|
Folic
Acid
|
||||||||
DisclaimerSome of the facts in this example have been fictionalized for instructional purposes. |
||||||||
|
||||||||
Step 1.1 Write a problem statement. |
||||||||
|
Each year in the US, 2,000-3,000 of the 4,000 pregnancies affected by fatal or debilitating birth defects of the spine (spina bifida) and brain (anencephaly) could be prevented by a vitamin--folic acid. These defects are called neural tube defects (NTDs). Babies born with spina
bifida have an opening along their spine, through which the spinal tissue
protrudes. These babies often need to have many surgical treatments when
they are young, and most grow into adulthood with varying degrees of disability,
including paralysis of the feet and legs, and lack of control of the bowels
and bladder. Mental retardation sometimes occurs and learning disabilities
are common. In 1992, the United States Public Health Service (PHS) issued the recommendation that women of childbearing age consume 400 micrograms of folic acid daily to prevent NTDs. Even with this recommendation, there have been more babies born in the last 8 years with preventable spina bifida and anencephaly than born with defects caused by the thalidomide tragedy of the late 1950s and early 1960s. Lifetime costs for medical, developmental, and other services for children born with spina bifida are estimated to be about $500 million annually. Folic acid is a B-vitamin that is essential to human health. It is required for the body to make DNA and RNA, the blueprints for development of all cells. It is especially vital to a developing embryo because rapid cell division occurs early in fetal development. Consuming folic acid before conception and through the first month of pregnancy will prevent 50-75% of neural tube defects from occurring. |
||||||||
Step 1.2 Assess the problem's relevance to your program. |
||||||||
|
The Centers for Disease Control and Prevention (CDC) had a mandate to prevent disease, injury, and disability; birth defects were a specific focus of the Birth Defects and Developmental Disabilities Division of CDC's National Center for Environmental Health. CDC was integral in initiating and implementing the 1992 PHS recommendation and has since made a commitment toward making sure that all women of child-bearing age know about the recommendation and can act on it. In 1997, various government and non-government agencies formed a national task force [now called the National Council on Folic Acid (NCFA)] to reduce birth defects by promoting folic acid consumption. In 1998, the Birth Defects Prevention Act was passed. This act recommended that steps be taken to ensure that preventable birth defects be significantly reduced. The CDC also work closely with the National March of Dimes Birth Defects Foundation, the Spina Bifida Association of American, and many other health care and public health organizations. |
||||||||
Step 1.3 Explore who should be on the planning team and how team members will interact. |
||||||||
|
Organizations that were included are:
The Centers for Disease Control and Prevention had resources for beginning the health communication planning process and technical experts to do the process in a systematic manner. Under CDC's leadership, the National Council on Folic Acid (NCFA) was established. Members of the council included:
NCFA served as a steering group, making decisions and broad directives, with ad-hoc committees formed to tackle specific projects identified during the planning process. Early in this process, NCFA members delineated their roles based on each of their organization's resources and capabilities. For example, CDC had resources and expertise to conduct the formative and summative research for the campaign, so they took the lead on this activity. March of Dimes and others had the capacity and infrastructure to disseminate materials. The health care professional organizations had the capacity to reach their members with information about folic acid. Every member had something to contribute to the overall effort. |
||||||||
Step 1.4 Examine and/or conduct necessary research to describe the problem. |
||||||||
All women
of reproductive age capable of becoming pregnant could be affected by a
neural tube defect-affected pregnancy if they consume inadequate amounts
of folic acid. Specific populations at high risk for a neural tube defect-affected
pregnancy are women with a previously affected pregnancy, women of low socioeconomic
status, and women of Hispanic ethnicity. Other general health, environmental,
and social conditions related to the problem include:
The impact of having a baby with spina bifida or losing a baby born with anencephaly is profound - emotionally, spiritually, and financially. Although neural tube defects (NTDs) are not very common (2,000 - 3,000 occurring each year in the United States), the severity of the problem is extreme. The neural tube develops very early in pregnancy, about 2-4 weeks after conception. This is often before a woman knows she is pregnant; therefore, it is often before she can begin taking sufficient amounts of folic acid supplements to prevent NTDs. As of January 1998, "enriched" foods contained increased levels of folic acid. However, for women to reach the goal of 0.4 mg/day of folic acid, it was estimated that they would need to consume large volumes of food containing the synthetic nutrient. Additionally, natural sources of food folate needed to be consumed in large quantities in order to reach this goal. Women were not always willing to eat the large volumes of food needed to reach the goal. However, the effects of fortification on blood folate levels of women was not known, so studies monitoring the effects of fortification were undertaken. In the meantime, efforts to encourage women to get enough folic acid through diet and supplements were initiated. |
||||||||
Step 1.5 Determine and describe distinct subgroups affected by the problem. |
||||||||
|
All women of reproductive age capable of becoming pregnant can be affected. Specific populations at high risk for neural tube defect pregnancies are women with a previous history of NTD pregnancies, women of low socioeconomic status (SES), and women of Hispanic ethnicity. Women in low socioeconomic populations were believed to have higher prevalence of neural tube defects because of poor diets and /or a higher number of pregnancies per woman with a previously affected pregnancy. It was also found that the rate of neural tube defects were 1.5-3 times higher for Hispanic women than for women in the general population. Studies showed that non-pregnant women under age 25 were least likely to consume a daily multivitamin, with only 19% reporting that they did. This group accounted for approximately 39% of all U.S. births. CDC conducted an assessment of existing research at the beginning of the project in 1996. Some states like South Carolina and Texas had already been conducting research on a local level and had some audience data to offer. National surveys such as the Pregnancy Risk Assessment Monitoring System (PRAMS), the Behavioral Risk Factor Surveillance System (BRFSS), and the National Survey on Family Growth (NSFG) provided some information on issues such as pregnancy behavior, birth control use, and vitamin use. Background levels from a 1995 survey by the National March of Dimes Birth Defects Foundation and the Gallup Organization showed awareness of the term "folic acid" at about 52%, but specific knowledge about folic acid to be very low-only 5% of the total sample knew that folic acid helps prevent birth defects, and only 2% knew that a woman should take folic acid before pregnancy in order for it to be effective. CDC began commissioning questions on the Healthstyles survey, a mail panel survey on health issues, which is linked to a marketing survey database. That way, as groups of women were identified through behavioral or attitudinal variables, variables that helped to plan outreach could also be identified. The survey contained questions related to attitudes about pregnancy, birth defect prevention and vitamin use. The items were developed using Social Cognitive Theory, which looks at psychological, social and environmental influences on behavior. For these reasons, CDC and its partners chose to conduct further research among women in the following categories:
|
||||||||
Step 1.6 Write a problem statement for each subgroup you plan to consider further. |
||||||||
|
The following subgroups were identified for participation in focus group research: African American/White/English-speaking Hispanic women who intended to become pregnant within 1 year:
African American/White/English-speaking Hispanic women who intended to become pregnant in the future (but not in the next year):
African American/White women who never intended to become pregnant: (but who could become pregnant):
Spanish-speaking Hispanics*:
* The women in the Hispanic focus groups were not divided based on their intention to become pregnant or not become pregnant. Healthstyles data from 1996 and 1997 showed that they were less likely to say that they would never become pregnant in the future. The problem for each subgroup was defined as: Women between the ages of 18-44 are not regularly consuming enough folic acid, which could prevent NTDs. |
||||||||
Step 1.7 Gather information necessary to describe each subproblem defined in new problem statement. |
||||||||
|
More focus group data were collected to better understand why women did not consume enough folic acid (multivitamins) and to determine what women knew about folic acid and birth defects. Click on the "Tools for Research" button to see more information about focus groups. |
||||||||
Step 1.8 Assess factors and variables that can affect the project's direction. |
||||||||
|
Strengths
Weakness
Opportunities
Threats
Two issues that often got connected with promoting folic acid consumption among all women of reproductive age were sexually active young people and elective termination of pregnancies after they had been diagnosed with neural tube defects. The campaign had to be very careful not to promote pre-marital sex. Second, the campaign did not promote termination if a baby was diagnosed with neural tube defects in utero. The goal of the campaign was to prevent neural tube defects, not to prevent the birth of the babies who have those defects. Work with partner organizations, such as the Spina Bifida Association of America, was especially helpful in making sure the campaign was sensitive to this issue. |
||||||||
|
||||||||
Step 2.1 List the direct and indirect causes of each subproblem that may require intervention(s). |
||||||||
|
According to research data, women were not consuming enough folic acid for the following reasons:
|
||||||||
Step 2.2 Prioritize and select subproblems that need interventions(s). |
||||||||
|
For this intervention, the following subproblems were selected:
|
||||||||
Step 2.3 Write goals for each subproblem. |
||||||||
| The Centers
for Disease Control and Prevention (CDC) established a goal of increasing from 25% to 50% the proportion of women consuming the US Public Health Service recommended level of folic acid. They also had a goal to increase the fortification levels in cereal grain products, and in increasing blood levels. The overall goal was focused on reducing the incidence of NTDs.. In October 1997, the National Council on Folic Acid identified a four-fold strategy for accomplishing these goals:
|
||||||||
Step 2.4 Examine relevant theories and best practices for potential intervention(s). |
||||||||
| After
examining various theories and practices the following interventions were
considered:
Health Communication/Education
Health Policy/Enforcement
Health Engineering
|
||||||||
Step 2.5 Consider SWOT and ethics of intervention options. |
||||||||
|
Health Communication/Education Strengths
Weaknesses
Opportunities
Threats
Ethics
Health Policy/Enforcement Strengths
Weaknesses
Opportunities
Threats
Ethics
Health Engineering Strengths
Weaknesses
Opportunities
Threats
Ethics
Strengths
Weaknesses
Opportunities
Threats
Ethics
|
||||||||
Step 2.6 For each subproblem, select the intervention(s) you plan to use. |
||||||||
|
All of the interventions were to be implemented, however health communication interventions showed the most promise and were selected as the focus. Health communication strategies work best in changing awareness, knowledge, attitudes, and simple behaviors, especially if they are science-based, theory-driven, grounded in audience research, and implemented sufficiently during the planning, implementation and evaluation processes. Click here to see the chart. |
||||||||
Step 2.7 Explore additional resources and new partners. |
||||||||
| CDC had enough funding for the development of an intervention, but needed to recruit more partners for dissemination of materials. Ideas for obtaining funding for evaluation also needed to be investigated. | ||||||||
Step 2.8 Acquire funding and solidify partnerships. |
||||||||
| The National Council on Folic Acid invited new partners to help with the design and implementation of strategies. At an October 1997 meeting each partner indicated what it could contribute to the health communication planning, implementation, and evaluation process. NCFA members met by phone (conference call) once a month and in-person quarterly to keep all partners informed of organization-specific initiatives and the campaign's progress. | ||||||||
|
||||||||
Step 3.1 For each subproblem, determine if intervention is dominant. |
||||||||
|
Health Communication/education
Engineering
Policy/Enforcement
Health-related community services
|
||||||||
Step 3.2 Determine whether potential audiences contain any subgroups (audience segments). |
||||||||
| Target
audience group:
Women between the ages of 18-44 were selected for intervention. Special emphasis was given to Hispanic women. Using 2 years of data compiled from Healthstyles and Neural Tube Defect (NTD) surveillance data, the target population was segmented based on the following five variables:
|
||||||||
Step 3.3 Finalize intended audiences. |
||||||||
|
Statistical analyses were performed to obtain homogenous groups that could be described. Two groups emerged:
Both groups were selected for intervention. Pregnancy contemplators were selected because they seemed most "ready" to act on a compelling message. Furthermore, Spanish-speaking Hispanic women, those most at risk for NTDs, could be reached by targeting this group. Pregnancy pre-contemplators were selected because they experience half of all pregnancies. However this group was difficult to reach because of their strong "denial" about the likelihood of getting pregnant. |
||||||||
Step 3.4 Write communication goals for each audience segment. |
||||||||
|
The long-term goal
for all audiences was to have all women consuming Pregnancy Contemplators: For this group, campaign members wanted to increase the number of women who understood the connection between folic acid prior to conception and birth defects, as well as increase the number of women who consumed the appropriate amount of folic acid before pregnancy. Pregnancy Pre-contemplators: For this group, the goals were to raise awareness among young women and convince them that they should be taking a multivitamin, folic acid supplement, or eating foods fortified with folic acid not for a pregnancy, but because they are ready to get pregnant. This held true regardless of whether the women were or were not planning to get pregnant. Additionally, NCFA members wanted to increase the number of women who consumed appropriate amounts of folic acid. |
||||||||
Step 3.5 Examine and decide on communication-relevant theories and models. |
||||||||
| Social marketing principles were used throughout the process with an emphasis on audience input regarding the "exchange" proposition-in this case, extensive research was conducted to understand motivations both for and against the target behavior: consumption of folic acid. Audience input was solicited numerous times in campaign planning. Also, Social Cognitive Theory was used to systematically look at psychological, social, and environmental influences on behavior. | ||||||||
Step 3.6 Undertake formative research. |
||||||||
|
Extensive audience research was completed among women in the target audience. Sixteen focus groups with women of childbearing age were conducted from March through June of 1998, in Atlanta, Miami and Houston. Four of the focus groups were held in Spanish with women from various Spanish cultural origins. Twelve groups were conducted in English with mixed groups of African-American, non-Hispanic Whites, and English-speaking Hispanic women. Secondary data was collected from commercial marketing and health databases. |
||||||||
Step 3.7 Write profiles for each audience segment. |
||||||||
|
Primary Target Audiences: Pregnancy Contemplators: Women of childbearing age, 18-35 who were planning to get pregnant in the next year. These women were more likely married and had children living at home. Some of these women took a multivitamin and others did not. Women who were currently planning a pregnancy, or thought they might become pregnant in the near future, were motivated to take a daily multivitamin containing folic acid to ready their body for pregnancy and/or to help prevent birth defects. This group was ethnically diverse including African-American, non-Hispanic White, and Spanish-speaking Hispanic women. Pregnancy Pre-contemplators: Women of childbearing age, 18-24, who could become pregnant, i.e., were sexually active and able to conceive. Pre-contemplators were more likely to be single with no children at home. These women were not planning a pregnancy in the near future and were unlikely to be taking a vitamin supplement containing folic acid. They were not interested in taking a supplement containing folic acid for pregnancy reasons, but were motivated when told that folic acid would help them feel good and protect them against heart disease. Since this group accounted for a significant percentage of pregnancies, all of which were unplanned, there was a need for these women to be taking a folic acid supplement. The women were surprised to learn that at least 50% of all pregnancies were unplanned. They felt that they personally would not have an unintended pregnancy; therefore, would not need to take a multivitamin and/or a folic acid supplement. This group was ethnically diverse including African-American, non-Hispanic White, and English-speaking Hispanic women. Some of the key findings of the research were:
Secondary Target Audiences Secondary audiences emerged for both groups. Emphasis was placed on healthcare providers of women. Mothers and spouses were also identified as potential secondary audiences for the Pregnancy Contemplators. Seven focus groups, including various kinds of health care providers, were conducted to explore the knowledge of the connection between folic acid and birth defects. The groups also examined the health care providers' perceptions about opportunities and barriers they encountered when talking with their female patients about folic acid. Groups were conducted with physicians, nurses, nurse practitioners, pharmacists, and nutritionists in Atlanta, GA, and Bethesda, MD, during April and May of 1998. Key findings from the focus groups with health care providers were:
|
||||||||
Step 3.8 Rewrite goals as measurable communication objectives. |
||||||||
|
By December 2002, increase by 20% the number of women ages 18-35 who are aware of folic acid (March of Dimes (MOD)-Gallup 1998 survey: 63% of women aged 18-34 had heard, read or seen something about folic acid - 2002 Goal: 75.6%). By December 2002, increase by 50% the proportion of women aged 18-35 who know that taking a multivitamin containing folic acid (or folic acid alone) can reduce a woman's chances of having a baby with certain birth defects (MOD-Gallup 1998 survey: 14% of women aged 18-34 stated that folic acid 'can help prevent birth defects' - 2002 Goal: 21.0%). By December 2002, increase by 50% the number of women aged 18-35 who know that a multivitamin containing folic acid (or folic acid alone) needs to be taken BEFORE pregnancy to prevent certain birth defects (MOD-Gallup 1998 survey: 7% of women aged 18-34 stated that 'folic acid should be taken before pregnancy' - 2002 Goal: 10.5%). By December 2002, increase by 12% the number of women aged 18-35 who report taking a daily vitamin that contains folic acid (MOD-Gallup 1998 survey: 30% of women aged 18-34 reported taking a vitamin that contains folic acid every day - 2002 Goal: 33.6%). |
||||||||
Step 3.9 Write creative briefs. |
||||||||
|
To achieve the objectives of the program, a creative brief was developed for each target audience: Pregnancy Contemplators and Pregnancy Pre-contemplators. These briefs were used to guide the development of the campaigns. Target Audience
#1 - Pregnancy Contemplators - Women of childbearing age, Secondary audiences: The health/support systems for these women: friends, mothers, health professionals, etc. Two campaigns were implemented here, one for a general audience and one for a Hispanic audience. Objective(s) Convince women that they must start taking a multivitamin with folic acid (or a folic supplement) before they get pregnant. Obstacles
Key Promise If I take a multivitamin with folic acid everyday before I get pregnant, I will reduce the risk of my baby being born with birth defects. Support Statements/Reasons Why
Tone It was necessary that the communication convey a sense of good health, warmth, and energy because that is how this audience saw itself. However, a sense of importance or urgency to motivate women to change their behavior was required as well. Media Television, Radio, and Print Creative Considerations Spots were produced in English and Spanish in order to recognize and reach diverse populations. Target Audience #2 - Pregnancy Pre-contemplators - Women of childbearing age, 18-24, who could become pregnant. These were women who were, or could be, sexually active and able to conceive. They were not planning a pregnancy in the near future and were unlikely to be taking a vitamin supplement with folic acid. However, since this group accounted for a significant percentage of pregnancies, most of which were unplanned, there was still a need for these women to take a folic acid supplement. Objective(s) To raise awareness among young women that taking a multivitamin or folic acid supplement is necessary, regardless of whether they are planning to become pregnant or not. Obstacles
Key Promise If I take folic acid every day, I will look and feel better, as well as reduce the risk of my baby being born with birth defects. Support Statements/Reasons Why
Tone This campaign was geared toward a younger audience and addressed them on their level: hip, youthful and energetic. The tone conveyed a sense of good health and vibrancy; that was how this audience perceived themselves. Media Television, Radio, and Print PSAs Creative Considerations Spots had to recognize a diverse population. |
||||||||
Step 3.10 Confirm plans with stakeholders. |
||||||||
| Stakeholders were shown the results of the research conducted up to this point. The rationale for target audiences and priorities was explained. The creative briefs were shared with partners and plans were discussed for the next phases of the campaign. Evaluation needs were discussed, and it was agreed upon that funding would be sought from the CDC 1% Evaluation Program. | ||||||||
|
||||||||
Step 4.1 Draft timetable, budget, and plan for developing and testing communication mix. |
||||||||
| Budgets and timetables were developed in conjunction with the partners and contractors, in order to ensure that all expectations were reasonable and would be met. NCFA partners were also invited to observe concept and message testing with audience members. | ||||||||
Step 4.2 Develop and test creative concepts. |
||||||||
| Nine concepts
were developed; four were specifically designed to appeal to contemplators,
or those who were planning pregnancies in the next year. Four were created
for noncontemplators. One additional concept was created to test its appeal
to both groups. The concepts developed for pregnancy contemplators were
created in Spanish and English.
Seventy-nine women participated in nine focus groups. They were conducted to test if women could identify the main idea of each concept, and to determine if the concepts motivated the target audience to increase their folic acid consumption. Five focus groups included women of different racial and ethnic backgrounds and the remaining four groups were conducted with Hispanic women. Communication concepts Concepts developed for Pregnancy Contemplators
Important Findings from concept testing with contemplators:
Concepts developed for Pregnancy Pre-contemplators
Important findings from concept testing with Pre-contemplators
Individuals Affected by Spina Bifida The moderator described the draft concepts to people impacted by spina bifida. It was important to receive input from this population in order to guard against offending people.
Other important findings from concept testing:
|
||||||||
Step 4.3 Develop and pretest messages. |
||||||||
|
Individual interviews with women of childbearing age in Miami and Washington, DC were conducted during June and July 1998 in English and Spanish with African American, Hispanic, and non-Hispanic white women. Women in each audience segment were shown creative material (mock-ups of television, radio, and print ads) designed to appeal to them. A variety of issues were explored and discussed in each group including:
|
||||||||
Step 4.4 Pretest and select settings. |
||||||||
| The audience
research indicated a variety of settings for reaching each audience. Television,
radio, and print advertising all showed promise for reaching both audiences.
Settings for reaching pregnancy contemplators included:
Settings for reaching pregnancy pre-contemplators included:
|
||||||||
Step 4.5 Select, integrate, and test channel-specific communication activities. |
||||||||
|
Television, radio, and print advertising all showed promise for reaching both audiences. The channels selected were divided by target audience and these results were shared with partners on NCFA. Pregnancy Contemplators were frequent users of in-home pregnancy tests, shopped at Walmart, and watched the Learning Channel and the Family Channel. They read the classifieds section of the newspaper and a number of women's magazines (Better Homes and Garden). English speakers listened to country or golden oldie radio stations. Spanish speakers listened to Spanish radio. Pregnancy Pre-contemplators were also frequent users of in-home pregnancy tests, shopped at the Gap and the Limited, drank designer coffees and used dry cleaning services. They watched the Travel channel and read the entertainment section of the newspaper. They listened to progressive rock radio stations and read Vanity Fair and Cosmopolitan. They were concerned about fitness, so they may have belonged to a gym or fitness club to keep in shape. |
||||||||
Step 4.6 Identify and/or develop, pretest, and select materials. |
||||||||
| Core materials
developed included television, radio, and print public service announcements (color for women's magazines and black/white for newspapers) posters and brochures. Based on responses to pre-testing that occurred in previous steps, final materials were developed. Some messages were altered and some were changed all together. Below, some final versions are noted:
|
||||||||
Step 4.7 Decide on roles and responsibilities of staff and partners. |
||||||||
| The CDC had funds enough to produce core/template materials which partners could use however they wished. Partners indicated that once the "tested messages/products" were developed, they would tailor them for their audiences, reproduce them for their membership/constituencies, and mobilize their members/constituents to disseminate them. | ||||||||
Step 4.8 Produce materials for dissemination. |
||||||||
| Because of limited resources and agreements made with NCFA partners, the CDC developed limited quantities of materials and provided partners with electronic copies (masters) of all materials for them to reproduce and distribute. | ||||||||
Step 4.9 Finalize and briefly summarize the communication plan. |
||||||||
| NCFA partners
routinely discussed resource needs. They also updated each other about organizational
initiatives that could both help or hinder the overall campaign. Members
made every effort to coordinate activities so as to minimize competition
among members for finite resources such as news media attention and public
service advertising slots. Since each NCFA member tailored the "audience-tested" materials for use among their key audiences/constituents and in accordance with their organization's calendar of events, a "loose" timeline was agreed upon by partners. January 1999 -- Partners
meeting Since all NCFA members had participated in the formative research and had access to all product "templates" each member was encouraged to use the information and products as creatively as possible. NCFA members updated each other about activities during monthly conference calls and quarterly in-person meetings. Meeting minutes documented partner contributions to the overall effort. |
||||||||
Step 4.10 Share and confirm communication plan with appropriate stakeholders. |
||||||||
| No formal written plan was developed for the overall effort. Each partner developed plans specific to the audience and activities that they undertook AND kept other partners informed about their plans so as to avoid conflicts. | ||||||||
|
||||||||
Step 5.1 Identify and engage stakeholders. |
||||||||
| Stakeholders included the National Council on Folic Acid (NCFA) and the CDC. Other health communication professionals would be interested in the results from the evaluation in order to improve other programs. It was important that the evaluation was designed to answer the questions for the National Council on Folic Acid and for it to provide useful information for future programs. | ||||||||
Step 5.2 Describe the program. |
||||||||
|
The folic acid campaign was a multi-faceted program that:
|
||||||||
Step 5.3 Determine what information stakeholders need and when they need it. |
||||||||
| Before
the campaign began, CDC was successful in acquiring funds to evaluate the
campaign effort. Key questions that CDC and NCFA members were interested
in had to do with both the process of the campaign as well as its outcomes.
Process Evaluation Research Questions:
Outcome Evaluation Research Questions:
|
||||||||
Step 5.4 Write intervention standards that correspond with the different types of evaluation. |
||||||||
|
By December 2002, increase by 20% the number of women ages 18-35 who are aware of folic acid. By December 2002, increase by 50% the proportion of women aged 18-35 who know that taking a multivitamin containing folic acid (or folic acid alone) can reduce a woman's chances of having a baby with certain birth defects. By December 2002, increase by 50% the number of women aged 18-35 who know that a multivitamin containing folic acid (or folic acid alone) needs to be taken BEFORE pregnancy to prevent certain birth defects. By December 2002, increase by 12% the number of women aged 18-35 who report taking a daily vitamin that contains folic acid. |
||||||||
Step 5.5 Determine sources and methods that will be used to gather data. |
||||||||
|
Process and evaluation outcome questions were asked. The following information was gathered: Click here to see the chart. |
||||||||
Step 5.6 Develop an evaluation design. |
||||||||
|
Refer to the conceptual model for the evaluation of the National Folic Acid Campaign from page 6 of The National Folic Acid Campaign Evaluation Plan (pdf file) The National Folic Acid Campaign Evaluation Plan (FA_Eval_Plan.pdf) |
||||||||
Step 5.7 Develop a data analysis and reporting plan. |
||||||||
|
The following chart illustrates the data analysis that was used in this campaign. It depicts what comparisons were made for the evaluations, what data was analyzed to establish the comparisons and where the aforementioned information was gathered. Click here to see the chart. When all the evaluation is done and if funding continues, six reports will be developed during the course of this evaluation: three process evaluation reports and three outcome evaluation reports from each year of the campaign. A process evaluation report detailing the methods used and results from media and non-media monitoring data collection activities will be written for each of the monitoring periods. In addition, three outcome evaluation reports detailing the methods used and findings from each of the surveys (E-FACES/S-FACES 2000,2001, and 2002) will be produced. These reports include copies of all data collection instruments. |
||||||||
Step 5.8 Formalize agreements and develop an internal and external communication plan. |
||||||||
|
Because this evaluation was complex, various organizations were involved in implementing different components of the evaluation. The CDC oversaw and funded the evaluation of the National Folic Acid Campaign, and Westat was the organization responsible for designing and conducting the campaign evaluation. The MOD, an agency that has partnered with the CDC and other agencies in NCFA, contributed through distribution of campaign PSAs and reporting on chapter activities related to the campaign. The Spina Bifida Association of American (SBAA), a member of the NCFA, produced two PSAs on folic acid consumption and provided tracking data on these PSAs. During the first monitoring period, the following five organizations were involved in monitoring campaign activities: TVAccess, Burrelle's Information Services, Video Monitoring Services, NewsWorld Television/Potomac Television, and Bienestar LCG Communications (LCG). LCG was also responsible for placing Spanish-language print, television, and radio campaign PSAs. Finally, Westat worked with MarketFacts to implement both the E-FACES and S-FACES 2000 surveys. The CDC staff met weekly. E-mail communication was also a key way to keep everyone informed of project progress. NCFA partners met in person quarterly, but met by telephone every month. Notes of discussions and decisions were recorded and distributed to all partners. NCFA had several ad-hoc committees tackling different components of the communication effort (reaching women, reaching healthcare providers, reaching policy makers). Take a look at Table 1.1 from page 10 of the National Folic Acid Campaign Evaluation Plan (FA_Eval_Plan.pdf). |
||||||||
Step 5.9 Develop an evaluation timetable and budget. |
||||||||
|
Partner Training: 01/1999 Campaign Launched Mother's Day: 05/1999 Evaluation Began: 06/1999 First Monitoring Period: 06-10/1999 Development of Communication Exposure Index (CEI): 10-11/1999 Selection of higher/lower exposure markets: 11/1999 2000 E-FACES/S-FACES: 11/1999-03/2000 2001 E-FACES/S-FACES: 11/2000-03/2001 2002 E-FACES/S-FACES: 11/2001-03/2002 Click here to see the chart. |
||||||||
Step 5.10 Summarize the evaluation implementation plan and share it with staff and stakeholders. |
||||||||
|
The evaluation plan was reviewed by CDC scientists and presented to partners for input. Core components of evaluation included:
|
||||||||
|
||||||||
Step 6.1 Integrate communication and evaluation plans. |
||||||||
| NCFA took a very pragmatic approach to integrating communication and evaluation efforts: the partnership counted on NCFA members to participate/contribute toward the effort in accordance with their technical and resource capabilities. Since CDC had expertise in research and had some financial resources, it took the lead on formative and summative evaluation activities soliciting regular input from partners. Since many NCFA partners had strong organizational infrastructures for reaching various audiences, they would take the lead in disseminating campaign materials to those audiences and would share their activities with CDC for use in the process evaluation. | ||||||||
Step 6.2 Execute communication and evaluation plans. |
||||||||
| The media campaign was launched on Mother's Day 1999 to provide the media with an interesting story about the connection between motherhood, birth defects and folic acid. | ||||||||
Step 6.3 Manage the communication and evaluation activities. |
||||||||
| Because the overall campaign had a very decentralized implementation strategy, management of the campaign consisted of regular communication between NCFA partners about campaign progress and opportunities. | ||||||||
Step 6.4 Document feedback and lessons learned. |
||||||||
| Records outlining the campaign development from all the various partners and contractors were documented in meeting minutes. NCFA members routinely discussed what was working, what wasn't, what could be improved upon, and what was learned that could be used in the future. | ||||||||
Step 6.5 Modify program components based on evaluation feedback. |
||||||||
| Information collected from evaluation activities was used to adjust campaign activities. | ||||||||
Step 6.6 Disseminate lessons learned and evaluation findings. |
||||||||
|
CDC and NCFA members have shared findings and lessons learned along the way in a variety of forums and formats: at professional meetings, in training health professionals, in newsletters, and in publications, like CDC's Morbidity Mortality Weekly Report. Staff is currently writing articles for publication in peer-reviewed journals. |