# Proposed Biosurveillance Marketing Strategy

# November 30, 2007

**Overview**

The Centers for Disease Control and Prevention (CDC) has as its mission
"To promote health and quality of life by preventing and controlling
disease, injury, and disability." In undertaking this mission, CDC is
frequently tasked with communicating to the public the newest science
and its relevance to the public. Often the scientific information is
complex, and related to health behaviors that are long ingrained in the
social fabric. Changing social norms in the face of new evidence to
support health decision making is a challenge that CDC communicators
routinely face. In other cases, novel information becomes available that
can radically transform health or health-seeking behaviors that was
previously unknown, such as the role of consuming folic acid to prevent
spina bifida. In this instance, overcoming an entrenched social norm was
not required; instead building awareness, stimulating legislative
mandate and increasing public demand was the goal of CDC communications
efforts.

**\
**In June, 2006, The American Health Information Community (AHIC) issued
a recommendation that stated:

> "HHS, in collaboration with privacy experts, State and local
> government public health agencies and clinical care partners, should
> develop public communications materials to educate the general public
> about the information that is used for biosurveillance including the
> benefits to the public's health, improved national security, and the
> protection of patient confidentiality."

After discussion within AHIC, and with representatives of the
Coordinating Center for Health Information and Service (CCHIS) at the
Centers for Disease Control and Prevention (CDC), this call to action
was elaborated in 2007:

> "CDC will convene a meeting with partners in February, 2008 and
> develop a 1-2 page communications message for use with public
> communications."

CDC communications staff propose the following strategy to inform the
American public about the benefits of biosurveillance to public\'s
health, to address the role of biosurveillance in maintaining national
security, and to meet public health's commitment to protection of
patient confidentiality while serving the biosurveillance needs of the
Nation.

**Health Protection: Past, Present, and Future**

CDC's third Health Protection Goal is "People Prepared for Emerging
Health Threats" which is defined as "People in all communities will be
protected from infectious, occupational, environmental, and terrorist
threats." Toward meeting this goal, the proposed overarching goal of the
proposed communication effort is to alter the information environment
around the issue of public health uses of personal health data in such a
way that the public understands, accepts and supports these uses. The
strategy to achieve this goal has three components:

1.  Illustrate in a relevant way for different consumer segments the
    value of public health biosurveillance in advancing the health of
    individuals, families and society-while protecting confidentiality,

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1.  Generate interest and intent to use gathered information for
    personal action,

> emphasizing the personal and social benefits of awareness to the
> consumer, and

2.  Point out the risks to individuals, families and the Nation of not
    having this information available to detect threats, protect persons
    and property, and prevent and control disease transmission.

**The Role of Communications**

At a strategic level, CDC has the ability to organize and deploy
strategic communication interventions that can demonstrably influence
knowledge and awareness on health topics, as well as to motivate
behavior change. Typical aspects involved in building awareness around a
topic for which there is a dearth of public knowledge follow a roadmap
of key developmental milestones:

-   Statement of the Problem -- Call to Action (the gap between
    acceptable or desirable health status and the current level status)

-   Environmental scanning/literature review (including an assessment of
    current and past national efforts and programs related to
    biosurveillance, preliminary audience segmentation, and culling
    existing market research highlighting past/current attitudes and
    beliefs around biosurveillance issues)

-   Selection and use of appropriate health behavior theory (ies) to
    incorporate into the campaign that influence the motivators for
    behavior change

-   Evaluation planning -- Includes process, outcome, and impact
    measures that engage stakeholders and has a focused evaluation
    design

-   Identification of key audiences, channels, reach, frequency
    utilizing primary and secondary audience market research

-   Message development by target audience

-   Message testing and refinement by target consumer demographic
    profiles

-   Message deployment, assessment, and episodic theme refreshment

-   Consumer participation and understanding evaluation

-   Publication

**Multi-modal health promotion strategy**

A key aspect of the proposed strategy is in using multiple modes to
communicate with the American public to create a tapestry of awareness,
where messages from multiple trusted sources overlap and reinforce one
another across different demographics and emanate from a variety of
technologies. Important considerations, such as understanding the impact
of privacy laws and public health's role in protecting personal
information must be fully explored and tested prior to initiating public
communication.

Several communication tactics are recommended:

-   Media Plan\--press releases, letters to the editor, speaking
    engagements by senior leadership, content inclusion into public
    health conferences, awareness days, etc. will build the broadest
    level of awareness using the widest forms of broadcast transmission.
    The reach of messages through broadcast approaches is limited to the
    extent that persons use mediating technologies, such as the
    Internet, TV and radio. Engagement from top to bottom of health care
    delivery systems, public and private sharing dialogue between
    trusted source and consumer is key to the success of this effort.

-   eHealth Plan will include blogging, consumer engagement through
    electronic fora, webinar and virtual worlds billboarding to reach
    technically savvy consumers and decisionmakers.

-   Consumer Plan will include direct-to-consumer marketing and radio to
    reach more specific audiences, using a hyper-targeting methodology
    to deploy locally tailored messages to grassroots constituencies.

-   Policymaker Plan will include information to explain this effort,
    including Hill briefings, commentary for public testimony, and
    budget narrative to support the CDC Health Protection Goal three.
    Local and state partner engagement, leaders-to-leaders common
    talking points and consideration of the role of third party
    validators and Centers of Excellence research agendas will
    underscore efforts to make transparent and open all communications
    about biosurveillance emanating from CDC.

Local partner communications, if synchronized with major milestones and
harmonized with CDC messaging will not only complement, but synergize
greater results than the sum of separate communications. Additionally, a
key component of this effort (and likely to play a major role in its
success) will be to identify and approach partners, such as clinicians,
physician administrators, emergency department, family practitioners,
nurses, EMT first responders, etc. that can directly and effectively
deliver campaign messages to their respective target constituencies. The
table below offers examples of both CDC specific and partner-based
activities in support of biosurveillance awareness.

+-------------------------------------+--------------------------------+
| **Examples of CDC campaign          | **Examples of local partner    |
| activities**                        | activities**                   |
+-------------------------------------+--------------------------------+
| -   [www.cdc.gov/biosurveillance](  | -   Health dialogue between    |
| http://www.cdc.gov/biosurveillance) |     providers and patients     |
|     updates                         |                                |
|                                     | -   Scientific and             |
| -   CDCInfo -- public inquiries     |     consumer-level publication |
|     response                        |     and speaking engagements   |
|                                     |                                |
| -   Radio broadcasts and podcasts   | -   Exhibits at consumer       |
|                                     |     health fairs and other     |
| -   Electronic journals (MMWR,      |     local events               |
|     etc.)                           |                                |
|                                     |                                |
| -   Blogs, webinars, virtual worlds |                                |
|                                     |                                |
| -   Bi-directional communication    |                                |
|     between public health officials |                                |
|     and local clinicians            |                                |
+-------------------------------------+--------------------------------+

**Stakeholders/Resources**

A successful campaign of this magnitude should involve multiple
stakeholders both internally and externally. External partners should
include professional organizations for local and state public health,
groups interested in privacy rights like the Markle Foundation and
Connecting for Health, federal partners like DHS, DoD, VA, perhaps even
the FDA or EPA. There are two requirements that need to be addressed
early on; either 1) CDC will need a substantial amount of funding to be
responsible for the bulk of an effort of this magnitude or 2) We will
need time to build a true coalition of partners with each responsible
for a portion of the work. At this time, there are few fiscal resources
to accomplish an effort like this one. There is funding to begin
formative research around public perceptions of the government's role in
public health surveillance, but more should be contributed to this.
Personnel resources are limited, a project of this scope should have
multiple full time staff devoted to it.

**High level Deliverables --**

A. [Planning]{.underline}

> A1 Statement of the problem and plan to address the issues
>
> A2 Environmental scan/literature review
>
> A3 Formative research methodology and health behavior theory selection
>
> A4 Identification and selection of key audiences and communication
> channels

B. [Concept and Message Development and Testing]{.underline}

> B1 Develop creative brief, initial concepts, and messages (per
> selected target audience)
>
> B2 Testing and refinement of messages with selected audiences
>
> B3 Interim analysis to assure synchronization between messages and
> audiences.

C. [Rollout]{.underline}

> C1 Coordination of Media, eHealth, Consumer and Policymaker tactics
>
> C2 Message deployment, assessment of message reach, and episodic theme
> refreshment of campaign themes
>
> C3 Local consumer participation events, media tour

D. [Evaluation]{.underline}

D1 Process and outcome evaluation

> D2 Publication

**Success Metrics**

First year goals will be evaluated by process measures, describing the
preparatory steps and progress toward meeting intervention milestones.
Outcome metrics, or those that will describe success/failure will lie in
study of repeated consumer interactions, monitoring of dyadic
communications venues and a mixture of qualitative and quantitative
methods for assessing the move from dawning awareness to knowledge and
recall, and eventually to acceptance of biosurveillance, in principle,
as a necessary aspect of national, social, and personal security.

JPA 11/30/07 -- v.1.3

# CDC Biosurveillance Marketing Strategy Team

# John Anderton, Cynthia Baur, Fred Fridinger, Lisa Hines, 

# Gail Horlick, Lourdes Martinez-Cox, Kristin Uhde