Improving health: applying qi to public health messaging and social media

1. Improving health:applying qi to public health messaging and social media

2. Strengthening the Community of Practice for Public Health Improvement Presented by Eileen R Daley RN, MPH Black Hawk County Health Department, Iowa December 6, 2012

3. Integrating QI Strategies with the Community Health Needs Assessment and Planning Process

4. Needs Assessment Planning Teams • Silent brainstorm • Sorting and grouping of issues to build an “Affinity Diagram” for each domain • Cross-walk of issue “headers” to the Iowa Standards to identify needs • Prioritizing statements of need through evaluation criteria and rank order • Consensus decision-making to identify priority need(s) for each group, and • Translating priority needs into goal statements Teams were organized around the six domains of the Iowa Public Health Standards Group Process Strategies

5. Preventing Epidemics & the Spread of Disease

6. Identify an Opportunity for Improvement The process selected to improve is the lack of unified, timely, and culturally appropriate disease prevention messages to assist with the control of sexually transmitted infections (STI) in persons 15 – 24 years of age* • Consistent with the health improvement plan to provide clear, culturally appropriate, timely and effective education and information about prevention, management and control of communicable diseases to the public, and • Consistent with PHAB Standard 3.1, Provide Health Education and Health Promotion Policies, Programs, Processes, and Interventions to Support Prevention and Wellness *Black Hawk County has one of the highest rates of combined Chlamydia, Gonorrhea and Syphilis in the state of Iowa

7. PLAN: Assemble the QI Team Sub-group of the Community Resources Uniting for Sexual Health (CRUSH) Coalition with representation from: • Allen Hospital Women’s Health (MCH contractor) • Black Hawk County Board of Health • Iowa Department of Public Health • Black Hawk County Health Department (Lead Agency) • ME&V Healthcare Marketing Firm (contracted) • Planned Parenthood • University of Northern Iowa Student Health Services • Wheaton Franciscan Healthcare Women’s Health Clinic

8. Early AIM Statement • By November 2012, [social marketing measure pending marketing consultant input] will occur with persons 15 – 24 years residing in Black Hawk County • Marketing firm input needed to provide measure of success in reaching the target population • Initial AIM addressed short term results (within the scope of the project period) and did not address the long term outcome necessary to improve public health practice

9. Examine the Current ApproachWhat is contributing to the high rate of STIs in BHCo?

10. Control & Influence Chart Analysis of Issues Impacting STI Rates

11. Develop an Improvement Theory IF we undertake a targeted social media campaign, THEN we will decrease the incidence of STIs among men and women aged 15 – 24 in Black Hawk County

12. Revised AIM StatementShort – Medium – Long Term Measures • By November 2012, social media click - through* will occur at a frequency of at least 0.01% for Facebook and 0.10% for YouTube, with persons 15 – 24 years residing in Black Hawk County (short – term measure) • By the end of 2013, an increase in STI testing and disease confirmation will occur as a result of greater awareness/disease risk (medium term measure) • By the end of 2014, a decrease in STI rates will begin to occur as a result of increased testing and disease confirmation (long term measure) *Consumer “clicks” an advertisement impression for more information, i.e. STI education & link to testing sites

13. DO: Test an Improvement TheorySocial Marketing Campaign Strategy • Research confirmed the Waterloo and Cedar Falls markets ranked highest in STIs in Black Hawk County • Facebook and YouTube were the two social marketing communication mediums recommended because they can pinpoint the target audience by: • Age • Gender • Geography, and • Type of music listened to

14. Facebook has rules and regulations when it comes to social media marketing on their site, including no sexual words in ads when targeting people under the age of 18 • Research also showed that college age students, living in Cedar Falls, are high users of Facebook • “Test” and “prevention” campaigns targeted Men and Women 18 through 24 years of age, living in Cedar Falls

15. Facebook Survey Test Phase - Ad

16. Facebook Survey Test Phase

17. Facebook STI Prevention Campaign

18. STI Prevention Campaign Website

21. YouTube does not have any rules and regulations about using sexual terminology in a campaign ad • The City of Waterloo has an African American population of 15.5% (twice that of the County) and 76% of African American’s use YouTube (as compared to 50% of African American’s use Facebook) • The campaign targeted Men and Women 15 through 24 years of age, living in Waterloo

22. YouTube Survey Test Phase

23. YouTube Survey Test Phase - Ad

24. YouTube STI Prevention Campaign YouTube Ad #1 YouTube Ad #2

25. STI Prevention Campaign Website

28. STUDYIs Social Media Marketing Effective For This Audience?

29. Dealing With the Ups and Downs • Determining a social marketing measure of success • Negotiating a budget to expand from an original one month to a three month prevention campaign • Negotiating with the marketing firm for a benchmark of success • Pressure by community partners to justify the effectiveness and expense of social marketing when resources are scarce • Bundling revenue sources • Demonstrating gain to community partners and Marketing Agency Challenges Solutions

30. Lessons Learned • Be respectful of what everyone brings to the process • Involve community partners that may have something to gain or learn from the process • Accept that progress may not happen as you expect; let the process work and use the results to strengthen public health practice and community partnerships • Keep your governing board informed of successes and limitations as the process may lead to new endeavors and organizational change

31. ACTStandardizing the Theory and Sustainability • Funding for future social marketing ad campaigns and website expense • Justify to external funders based on results of process improvement • Collaboration with community partners to jointly sponsor campaigns • Build into FY2014 and beyond budgeting processes • Continue to work with CRUSH coalition to identify medium and long term benchmarks as well as monitor results • Share successes with public health partners

32. Thank youEileen R. Daley, RN, MPHBlack Hawk County Health Department319-291-2413 or edaley@co.black-hawk.ia.us ME&V Healthcare Marketing Generating Electrifying Results 6711 Chancellor Drive Cedar Falls, IA 50613 319.268.9151 www.MEandV.com

33. Proactive and Local Health Messages (PALM) Zanesville-Muskingum County Health Department Zanesville, Ohio Beverly Huth, Community Health Planner

34. Zanesville-Muskingum CountyZanesville, Ohio • Population 85,000 • Combined city county health district • Y Bridge City • Appalachian County • 65 Employees • Accreditation 2013 or 2014

35. PLAN:QI Project Selection Focus • In 2011, 32.4% of ZMCHD media messages met desired criteria • Proactive health messages • Messages based on local health needs

36. PLAN:Initial AIM Statement By October 31, 2012, ZMCHD will increase: The percentage of public health community messages based on local health need from 48.6% to 60% and increase the percentage of messages that are both proactive and based on local health need from 32.4% to 50%.

37. PLAN:AIM Statement Evolved By October 31, 2012, ZMCHD will increase the % of public health messages based on local health need* and increase the % of public health messages initiated by HD and based on local health need as measured by media exposures. Measure 1: Increase public health messages based on local health need from 48.6% to 60%. Measure 2: Increase the percentage of public health messages initiated by the health department based on local health need from 32.4% to 50%. Measure 3: Increase the number of message ideas generated by staff members (other than the PIO) from 1 to 5.

38. Tools the Team Used

39. DO: Collect the Data

40. Do: Design New Messaging Process

41. Study: Data Results • Improved from 48.6% to 65% Exceeds target by 5% points • Improved from 32.4% to 73% Exceeds target by 23% points • Improved from 1 to 27 messages generated by staff Significantly exceeds target • % of Messages Based on Local Needs Target of 60% • % of Messages Proactive Target of 50% • # of Messages Generated by HD Staff(other than PIO) Target of 5

42. Act: Sustain the Gains • Create new work flow process • Educate staff • PIO Trains Staff on News Advisory Report • PIO Sends Quarterly Reminders • Collect Data to Stay on Track and Maintain Gains

43. Challenges and Struggles • AIM statement. Clear definitions and measures. • What is the intervention? Defining the “DO”. • Analyzing the data. Are we comparing apples to apples?

44. 30 Seconds of Advice • Follow the PDSA process • Trust the team • Keep pushing forward • Build sustainability into the new process • Finally, don’t be surprised if your PDSA looks more like this………

45. PLAN-DO-STUDY-ACTCYCLE ACT DO Thank you!

46. Quality improvement and digital communications (Click here to Access the Prezi presentation)