gender minorities (SGM) in Brazil.

METHODS

Cross-sectional web-based survey targeting adult SGM living in Brazil (2021-2022) recruited on social media and dating apps. We used the 12-item HIV Knowledge Assessment (HIV-KA) questionnaire to assess HIV knowledge, three items of which address pre-exposure prophylaxis (PrEP), post-exposure prophylaxis and TasP. Perceived accuracy of the U = U slogan was assessed with the question: "With regards to HIV-positive individuals transmitting HIV through sexual contact, how accurate do you believe the slogan U = U is?". We a priori grouped the study population into three mutually exclusive groups: people living with HIV (PLHIV), HIV negative and HIV unknown. We used logistic regression models to assess factors associated with high HIV knowledge and perception of the U = U as completely accurate.

RESULTS

Of 50,222 individuals accessing the questionnaire, 23,981 were included: 5071 (21.0%) PLHIV, 17,257 (71.5%) HIV negative and 1653 (6.9%) HIV unknown. The proportion of participants with high knowledge was significantly higher for PLHIV and HIV negative (48.1% and 45.5%, respectively) compared to 26.1% of HIV unknown. More PLHIV perceived U = U as completely accurate (80.4%), compared to 60.0% of HIV negative and 42.9% of HIV unknown. HIV knowledge correlates with perceived accuracy of the U = U slogan across all groups. Higher HIV knowledge was associated with higher income and education regardless of HIV status. Among HIV-negative participants, PrEP awareness and use were associated with higher knowledge and accurate perception of the U = U slogan.

CONCLUSIONS

Our findings show that HIV knowledge and perceived accuracy of U = U are strongly correlated, that knowledge differs according to HIV status, and that poor socio-economic is linked to poor knowledge among SGM from Brazil. Educational strategies regarding TasP, U = U and zero risk targeting socio-economically vulnerable populations are urgent in Brazil.

Recommendations for Improving Oral Pre-exposure Prophylaxis Implementation and Social Marketing in Ugandan Fisherfolk Communities: A Qualitative Exploration

Background: HIV is hyperendemic among fisherfolk in Sub-Saharan Africa, especially around Lake Victoria, Uganda. Purpose/Research Design: We conducted cross-sectional semi-structured interviews about oral pre-exposure prophylaxis (PrEP) implementation with 35 Ugandan fisherfolk (15 women, 20 men) and 10 key stakeholders (healthcare providers, policymakers, community leaders). We used a directed content analysis approach based on implementation science and social marketing frameworks. Results: Participants showed high acceptability for PrEP. Anticipated barriers among fisherfolk included stigma (due to similar medications/packaging as HIV treatment); misconceptions; mobility, competing needs, poverty, and partner conflict. Anticipated provider barriers included insufficient staffing and travel support. Recommendations included: change PrEP packaging; integrate PrEP with other services; decrease PrEP refill frequency; give transportation resources to providers; train more healthcare workers to provide PrEP to fisherfolk; and use positively framed messages to promote PrEP. Conclusions: Results can inform policymakers and healthcare organizations on how to overcome barriers to PrEP scale-up in most at-risk populations with poor healthcare access.

Evidence-Based Storytelling for a Strategic Roadmap to Promote Cancer Prevention via Adolescent HPV Vaccination in Northern New England

Vaccination rates for the human papillomavirus (HPV) among rural youth in northern New England lag those of more urbanized areas. Reasons include a lack of available medical offices, time constraints, perceptions of vaccines and HPV, and, to a smaller degree, delays caused by the COVID-19 pandemic. We have a responsibility to increase vaccinations in these communities. To do so, vaccination experts recommend addressing the three C's of vaccination hesitation: confidence, complacency, and convenience. With this framework as our foundation, in this article we detail a plan to address these important elements, and we add several more C's: clinics, communication, collaboration, community, capacity, and commitment to the list as we discuss the essential pieces-human, infrastructural, and perceptual-needed to create and promote successful, community-supported, school-based HPV vaccination clinics to serve youths aged nine to 18. We then integrate research and storytelling science into an innovative Persuasion Playbook, a guide for local opinion leaders to use in creating evidence-based, pro-vaccine messages on the community level to promote the clinics via evidence-based, pro-vaccination messages.

Using audience segmentation to identify implementation strategies to improve PrEP uptake among at-risk cisgender women: a mixed-methods study protocol

BACKGROUND

In the USA, 19% of new HIV infections occur among cisgender women (cis women); however, only 10% of eligible cis women have been prescribed pre-exposure prophylaxis (PrEP) for the prevention of HIV infection (an evidence-based intervention). A fundamental challenge for expanding HIV prevention to cis women is ensuring implementation strategies are tailored to the various healthcare settings in which cis women seek care and the heterogeneous providers nested within these settings. This project's specific aims are to (1) explore clinician-level characteristics and organizational climate factors that are related to variability in adoption of PrEP service delivery as an evidence-based intervention for cis women; (2) identify latent audience segments of women's health providers as the related to PrEP acceptability, adoption, and maintenance and analyze demographic correlates of these segments; and (3) identify audience segment-specific implementation strategies to facilitate the adoption of PrEP as an evidence-based intervention among at-risk cis women.

METHODS

Using the i-PARIHS framework, this mixed-methods study examines three domains for guiding audience segmentation to facilitate PrEP implementation for cis women: innovation (degree of fit with existing practices, usability), recipient beliefs and knowledge and context factors (organizational culture, readiness for change), needs to determine appropriate facilitation methods. To achieve aim 1, qualitative interviews will be conducted with PrEP-eligible cis women, women's health providers, and other key stakeholders. Aim 2 will consist of a quantitative survey among 340 women's health providers. Latent class analysis will be used to facilitate audience segmentation. To achieve aim 3, a panel of 5-8 providers for each audience segment will meet and engage in iterative discussions guided by Fernandez's implementation mapping to identify (1) implementation outcomes and performance objectives, determinants, and change objectives and (2) determine and refine of implementation strategies for each audience segment.

DISCUSSION

This exploratory mixed methods study will provide an empirical foundation to inform the development implementations strategies aimed at increasing PrEP delivery to cis women among heterogenous groups of providers.

Public Relations as a Factor in the Prevention of Suicide: The Veteran Administrations Crisis Line

This study examines the effectiveness of the Veterans Administration's (VA) public relations and the effectiveness of advertisements of its suicide hotline, which is called the veterans crisis line (VCL). Using the organization-public relations theory (OPR) this study examined whether known failures of VA marketing campaigns for the VCL could be related to public relations factors. This study found that the VA suffers from a negative perception with veterans, and this translated into lower support for the VCL compared to another suicide hotline. This study concludes that ineffective public relations may indeed be a factor in the reluctance of veterans in crisis to call the VCL for life saving mental health support.

A scoping review of media campaign strategies used to reach populations living with or at high risk for Hepatitis C in high income countries to inform future national campaigns in the United Kingdom

BACKGROUND

With the advent of direct acting antivirals, the World Health Organisation proposed eliminating Hepatitis C as a public health threat by 2030. To achieve this, countries need to diagnose, engage in care and treat their undiagnosed populations. This will require sensitisation campaigns. However previous media campaigns have had mixed impact. We conducted a scoping review to identify and understand the impact of previous Hepatitis C media campaigns. These findings could inform the delivery of future campaigns.

METHODS

We searched five electronic databases for published literature on media campaigns conducted for Hepatitis C awareness, testing, and treatment in Organisation for Economic Co-operation and Development (OECD) countries since 2010. Two independent reviewers screened citations for inclusion. Additionally, we spoke to stakeholders in the Hepatitis C field in the UK and conducted a Google search to identify any unpublished literature. A quantitative synthesis was conducted to identify targeted populations, strategies and media used, aims and impact of the campaigns.

RESULTS

A title and year of publication screening of 3815 citations resulted in 113 papers that had a full abstract screen. This left 50 full-text papers, 18 were included of which 9 (50%) were from Europe. 5 (27.8%) of campaigns targeted minority ethnicities, and 9 (50%) aimed to increase testing. A Google search identified 6 grey literature sources. Most campaigns were not evaluated for impact. Discussions with stakeholders identified several barriers to successful campaigns including lack of targeted messaging, stigmatising or accusatory messaging, and short-lived or intermittent campaign strategies.

CONCLUSION

Future campaigns will likely need to be multifaceted and have multiple tailored interventions. Campaigns will need to be sizeable and robust, integrated into health systems and viewed as an ongoing service rather than one-offs.

Evaluation of the "We Can Do This" Campaign Paid Media and COVID-19 Vaccination Uptake, United States, December 2020-January 2022

Public education campaigns are promising methods for promoting vaccine uptake. In April 2021, the U.S. Department of Health and Human Services launched the We Can Do This COVID-19 public education campaign. This study is one of the first evaluations of this COVID-19 public education campaign. We tested associations between channel-specific campaign exposure (i.e. digital, TV, radio, print, and out-of-home advertising) and COVID-19 first-dose vaccinations among a nationally representative online sample of 3,278 adults. The study introduces novel ways to simultaneously evaluate short- and long-term cumulative media dose, filling an important gap in campaign evaluation literature. We observed a positive, statistically significant relationship between the short-term change in digital media dose and the likelihood of first-dose vaccination, and a positive, statistically significant relationship between long-term cumulative TV dose and the likelihood of first-dose vaccination. Results suggest that both digital and TV ads contributed to vaccination, such that digital media was associated with more immediate behavioral changes, whereas TV gradually shifted behaviors over time. As findings varied by media channel, this study suggests that public education campaigns should consider delivering campaign messages across multiple media channels to enhance campaign reach across audiences.

Evaluating use of mass-media communication intervention 'MTV-Shuga' on increased awareness and demand for HIV and sexual health services by adolescent girls and young women in South Africa: an observational study

OBJECTIVE

To investigate the effect of exposure to MTV Shuga:Down South' (MTVShuga-DS) during the scale-up of combination HIV-prevention interventions on awareness and uptake of sexual reproductive health (SRH) and HIV-prevention services by adolescent girls and young women (AGYW).

DESIGN

One longitudinal and three cross-sectional surveys of representative samples of AGYW.

SETTING

AGYW in four South African districts with high HIV prevalence (>10%) (May 2017 and September 2019).

PARTICIPANTS

6311 AGYW aged 12-24.

MEASURES

Using logistic regression, we measured the relationship between exposure to MTV Shuga-DS and awareness of pre-exposure prophylaxis (PrEP), condom use at last sex, uptake of HIV-testing or contraception, and incident pregnancy or herpes simplex virus 2 (HSV-2) infection.

RESULTS

Within the rural cohort 2184 (85.5%) of eligible sampled individuals were enrolled, of whom 92.6% had at least one follow-up visit; the urban cross-sectional surveys enrolled 4127 (22.6%) of eligible sampled individuals. Self-report of watching at least one MTV Shuga-DS episode was 14.1% (cohort) and 35.8% (cross-section), while storyline recall was 5.5% (cohort) and 6.7% (cross-section). In the cohort, after adjustment (for HIV-prevention intervention-exposure, age, education, socioeconomic status), MTVShuga-DS exposure was associated with increased PrEP awareness (adjusted OR (aOR) 2.06, 95% CI 1.57 to 2.70), contraception uptake (aOR 2.08, 95% CI 1.45 to 2.98) and consistent condom use (aOR 1.84, 95% CI 1.24 to 2.93), but not with HIV testing (aOR 1.02, 95% CI 0.77 to 1.21) or acquiring HSV-2 (aOR 0.92, 95% CI 0.61 to 1.38). In the cross-sections, MTVShuga-DS was associated with greater PrEP awareness (aOR 1.7, 95% CI 1.20 to 2.43), but no other outcome.

CONCLUSIONS

Among both urban and rural AGYW in South Africa, MTVShuga-DS exposure was associated with increased PrEP awareness and improved demand for some HIV prevention and SRH technologies but not sexual health outcomes. However, exposure to MTVShuga-DS was low. Given these positive indications, supportive programming may be required to raise exposure and allow future evaluation of edu-drama impact in this setting.

Characterizing Twitter Content About HIV Pre-exposure Prophylaxis (PrEP) for Women: Qualitative Content Analysis

BACKGROUND

HIV remains a persistent health problem in the United States, especially among women. Approved in 2012, HIV pre-exposure prophylaxis (PrEP) is a daily pill or bimonthly injection that can be taken by individuals at increased risk of contracting HIV to reduce their risk of new infection. Women who are at risk of HIV face numerous barriers to HIV services and information, underscoring the critical need for strategies to increase awareness of evidence-based HIV prevention methods, such as HIV PrEP, among women.

OBJECTIVE

We aimed to identify historical trends in the use of Twitter hashtags specific to women and HIV PrEP and explore content about women and PrEP shared through Twitter.

METHODS

This was a qualitative descriptive study using a purposive sample of tweets containing hashtags related to women and HIV PrEP from 2009 to 2022. Tweets were collected via Twitter's API. Each Twitter user profile, tweet, and related links were coded using content analysis, guided by the framework of the Health Belief Model (HBM) to generate results. We used a factor analysis to identify salient clusters of tweets.

RESULTS

A total of 1256 tweets from 396 unique users were relevant to our study focus of content about PrEP specifically for women (1256/2908, 43.2% of eligible tweets). We found that this sample of tweets was posted mostly by organizations. The 2 largest groups of individual users were activists and advocates (61/396, 15.4%) and personal users (54/396, 13.6%). Among individual users, most were female (100/166, 60%) and American (256/396, 64.6%). The earliest relevant tweet in our sample was posted in mid-2014 and the number of tweets significantly decreased after 2018. We found that 61% (496/820) of relevant tweets contained links to informational websites intended to provide guidance and resources or promote access to PrEP. Most tweets specifically targeted people of color, including through the use of imagery and symbolism. In addition to inclusive imagery, our factor analysis indicated that more than a third of tweets were intended to share information and promote PrEP to people of color. Less than half of tweets contained any HBM concepts, and only a few contained cues to action. Lastly, while our sample included only tweets relevant to women, we found that the tweets directed to lesbian, gay, bisexual, transgender, queer (LGBTQ) audiences received the highest levels of audience engagement.

CONCLUSIONS

These findings point to several areas for improvement in future social media campaigns directed at women about PrEP. First, future posts would benefit from including more theoretical constructs, such as self-efficacy and cues to action. Second, organizations posting on Twitter should continue to broaden their audience and followers to reach more people. Lastly, tweets should leverage the momentum and strategies used by the LGBTQ community to reach broader audiences and destigmatize PrEP use across all communities.

Recalled Exposure to COVID-19 Public Education Campaign Advertisements Predicts COVID-19 Vaccine Confidence

This study examined the relationship between recalled exposure to the We Can Do This COVID-19 Public Education Campaign (the Campaign) and COVID-19 vaccine confidence (the likelihood of vaccination or vaccine uptake) in the general population, including vaccine-hesitant adults (the "Movable Middle"). Analyses used three waves of a triannual, nationally representative panel survey of adults in the U.S. fielded from January to November 2021 (n = 3,446). Proportional odds regression results demonstrated a positive, statistically significant relationship between past 4-month Campaign recall and vaccine confidence, controlling for lagged reports of Campaign recall and vaccine confidence; concurrent and lagged fictional campaign recall; survey wave; and sociodemographics. Results indicated that as one moves from no Campaign recall to infrequent recall, there is a 29% increase in the odds of being in a higher vaccine confidence category. Findings offer evidence of the impact of a COVID-19 public education campaign on increasing vaccine confidence.

Effectiveness of Prevention Interventions Using Social Marketing Methods on Behavioural Change in the General Population: A Systematic Review of the Literature

In an effort to encourage people to adopt healthy behaviours, social marketing is increasingly used in disease prevention and health promotion. This systematic review aimed to evaluate the effect of prevention initiatives that use social marketing techniques on achieving behavioural change in the general population. We conducted a systematic review of PubMed, Embase, Science Direct, Cochrane, and Business Source Complete. Among 1189 articles identified across all databases, 10 studies met the inclusion criteria (six randomized controlled trials and four systematic reviews). The number of social marketing criteria used varies according to the studies. The results showed positive effects overall, albeit not always statistically significant. The quality of the studies was mixed: 3/4 of the systematic reviews did not meet the methodological criteria, and four out of six randomized trials had at least a high risk of bias. Social marketing is not fully exploited in prevention interventions. However, the greater the number of social marketing criteria used, the more positive the effects observed. Social marketing thus appears to be an interesting concept to bring about behavioural change, but it requires rigorous monitoring to ensure maximum effectiveness.

Preventing the COVID-19 Outbreak in Vietnam: Social Media Campaign Exposure and the Role of Interpersonal Communication

The present study focused on the success story of Vietnam's ability to control the COVID-19 outbreak in the early stages to examine the associations between exposure to the Vietnam Ministry of Health's COVID-19 prevention social media campaign messages, interpersonal communication, attitudes, perceived norms, self-efficacy, and intentions to stay at home. A cross-sectional survey was conducted with residents in Ho Chi Minh City (N = 360). Results from mediation analyses indicated that interpersonal communication mediated the effect of social media campaign exposure on intentions to stay at home. Moreover, interpersonal communication shaped injunctive norms and self-efficacy that were conducive to behavioral intentions. These results underscored the need to leverage the power of social media and interpersonal communication in public health campaigns to prevent infectious outbreaks.

Television airings of U.S. federal COVID-19 public service announcements in 2020 were associated with market-level political orientation, not COVID-19 rates

Televised public service announcements were one of the ways that the U.S. federal government distributed health information about the COVID-19 pandemic to Americans in 2020. However, little is known about the reach of these campaigns or the populations who might have been exposed to the information these ads conveyed. We conducted a descriptive analysis of federally-affiliated public service announcement airings to assess where they were aired and the market-level social and demographic characteristics associated with the airings. We found no correspondence between airings and COVID-19 incidence rates from March to December 2020, but we found a positive association between airings and the Democratic vote share of the market, adjusting for other market demographic characteristics. Our results suggest that PSAs may have contributed to divergent exposure to health information among the U.S. public during the first year of the COVID-19 pandemic.

Innovative perception analysis of HIV prevention messaging for black women in college: a proof of concept study

BACKGROUND

Black women in college are disproportionately affected by HIV, but have not been a population of focus for HIV prevention campaigns. This study used content from a preexisting HIV media campaign to assess its relevancy and acceptability among Black women in college.

METHODS

Media viewing and listening sessions were convened with Black women enrolled at an HBCU (n = 10) using perception analyzer technology-hardware and software tools that are calibrated to gather and interpret continuous, in-the-moment feedback. Matched pre-and-post-test responses from focus groups were obtained from the perception analyzer data. Descriptive statistics and t-tests were used to characterize the data.

RESULTS

Students were more likely to personally identify with media content that included profound statements, along with memorable people and actors [95% CI: 1.38, 2.27]. In over half of the vignettes, participants reported that content representing students' society, culture, or interests was missing.

CONCLUSIONS

HIV prevention media campaigns may offer potential in increasing HIV awareness and risk perceptions; further research is needed to evaluate optimal content tailoring for both cultural and climate relevancy.

How Little Do We Know about HIV and STIs Prevention? Results from a Web-Based Survey among the General Population

Background: Prevention campaigns have led to a significant decrease in new HIV diagnoses in Western Europe, while other sexual transmitted infections (STIs) have shown an opposite trend. Several educational programs are promoted among young students, whereas informational campaigns addressing the general population are scarce. We aimed to investigate the level of awareness regarding STIs among the general population. Methods: We proposed a questionnaire regarding STIs and HIV to the general population in Italy. We assigned 1 point to correct, 0.5 point to partially correct, and 0 point to wrong answers. We collected data about age, sex, region of origin, level of education and whether they were health workers. Results: Overall, 2183 people answered the questionnaire, of which 555 aged over 50 years old. Being male, older than 50 years old, retired or unemployed, not educated, and no regular use of condoms were associated with lower scores. Only 16% of participants knew the Undetectable = Untransmittable (U = U) campaign. Overall, 2131 (97.6%) people think more educational campaigns should be offered. Of interest, 80% said the questionnaire led them to learn more about HIV and STIs. Conclusion: Our study reveals several gaps in general population awareness about HIV and STIs, especially among people aged over 50 years old. Most participants stated that the questionnaire was a learning opportunity. These data suggest that improvement of knowledge could start from easy-to-dispose medium, such as surveys and questionnaires delivered through social media. Furthermore, particular attention should be paid to population segmentation and campaign tailoring to enhance interventions effectiveness. Our data reinforce the need for more informational and educational campaigns tailored to the specific segments of the population.

Fifteen Years after a 10-year Retrospective: The State of Health Mass Mediated Campaigns

In 2006, a 10-year retrospective of successful mass mediated health communication campaigns reviewed the field and highlighted strategies for successful campaigns. In the 15 years since the retrospective, there have been dramatic changes in the media environment and advances in health communication research. In this article, we describe changes in the health communication media landscape and in our understanding of mass mediated health communication campaigns in the 15 years since the retrospective. Although the media environment has shifted, we argue that effective principles of health communication have remained relatively constant. We note significant advances in technology since the previous retrospective that can further advance health communication campaigns, with new technologies offering promise as channels for health communication campaigns as well as for campaign planning. We also recommend that campaign researchers report in detail on their use of theory, audience segmentation, channel selection, and the role of formative research when describing campaign efforts; that communicators continue to develop frameworks that integrate principles of effective campaign design; and that additional research focus on understanding how technology can be effectively incorporated into campaign planning, distribution, and evaluation.

Perceptions of Public Messaging to Facilitate Help Seeking during Crisis among U.S. Veterans at Risk for Suicide

OBJECTIVE

The primary objectives of this study were to (1) examine how veterans at risk for suicide understand and interpret suicide prevention messages, and (2) identify message features that support (or hinder) help seeking behaviors.

METHOD

Individual virtual interviews (N = 40) were conducted from August 2018 to April 2019 with a nationwide sample of veterans who had a recent non-fatal suicide attempt. Participants were exposed to three messages in public circulation that promote help seeking during crisis and an interview guide steered open-ended conversations on the mechanisms of persuasive communication. Interview transcripts were analyzed using a constant comparison analytic strategy in Atlas.ti.

RESULTS

Preferences for particular kinds of messages and features emerged during interviews based on a need for novel, emotionally intense stimuli among veterans. Specifically, messages with solemn themes and darker, more provocative imagery were believed to be particularly potent for engaging those at high risk. Although the goal of promoting help seeking was discernable, actionable steps (crisis line use) were not clearly communicated potentially preventing messages from increasing help seeking behaviors.

CONCLUSION

While messaging was perceived as capable of intervening to promote help seeking, participants reported distinct communication preferences and needs during periods of high risk. Findings underscore the significance of involving those with lived experience to inform the effective design and use of help seeking messaging targeting veterans at risk for suicide.HighlightsPublic messaging (campaigns) is a portable suicide prevention interventionCareful study is needed to effectively communicate help seeking messagesFindings inform the effective use of campaigns with veterans at risk for suicide.

Let Me Prep You to PREP Me: Amplifying the Voices of Black Women and Their Providers to Consider PrEP as an HIV Prevention Option

Despite the high efficacy of pre-exposure prophylaxis (PrEP) in preventing HIV acquisition, PrEP uptake among Black cisgender women remains low. Our qualitative study assessed Black cisgender women's perspectives, attitudes, and acceptability towards PrEP, in addition to exploring PrEP-related attitudes, facilitators, and barriers to PrEP access among health care staff. This study was conducted to ascertain data to inform the development of our HIV prevention app-Savvy HER-which is being designed for Black cisgender women. Our findings indicated that Black women had low levels of PrEP acceptability and high levels of misconceptions, inaccurate knowledge, and stigma towards PrEP. Health care providers in our sample confirmed barriers of stigma, misconceptions, and knowledge among their patients coupled with difficulty accessing PrEP due to structural barriers. Our study indicated that there is a critical need to heighten Black cisgender women's PrEP knowledge and HIV risk perception in order to increase PrEP acceptability and uptake.

Public Health Messaging during the COVID-19 Pandemic and Beyond: Lessons from Communication Science

The COVID-19 pandemic has made it clear that effective public health messaging is an indispensable component of a robust pandemic response system. In this article, we review decades of research from the interdisciplinary field of communication science and provide evidence-based recommendations for COVID-19 public health messaging. We take a principled approach by systematically examining the communication process, focusing on decisions about what to say in a message (i.e., message content) and how to say it (i.e., message executions), and how these decisions impact message persuasiveness. Following a synthesis of each major line of literature, we discuss how science-based principles of message design can be used in COVID-19 public health messaging. Additionally, we identify emerging challenges for public health messaging during the COVID-19 pandemic and discuss possible remedies. We conclude that communication science offers promising public health messaging strategies for combatting COVID-19 and future pandemics.

The use of positive and negative appeals in social advertising: a content analysis of television ads for preventing HIV/AIDS

Effectiveness of positive and negative appeals in social advertising depends on the target audience and the context in which the messages are applied. However, there is a dearth of research on the real use of such message appeals by social marketers. Considering the importance of practice theory in social marketing, this paper presents a longitudinal research on the use of positive and negative appeals in social advertising, since communication has been particularly relevant in social marketing practices over time. A content analysis of 375 HIV/AIDS-prevention TV ads from four European countries indicates that positive appeals had expressive and higher proportional use over the entire period under analysis. The researchers identified positive appeals, especially in rhetoric, music and voice tonality, while negative appeals are more prevalent in narratives and signs from the scenes. The results show that participation of public figures promoting coping response was low, but increasing over time. Negative appeals are mostly expressed in countries with higher uncertainty avoidance indexes and higher epidemic incidence rates. The prevalence of positive and negative appeals in social advertisements informs about practitioners’ choices when designing campaigns and allows analyzing congruity between the use of appeals and theoretical recommendations for social marketing effectiveness. The study opens the discussion about the application of social marketing theories into practice and how the analysis of social marketing practices may contribute to design innovative theoretical approaches, particularly regarding a topic plagued by inconsistent findings in the literature on message-frame effectiveness in social marketing. The practitioners’ preference for the gain-frame perspective over the protection motivation approach allows inquiring about the motivations and constraints leading to that choice.

Discipline for pleasure: a new governmentality of HIV prevention

This article explores recent HIV prevention campaigns for pre-exposure prophylaxis (PrEP), focusing on how they integrate pleasure and desire in their calls for self-discipline through a continual use of pharmaceuticals. This emerging type of health promotion, here represented by ads promoting the preventive use of pharmaceuticals, no longer simply approaches target groups with demands to abstain from harmful substances or practices and thus control risks, but also includes messages that recognize individuals' habits, values, and their desires for pleasure. Drawing on Foucault's work concerning discipline and security, we suggest that a novel, permissive discipline is emerging in contemporary HIV prevention. Further guided by Barthes's theory of images, we analyse posters used in prevention campaigns, scrutinizing their culture-specific imagery and linguistic messages, i.e. how the words and images interact. We conclude that these campaigns introduce a new temporality of prevention, one centred on pleasure through the pre-emption and planning that PrEP enables.

Sólo Se Vive Una Vez: Evaluation of a Social Marketing Campaign Promoting HIV Screening and Prevention for Immigrant Latinxs

Latinxs in the U.S. are disproportionately affected by HIV and more likely to have delayed diagnosis than their non-Latinx peers. We developed and implemented Sólo Se Vive Una Vez (You Only Live Once), the first Spanish-language campaign aimed at improving HIV testing and prevention among Latinx immigrants in Baltimore, Maryland. Sólo Se Vive Una Vez featured a website (www.solovive.org) and social marketing campaign promoting free HIV testing through the Baltimore City Health Department (BCHD) clinic and Latinx outreach team. The campaign was not associated with a change in the overall number of Latinxs obtaining HIV testing. However, Latinx HIV testers who reported being exposed to the campaign had significantly higher rates of high-risk sexual behaviors, mean number of sexual partners, and substance use. The campaign was also associated with increased PrEP referrals through the BCHD Latinx outreach team.

A Longitudinal Analysis of the Impact of Health Behavior Campaigns on HIV-Risk Behaviors and HIV Incidence in Eswatini

Between 2010 and 2015, Eswatini conducted mass media health behavior campaigns (HBCs) designed to avert new HIV infections. Using longitudinal data from the nationally representative Swaziland HIV Incidence Measurement Survey of 2011, we describe the impact of exposure to HBCs on selected HIV risk behaviors and HIV incidence among sexually active, HIV-negative adults (n = 11,232). Exposure to partner reduction HBCs was significantly associated with reporting fewer (i.e., 1 versus 2, or 2 versus ≥ 3) sexual partners in the prior 6 months at baseline among women (aOR = 3.02; 95% CI 1.38, 6.62); and at both baseline and at 6-months follow-up for men (aOR = 2.26; 95% CI 1.49, 3.44; aOR = 1.95, 95% CI [1.26-3.00], respectively). Despite these reported partner reductions, there was no association between HBC exposure and prospectively observed HIV seroconversions (n = 121). This analysis strengthens the evidence that HIV prevention at the population level requires integrated strategies.

Awareness, Utilization, and Preferences for Traditional and Contemporary HIV Prevention Strategies Among Facebook and Instagram-Using MSM in the United States

HIV prevention research among men who have sex with men (MSM) has traditionally focused on individual risk reduction strategies. Our study evaluated awareness, utilization, and preferences for 10 complementary HIV prevention strategies among 1,286 MSM recruited via Facebook and Instagram from June-August 2018. Ages ranged from 18-85 years, and the majority were non-Hispanic white (n = 1,019, 79.24%), college-educated (n = 819, 63.69%), gay-identifying (n = 1,074, 83.51%), and partnered (n = 808, 62.83%). Post-exposure prophylaxis was the least familiar option, and engaging in sexual activities other than anal sex was the most utilized option. Progressively older and bisexual-identifying MSM were less likely, but those with higher educational levels and easy access to local HIV resources were more likely to be aware of and to be utilizing a greater number of strategies. Additionally, Hispanic MSM were less likely to be aware of, and those in a “closed” relationship were less likely to be utilizing a greater number of strategies. In a subset of 775 multiple strategy users, pre-exposure prophylaxis, regularly testing for HIV, and limiting the number of sex partners emerged as the most preferred options. Combination intervention packages for MSM should be tailored to personal circumstances, including sexual orientation, relationship characteristics and access to local HIV resources.

Elevated Perceived Risk for HIV as a Barrier to Accessing Health Care Among Black Men Who Have Sex with Men

We sought to examine how self-perception of risk for HIV and HIV status information avoidance are related to HIV testing uptake and engagement in routine health care among Black men who have sex with men (BMSM)-the group at highest risk for HIV in the USA. To do so, we used generalized linear modeling and serial mediation modeling to assess data from 342 HIV-negative BMSM collected from 2017 to 2019 in Atlanta, GA, USA. Participants reported considerable concern for testing HIV-positive; 40% reported believing they would test positive for HIV; 27% reported being "extremely concerned about getting HIV"; and 17% reported worrying about HIV "all the time". Mediation analyses demonstrated that greater concern for HIV was associated with longer intervals since the last HIV test and the last health-care appointment. BMSM perceived themselves to be at considerable risk for HIV, but critically, this outlook did not yield improved health-care behaviors. Findings highlight the need to reconceptualize our public health approach to reaching BMSM. Emphasizing risk behavior and targeting efforts toward BMSM may have unintended consequences and need to be reevaluated. Despite continued efforts to improve HIV-related outcomes, we are failing to meet the needs of BMSM.

Arresting fake news sharing on social media: a theory of planned behavior approach

Purpose

This study aims to examine the collective impact of awareness and knowledge about fake news, attitudes toward news verification, perceived behavioral control, subjective norms, fear of missing out (FoMO) and sadism on social media users’ intention to verify news before sharing on social media.

Design/methodology/approach

The current study’s conceptual framework is developed by a comprehensive literature review on social networking and the theory of planned behavior. The data for samples were collected from 400 respondents in India to test the conceptual framework using the partial least square–structural equation modeling technique.

Findings

The results show that awareness and knowledge, perceived behavioral control, attitudes toward news verification and FoMO are significant predictors of intention to verify news before sharing.

Research limitations/implications

The present study concludes implications for managers of social media companies and policy actors that want to take steps toward arresting the spread of fake news via social media.

Originality/value

Academic investigation on fake news sharing on social media has recently gained traction. The current work is unique because it uses the theory of planned behavior as a basis for predicting social media user’s intention to verify news before sharing on social media.

90 DAYS: An investigation of a short entertainment-education film to improve HIV status disclosure among black women living with HIV in Miami-Dade County

Within Miami-Dade County, Black women experience disproportionate rates of HIV incidence and prevalence. Status disclosure to sexual partners is central to mitigating the HIV epidemic and ensuring a healthier lifestyle for those living with the virus. The disclosure processes model (DPM) posits that barriers such as stigma and negative outcome expectations often facilitate disclosure avoidance. Therefore, this study investigated the utility and acceptability of an entertainment-education (EE) short film, 90 DAYS, for disclosure among Black women living with HIV in Miami-Dade County. Employing photo-elicitation (Harper, 2002), focus groups were conducted with 48 participants. After screening the 90 DAYS film about stigma and disclosure, participants were asked semi-structured questions based upon extant EE and DPM literature. Via inductive and deductive processes, five themes were derived from the data. Participants found the 90 DAYS film to be an empowering counter-narrative that could be used to overcome multiple disclosure-related factors. They felt it provided a social script for how to disclose to their sexual partners. A novel finding of this investigation was that respondents asserted the film could facilitate safer disclosure events. Additional themes included the film being a resource of hope for young and newly diagnosed women; and an educational tool for the community. Altogether, findings lend promise to the use of EE for addressing disclosure avoidance among Black women living with HIV.

Food Safety and Rural Parents in China: Investigating an Effective Path for Risk Communication

Measurements of the effects of improvements in single communication elements (audience, channel, message, etc.) to promote risk and health communication effectiveness have been widely studied; however, whether a combination of optimum communication elements always leads to successful communication has rarely been discussed. In this study, we investigated communication with 909 rural parents in China to explore how these carefully selected communication elements worked together to contribute to the effectiveness of food-related risk communication. Specifically, two sets of communication strategies were designed with different combinations of optimum communication elements and were applied to parents segmented by perception biases. The outcomes show that the effectiveness of communication did not necessarily depend on the combination of optimum elements, but rather on the key element that the audience cared most about. The finding of this research also underscores the need for increased awareness and the importance of both the investigation of the socio-demographic and dimensional perception characteristics of the segmented cluster, and the outcome evaluation procedure in the identification of the key element. Our study develops quantitative exploration of risk communication effectiveness and provides new insight regarding risk/health communication in rural China. An effective path and methodology for risk communication in the rural area of China has been proposed, which would not only provide a practical reference for Chinese practitioners to launch real risk communication campaigns in rural areas, but also methodologically contribute to successful efforts to identify the key element and improve effective communication practices for a larger range of health-related issues.

Health communication campaigns to drive demand for evidence-based practices and reduce stigma in the HEALing communities study

BACKGROUND

The HEALing Communities Study (HCS) is testing whether the Communities that Heal (CTH) intervention can decrease opioid overdose deaths through the implementation of evidence-based practices (EBPs) in highly impacted communities. One of the CTH intervention components is a series of communications campaigns to promote the implementation of EBPs, increase demand for naloxone and medications for opioid use disorder (MOUD), and decrease stigma toward people with opioid use disorder and the use of EBPs, especially MOUD. This paper describes the approach to developing and executing these campaigns.

METHODS

The HCS communication campaigns are developed and implemented through a collaboration between communication experts, research site staff, and community coalitions using a three-stage process. The Prepare phase identifies priority groups to receive campaign messages, develops content for those messages, and identifies a "call to action" that asks people to engage in a specific behavior. In the Plan phase, campaign resources are produced, and community coalitions develop plans to distribute campaign materials. During the Implement stage, these distribution plans guide delivery of content to priority groups. Fidelity measures assess how community coalitions follow their distribution plan as well as barriers and facilitators to implementation. An evaluation of the communication campaigns is planned.

CONCLUSIONS

If successful, the Prepare-Plan-Implement process, and the campaign materials, could be adapted and used by other communities to address the opioid crisis. The campaign evaluation will extend the evidence base for how communication campaigns can be developed and implemented through a community-engaged process to effectively address public health crises.

Exploring Current Stereotypes and Norms Impacting Sexual Partner HIV-Status Communication

This study sought to explore HIV-related stereotypes and norms that impact HIV-status communication with potential sexual partners. A series of focus groups and in-depth interviews were conducted (N = 59) with HIV-positive and HIV-negative MSM (75%) and Heterosexuals (25%). Findings indicate that HIV stereotypes and stigma remain as barriers to HIV-status discussion. Differences also emerged across groups: 1) HIV-negative MSM were more likely to report engaging in HIV-status communication, 2) HIV-positive MSM described inconsistent HIV-status communication and reported concealing their status at times, and 3) Heterosexuals reported being least likely to engage in HIV-status communication; often using the blanket question "Are you clean?" to encompass all STIs and avoiding direct HIV-status discussion. Overall, findings indicate that many HIV stereotypes and stigma-related communication norms persist that discourage discussion of sexual partners' HIV-status prior to sexual activity.

Individual and contextual predictors of comprehensive HIV and AIDS knowledge among young females in Ghana

Sub-Saharan Africa is a region that is severely affected by the HIV and AIDS pandemic with females disproportionately affected. Having accurate and comprehensive knowledge about HIV and AIDS is a major strategy in the fight against the pandemic. This study sought to examine the individual and contextual predictors of comprehensive HIV and AIDS knowledge among young women in Ghana. The study used the females' file from the 2014 Ghana Demographic and Health Survey dataset. A total of 1 407 young women were used for the analysis. Both bivariate and multivariate analyses were done. The results showed that about 22% of the respondents had comprehensive HIV and AIDS knowledge. Young women with secondary and higher levels of education (AOR = 2.85, p < 0.01) and those from the Upper East Region (AOR = 7.15, p < 0.001) had higher odds of comprehensive HIV and AIDS knowledge. However, those cohabiting (AOR = 0.57, p < 0.01) and those who do not watch TV at all (AOR = 0.50, p < 0.01) had lower odds of comprehensive HIV and AIDS knowledge. Comprehensive HIV and AIDS knowledge is low among young women in Ghana and the predictors are both individual (marital status and education) and contextual (region, watching television and listening to radio). A concerted effort is needed to improve the HIV and AIDS knowledge of young people. Mass media campaigns aimed at improving comprehensive HIV and AIDS knowledge should appreciate the individual and contextual factors that influence the comprehensive HIV & AIDS knowledge of young women.

Shigellosis Among Gay and Bisexual Men: A Qualitative Assessment to Examine Knowledge, Attitudes, and Practices

BACKGROUND

Shigellosis is a highly contagious enteric bacterial disease transmitted through the fecal-oral route. It is primarily transmitted through person-to-person contact and via contaminated food and water. Outbreaks of shigellosis among men who have sex with men (MSM) attributed to sexual person-to-person contact have been reported. These outbreaks are of concern because they are often caused by multidrug-resistant strains of Shigella. Little is known about shigellosis-related knowledge, attitudes, and practices among gay, bisexual, and other MSM.

METHODS

Six focus groups were conducted among self-identified gay or bisexual men in Atlanta, GA, in Fall 2017. Participants were asked about shigellosis-related knowledge, attitudes, and practices. Focus groups were audio recorded, and the transcribed audio was analyzed using inductive and deductive thematic coding.

RESULTS

Among the 24 focus group participants, most perceived that diarrheal illness was caused by contaminated food. Knowledge of shigellosis and Shigella was low, with most never having heard of the disease or bacteria. Participants did not perceive shigellosis to be a serious health concern, especially when compared with HIV; however, they did perceive gay and bisexual men to be at risk of Shigella infection. Participants reported mixed intentions to change sexual behaviors to prevent shigellosis or talk with sexual partners about diarrhea.

CONCLUSIONS

Health communication and education efforts could be used to increase knowledge about shigellosis and shift perceptions about the severity of shigellosis among gay, bisexual, and other MSM. Additional work is needed to identify effective ways to promote shigellosis-related prevention behaviors among gay, bisexual, and other MSM.

Knowledge, attitudes and practices of young adults towards HIV prevention: an analysis of baseline data from a community-based HIV prevention intervention study in two high HIV burden districts, South Africa

BACKGROUND

With an HIV incidence of 1.00 skewed against women (1.51), adolescents in South Africa are at high HIV risk. This paper assesses young adults' (18-24 years) knowledge, attitudes and practices regarding HIV prevention in Nkangala and OR Tambo districts.

METHODS

A cross-sectional household survey was conducted in two districts in 2017/8. Participants completed computer-assisted self-interviews on HIV knowledge, attitudes, behaviour practices, use of social media and condom use at last sex (proxy for high-risk sex). HIV knowledge was assessed using the South African-adapted UNAIDS scale. Descriptive analyses were conducted and logistic regression models were built to assess factors associated with being knowledgeable of HIV and condom use at last sex.

RESULTS

One thousand nine hundred fifty-five participants were interviewed (90% response rate). Less than half (44.7%) had correct knowledge of HIV prevention and 73% used a condom at last sex. Social media use predicted high HIV knowledge as higher odds were observed among participants using the print media (aOR1.87; 1.34-2.60), WhatsApp (aOR1.55; 1.26-1.90), radio/television (aOR2.75; 1.15-6.55) although social networking sites' use protected against knowledge acquisition (aOR0.53; 0.34-0.82). Females (aOR0.75; 0.58-0.97) and participants reporting sexual risk were less likely to have HIV knowledge as negative associations were found for having multiple sexual partners in the last 3 months (aOR0.63;0.48-0.82) and ever having sex (aOR0.37;0.23-0.61). Participants who abused drugs (aOR1.40; 1.05-1.88) and had attitudes accepting people living with HIV (aOR2.05; 1.14-3.69) had higher odds of having HIV knowledge. Females (aOR0.70; 0.54-0.91), students (aOR0.52; 0.40-0.66) and participants who abused drugs (aOR0.58; 0.43-0.77) were less likely to report condom use at last sex.

CONCLUSIONS

There is a correlation between media use and HIV knowledge, non-condom use and HIV knowledge, and high-risk sexual behaviours and less HIV knowledge. An aggressive community media campaign utilising locally available, preferred and accessible media platforms among young adults is required for behaviour change.

Effectively Communicating About HIV and Other Health Disparities: Findings From a Literature Review and Future Directions

Despite significant progress in the prevention and treatment of HIV, disparities in rates of infection remain among key groups in the United States, including blacks and African Americans; Hispanics/Latinos; and men who have sex with men (MSM). The U.S. Department of Health and Human Services' initiative, Ending the HIV Epidemic: A Plan for America, calls for addressing HIV-related disparities and reducing stigma and discrimination associated with HIV. The goal of this literature review was to identify approaches for effectively communicating about health disparities across the HIV care continuum. We reviewed the literature to investigate strategies used to communicate health disparities and to identify potential unintended adverse effects resulting from this messaging. Messages about health disparities often target subgroups at higher risk and can be framed in a variety of ways (e.g., social comparison, progress, impact, etiological). Studies have examined the effects of message framing on the risk perceptions, emotional reactions, and behaviors of individuals exposed to the messaging. The evidence points to several potential unintended adverse effects of using social comparison framing and individual responsibility framing to communicate about health disparities, and visual images and exemplars to target messages to higher-risk subgroups. There is not yet a clear evidence-based approach for communicating about health disparities and avoiding potential unintended effects. However, we offer recommendations for communicating about HIV-related disparities based on our findings. Because we found limited literature that addressed our research questions in the context of HIV, we propose a research agenda to build an evidence base for developing effective messages about HIV-related disparities.

Get Yourself Tested Goes to High School: Adapted Sexually Transmitted Disease Prevention Campaign and Associated Student Use of Clinic Sexually Transmitted Disease Testing Services

BACKGROUND

In an attempt to increase high school students' sexually transmitted disease (STD) testing rates, the Centers for Disease Control and Prevention's Division of Adolescent and School Health partnered with ICF and Chicago Public Schools to adapt and implement the "GYT: Get Yourself Tested" health marketing campaign for a high school.

METHODS

Clinic record data and student retrospective self-report surveys (n = 193) tested for differences between the GYT intervention school and a comparison school on a number of outcomes, including human immunodeficiency virus and STD testing.

RESULTS

Clinic record data showed that testing increased significantly more for the intervention than the comparison school during the GYT implementation period (B, 2.9; SE, 1.1, P < 0.05). Furthermore, the odds of being tested at the referral clinic were more than 4 times (odds ratio, 4.4) as high for students in the campaign school than for those in the comparison school (95% confidence interval, 2.3-8.2). Survey data did not show increased self-reported testing but, more students in the GYT school (92.7%) were aware of where to receive free, low-cost, or affordable human immunodeficiency virus and STD testing than students in the comparison school (76.0%; P < 0.01). Among sexually experienced students (n = 142), significantly more from the campaign school reported that they intended to test for STDs in the next 3 months (48.4% strongly agree and 33.2% agree) compared with those at the comparison school (27.4% strongly agree and 32.9% agree; P < 0.05).

CONCLUSIONS

Our pilot suggests that a student-led GYT campaign in high schools may successfully increase STD testing of students. Although some of the findings from this pilot evaluation are promising, they are limited, and broader implementation and evaluation is needed. Future evaluation efforts can include more rigorous study designs, multiple schools or districts, longer campaign and evaluation across an entire school or calendar year, or in combination with other school-based testing strategies like a mass school-based screening event.

Using Media to Promote Public Awareness of Early Detection of Kaposi's Sarcoma in Africa

Background

Despite its hallmark cutaneous presentation, most Kaposi's sarcoma (KS) in Africa is diagnosed too late for effective treatment. Early diagnosis will only be achievable if patients with KS present earlier for care. We hypothesized that public awareness about KS can be enhanced through exposure to common media.

Methods

We developed educational messages regarding early detection of KS for the general African public portraying a three-part theme: “Look” (regularly examine one's skin/mouth), “Show” (bring to the attention of a healthcare provider any skin/mouth changes), and “Test” (ask for a biopsy for definitive diagnosis). We packaged the messages in three common media forms (comic strips, radio, and video) and tested their effect on increasing KS awareness among adults attending markets in Uganda. Participants were randomized to a single exposure to one of the media and evaluated for change in KS-related knowledge and attitudes.

Results

Among 420 participants, media exposure resulted in increased ability to identify KS (from 0.95% pretest to 46% posttest); awareness that anyone is at risk for KS (29% to 50%); belief that they may be at risk (63% to 76%); and knowledge that definitive diagnosis requires biopsy (23% to 51%) (all p < 0.001). Most participants (96%) found the media culturally appropriate.

Conclusion

Exposure to media featuring a theme of “Look,” “Show,” and “Test” resulted in changes in knowledge and attitudes concerning KS among the general public in Uganda. High incidence and poor survival of KS in Africa are an impetus to further evaluate these media, which are freely available online.

'Break the Chains 2015' community-based HIV prevention campaign for men who have sex with men in Switzerland: non-randomised evaluation and cost analysis

OBJECTIVES

To study the implementation, effects and costs of Break the Chains, a community-based HIV prevention campaign for men who have sex with men (MSM) in Switzerland, from March to May 2015, which aimed to reduce early HIV transmission by promoting the campaign message to adopt short-term risk reduction followed by HIV testing.

DESIGN

Non-randomised evaluation and cost analysis.

SETTING

Gay venues in 11 of 26 cantons in Switzerland and national online media campaign.

PARTICIPANTS

MSM in online surveys (precampaign n=834, postcampaign n=688) or attending HIV testing centres (n=885); campaign managers (n=9); and campaign staff (n=38) or further intermediaries (n=80) in an online survey.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcome measure was the proportion of MSM at risk of HIV acquisition or transmission who adhered to the campaign message. Secondary outcomes were postcampaign test uptake, knowledge about HIV primary infection and sense of belonging to the gay community.

RESULTS

Campaign staff estimated that they contacted 17 145 MSM in 11 cantons. Among 688 respondents to the postcampaign survey, 311 (45.2%) were categorised as MSM at risk. Of 402/688 (58.5%) MSM who had heard about Break the Chains 2015, MSM categorised as being at risk were less likely to report adherence to the campaign message than MSM not at risk (adjusted OR 0.24; 95% CI 0.14 to 0.42). Twenty per cent of MSM with a defined risk of HIV acquisition or transmission who adopted risk reduction declared having done so because of the campaign. Costs for one MSM at risk to adhere to the campaign message were estimated at USD purchasing power parity 36-55. The number of HIV tests in the month after the campaign was twice the monthly average.

CONCLUSION

Break the Chains increased HIV testing, implying that community-based campaigns are useful HIV prevention strategies for MSM. Additional interventions are needed to reach MSM at the highest risk of infection more effectively.

Meeting the Sexual Health Needs of Bisexual Men in the Age of Biomedical HIV Prevention: Gaps and Priorities

The field of HIV/STI prevention has primarily focused on gay men (or "men who have sex with men" [MSM] as a broad category) with limited attention to bisexual men in particular. Although bisexual men are also at increased risk for HIV and other STI, they are less likely to utilize HIV/STI prevention services than gay men, and very few interventions have been developed to address their unique needs. Further, while biomedical advances are changing the field of HIV prevention, bisexual men are also less likely to use biomedical HIV prevention strategies (e.g., pre-exposure prophylaxis [PrEP]) than gay men. In an effort to advance research on bisexual men and their sexual health needs, the goals of this commentary are: (1) to review the empirical literature on the prevalence of HIV/STI among bisexual men, the few existing HIV/STI prevention interventions developed for bisexual men, and the use of biomedical HIV prevention among bisexual men; (2) to describe the ways in which the field of HIV/STI prevention has largely overlooked bisexual men as a population in need of targeted services; and (3) to discuss how researchers can better address the sexual health needs of bisexual men in the age of biomedical HIV prevention.

A Psychometric Approach to Theory-Based Behavior Change Intervention Development: Example From the Colorado Meaning-Activity Project

Background

There has been a notable disconnect between theories of behavior change and behavior change interventions. Because few interventions are both explicitly and adequately theory-based, investigators cannot assess the impact of theory on intervention effectiveness. Theory-based interventions, designed to deliberately engage the theory's proposed mechanisms of change, are needed to adequately test theories. Thus, systematic approaches to theory-based intervention development are needed.

Purpose

This article will introduce and discuss the psychometric method of developing theory-based interventions.

Methods

The psychometric approach to intervention development utilizes basic psychometric principles at each step of the intervention development process in order to build a theoretically driven intervention to, subsequently, be tested in process (mechanism) and outcome studies. Five stages of intervention development are presented as follows: (i) Choice of theory; (ii) Identification and characterization of key concepts and expected relations; (iii) Intervention construction; (iv) Initial testing and revision; and (v) Empirical testing of the intervention.

Results

Examples of this approach from the Colorado Meaning-Activity Project (COMAP) are presented. Based on self-determination theory integrated with meaning or purpose, and utilizing a motivational interviewing approach, the COMAP intervention is individually based with an initial interview followed by smart phone-delivered interventions for increasing daily activity.

Conclusions

The psychometric approach to intervention development is one method to ensure careful consideration of theory in all steps of intervention development. This structured approach supports developing a research culture that endorses deliberate and systematic operationalization of theory into behavior change intervention from the outset of intervention development.

How learning misconceptions can improve outcomes and youth engagement with gambling education programs

BACKGROUND AND AIMS

Gambling education programs typically focus on promoting gambling as a high-risk activity with harmful effects; however, these programs demonstrate limited effects on the prevention of gambling problems. This paper proposes a clear theoretical framework to inform the content and delivery of gambling education initiatives and draws on psychological and pedagogical research to address some of the practical issues associated with its implementation.

METHODS

Literature was reviewed across fields of psychology, public health, and pedagogy to provide key recommendations to improve the outcomes of gambling education.

RESULTS

Four key recommendations were made for the development of future gambling education programs centering on theoretical approach, specialized content, and delivery.

DISCUSSION AND CONCLUSIONS

Recommended advancements are as follows: (a) evidence suggests shifting away from messages about gambling harms and instead applying a cognitive-developmental framework of problem gambling that may improve youth engagement by increasing personal relevance. (b) The cognitive model of problem gambling suggests that misconceptions about the profitability of gambling games (e.g., the gambler's fallacy) play an important role in the development of problems and should be a key target for education. However, exposing such misconceptions requires the challenge of teaching the mathematical principles that underpin them. (c) The pedagogical field provides valuable insights into teaching complex concepts. Research that applies the conceptual change model to science education suggests misconceptions also facilitate learning new complex information, such as gambling-related mathematical concepts (i.e., randomness and statistics). (d) In addition, improvements in computer-assisted teaching methods provide opportunities to use simulations and visualizations to help teach abstract concepts and correct such misconceptions.

Counselling and knowledge on iron and folic acid supplementation (IFAS) among pregnant women in Kiambu County, Kenya: a cross-sectional study

Background: The increased demand for iron and folic acid during pregnancy is not met through diet due to insufficiency or reduced bioavailability of nutrients among women from low income countries. Thus, iron and folic acid supplementation (IFAS) is a promising interventional strategy for control of anaemia during pregnancy. Kenya adopted the global IFAS intervention with a target of 80% coverage by 2017, however, the compliance remains low. Increasing awareness, counselling, communication and community education on IFAS have improved compliance among pregnant women. Thus, we aimed to determine: IFAS knowledge, availability, practices, and content of IFAS counselling among pregnant women attending health facilities in Kiambu County, Kenya.

Methods: A cross-sectional study involving 364 pregnant women aged 15-49 years. A two stage cluster sampling, including one sub-county and five public health facilities were used. A pre-tested, structured questionnaire consisting of socio-demographic data, maternal knowledge and counselling on IFAS was used. An observation checklist was used to observe practices and content of antenatal counselling session in each facility. Data was analysed using STATA in which descriptive and inferential statistics were computed.

Results: Of 364 respondents, less than half (40.9%) scored high on knowledge on IFAS. Women who were counselled on duration of IFAS intake, side effects, and their mitigation were more likely (p <0.005) to have high IFAS knowledge. Although all the health facilities had varied IFAS posters displayed, none had key IFAS counselling documents.

Conclusion: Less than half of the pregnant women had high IFAS knowledge, IFAS documents were scarce in health facilities, IFAS counselling information in different health facilities was limited and varied, and content of counselling was associated with levels of knowledge on IFAS. This underscores the need to strengthen focused and targeted IFAS counselling for pregnant women and standardization of counselling messages to improve compliance and pregnancy outcomes.

Counselling and knowledge on iron and folic acid supplementation (IFAS) among pregnant women in Kiambu County, Kenya: a cross-sectional study

Background: The increased demand for iron and folic acid during pregnancy is not met through diet due to insufficiency or reduced bioavailability of nutrients among women from low income countries. Thus, iron and folic acid supplementation (IFAS) is a promising interventional strategy for control of anaemia during pregnancy. Kenya adopted the global IFAS intervention with a target of 80% coverage by 2017, however, the compliance remains low. Increasing awareness, counselling, communication and community education on IFAS have improved compliance among pregnant women. Thus, we aimed to determine: IFAS knowledge, availability, practices, and content of IFAS counselling among pregnant women attending health facilities in Kiambu County, Kenya. Methods: A cross-sectional study involving 364 pregnant women aged 15-49 years. A two stage cluster sampling, including one sub-county and five public health facilities were used. A pre-tested structured questionnaire consisting of socio-demographic data, maternal knowledge and counselling on IFAS was used. An observation checklist was used to observe practices and content of antenatal counselling session in each facility. Data was analysed using STATA in which descriptive and inferential statistics were computed. Results: Of 364 respondents, less than half (40.9%) scored high on knowledge on IFAS. Women who were counselled on duration of IFAS intake, side effects, and their mitigation were more likely (p <0.005) to have high IFAS knowledge. Although all the health facilities had varied IFAS posters displayed, none had key IFAS counselling documents. Conclusion: Less than half of the pregnant women had high IFAS knowledge, IFAS documents were scarce in health facilities, IFAS counselling information in different health facilities was limited and varied and content of counselling was associated with levels of knowledge on IFAS. This underscores the need to strengthen focused and targeted IFAS counselling for pregnant women and standardization of counselling messages to improve compliance and pregnancy outcomes.

Community Perspectives on Contraception in the Context of the Zika Virus in the U.S. Virgin Islands: Implications for Communication and Messaging

BACKGROUND

Between January and October 2016, 575 symptomatic confirmed cases of Zika virus infection were reported in the U.S. Virgin Islands (USVI). Zika virus infection during pregnancy can cause serious birth defects. Preventing unintended pregnancy among women who choose to delay or avoid pregnancy is a primary strategy to reduce these adverse outcomes.

METHODS

A rapid assessment, using one men's and five women's focus groups (N = 43), was conducted to inform communication efforts to increase awareness of contraception as a means for preventing unintended pregnancy in the context of a Zika outbreak in the USVI.

RESULTS

Findings showed that people of reproductive age were aware of the relationship between Zika virus infection during pregnancy and adverse birth outcomes. However, when discussing methods for prevention, participants did not include preventing unintended pregnancy as a strategy to reduce these adverse outcomes. When asked about family planning in the USVI, participants discussed that, for some, planning pregnancies is not common. Participants wanted communications about contraception to include available methods, side effects, costs, and safety. Optimal communication channels included social media and local spokespersons. Participants identified health care providers as a trusted information source.

CONCLUSIONS

Findings from this assessment informed the design of a culturally appropriate communication strategy to raise awareness of the prevention of unintended pregnancy as a primary strategy to reduce Zika-related adverse birth outcomes in the USVI.

Characterizing Media Content and Effects of Organ Donation on a Social Media Platform: Content Analysis

BACKGROUND

The lack of organ donors has become a barrier for the development of organ transplantation programs, and many countries are currently facing a severe shortage of deceased organs. Media campaigns on social media have the potential to promote organ donation. However, little is known about what kind of media content is the most appropriate for this purpose.

OBJECTIVE

This study aimed to analyze media posts regarding organ donation on Weibo, a social media platform, and to identify the media themes that are most advantageous in promoting public awareness and attitudes concerning organ donation.

METHODS

Based on 16 million social media users' posts randomly extracted from January 1 to December 31, 2017, 1507 reposts of 141 distinct media posts relevant to organ donation were found. We analyzed the media posts' themes and examined their effects in promoting public awareness about organ donation by comparing the number of reposts and comments they prompted. The themes' impact on attitude toward organ donation was gauged using the comments indicating support and intentions for organ donation.

RESULTS

Overall, 5 major themes were identified from the media posts, among which "organ donation behaviors" constituted the highest proportion (58/141, 41.13%). However, themes of "statistical descriptions of organ donation" and "meaningfulness of donation" were the most influential in promoting awareness on organ donation: approximately 3 of 10 commenters for the former theme and 2 of 10 commenters for the latter expressed intentions to become organ donors. These two themes, along with "meaningfulness of organ donation for society," a subtheme of "meaningfulness of donation," were the most effective for evoking support and intentions for donation.

CONCLUSIONS

A discrepancy was revealed between the media themes that were the most salient on the media agenda and those that were the most effective in increasing organ donation awareness and intentions on social media. These findings provide guidance for campaigns on organ donation. The results also suggest the potential of campaigns on social media for promoting prosocial health behaviors and highlight the importance of strategic message design for serving this goal.

Testing Makes Us Stronger™: Evaluating the correlation between exposure and intermediate outcomes targeted by the campaign's messages

OBJECTIVES

To examine whether self-reported exposure to Testing Makes Us Stronger™ (TMUS), an HIV testing health communication campaign for black gay, bisexual, and other men who have sex with men (BMSM), was associated with key intermediate outcomes targeted by the campaign's messages.

METHODS

Data from sexually active, HIV-negative or unknown status BMSM aged 18-44 (N = 590) were collected through an anonymous Web-based survey that measured sociodemographics, campaign exposure, attitudinal beliefs, normative beliefs, self-efficacy, and HIV testing intentions, among other variables. The association between exposure to TMUS and intermediate outcomes was evaluated using propensity-score weight adjusted correlations.

RESULTS

Exposure to TMUS was high (43%) among the priority audience. Exposure to the campaign was correlated with 8 of 11 intermediate outcomes measured, including key attitudinal beliefs about the accessibility of the test and benefits to the individual, injunctive norms, self-efficacy, and HIV testing intention.

CONCLUSION

Adhering to principles of effective campaign design, such as using theory as a conceptual foundation for message design, can increase a campaign's chances for successfully meeting its goals and objectives.

PRACTICE IMPLICATIONS

Findings from this study can be used to inform message design for other communication efforts to promote HIV testing among BMSM.