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

‘‘It Makes You Rethink Your Choice of the Pill’’ Designing ¡Effec+ve ¡Contracep+ve ¡Campaign ¡Messages: ¡ ¡ A ¡theory-­‑based ¡research ¡approach Beth Sundstrom, PhD, MPH; Andrea L. DeMaria, PhD, MS; Annabel Jones, MA; and Stephanie Meier, BS

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

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

Women’s ¡Health ¡Research ¡Team ¡ Cervical ¡Cancer-­‑Free ¡South ¡Carolina ¡ hhp.cofc.edu/whrt • Collaborate • Innovate • Advocate facebook.com/womenshealthresearchteam WHRT_CofC

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 II. Theory of Planned Behavior • Innovation • Relative advantage, compatibility, • Attitude complexity, • Subjective Norm observability, etc. • Behavioral Intention • Communication Channels • Time • Social System

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

did you know female doctors USE THE IUD 3x more than other women? - American College of Obstetricians and Gynecologists (ACOG) Why think about birth control every day? Ask your doctor about the IUD today. Visit Bedsider.org for more information 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.

Demographics ¡ Ages 18-44 (23.6) Race/Ethnicity 15% White or Caucasian 85% Black or African American Birth Control Method 1% 3% 5% 5% 4% Calender None 33% OCP IUD Implant NuvaRing 49% Condom

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.” “With the percentages that they have for the IUD and the Relative Advantage: implant of 99% versus the pill that’s 91% effective, that kind Effectiveness of opens your eyes a little bit, since, most people go for the pill.” “This one about the female doctors who are strong and Observability: independent really got to me. If they were to do it to their Characters bodies then I’d feel a little more comfortable doing it to my own body.” “I think [QR Codes] are good because people always have Complexity: smartphones now, or iPads, that you can scan those, so if I Information-Seeking 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.” “[LARC] is a healthy choice, like you would choose to Compatibility: The exercise, you would choose the birth control option that Healthy Choice works the best.”

Cervical ¡Cancer-­‑Free ¡South ¡Carolina ¡ Message ¡Copy ¡ did you know female doctors Theory of Planned Diffusion of USE THE IUD Behavior Innovations 3x more than other women? • Normative Beliefs • Innovator - American College of Obstetricians and Gynecologists (ACOG) Why think about birth control every day? • Perceived • Complexity Ask your doctor about the IUD today. Behavioral Control • Observability • Self-efficacy Visit Bedsider.org for more information • Relative Doctors prefer the intrauterine device (IUD) because it is safe, easy and effective Advantage Small in size - big in success - IUDs are 99% effective at preventing pregnancy. IUDs should be FREE because of the Affordable Care Act. • Trialability

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.

e e e e e e e unh fri pful harm inc irr dif 0.93 0.74 0.62 Attitude 0.49 0.83 pri e 0.62 fri e 1 . 4 3 e fem 0.45 0.75 0.27 Intention SN 12 e e val 0.52 0.85 e me some e 1.11 0.47 PBC 0.63 0.44 e Model Fit Statistics upto- con- hcp ins info able me trol RMSEA CFI NFI 0.062 0.962 0.945 e e e e e e

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

Next ¡Steps… ¡ Cervical ¡Cancer-­‑Free ¡South ¡Carolina ¡ • 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 of 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!