It Makes You Rethink Your Choice of the Pill Designing Effec+ve - - PowerPoint PPT Presentation

Beth Sundstrom, PhD, MPH; Andrea L. DeMaria, PhD, MS; Annabel Jones, MA; and Stephanie Meier, BS

Designing ¡Effec+ve ¡Contracep+ve ¡Campaign ¡Messages: ¡ ¡

A ¡theory-­‑based ¡research ¡approach

‘‘It Makes You Rethink Your Choice of the Pill’’

Background ¡

Unintended Pregnancy

• Over half of pregnancies are unintended
• 76% of these births are publicly funded
• Healthy People Goal: 44% by 2020
• Long-acting reversible contraception (LARC)
• Implant and IUDs
• Over 99% effective

Cervical ¡Cancer-­‑Free ¡South ¡Carolina ¡ Why ¡(Not) ¡LARC? ¡

• Safe, Convenient, User-Friendly
• High continuation rates; well-liked

Several Factors Impact Uptake:

• Lack of knowledge
• Lack of awareness (of effectiveness)
• Misinformation
• Fear of side effects
• Health care providers may not recommend

Many successful campaigns/interventions

• Contraceptive Choice Project (75%!)

Purpose ¡ Health Communication

• Systematic theory-based formative research
• Preproduction & production message testing
• Concepts and designs that appeal to women

Cervical ¡Cancer-­‑Free ¡South ¡Carolina ¡ Women’s ¡Health ¡Research ¡Team ¡

• Collaborate
• Innovate
• Advocate

hhp.cofc.edu/whrt

WHRT_CofC facebook.com/womenshealthresearchteam

Cervical ¡Cancer-­‑Free ¡South ¡Carolina ¡ Women’s ¡Health ¡Research ¡Team ¡

• Research Team: Undergraduate, graduate, and faculty
• Research Learning Opportunities
• Publications and Presentations
• Community Partners

Theore+cal ¡Frameworks ¡

• I. Diffusion of Innovations

Theory

• Innovation
• Relative advantage,

compatibility, complexity,

• bservability, etc.
• Communication

Channels

• Time
• Social System
• II. Theory of Planned

Behavior

• Attitude
• Subjective Norm
• Behavioral Intention

Methods ¡ Phase 1: 6 focus groups (n=61), 2 hours, $50 Phase 2: 18 interviews, 30 minutes, $25 Phase 3: Web-based survey (n=547), 15 minutes Participant Recruitment: January – July 2014

• Facebook, email, online ads, and printed flyers
• Women ages 18-44 living in Charleston, S.C.

Message ¡Design ¡

Review of LARC Acceptability Studies and Relevant Theoretical Concepts Message Concepts Designed Focus Groups (Phase I) Message Concepts Revised Intercept Interviews (Phase II) Preproduction Message Development Production Message Testing Web-based Surveys (Phase III)

did you know female doctors

USE THE IUD

3x more than other women?

Why think about birth control every day? Ask your doctor about the IUD today. Doctors prefer the intrauterine device (IUD) because it is safe, easy and effective

Small in size - big in success - IUDs are 99% effective at preventing pregnancy. IUDs should be FREE because of the Affordable Care Act.

• American College of Obstetricians and Gynecologists (ACOG)

Visit Bedsider.org for more information

Demographics ¡

85% 15% Race/Ethnicity

White or Caucasian Black or African American

1% 33% 49% 4% 3% 5% 5%

Birth Control Method

Calender None OCP IUD Implant NuvaRing Condom

Ages 18-44 (23.6)

Phase ¡1 ¡and ¡2: ¡Qualita+ve ¡Results ¡

Theme Illustrative Quote Cost

“Since it’s free, that changes a lot because I feel like my previous perception was that this was really expensive and I would never do it just for that reason.”

Source

“Without a source, the statistic doesn’t really mean anything.”

Relative Advantage: Effectiveness

“With the percentages that they have for the IUD and the implant of 99% versus the pill that’s 91% effective, that kind

• f opens your eyes a little bit, since, most people go for the

pill.”

Observability: Characters

“This one about the female doctors who are strong and independent really got to me. If they were to do it to their bodies then I’d feel a little more comfortable doing it to my

• wn body.”

Complexity: Information-Seeking

“I think [QR Codes] are good because people always have smartphones now, or iPads, that you can scan those, so if I were interested in that, if that was in a magazine, I would definitely scan it because then you have it in your phone to look up later.”

Compatibility: The Healthy Choice

“[LARC] is a healthy choice, like you would choose to exercise, you would choose the birth control option that works the best.”

Cervical ¡Cancer-­‑Free ¡South ¡Carolina ¡ Message ¡Copy ¡

did you know female doctors

USE THE IUD

3x more than other women?

• American College of Obstetricians and Gynecologists (ACOG)

Diffusion of Innovations

• Innovator
• Complexity
• Observability
• Relative

Advantage

• Trialability

Theory of Planned Behavior

• Normative Beliefs
• Perceived

Behavioral Control

• Self-efficacy

Phase ¡3: ¡Web-­‑based ¡Survey ¡

Predicting women’s responses to contraceptive access messages: An application of the theory of planned behavior

• 547 women, 18-44, Charleston, S.C.
• Test and confirm efficacy of message concepts and

designs

• Descriptive statistics to analyze participant

characteristics and survey items

• Reliability analyses were conducted on the theory of

planned behavior (TPB) constructs to assess internal consistency

• Structural equation modeling (SEM) was used to

determine the fit of the TPB.

1 . 4 3 0.52 0.27 e e e e e e e e e e Intention Attitude

SN PBC

dif fri pful harm inc irr

unh

fri me val fem con- trol upto- me able info ins hcp e e e e e e e 0.45 0.85 0.62 0.47 0.44 0.63 1.11 0.75 0.49 0.62 0.93 0.74 0.83 e e e e

pri 12 some

Model Fit Statistics RMSEA CFI NFI 0.062 0.962 0.945

Phase ¡3: ¡Results ¡

• Almost 60% of participants indicated that they

felt more positively about the IUD and implant after viewing the posters.

• Approximately half of participants reported that

the posters prompted them to search for more information about LARC methods and/or initiate a discussion about these options.

Message ¡Takeaways ¡

• Safe (Healthy)
• Easy
• (Most) Effective
• Emphasize Choice
• Empower Women/Self-Efficacy

(Information, Statistics, Credible Sources)

• Cost (Affordable Care Act)
• Access: Health Care Providers

Budget ¡

Activity Cost Focus Groups ($50 x 61) $3050 Interviews ($25 x 18) $450 Survey ($100 x 3) $300 Advertising, Parking, Other $200 $4000

Cervical ¡Cancer-­‑Free ¡South ¡Carolina ¡ Next ¡Steps… ¡

• Working with community partners
• A group pretest-posttest quasi-

experimental study

• Create and test a contraceptive

decision making health communication campaign

Sundstrom, B., DeMaria, A.L., Meier, S., Jones, A., & Moxley, G.E. (In Press). “It makes you rethink your choice

• f the Pill:” Theory-based formative research to design a

contraceptive access campaign. Journal of Health Communication.

Cervical ¡Cancer-­‑Free ¡South ¡Carolina ¡ Research ¡In ¡Ac+on ¡

• How can you apply formative audience

research in your work?

• How can you apply preproduction and

production message testing in your work?

• How can we help?

The ¡Art ¡of ¡Messaging ¡

Qualitative Data

Identifying Themes/Patterns

Creating Messages Let’s Try it!