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Singler L, Uhlenbrauck G, Corbie-Smith G, Richmond A, Hattem A, Linney K, Cohen-Wolkowiez M. Say Yes! COVID Test: A Health Communication Campaign to Encourage Use of Rapid, At-Home Antigen Testing in Underserved and Historically Marginalized Communities. Inquiry 2023; 60:469580221146046. [PMID: 36704996 PMCID: PMC9903010 DOI: 10.1177/00469580221146046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
This paper describes a robust health communication campaign that supported Say Yes! COVID Test, the first National Institutes of Health (NIH)-sponsored initiative promoting community-wide, at-home, rapid antigen testing for severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2), the cause of the COVID-19 pandemic. The primary goals of the health communication campaign were to promote awareness of the program among local residents, facilitate test kit distribution, and encourage frequent test kit use. To plan and implement the campaign, the team applied principles of social marketing. The populations of focus were adult residents of selected communities in North Carolina (Greenville, Pitt County) and Tennessee (Chattanooga, Hamilton County), with an emphasis on underserved and historically marginalized populations. Following an accelerated planning phase, the campaign included digital, out-of-home, television, and radio advertising, in addition to public relations and organic social media. Collectively, this campaign coupled with our grassroots community engagement efforts facilitated the distribution of 66 035 test kits across both communities, or more than 1.6 million at-home tests. Facebook ads were the most successful in driving online test kit orders (7.9% conversion rate in Pitt County; 8.1% conversion rate in Chattanooga), although employing a variety of marketing channels enabled reach across multiple subpopulations. Market research data indicated high program awareness but low uptake in testing. Lessons learned from campaign planning and implementation can inform future public health initiatives, including selecting the appropriate marketing mix to facilitate awareness, and collaborating with community partners and local health departments to ensure successful program execution.
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Affiliation(s)
- Lindsay Singler
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Gina Uhlenbrauck
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | | | - Al Richmond
- Community-Campus Partnerships for Health, Raleigh, NC, USA
| | - Amy Hattem
- Pitt County Health Department, Greenville, NC, USA
| | - Kristen Linney
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Michael Cohen-Wolkowiez
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA,Michael Cohen-Wolkowiez, Duke Clinical Research Institute, 300 W Morgan St, Durham, NC 27701, USA.
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Hallinan ZP, Forrest A, Uhlenbrauck G, Young S, McKinney R. Barriers to Change in the Informed Consent Process: A Systematic Literature Review. IRB 2016; 38:1-10. [PMID: 27301167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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Welch MJ, Lally R, Miller JE, Pittman S, Brodsky L, Caplan AL, Uhlenbrauck G, Louzao DM, Fischer JH, Wilfond B. The ethics and regulatory landscape of including vulnerable populations in pragmatic clinical trials. Clin Trials 2015. [PMID: 26374681 DOI: 10.1177/174074515597701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Policies have been developed to protect vulnerable populations in clinical research, including the US federal research regulations (45 Code of Federal Regulations 46 Subparts B, C, and D). These policies generally recognize vulnerable populations to include pregnant women, fetuses, neonates, children, prisoners, persons with physical handicaps or mental disabilities, and disadvantaged persons. The aim has been to protect these populations from harm, often by creating regulatory and ethical checks that may limit their participation in many clinical trials. The recent increase in pragmatic clinical trials raises at least two questions about this approach. First, is exclusion itself a harm to vulnerable populations, as these groups may be denied access to understanding how health interventions work for them in clinical settings? Second, are groups considered vulnerable in traditional clinical trials also vulnerable in pragmatic clinical trials? We argue first that excluding vulnerable subjects from participation in pragmatic clinical trials can be harmful by preventing acquisition of data to meaningfully inform clinical decision-making in the future. Second, we argue that protections for vulnerable subjects in traditional clinical trial settings may not be translatable, feasible, or even ethical to apply in pragmatic clinical trials. We conclude by offering specific recommendations for appropriately protecting vulnerable research subjects in pragmatic clinical trials, focusing on pregnant women, fetuses, neonates, children, prisoners, persons with physical handicaps or mental disabilities, and disadvantaged persons.
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Affiliation(s)
- Mary Jane Welch
- Human Subjects' Protection, College of Nursing, Rush University Medical Center, Chicago, IL, USA
| | - Rachel Lally
- Columbia University Medical Center, New York, NY, USA
| | - Jennifer E Miller
- Kenan Institute for Ethics, Duke University, Durham, NC, USA Edmond J. Safra Center for Ethics, Harvard University, Cambridge, MA, USA Division of Medical Ethics, NYU Langone Medical Center, New York, NY, USA
| | - Stephanie Pittman
- Human Subjects' Protection, Rush University Medical Center, Chicago, IL, USA
| | - Lynda Brodsky
- Cook County Health & Hospitals System, Chicago, IL, USA
| | - Arthur L Caplan
- Division of Medical Ethics, NYU Langone Medical Center, New York, NY, USA
| | - Gina Uhlenbrauck
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - Darcy M Louzao
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | | | - Benjamin Wilfond
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital, Seattle, WA, USA Division of Bioethics, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
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Welch MJ, Lally R, Miller JE, Pittman S, Brodsky L, Caplan AL, Uhlenbrauck G, Louzao DM, Fischer JH, Wilfond B. The ethics and regulatory landscape of including vulnerable populations in pragmatic clinical trials. Clin Trials 2015; 12:503-10. [PMID: 26374681 DOI: 10.1177/1740774515597701] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Policies have been developed to protect vulnerable populations in clinical research, including the US federal research regulations (45 Code of Federal Regulations 46 Subparts B, C, and D). These policies generally recognize vulnerable populations to include pregnant women, fetuses, neonates, children, prisoners, persons with physical handicaps or mental disabilities, and disadvantaged persons. The aim has been to protect these populations from harm, often by creating regulatory and ethical checks that may limit their participation in many clinical trials. The recent increase in pragmatic clinical trials raises at least two questions about this approach. First, is exclusion itself a harm to vulnerable populations, as these groups may be denied access to understanding how health interventions work for them in clinical settings? Second, are groups considered vulnerable in traditional clinical trials also vulnerable in pragmatic clinical trials? We argue first that excluding vulnerable subjects from participation in pragmatic clinical trials can be harmful by preventing acquisition of data to meaningfully inform clinical decision-making in the future. Second, we argue that protections for vulnerable subjects in traditional clinical trial settings may not be translatable, feasible, or even ethical to apply in pragmatic clinical trials. We conclude by offering specific recommendations for appropriately protecting vulnerable research subjects in pragmatic clinical trials, focusing on pregnant women, fetuses, neonates, children, prisoners, persons with physical handicaps or mental disabilities, and disadvantaged persons.
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Affiliation(s)
- Mary Jane Welch
- Human Subjects' Protection, College of Nursing, Rush University Medical Center, Chicago, IL, USA
| | - Rachel Lally
- Columbia University Medical Center, New York, NY, USA
| | - Jennifer E Miller
- Kenan Institute for Ethics, Duke University, Durham, NC, USA Edmond J. Safra Center for Ethics, Harvard University, Cambridge, MA, USA Division of Medical Ethics, NYU Langone Medical Center, New York, NY, USA
| | - Stephanie Pittman
- Human Subjects' Protection, Rush University Medical Center, Chicago, IL, USA
| | - Lynda Brodsky
- Cook County Health & Hospitals System, Chicago, IL, USA
| | - Arthur L Caplan
- Division of Medical Ethics, NYU Langone Medical Center, New York, NY, USA
| | - Gina Uhlenbrauck
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - Darcy M Louzao
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | | | - Benjamin Wilfond
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital, Seattle, WA, USA Division of Bioethics, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
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