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«January 2010 1 Table of Contents I. Executive Summary A. Methodology B. Major Findings C. Implications for Communications II. Introduction A. ...»

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Perceptions of Draft and Existing Chlamydia Educational Materials:

Final Report from Focus Groups with Females Ages 15–25

January 2010


Table of Contents

I. Executive Summary

A. Methodology

B. Major Findings

C. Implications for Communications

II. Introduction

A. Guidance from Earlier Research Activities

B. Theoretical Foundation

III. Methodology

A. Participants

B. Consent

C. Products and Procedures

D. Analysis

IV. Limitations

V. Summary of Findings

A. Chlamydia Knowledge & Sources of Knowledge

B. Poster Concepts

1) Designs

2) Approaches

3) Calls to Action

4) Content

5) Sources

6) Channels and Formats

C. Logo Designs

D. Brochure/Factsheet Content

1) Basic Chlamydia Information

2) Talking to your doctor

3) Talking to your partner

4) Channels

E. Public Service Announcements

F. Online Testing

G. Website Features

VI. Recommendations

A. General Recommendations

1) Focus of the Campaign: Messages and Audiences

2) Call to Action

3) Secondary Audiences

4) Potential Partners and Channels

B. Overarching Concept and Materials Development Recommendations

1) Approaches & Messaging

2) Language Preferences

3) Design Elements

2 Recommendations for Developing Specific Materials



1) Calls to action

2) Logos

3) Public Service Announcements

4) Brochure/Factsheet Content

5) Interactive Website Components

6) D. Other Recommendations

1) Online Testing Kits

–  –  –

Appendix A: HBM and TPB Strategic Approach Appendix B: Moderator’s Guide Appendix C: Poster Concepts Appendix D: Calls to Action Appendix E: Logo Designs Appendix F: Brochure/Factsheet Content Appendix G: Suggestions for Interactive Website

–  –  –

4 I. Executive Summary Over 1.2 million chlamydia (CT) infections were reported to the Centers for Disease Control and Prevention (CDC) in 2008. Frequently it is asymptomatic, which facilitates transmission between sex partners. CT can cause serious problems in women if left untreated, including pelvic inflammatory disease and infertility. CDC currently recommends that all sexually active women ages 25 years and younger be screened annually for CT. This recommendation reflects the high incidence of CT in this population. According to CDC’s 2008 Surveillance Report, rates of CT were almost three times higher among women than among men, with the heaviest burden among women ages 15 to 24 years of age. Yet despite these recommendations, screening is largely missing its target population; the average age of a woman being screened for CT is 28.9 years.

The Centers for Disease Control and Prevention (CDC), Division of Sexually Transmitted Diseases (STD) Prevention commissioned a series of focus groups with teenage and young adult females (ages 15–25) to discuss issues related to CT and CT screening. Specifically, the purpose of this formative research study was to inform the development of a CT-related infertility prevention communication campaign.

Two research activities, a literature review and exploratory research, and two health communication/public health theories, Health Belief Model and Theory of Planned Behavior, have guided the research and materials development processes.

A. Methodology This study included three segments of females ages 15–25. CDC is targeting 15–25 year-olds because these individuals have the highest incidence of CT. The three segments of participants

are as follows:

 Females aged 15–17 (teenagers)  Females aged 18–25 who attend school (young adult students)  Females aged 18–25 who work (working young adults) A total of 18 focus groups were conducted in four cities across the United States (Atlanta, GA;

Alexandria, VA; Chicago, IL; and Dallas, TX). One dyad was conducted in Alexandria, VA.

Participants were recruited by market research firms in these locations.

All focus groups were conducted in professional focus group facilities. The moderators used a semi-structured moderator’s guide to briefly discuss participants’ existing knowledge and awareness of CT and gain in-depth feedback about draft and existing educational materials.

Focus groups were designed to solicit feedback about the design (i.e., visual elements and layout), concept (i.e., general idea), and approach (i.e., tone and feel) of educational materials and products. Products included six poster concepts; six calls to action; 13 logos; three types of information about CT (i.e., basic information, details about talking to one’s doctor, details about talking to one’s partner); and nine public service announcements. All materials except four logos and all of the public service announcements were developed specifically for this research.

5B. Major Findings

Chlamydia Knowledge & Sources of Knowledge Most participants identified CT as an STD, but few knew much more about the topic. Some knew that CT was curable, that it did not always have symptoms, or that it could lead to infertility. School or health class, health care providers, and television were sources of information about CT.

Poster Concepts Participants provided feedback on six poster concepts that were developed to empower women;

diminish barriers to CT testing by overcoming stigma and emphasizing ease of testing; and emphasize women’s health and infertility in relation to broader aspirations.

The woman you want to be was the most preferred poster overall. It was preferred in terms of message and design because it made participants think about their future and how their decisions can make an impact on their life. Others liked that it had a positive message—that there are some negative health impacts from CT that could be prevented through testing and treatment. This concept was considered empowering.

The Café poster was the second most preferred poster. Participants appreciated how the message and visual display suggested that people are not alone—that everyone, across races/ethnicities, ages, and socioeconomic classes is at risk for STDs and should be tested. The concept resonated with some participants because they could relate to the situation.

Scan your hardware tested well with teenage (15–17-year-old) participants. They appreciated the humorous analogy and attention getting nature of the poster and considered it relevant to their lives. Some in the young adult (18–25-year-old) segment stated that humorous messages like this one do not take the issue of STDs seriously. Other young adult participants did not like the comparison of a human body to something mechanical or replaceable like a computer.

The Confidence poster was met with mixed feedback. Many participants did not like the visual execution, but did appreciate the empowering message. There was some confusion over the connection between the “confidence” theme and CT. Many liked how the message referenced that a woman should be confident, but did not consider the featured model to be confident.

The Library poster was disliked by many participants. The intended message was to reduce stigma and suggest that your peers do not need to know if you get tested for STDS. However, it was interpreted as meaning that others would not think it is important or appreciate that someone gets tested. Although the message was intended to reduce stigma, the imagery suggested that people who need testing or have been tested should be isolated.

The Lots of things poster was considered inappropriate because it featured a urine sample and included a message that was perceived to stereotype women.

–  –  –

Participants were interested in campaign materials that featured men as well as women. A few participants pointed out that excluding men suggests that only women get CT or that it is not a man’s responsibility to be screened for STDs.

Participants across segments were interested in attention-getting, relevant concepts that used fear appeals (i.e., compelling information about the prevalence of CT, its ease of transmission, and possible consequences), yet gave women a simple, actionable step to take. Young adult participants viewed the use of humor less positively than those in the teenage segment.

Call to Action Three of the calls to action were the most popular across groups: Get informed. Get tested. Get on with your life.; No symptoms is no excuse. Get tested.; and Testing is easy. Knowing is everything.

Poster Content Participants wanted minimal, but direct, straight-forward and factual content on the posters.

Some were interested in additional details about CT, which could be provided through a website or other support materials.

Participants provided negative feedback on poster content and calls to action that suggested that STDs and STD testing should not be taken seriously. Phrases like “no big deal,” “get on with your life,” or “don’t stress” were disliked by many participants.

Poster Sources, Channels, and Formats Participants reported that materials should come from CDC, “a health organization,” and “school.” A few participants suggested that women should design the materials. The poster content could be used in magazine advertisements, posters, television commercials, and radio announcements.

Logo Designs Participants preferred logos with straightforward text and relevant images. The top-rated logo was “Get tested” because of its simple message and the stick figures, which conveyed intimacy;

though some felt the hearts did not apply to all contexts in which STDs are transmitted. The “Get checked” logo was also popular because it was easily linked with STD testing, but it was considered similar to existing logos (e.g., “Click-it or Ticket,” Nike). The phrases “Knowing is everything” and “I know” resonated well with participants. Although some felt the connection of these phrases to an STD testing campaign was not inherently clear, they appreciated how these phrases could be used in a campaign. Some participants recognized the “GYT” logo, and they liked it more than the participants who had never seen it before. The GYT logo with the acronym 7 spelled out was received more positively than the same logo without the phrase.

The groups did not like vague text or phrases. “Get over it,” “Scan it,” “Think.

Act. Be.,” and “It’s all you” were unpopular across all racial/ethnic groups and age groups.

Brochure/Fact Sheet Content Participants remarked that the content in each of the three versions was clear and easy to read.

Similar to poster content, participants preferred content that takes STDs and STD testing seriously. Across versions, participants requested that information about CT in same-sex relationships be included.

The “basic” CT information was viewed favorably. It provided answers to many participants’ questions, but left unanswered questions about how CT affects men, how an individual can experience symptoms if already treated for CT, how CT makes it easier to get HIV, and what it means to use condoms the “right way.” Many thought the information about oral sex was vague and uncertain, making it seem unreliable. Some were offended by the use of informal language in the content and the inclusion of a statement that promotes abstinence.

Participants were mixed on their opinions of the “talking to your doctor” content. They liked the content about CT testing but were mixed about the other sections. Young adult participants felt that much of the information was not relevant to them. Teenage participants viewed the information more positively. Participants felt that there was repetition in the information that could be eliminated. Some were confused by the detailed description of those individuals who need to be tested for CT. Many felt that the tips section could be shortened while also providing more actionable tips.

Perceptions were split by age on the content about speaking with one’s partner. Teenage participants were generally positive about the content, while the young adults thought it was unnecessary because it addressed personal and psychological issues that they could handle on their own. Participants liked the information about ways that CT is transmitted.

Participants would expect to receive this information from health care providers’ offices, schools, non-profit organizations, CDC, and the National Institutes of Health (NIH). They would like to receive the information in informational sheets, brochures, television announcements, newspapers, and Web content.

8Public Service Announcements

Participants reviewed nine public service announcements from existing and past campaigns about STDs and STD testing. Participants liked the use of videos that referenced men’s roles in relationships and STD testing/prevention or depicted intimate relationships represented a diversity of individuals, including those who looked like them; conveyed relatable friendships or real-life conversations between friends included specific information about STDs and presented relatable situations.

Findings suggest the need to strategically consider the tone and length of PSAs for a topic such as STDs, as well as the use of celebrities. The inclusion of celebrities elicited mixed reactions, but leaned toward negative. While celebrities effectively caught the audience’s attention, the message was not necessarily retained. Participants suggested that a PSA could lose credibility if viewers do not think the celebrity is appropriate for the topic. Participants did not like announcements that are short (under 20 seconds) or include fast speaking. Participants did not like the use of humor that does not take the issue of STDs seriously.

Online Testing Participants who were asked about ordering an online screening test were supportive but had concerns about confidentiality, reliability, and waiting period for results.

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