A COMMUNICATIONS STRATEGY 

FOR THE NATIONAL CHILDREN’S STUDY 

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 

National Institutes of Health 

Centers for Disease Control and Prevention 

U.S. ENVIRONMENTAL PROTECTION AGENCY 

COMMUNICATIONS STRATEGY
 

This strategy describes the overall direction of 

communications for the National Children’s 

Study. State and federal health officials, national 

and local partners, Study coordinators, and other 

supporting organizations are encouraged to use 

this document to prepare communications 

activities and materials that meet their specific 

needs.Although this strategy is intended to 

promote consistency of communications about 

the Study, it is not an outline of specific 

communications campaigns or tactics. 

The sections that follow provide details on the 

Study’s key communications issues, insight into 

audiences and message development, and details 

on the multiple communications phases of the 

Study.This document focuses on the initial phases 

of the Study; additional detail will be added to the 

communications strategy for later phases of the 

Study as implementation unfolds. 

This strategy is 

designed to guide 

message and materials 

development for all 

audiences over the 

length of the Study. 

1 
INTRODUCTION 

INTRODUCTION
 

The National Children’s Study is the largest longterm study of children’s health and development 

ever to be conducted in the United States, 

involving 100,000 children from before birth to 

age 21.The Study aims to better understand the 

link between the environments in which children 

are raised and their physical and mental health 

and development. By looking for relationships 

between environments and children’s physical 

and mental progress, the Study seeks to find 

basic causes of many of today’s major childhood 

diseases and disorders and to determine not only 

which aspects of the environment are harmful, 

but also which factors are harmless or helpful to 

children’s health and development. 

Examples of research questions to be examined 

include: How are prenatal exposures to pesticides 

linked to increased risk for learning and developmental 

disabilities? How are early childhood viral infections 

linked to the occurrence of asthma? How do 

individual, family, and community factors affect 

childhood injuries? 

The Study will provide information to help 

generations of Americans meet the health, 

economic, and social challenges associated with 

many serious health conditions. It will build a 

source of data that may answer questions about 

links between environments and the origins of 

childhood and adult diseases. 

The National Children’s Study 

will recruit more than 100,000 

women from across the United 

States who are pregnant or are 

The Study will focus on a set of key 

scientific research questions that 

address some of the most pressing 

health and development concerns for 

children today, including: 

■	 Pregnancy-related outcomes 

■	 Injury 

■	 Asthma 

■	 Obesity, diabetes, and physical
 

development
 

■	 Outcomes related to child 

development and mental health 

2 
INTRODUCTION 

likely to have a child in the near future, will follow 

their prenatal health, and will then follow the health 

and development of their children from birth through 

the age of 21. These women will represent a cross 

section of ethnic, geographic, and socioeconomic 

groups. By including families from varied backgrounds 

and family structures, the Study can better investigate 

issues of vital interest to all communities and shed 

light on health disparities. 

For the Study to be successful over so many years, 

and for it to maintain the participation of tens of 

thousands of families, will require a significant 

mobilization of people, funding, and leadership at 

all levels. It will also require careful attention to 

privacy and confidentiality, timing for reporting 

Study findings, and ethical considerations that 

arise in research involving children. This effort can 

go forward only with the enthusiasm of scientists 

throughout the country and can meet its objectives 

only with the support of local community 

institutions and organizations. 

The National Children’s Study is a collaborative 

effort led by the U.S. Department of Health and 

Human Services (DHHS)—through the National 

Institutes of Health (NIH) and the Centers for Disease 

Control and Prevention (CDC)—and the U.S. 

Environmental Protection Agency (EPA). 

Led by the NIH’s National Institute of Child Health 

and Human Development (NICHD), the Study will 

benefit from input of more than 40 other federal 

agencies and departments. 

The Study will be implemented by study teams at 

university hospitals, community hospitals, local 

health clinics and sites, and/or physicians’ offices 

across the country. These teams will recruit 

participants in or near their hometowns. 

In addition, Study planners will build partnerships 

among local communities, health care providers, 

and federal and non-federal scientists, as well as 

parent, advocacy, and private industry groups, to 

inform the Study throughout its duration and 

ensure the greatest benefit to the nation’s children. 

Each local partner, team member, and participant 

brings unique perspectives and insights to help build 

a supportive environment in which communities are 

engaged and participants are enrolled. 

3 
UNDERSTANDING THE COMMUNICATIONS CHALLENGES,BARRIERS, AND OPPORTUNITIES 

UNDERSTANDING THE 

COMMUNICATIONS 

CHALLENGES, BARRIERS, 

AND OPPORTUNITIES 

The National Children’s Study is unprecedented. 

A study of this magnitude, with extensive 

research goals and involving participants from 

many ethnic and social backgrounds, has never 

been attempted. In fact, no clear frame of 

reference exists to aid in communicating with 

the combination of audiences the Study seeks to 

reach.Therefore, a large part of communications 

about the Study, whether with health care 

providers, partners, or potential participants, will 

outline the intent, scope, and value of the Study. 

In developing this communications strategy, the Study 

planners sought to gain greater insight into audiences’ 

current knowledge of longitudinal or observational 

studies. They also sought to learn the key issues, 

A thorough, formative research phase aided 

communication planning. Small focus groups 

were conducted by Study leaders at the EPA 

and the NICHD. Results from this research 

are incorporated into the strategy, particularly 

in the opportunities and barriers, and in 

the discussion of the phased approach to 

communications. In addition, Study planners 

conducted reviews of the media environment 

related to children’s health and the environment 

and searched published reports related to 

research involving children. A media audit, 

Web site audit, and literature review were 

key components of the research.1-6 

barriers to, and opportunities for communications that 

result from the Study’s unique design. 

A series of focus groups were conducted with each 

of the following audiences: 

■ Health care professionals:1 

Obstetricians;
 

Pediatricians;
 

Family practitioners;
 

Nurses; and
 

Nurse practitioners.
 

■ Community leaders:1 

Social service agencies;
 

Environmental advocacy groups; and
 

Maternal health support organizations.
 

■ Potential Study participants:2, 3 

Pregnant women and pregnant teenagers;
 

Couples considering pregnancy; and
 

Parents.
 

4 
UNDERSTANDING THE COMMUNICATIONS CHALLENGES,BARRIERS, AND OPPORTUNITIES 

Despite the unprecedented nature of this study, 

Study planners are benefiting from lessons learned 

throughout the long history of longitudinal health 

research, including:4 

■	 The Framingham Heart Study supported 

important discoveries about the linkages among 

health, diet, and heart disease that have been 

adopted into medical practice. The Framingham 

Study’s ability to gain community support across 

organizations, from physicians to school principals, 

in order to maintain consistent success over so 

many years has influenced the National Children’s 

Study design. 

■	 The Women’s Health Initiative has shown how 

mass media can be used effectively to support 

recruitment for a national study, and how 

frequent news about study results encourages 

retention and keeps partners engaged. 

CHALLENGES 

This section focuses on Study challenges and 

addresses how communications strategies can help 

overcome them. 

■	 Study Design and Participation Requirements 

The design of the Study, especially its length, 

scope, goals for recruitment, and requirements of 

participation, presents major challenges to successful 

communication. Unlike a clinical trial, in which 

participants take medication or engage in a 

prevention or treatment activity, an observational 

study like the National Children’s Study collects 

information about participants’ lifestyles at home, 

at school, and at play. At designated points in time, 

scientists will collect information about children’s 

and parents’ daily activities. Participation will involve: 

■	 Office visits to a Study site on a few occasions 

during pregnancy and in the baby’s first year of 

life, and less frequently in subsequent years; 

■	 Collection of participant samples, such as urine, 

blood, or hair, and other information regarding 

the child’s environment and health status; and 

■	 Home visits for the collection of environmental 

samples, such as indoor and outdoor air, water, 

or other components. 

Study leaders will conduct ongoing correspondence 

with participant families through in-person contact, 

telephone, mail, the Internet, and home visits. 

The extent of these requirements and the length of the 

commitment may be obstacles for both recruitment 

and retention. In focus groups conducted for the 

Study, parents expressed concern about the frequency 

of visits to the Study site, as well as about the types 

of samples that will be collected.2, 3 

➤ Communications Approach: Study planners are 

sensitive to unique cultural and regional issues 

participants will face and will help Study teams 

customize messages and channels to be effective 

with each audience. An established network of 

community advocates will help to bolster these 

5 
UNDERSTANDING THE COMMUNICATIONS CHALLENGES,BARRIERS, AND OPPORTUNITIES 

efforts to educate potential participants about 

sample collection, its rationale, and various 

measures to ensure participants’ safety and 

comfort. Participants will also be surrounded by 

supportive information from the Study site, their 

physicians, and community-based advocates. 

■ Children as Study Subjects 

Research with children requires special protections 

for many reasons, among them the fact that they 

themselves cannot give permission to participate 

until they reach a certain age. 

Medical studies have established precedents for the 

safe and responsible recruitment of children, and 

institutional regulations govern ethical conduct of 

research involving children. National Children’s 

Study planners are committed to following these 

regulations to ensure participants’ safety. Furthermore, 

they are designing the Study to ensure minimal risk 

to participants. 

Generally, the participation of children is achieved with 

at least one parent’s or guardian’s informed consent. 

➤ Communications Approach: Study teams will 

discuss all important aspects of the Study’s 

structure, intent, and methods with every 

mother, father, or guardian interested in taking 

part in this endeavor. The Study will adopt a 

policy of frequent, two-way communication that 

emphasizes clarity and accessibility, and employs 

multiple modes of information distribution. 

Informational materials, Web sites, informed 

consent forms, and possibly interactive computer 

programs will be made available at appropriate 

reading levels and in the languages spoken by the 

families involved to ensure they get the information 

they need. A supportive community environment, 

where being a “National Children’s Study child” is 

valued, will also reinforce parents’ decision making. 

Advocates in schools, places of worship, and 

physicians’ offices will all play important roles in 

informing participant families about the Study. 

■ Reaching All Audiences 

Health disparities are a key focus of the National 

Children’s Study. To ensure that health disparities 

are adequately addressed in the Study design, Study 

teams may recruit extra participants from minority 

populations using many channels. 

➤ Communications Approach: Communications 

with community supporters and partner 

organizations will be essential to meeting this 

challenge. Messages will be tailored so that 

language, education, or access to information do 

not limit participation. Study information will be 

disseminated through multiple outlets, including 

places of worship, libraries, retail outlets, and 

community centers. Study coordinators will 

develop materials inclusive of and appealing to 

ethnically diverse audiences, and in formats 

conducive to distribution in nontraditional 

settings. Communications and media audits will 

be conducted in each community to fully 

research the unique cultural issues surrounding 

health and the environment. This research will 

help counsel supporters on how to reach their 

communities with Study messages. 

6 
UNDERSTANDING THE COMMUNICATIONS CHALLENGES,BARRIERS, AND OPPORTUNITIES 

BARRIERS 

Implementing this study will also involve 

overcoming or addressing many barriers to 

participation. This section focuses on barriers and 

addresses how communications strategies can help 

overcome them. 

■ Length 

The 21-year length of the Study may prove to be the 

largest barrier to recruitment and retention. Mothers 

and families face many immediate concerns, including 

their health, their pregnancies, or becoming 

pregnant; they may find committing to the Study 

too difficult. Community leaders polled 

about the Study noted that, for women 

and families who face challenges with 

transportation and difficulty in leaving 

jobs for health appointments, issues such 

as access to care and adherence to Study 

requirements will be major barriers to participation 

and may ultimately affect recruitment and retention. 

The length of the Study may also make partner 

organizations hesitant to commit to such a longterm effort. In focus groups conducted to aid the 

Study design, both health care providers and leaders 

of community organizations indicated that frequent 

feedback on Study data or results would be a key 

incentive to their participation.1 

➤ Communications Approach: The National 

Children’s Study will frame the Study’s length in 

balance with the participation requirements over 

time. Providing a timeline for Study families that 

shows levels of participation and that breaks the 

Study into multi-year segments will help to 

present the Study as a manageable commitment. 

In addition, communications will emphasize the 

benefits of sustained monitoring of the child’s 

health from infancy to adulthood. Health 

professionals and supporting organizations will 

also benefit from a segmented timeline and from 

a plan that includes key milestones for periodic 

reporting of data that highlight a return on the 

time invested. Ongoing communications among 

Study sites, referring health care professionals, 

and community organizations about participants 

will also help sustain interest and involvement 

over time. 

7 
UNDERSTANDING THE COMMUNICATIONS CHALLENGES,BARRIERS, AND OPPORTUNITIES 

■ Study Requirements/Samples 

The schedule of biologic samples that participants 

will be asked to provide for the Study may pose 

another barrier to participation. Among various 

cultures, planners will face specific challenges in 

communicating the need for sampling of blood, for 

instance. The time and inconvenience of participating 

may also seem burdensome to many prospective 

participants. Making participation as convenient as 

possible for participants will be an additional 

implementation challenge. 

➤ Communications Approach: Study leaders must 

explain the purpose of the sampling requirements 

and must speak to the individual barriers and 

motivators among various audience groups. To do 

so, they will need to develop written materials, 

particular to the sampling requirements, that are 

both culturally inclusive and appealing to many 

audiences. In addition, one-on-one discussions will 

offer another opportunity to explain procedures, 

to answer questions about the importance of the 

samples, and to address any sensitive Study 

requirements. Study planners may also develop 

videos that illustrate sampling techniques and 

reinforce benefits of the Study to those who enroll. 

Among other logistical factors, socioeconomic 

background and access to regular health care will 

help determine how physicians’ offices and 

community organizations might best work together 

to deliver such information to potential participants. 

■ Privacy/Confidentiality 

In Study-related discussion groups, expectant and 

current parents and other stakeholders consistently 

raised privacy as a key issue to participation.2, 3 

Community leaders and health care providers 

echoed these concerns.1 These groups all believed 

that participants must clearly understand the Study’s 

benefits and promise, and its processes for protecting 

the privacy of personal data.1-3 Many prospective 

participants may feel intimidated and insecure about 

the data collection and use, especially because many 

aspects of the Study will not be determined at the 

point of enrollment. Prospective participants may 

wonder about the ability of any large-scale study to 

protect their family’s private information over the 

long term. They might also fear that employers, 

health insurers, and other third parties will gain 

access to their information. 

➤ Communications Approach: The National 

Children’s Study is devoting careful attention to 

personal privacy. From the initial recruitment, 

through ongoing communications with Study staff, 

to the distribution of materials to participants, 

every aspect of the Study must convey that 

individual privacy is held in the highest regard. 

All procedures for data collection must include 

opportunities for clearly conveying confidentiality. 

All staff members will be trained and certified in 

confidentiality procedures to ensure uniform, 

secure handling of data. In addition, the Study 

will provide an environment and materials to 

support individual decision making to allay 

privacy concerns by reinforcing the value, 

purpose, and importance of the Study. 

8 
UNDERSTANDING THE COMMUNICATIONS CHALLENGES,BARRIERS, AND OPPORTUNITIES 

■ Incentives 

Most health consumers are aware that clinical trial 

research can provide health benefits either from the 

medical intervention being tested, or as a result of 

getting additional medical care for a specific condition. 

However, because this Study will observe and record 

exposures and health status and will provide only 

certain specific interventions, there is no direct 

medical benefit to weigh against the requirements 

of participation. There may be incidental benefits 

for participants, who may receive more medical 

evaluation through the Study than they would 

otherwise. Although some participants may have 

altruistic tendencies and share in the promise of 

improving the health of future generations, this 

motivation may not be sustained over 21 years. The 

more burdensome the requirements for observation, 

the more important incentives become. In the preStudy focus groups, potential participants, health 

care providers, and community leaders all spoke of a 

need for incentives to ensure sustained participation. 

Planners will assign incentives to Study participants 

that are appropriate to levels of participation and life 

stage. For instance, the Study will provide incentives 

at major milestones, such as on the children’s 

birthdays or after the completion of a segment 

of the Study. 

➤ Communications Approach: The communications 

challenge will be to appeal to all motivators for 

each audience so that tangible incentives are 

paired with other important benefits, such as 

access to researchers, 

a feeling of helping 

others, and receiving 

information about 

one’s health status. 

OPPORTUNITIES 

In addition to challenges and barriers, the National 

Children’s Study presents numerous opportunities 

for benefits and progress in children’s health. 

■	 Creating New Possibilities for Health Promotion 

Initiatives, Future Research, and Interventions 

Like its predecessor long-term studies, the 

National Children’s Study could have a 

measurable impact on health behavior. For 

instance, linking cholesterol and smoking to 

heart disease and stroke in the Framingham 

Heart Study led to changes in medical practice 

and resulted in numerous initiatives aimed at 

changing consumer behavior to improve the 

nation’s health. Through discoveries of linkages 

between children’s health and the environments 

The data and potential 

findings will change how 

medicine for children and 

adults is approached in many 

ways. Communications 

about the Study can 

influence perceptions and 

even behaviors over time. 

in which they live, the Study will 

potentially create opportunities for 

preventing disease through targeted 

interventions and for health promotion programs 

that can help address child health policy issues. 

The Study will also produce needed data to better 

inform strategies for environmental stewardship. 

9 
UNDERSTANDING THE COMMUNICATIONS CHALLENGES,BARRIERS, AND OPPORTUNITIES 

■	 Raising National Awareness of Children’s 

Health and Environmental Issues 

Discussions of the history, purpose, and goals of 

the Study will renew emphasis on the health of 

the nation’s children. Consistent messages and 

frequent news information based on Study findings 

will not only support recruitment and retention, 

but will also spotlight the major health challenges 

children face and the role of the environment in 

increasing or decreasing these challenges. 

■	 Encouraging Local Networks of Children’s 

Health and Environment Advocates 

By creating partnerships between Study 

coordinators and community organizations, 

the National Children’s Study will promote an 

exchange of ideas and information among local 

child health and environmental advocates. This 

interaction will not only support the Study, but 

will also foster efforts to tackle child health and 

environment issues on the local level. 

10 
THE ESSENTIAL ROLE OF PARTNERS 

THE ESSENTIAL ROLE 

OF PARTNERS 

The success of the National Children’s Study will 

depend, in large part, on the support of national 

partners who will provide access and credibility to 

the Study community and will enhance a network 

of partner organizations in the communities 

around the Study locations. Each community is 

unique, and each partner will bring special insight 

and expertise to the Study. Some of the key 

elements of successful partnerships rely on 

communications, including: 

■	 Clear and common language and terminology 

that allows the exchange of information between 

research sites and community organizations; 

■	 True reciprocity, in which community input to the 

progress of the Study is valued; 

■	 Strategic planning that examines the profile of 

each community and tailors communication 

tactics appropriately; and 

■	 Advisory committees of community leaders to 

help guide communications. 

The extent of partner involvement, and the types of 

partners involved, will vary by community and will 

be driven by the target audiences of each Study site. 

Partners may take on multiple roles, from supporting 

the Study through advertising, mailings, or brochure 

distribution; to recommending Study enrollment to 

members or constituents; to reinforcing Study 

retention through ongoing involvement with Study 

site coordinators and with the participants themselves. 

In many communities, 

churches, schools, and social 

service agencies may play a 

lead role in introducing the 

Study and reinforcing the 

recruitment efforts of the 

Study sites. 

11 
AUDIENCE ANALYSIS 

AUDIENCE ANALYSIS 


POTENTIAL PARTICIPANTS 

Who are they? 

The typical National Children’s Study family is every 

American family. Some may be working to balance 

family and career, others will be preparing for their 

first child, or even seeking fertility treatments to help 

them conceive. Some parents may be struggling to 

provide for their families, or they may be recent 

immigrants with extended families living in the 

home. Income level, time constraints, and lifestyle 

differences will be considered, among other factors, 

in the development of communications messages so 

that recruitment messages can be appropriately 

tailored to fit individual needs. 

Focus groups with pregnant women have helped 

identify why someone would or would not enroll 

in the Study.

2, 3 Key findings about motivators and 

barriers to Study participation are summarized to 

the right. 

How will the Study reach them? 

The National Children’s Study will address these 

barriers by maintaining open and clear communication 

with participants throughout the life of the Study. In 

addition, communications with potential participants 

will highlight and reinforce motivators to capitalize 

on the desire to help others. Study coordinators 

will need to consider needs of diverse groups and 

potential language barriers when developing 

communication materials. As much as possible, 

the National Children’s Study will also consider 

participants’ comfort and convenience in Study 

design. Pilot studies are currently under way to 

determine less invasive data collection methods 

for application in the Study. The organizers of the 

Study will try to coordinate site visits at convenient 

locations and times for participants. In addition, 

Study planners are paying special attention to privacy 

and confidentiality to ensure participant information 

is safe for the life of the Study and beyond. And Study 

teams will work to foster trusting relationships and 

ensure families’ successful and continued participation. 

NATIONAL PARTNERS 

Who are they? 

The National Children’s Study has gained the support 

and interest of some key national organizations, 

such as child health organizations, environmental 

advocates, professional associations representing 

MOTIVATORS 

Families would join the Study if: 

■	 It would allow them to learn more about 

and/or improve their children’s health 

■	 They would receive an incentive for 

participation, such as a gift or monetary 

incentive 

■	 Joining the Study would improve 

children’s health in the long term 

BARRIERS 

In regard to participation, families would 

be concerned about: 

■	 The privacy of information collected and 

how it would be used 

■	 Invasiveness of data collection methods 

■	 Transportation to the Study sites and 

frequency of visits 

■	 Feeling treated as research subjects, rather 

than as partners in the Study 

12 
AUDIENCE ANALYSIS 

industry and social science, child health foundations, 

academic institutions, and various corporations. 

Because of their national scope, the involvement 

of these organizations will help communicate to 

important constituents at every phase of the Study. 

As the Study proceeds, these supporters will be 

reached through individual contacts between Study 

planners and organization leaders. They will be 

called upon to assist with building awareness and 

supporting recruitment in Study communities. 

HEALTH CARE PROFESSIONALS 

Who are they? 

The support of myriad clinicians, most specifically 

obstetricians, pediatricians, family practitioners, 

nurses, and other primary care providers, will help this 

Study successfully reach its goal of recruiting 100,000 

participants. Health care professionals are uniquely 

positioned to help the Study build relationships 

with families and to encourage their participation. 

Therefore, an understanding of their knowledge, 

attitudes, and beliefs about the Study and about longterm studies is critical to informing communications 

and recruitment efforts with this group. 

Study planners will begin to engage obstetricians, 

pediatricians, family practitioners, and other primary 

care providers through their professional organizations. 

Once the Study is launched, primary care practitioners 

throughout the Study site regions may also participate 

in recruitment. 

During pre-planning discussion groups, health care 

providers expressed their excitement about the 

Study’s potential contributions to children’s health, 

as well as their concerns about participation. Their 

perceptions of anticipated participants’ concerns 

often influenced whether or not they would feel 

comfortable supporting the Study themselves.1 

Key findings from health professionals about their 

motivators and barriers are summarized below. 

How will the Study reach them? 

Study planners will use tailored communications 

to allay the reservations that health care providers 

might have about participating and to reinforce the 

participation motivators for the audience. Health 

professionals usually see many patients a day, 

sometimes in combination with teaching, research, 

and other responsibilities. Study planners hope to 

make it as simple as possible for providers to 

MOTIVATORS 

Health care professionals would support the 

Study if it: 

■	 Would make an unprecedented impact on 

children’s medicine 

■	 Could improve the health of people they 

serve in their communities 

■	 Would address key issues they see every 

day in their practices 

■	 Would offer personal or professional 

benefits to those connected with such a 

unique effort 

BARRIERS 

In regard to participation, health care 

professionals expressed concern about: 

■	 Having the time and/or staff resources to 

participate 

■	 Their patients’ confidentiality being 

protected, and that requirements on 

patients’ time and effort be reasonable 

■	 The invasiveness of data collection and the 

ease of addressing transportation issues 

■ Losing patients to other providers 

13 
AUDIENCE ANALYSIS 

contribute and to allow various levels of support. 

Study planners will need to be clear and thorough 

in communicating with health care providers about 

what is expected of them, and about what resources 

will be available to help them participate. Planners 

will also have to work to build trust among the 

health care professional community so that 

providers feel comfortable referring patients for 

recruitment and working with Study teams. 

COMMUNITY GROUPS 

Who are they? 

Families receive health care and support services from 

many community sources, including public health 

programs, non-profit organizations, and educational 

services; community, outpatient, and hospital-based 

clinics; and school-based programs. State and regional 

affiliates of national organizations also provide 

community services and support local health 

practitioners through research and advocacy efforts. 

During focus groups held for the Study, community 

organizations reported that they saw their role in the 

Study as primarily informing and distributing 

information to potential participants and, in 

some cases, recommending participation to their 

constituents.1 Reported motivators and barriers to 

their involvement are summarized to the right. 

How will the Study reach them? 

The National Children’s Study will work closely 

with these organizations to obtain their input and 

to take advantage of their experiences and insights. 

Many of these groups already volunteer their time in 

Study planning efforts by attending meetings of the 

Study Assembly, which are open to anyone from the 

scientific community and general public who is 

interested in the Study. Some group members have 

also raised issues before the National Children’s 

Study Federal Advisory Committee, whose members 

provide review and advice to Study planners. As 

much as possible, the Study will work to consider the 

priorities of these groups and will craft messages that 

incorporate and address them, while highlighting the 

important role these groups will play in the Study. 

MOTIVATORS 

Community groups would support the 

Study because: 

■	 This Study could improve the health of 

people in their communities 

■	 The Study is aligned with their 


organizational or personal goals
 

■	 They would want to be a part of this 


unique study to significantly impact
 

children’s health
 

BARRIERS 

In regard to participation, community 

groups expressed concern about: 

■	 Whether or not Study planners would 

consider their organizations’ key issues 

in Study design 

■	 Whether or not the Study would have 

value for their constituents, e.g., health 

benefits and tangible incentives 

■	 Confidentiality of data, the invasiveness 

of data collection measures, and other 

anticipated participant concerns 

■	 Whether or not the Study would be 

sensitive to women and children with 

special needs and from diverse groups, 

as well as the potential mistrust of 

government in certain populations 

14 
AUDIENCE ANALYSIS 

MEDIA 

The media will play a crucial role in communicating 

with the nation about the goals, progress, and 

findings of the National Children’s Study. Unlike 

communications with other audiences that rely on 

addressing barriers and reinforcing motivators, the 

success of communications with the media will rely on 

the ability to provide consistent, easy-to-understand 

key messages. These key messages are items that the 

media will likely include in all of their pieces about 

the Study. To ensure that media outlets can easily 

incorporate these points into their own articles, 

newsletters, and other materials, with little change 

or need for translation, Study planners and partners 

need to make sure that the key messages are concise, 

clear, and in plain language. 

Discussions among Study planners and partners 

produced the key messages to the right. It might be 

helpful to think of these key messages as “sound 

bites” that reporters, announcers, and other members 

of the media might include in a story about the Study. 

Prior to the Study’s launch, planners will engage 

reporters from national newspapers, television 

networks, news magazines, newswires, radio stations, 

print magazines, online journals, and other media 

outlets in frequent briefings about planning and 

recruitment progress. As recruitment continues, 

Study partners will also reach out to the local media 

venues, such as community newspapers and local 

access television, to maintain a steady stream of 

information that will help to retain and support 

Study participants. 

The National Children’s Study will also seek the 

attention of special populations’ media, outlets that 

provide focused information to certain groups. These 

venues provide an important lifeline to communities 

that have a vested interest in the Study’s findings. In 

providing information to these outlets, Study planners 

will reach constituents whose participation is critical to 

the success of the Study, including diverse populations, 

disease communities, and health care professionals. 

The media is a vital intermediary to the National 

Children’s Study. As planning continues, Study 

planners and partners will devise more specific 

tactics for communicating with the media to help 

convey consistent messages and to spur and 

maintain interest among communities. 

KEY MESSAGES 

The National Children’s Study can help pinpoint 

the root causes of many of today’s major diseases 

and disorders, including those that impact 

childhood directly and those that take shape 

in childhood but that ultimately impact adult 

health. It will provide a vast data resource from 

which to develop effective prevention strategies, 

establish health and safety guidelines, and 

inform efforts to create cures and interventions. 

The Study will help to determine not only the 

aspects of the environment that are harmful to 

child health and development, but also those 

aspects that are harmless or helpful to health 

and development. 

The Study will be a massive collaborative effort 

between Study planners and supporting partners 

in the public sector, including federal agencies, 

local health departments, and public health 

programs, and their counterparts in the private 

sector, including health and environmental 

advocacy groups, professional organizations, and, 

most important, the communities that support 

the children who are enrolled in the Study. 

15 
AUDIENCE ANALYSIS 

COMMUNITY OF THE NATIONAL CHILDREN’S STUDY 

This illustration shows how the various audiences from Study participants to health care professionals to the 

media make up the community of the National Children’s Study. 

Social Services 

Departments 

Schools 

Libraries 

Gyms & 

Recreational 

Centers 

Health 

Departments 

City Planning 

Departments 

Day Care 

Centers 

Local 

Governments 

Study
 

Participants
 

Pharmacies 

Local 

Media & 

Information 

Services 

Local 

Chambers of 

Commerce 

Community 

Health Fairs 

Internet 

Work Sites 

Restaurants 

Grocery 

Stores 

Colleges & 

Universities 

Extended 

Family 

Personal 

Support 

Networks 

Friends 

Neighbors 

Radio & TV 

Newspapers & 

Study 

Information 

Hotline 

Community 

Newsletters 

Children &
 

Parents
 

Men’s & 

Women’s 

Organizations 

Parents’ 

Organizations 

Youth 

Organizations 

Local 

Places of 

Worship 

Local Civic 

or Faith 

Leaders 

Community 

Advisory 

Boards 

Community 

Health 

Centers 

YMCAs 

YWCAs 

Hospitals 

Diabetes/ 

Asthma 

Clinics 

National Children’s Study Sponsors 

■ U.S. Department of Health and Human Services 

— National Institutes of Health 

— Centers for Disease Control and Prevention 

■ U.S. Environmental Protection Agency 

16 
THE STRATEGIC APPROACH: THREE PHASES OF COMMUNICATIONS 

THE STRATEGIC 

APPROACH:THREE PHASES

OF COMMUNICATIONS 

Communications for the National Children’s 

Study will unfold in phases that are designed to 

build the necessary internal and external support 

from partners and the public about the need for 

the Study. Key messages will also generate 

dialogue to support the initiation of the Study, 

as well as its recruitment and retention. 

Phase 1 includes activities leading up to the Study 

launch and the beginning of recruitment in 2007. 

PHASE 1: PRE-RECRUITMENT 

Goal: To build awareness and gain support for 

the overall goals of the Study from key influencers 

and the general public. To achieve this goal, 

communications will: 

■ Enhance the national dialogue 

concerning children’s health 

and environmental exposures. 

■ Build public understanding 

1 

that environmental exposures 

are a concern for child health and development. 

■ Inform potential supporters about the value of 

the Study in providing data for understanding 

why some children grow up healthy and why 

some face certain diseases, chronic conditions, 

or poor health. 

PHASE 2: RECRUITMENT 

Goal: To build a supportive environment for the 

recruiting efforts with a well-informed public, engaged 

partners, and active, referring health care professionals. 

To achieve this goal, communications will: 

■	 Engage partners and health care professionals in 

discussing and recommending the Study to 

patients and constituents. 

■	 Inform parents and prospective parents about the 

Study and its values for children. 

■ 

2 

Surround potential 

participants with 

consistent, supporting 

messages throughout 

Study communities. 

PHASE 3: 

RETENTION 

Goal: To maintain 

consistent, persistent, 

reinforcing messages 

3 

to participants and 

their communities. 

To achieve this goal, communications will: 

■	 Build and support relationships among Study 

participants, Study coordinators, and community 

partners. 

■	 Maintain a national dialogue on children’s health 

and the environment through the periodic 

announcement of Study results. 

17 
1 

PHASE 1: PRE-RECRUITMENT 

PHASE 1: 

PRE-RECRUITMENT 

While Study planners are developing the 

research protocols, defining the implementation 

plans, and pilot-testing sampling strategies, the 

emphasis of communications in this phase will be 

on setting the stage for a successful Study launch. 

The communications strategies for this phase 

are more thoroughly developed than for the 

later phases. Additional research and input into 

communications for later phases will be available 

as these phases begin. 

Communications activities in this phase focus 

on creating a national dialogue about children’s 

health and environmental issues, emphasizing 

the importance of the Study and illustrating its 

relevance to today’s health concerns. Study planners 

will be charged with answering the questions of 

“why children?” and “why now?” among others. 

Audiences 

Pre-recruitment communications will have to engage 

the audiences that will help initiate a dialogue with 

potential Study participants, including: 

■ Communities; 

■ Media; 

■ National organizations; 

■ Policy makers and government organizations; 

■ Health care providers; 

■ Researchers and scientists; 

■ Private and non-profit organizations; and 

■ Advocacy and support groups. 

Successful communications with these audiences 

will help to lay the foundations of Study benefits 

that will help in Phase 2. 

Message Approach 

Interviews with health care providers and community 

leaders indicated that messages should emphasize the 

impact and goals of the Study, specifically the impact 

that it will have on medicine and health care for 

generations to come.1,4 Messages for organizational 

and government leaders should be phrased as 

invitations, encouraging them to play a role in the 

Study’s development and implementation. 

Health care professionals reacted most favorably to 

the following approach: 

The National Children’s Study is the most 

comprehensive study ever conducted and seeks to 

discover the causes of and the means to prevent 

childhood diseases and injuries. Be a part of 

unprecedented research that will inform and 

impact children’s medicine for generations to come. 

In addition, pediatricians and family practitioners 

favored messages that compared the Study with 

previous longitudinal studies and that included 

more specifics on the Study goals: 

Just as the Framingham Study brought new 

insight into heart disease, the National Children’s 

Study can provide new research findings on 

children’s health; you can help discover the 

factors that link childhood diseases and health 

risks to environment, genes, and exposures. 

18 
PHASE 1: PRE-RECRUITMENT 

1 

Messages that gave prominence to the length of the 

Study were unappealing to this audience: 

The National Children’s Study is addressing the 

children’s health issues that are predominant in 

your practice in a national study that will 

include your patients and your community 

throughout the next 21 years. 

Community leaders were most impressed by 

messages relating the Study to their missions and 

health concerns: 

Over 21 years, the National Children’s Study will 

discover what makes children in your community 

healthy and why some face diseases. This Study 

is your opportunity to be part of the first-ever 

effort with the scope to study and impact 

children’s health care and environmental issues 

that concern the people you serve. 

Channels 

During the Pre-Recruitment Phase, Study planners 

reach audiences through many channels. The Study 

Assembly regularly brings together members of 

organizations with an interest in the Study to discuss 

important issues. Advocates and supporters interact 

and provide input on design and implementation 

planning. The Study Web site is up-to-date with 

details on the Study’s development. Quarterly 

electronic updates also inform the Study Assembly 

and Web site users of Study news and progress. 

Additional communications channels include: 

■	 Consumer media items targeted to audience 

segments in broadcast, online, and print formats; 

■	 Professional association meetings and publications; 

■	 Community organizations, schools, religious 

organizations, and retail outlets; and 

■	 Government partners, including interagency 

communications vehicles. 

Evaluation 

Tracking the results of Phase 1 outreach will allow 

Study planners to improve communications efforts 

and to plan for Phase 2. Initial evaluation will include: 

■	 Media monitoring, using clip services and 

Nielson’s SIGMA encoding to assess coverage and 

reach of news outreach efforts; 

■	 Electronic tracking to count visits to the Study 

Web site and other partner sites; 

■	 Surveys to monitor primary and secondary audience 

awareness of Study messages over time; and 

■	 Conferences and interviews with key stakeholders 

to compile message effectiveness data. 

19 
2 

PHASE 2: RECRUITMENT 

PHASE 2: 

RECRUITMENT 

Recruiting 100,000 participants is one of the 

greatest challenges of the National Children’s 

Study. Enrolling such a large number of 

participants will require a coordinated effort 

from research staff, health care providers, and 

supporters who can reach families and get 

them involved in the Study. Recruitment is 

slated to begin in early 2007 and will last through 

about 2011. However, the communications 

recruitment phase will begin before a single 

participant is enrolled. Using data collected in the 

Pre-Recruitment Phase, Phase 2 communications 

will develop networks to support the Study sites 

and will prepare them for outreach to potential 

participants once recruitment actually begins. 

Audiences 

Although both national and local outreach efforts are 

critical, Study planners anticipate that intense local 

grassroots campaigns will best support recruitment 

for each site. Such communications will promote 

the formation of community partnerships; build 

relationships with area obstetricians and other 

health care providers; and reach out to parenting 

groups, religious and community institutions, and 

other organizations that offer health information and 

support to families. In addition, because previous 

studies have demonstrated that endorsement and 

referral from trusted community leaders is a significant 

factor in encouraging Study participation, Study 

coordinators will form and maintain positive and solid 

relationships with such leaders via communications. 

Message Approach 

Communications campaigns for recruitment will 

focus on core messages that define the Study in 

ways that are meaningful to each participant. 

The Study will also develop and test messages 

and materials with potential participants to 

understand what methods might improve 

recruitment communications approaches. 

Channels 

Phase 2 will emphasize local communications 

channels. Study planners will aim to maintain 

awareness among the national audiences, while 

assisting local Study sites in working with the 

media and professional and consumer organizations 

to promote recruitment. Potential local 

communications channels include: 

■	 Local television stations and newspapers; 

■	 Regional and local medical, nursing, and allied 

health associations; 

■	 Social service organizations; 

■	 Physicians’ offices and health clinics; 

■	 Religious institutions; 

■	 Schools; 

■	 Consumer points of contact, such as supermarkets 

and pharmacies; and 

■	 State and local government offices. 

20 
PHASE 2: RECRUITMENT 

2 

Evaluation 

The true evaluation of Phase 2 will be in the 

tally of enrolled participants. Planners will look 

closely at enrollment at each Study site and will 

adjust communications efforts to support 

recruitment as needed. In addition, the Study may 

employ the following evaluative measures: 

■	 Tracking forms to assess whether materials are 

reaching the right audiences; 

■	 Enrollment status reports from Study sites to 

determine which audiences are not being 

reached; or 

■	 Interviews with stakeholders to determine any 

barriers to participation. 

Local communications campaigns will 

promote the formation of community 

partnerships; build relationships with 

area obstetricians and other health care 

providers; and direct outreach to parenting 

groups, religious and community 

institutions, and other organizations offering 

health information and support to families. 

21 
3 

PHASE 3: RETENTION 

PHASE 3: 

RETENTION 

Strong relationships and open communications 

will be essential to successful retention. Ideally, 

participants will come to rely upon and trust 

their Study representatives. Researchers will 

come to know individual participants over time, 

allowing for more personal approaches to 

retention. Community leaders can alert 

coordinators to changes in the community that 

may affect participating families’ decisions to stay 

in the Study and can help coordinators address 

retention problems on an individual basis. 

Audiences 

As the Study progresses, the primary audience 

for communications will be the participants, who 

will be segmented in multiple ways. In addition, 

Study coordinators and the health professionals 

that surround and support each Study site will 

also constitute a critical audience. The Study will 

need many of the supporting organizations that 

aided recruitment to continue their support of 

participants throughout the length of the Study, in 

some cases providing tailored communications to 

their constituents. 

Message Approach and Channels 

During the previous phases, and as more is learned 

about the communities involved and the participants, 

Study coordinators can inform message development 

and channels for Phase 3. Localized and individual 

messages and methods will likely be most effective. 

Input from partners and supporters will also help 

shape messages so that, as the needs of communities 

change and the children enter new life stages, 

participants are still getting the information and 

support they need. 

Evaluation 

Retention rates will be measured over time in many 

different ways. The communications support for 

retention may be evaluated through qualitative and 

quantitative research, including: 

■	 Surveys of participants to help understand 

participation motivators and barriers as they 

change with time; 

■	 Interviews with Study coordinators and community 

supporters to determine the effectiveness of 

messages and distribution methods; and 

■	 Case studies in select areas to follow specific groups 

of participants and determine how communications 

efforts are received and interpreted. 

22 
PHASE 3: RETENTION 

STRATEGIC COMMUNICATIONS 

STRATEGY TIMELINE 

Phase 1: 

Pre-Recruitment 

2004–2006 

■	 Establish initial Study 

sites 

Phase 2: 

■	 Build data and 

Recruitment specimen repositories 

■	 Build awareness in local 2007–2011 

communities 

■	 Establish confidentiality 

guidelines and rules for ■ Launch study privacy 

■	 Continue recruitment 

and enrollment through 

this entire period 

Phase 3: 

Retention 

2007–2032 

■	 Conduct ongoing clinic and home visits 

■	 Collect data about participants and their 

environments 

■	 Share results regularly 

■	 Provide informational feedback to participants 

and communities 

23 
EVOLUTION OF STUDY COMMUNICATIONS 

EVOLUTION OF STUDY 

COMMUNICATIONS 

Through monitoring, reporting, ongoing interviews, 

and conferences, Study leaders will seek to understand 

the outcomes of the communications initiatives and 

will use their evaluations to keep planning fresh. 

Evaluations conducted before, throughout, and 

after implementation of communications efforts will 

help to refine, adjust, and assess current and future 

activities and strategies. The program of evaluation 

may include: 

■	 Process evaluation to track communication efforts 

and determine whether communication links are 

in place and effective; 

■	 Outcome evaluation to assess the extent to which 

communications activities have had the intended 

effects; and 

■	 Impact evaluation to measure how much 

communications components contributed to the 

overall success of the Study. 

As discoveries are made, as the environment changes, 

and as new public health issues are raised, the Study 

will evolve. Study communications will also adapt to 

meet and address those changes. Although partners 

need to work with a common understanding of 

communications strategy, Study planners encourage 

them to adopt their own tactical plans specific to the 

needs and challenges they are facing. 

This document emphasizes the early phases of 

communications for the Study. Further research, 

findings, evaluation of early efforts, and, most 

important, input from partners and supporters 

will help shape communications over the length 

of the Study. 

24 
The National Children’s Study planners and coordinators welcome your feedback on this document. 

Please send your comments to NCS@mail.nih.gov and include “COMMUNICATIONS STRATEGY” 

in the subject line. 

References 

1. National Institute of Child Health and Human Development. (2004). Approaches to National Children’s 

Study message development for health care providers and community organization representatives. 

Washington, DC: National Institute of Child Health and Human Development. 

2. Dimitropoulos, L. (2003). National Children’s Study focus groups. Prepared for D.T. Lobdell of the U.S. 

Environmental Protection Agency on behalf of RTI International under contract 68-D-02-069. 

Washington, DC: U.S. Environmental Protection Agency. 

3. Dimitropoulos, L., & Prindle, C. (2003). National Children’s Study focus groups—follow-up. Prepared for 

D.T. Lobdell of the U.S. Environmental Protection Agency on behalf of RTI International under contract 

68-D-02-069. Washington, DC: U.S. Environmental Protection Agency. 

4. National Institute of Child Health and Human Development. (2003). Stakeholder interviews. 

Washington, DC: National Institute of Child Health and Human Development. 

5. National Institute of Child Health and Human Development. (2003). Literature Review Project, National 

Children’s Study. Washington, DC: National Institute of Child Health and Human Development. 

6. National Institute of Child Health and Human Development. (2002). National Children’s Study 

Community Engagement Workshop report. Washington, DC: National Institute of Child Health and 

Human Development. 
The National Children’s Study 

http://nationalchildrensstudy.gov 

NCS@mail.nih.gov 

For Administrative Use Only 

2005