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Promoting General Awareness of HPV, its Link to Cancer & Genital Warts: A Social Marketing Approach Allison Friedman, MS Eileen Dunne, MD Hilda Shepeard,

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Presentation on theme: "Promoting General Awareness of HPV, its Link to Cancer & Genital Warts: A Social Marketing Approach Allison Friedman, MS Eileen Dunne, MD Hilda Shepeard,"— Presentation transcript:

1 Promoting General Awareness of HPV, its Link to Cancer & Genital Warts: A Social Marketing Approach Allison Friedman, MS Eileen Dunne, MD Hilda Shepeard, MBA The findings & conclusions in this presentation are those of the authors and do not necessarily represent the views of CDC/ATSDR

2 Background  Most sexually active people acquire genital HPV at some time in their lives.  Yet there have been no national public health efforts to educate the public about HPV & its link to genital warts (GW) or cervical cancer (CC).  What little HPV information is available through the Internet & the popular/news media has been found to be unreliable, inaccurate, & incomplete.(1)  National surveys suggest that the public is largely unaware of HPV; most do not know about the HPV-CC link. (2) 1.Anhang et al., 2003; Brandt et al., 2005; Perrin et al., 2002; Stevens et al., 2004 2.ARHP, 2005; Wirthlin Worldwide, 2005; Kaiser Family Foundation, 2000

3  In 2001, Congress mandated CDC to “prepare and distribute educational materials for the public that include information on genital HPV, ” addressing: a) modes of transmission b) consequences of infection, including the HPV-CC link c) available scientific evidence on condom effectiveness for HPV prevention d) importance of regular Pap tests & other diagnostics for CC prevention  To be effective, these materials should be audience-centered, appropriate for, and relevant to target audiences (i.e., sexually active men & women).

4 Methods Between 2003-2005, CDC conducted formative research with men & women in the US. Participants were segmented by age, race/ethnicity (White, African American, Hispanic*), gender, and geographic location.  Exploratory Research: 35 focus groups explored the public’s (ages 25-45 yrs) awareness, perceptions & information needs regarding HPV (N=315).  Concept Testing: 14 focus groups** tested effectiveness of various communciation approaches in capturing attention & achieving intended results among audiences, ages 18-45yrs (N=117).  Message Testing: 15 focus groups** with adults (ages 18-29yrs) tested draft messages (Eng & Span) and designs for understandability, appropriateness & effectiveness (N=134). *Intention to expand/adapt materials in 5 languages (5 populations) **Also segmented by language (English/Spanish)

5 Exploratory Research Assessed public awareness of HPV, reactions to HPV information, and reactions to a hypothetical vaccine. Findings:  High awareness of GW; low awareness of HPV across all groups  Audience shock, fear, & concern in response to: Commonness & potential consequences of HPV Apparent ‘secrecy’ of government/public health agencies (AA)  Needed more information to assess vaccine acceptability  STD-associated stigma possible barrier to further info seeking & acceptance of a hypothetical vaccine

6 Exploratory Research: Implications Communication effort should:  Raise public awareness about HPV transmission, prevention, treatment and prevalence.  Be approached with caution in light of public fears/concerns, government distrust, and potential stigma (of HPV and CC)  Further research is needed to:  determine how to frame messages to minimize potential consequences  assess audience reactions to messages

7 Concept Testing Goal: Identify effective communciation approaches that capture audience attention & prompt further information-seeking, without instilling public fear or stigmatizing HPV or CC. - Assessed audience reactions to HPV fact sheet - Tested 3 approaches, 13 identify images, 28 headlines, 30 visuals/tones

8 Concept Testing: Results Participants reacted to HPV fact sheet with fear, confusion & anxiety. Fear & shock:  Commonness & potential severity, asymptomatic nature, lack of practical prevention, lack of cure, & lack of detection (men) of HPV Confusion:  HPV natural history, transmission, prevention, detection, clearance  Is HPV the same as cancer? HIV? Is it related to hygiene? (Hispanics ) Concerns & anxieties:  Desire/urgency to get tested for HPV  Doubts/distrust of partners & intentions to be more selective  Blame befalling women since only they can get diagnosed (women)

9  STD approach preferred by Latinas, younger women(<30yrs) & men for its personal & shared relevance. All groups wanted to know source of HPV acquisition.  Women >30yrs preferred a cervical cancer approach, but this approach was seen as irrelevant to men, and Latinas worried it would place the burden on women.  Identity images that stressed commonness & personal relevance preferred.  Headlines addressing the commonness & asymptomatic nature of HPV were viewed as most appealing.  Tones/images depicting men & women (real people), diversity, intimacy & couples were preferred. Concept/Approach Preferences

10 Recommendations for HPV Communication  STD approach may have broadest appeal  Need for two unique sets of materials: 1. General HPV info resources for both genders 2. Resources with more detailed HPV info for women  More research is needed to: Assess possible unintended consequences of STD approach Assess headlines emphasizing HPV prevalence, asymptomatic nature, & consequences Clarify most appropriate tones & images for HPV messaging

11 Message Testing Tested: - 2 versions of brochure content - 3 designs/headlines - 4 identity images Designs IndividualCoupleGroup Designs IndividualCoupleGroup Designs IndividualCoupleGroup

12 Results: Message Testing  Information useful, understandable, informative  Reactions to info reflected an appropriate level of concern, rather than a sense of alarm  Audience confusion about: seriousness of HPV (no need to get tested for HPV?) HPV-CC link: HPV types, notion of a “low-risk” virus HPV vs. HIV vs. HSV Pap test vs. HPV test incurable yet transient nature of HPV  Audience anxiety about: ease of HPV transmission asymptomatic & incurable nature of HPV lack of practical prevention options

13  Audiences preferred serious, eye-catching messages/designs, emphasizing indiscriminant, asymptomatic nature of HPV  Preference for statistics (↑ credibility, relevance), plain language, Q&A format, and messages minimizing blame  While message of ‘ no blame/shame ’ was clear, some felt HPV diagnosis would still prompt suspicions of partner infidelity  Hispanics appreciated guidance on how to discuss HPV with partner  Women did not want HPV framed as a women ’ s-only issue  Men wanted to know personal relevance & importance of HPV  All wanted clear guidance/ action steps (prevention, diagnosis) Message/Design Preferences

14 Motivated intentions:  Seek additional information  Talk to doctor/ friend/partner about HPV  Get regular Pap tests (women)  Be more cautious re. partner selection Unintended Reactions:  Desire to ‘ get tested for HPV ’  Feelings of helplessness/frustration (men) Trusted HPV information sources:  Public health/government, healthcare providers, hospitals, clinics  Some participants expressed distrust of government sources

15 Content Recommendations/Revisions  Target messages to minimize audience anxiety & stigma: Promote HPV as a common but important issue to know about Be upfront about transmission of HPV, but don ’ t lead with it Call-to-action should not emphasize urgent behavior change  Provide action steps for HPV, CC & STI prevention/risk reduction  Use statistics to convey high HPV prevalence  Add messaging to clarify identified points of confusion & address unintended reactions, e.g.,: Highlight info for men, reinforcing rarity of health consequences  Disseminate through trusted community-based organizations


17 Conclusions  HPV science may be inherently stigmatizing & confusing to audiences  This may have implications for current & future prevention efforts  A normalizing approach to HPV = most effective for maximizing audience awareness & empowerment, while minimizing undue fear/stigma & motivating information-seeking  Posters & booklets are available through CDC; currently being expanded  Broader communication effort developed to support this effort

18 Acknowledgments  Herschel Lawson (CDC)  Margo Gillman (Ogilvy PR)  Yolan Laporte (Ogilvy PR)  Jenny Mullen (Ogilvy PR)  Karen Toll (Ogilvy PR)  Emily Yu (Ogilvy PR)  Ogilvy PR Creative Team  Roxanne Barrow (CDC)  Mona Saraiya (CDC)  Amy Pulver (CDC)  John Douglas (CDC)  Lily Blasini-Alcivar (CDC)  Susan Delisle (CDC)  Donna McCree (CDC)

19 For More Information 1 -800-CDC-INFO Allison Friedman (404) 639-8537

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