You Have Options: Implementing and evaluating a contraceptive choice social marketing campaign.

Background: Up to two-thirds of pregnancies among young, unmarried women in the United States are unintended, despite increased access to highly effective contraceptive options. Aim: This study implemented and evaluated a social marketing campaign designed to increase access to a full range of contraceptive methods among women aged 18-24 years on a southeastern university campus. Methods: Researchers partnered with Choose Well and Student Health Services to design, implement, and evaluate You Have Options, a 10-week multi-media social marketing campaign. The campaign aimed to raise awareness, increase knowledge, and improve access to contraceptive options, including long-acting reversible contraception (LARC) methods among college women. A pretest-posttest web-based survey design measured campaign awareness and recognition, as well as attitudes, subjective norms, and behavior. Results: Participants demonstrated a significant increase in knowledge about intrauterine devices (IUDs) between pretest (M = 2.66, SD = 1.30) and posttest (M = 3.06; SD = 1.96); t(671) = -2.60, p < .01). Analysis revealed that frequent exposure to the campaign prompted participants to engage in discussions about LARC with friends (p < .05). In addition, 20- to 24-year-olds who reported seeing the campaign messages were more likely to seek out information (p < .01) and adopt a LARC method (p = .001) than 18- or 19-year-olds who saw the campaign messages. Conclusion: Findings from the study offer practical recommendations for implementing social marketing campaigns aimed at increasing access to LARC and reducing unintended pregnancy.

"People are struggling in this area:" a qualitative study of women's perspectives of telehealth in rural South Carolina.

Rural communities face disparities and barriers to health care access that may be addressed through telehealth programs; yet little research is available detailing rural women's attitudes toward telehealth. Researchers partnered with a women's reproductive health organization to conduct formative audience research to understand rural women's perspectives of telehealth in their communities. Qualitative research was conducted to improve understandings of women's perceptions of telehealth in rural South Carolina. In-depth interviews with 52 women aged 18-44 years were conducted in five rural counties in South Carolina during June - August 2015. Analytical techniques from grounded theory methodology were used throughout data collection and analysis. Participants believed a telehealth intervention would benefit the community by addressing reproductive health barriers, such as cost, transportation, and long wait times at local health care facilities. Participants' concerns included issues of confidentiality in a small town, discomfort with mediated communication, privacy, and the importance of relationship-centered care, including patient-provider communication and approachability of health care providers. Findings provide insight to design and implement telehealth interventions to improve women's health in rural communities.

"The Closer, the Better:" The Role of Telehealth in Increasing Contraceptive Access Among Women in Rural South Carolina.

BACKGROUND: Rural populations face unique health disparities that prevent women from accessing reproductive health care services. Telehealth initiatives offer a health care delivery tool to increase access to contraception. OBJECTIVE: To understand women's contraceptive needs and perceptions of accessing contraception through telehealth services. METHODS: Researchers conducted 52 in-depth interviews with women ages 18-44 years living in five rural counties in South Carolina from May to July 2015. Researchers employed constant comparative data analysis using HyperRESEARCH 3.7.2. RESULTS: Most participants identified as Black (62%) or White (28%). Findings suggest successful telehealth interventions should accommodate women's complex and nuanced community views, including benefits and barriers of telehealth, to improve access to contraceptive methods in rural locations. In addition, telehealth initiatives should frame contraception as contributing to women's overall health and well-being. CONCLUSIONS FOR PRACTICE: Telehealth initiatives may address barriers to contraceptive access in rural locations. Findings from this study offer theoretical and practical opportunities to guide telehealth interventions that support and empower women's access to contraceptive methods in rural areas.

Evaluating the Whoops Proof S.C. Campaign: A Pair-Matched Group Pretest-Posttest Quasi-experimental Study.

INTRODUCTION: In South Carolina, 50% of all pregnancies are unintended. Intrauterine devices (IUDs) and the implant are recommended as top-tier contraceptive options for all women and adolescents. The Whoops Proof S.C. campaign was evaluated to determine if women (ages 18 to 29) who do not intend to become pregnant in the next year report greater awareness of and positive regard for IUDs and the implant after exposure to a multi-channel campaign. METHODS: A pair-matched group pretest-posttest quasi-experimental design was utilized. A total of 1,439 women responded to the pretest survey (May-July 2016) and 1,534 responded to the posttest survey (October-November 2016) in four South Carolina counties. Statistical analysis include paired-sample and independent t-tests and one-way ANOVA tests for variance. RESULTS: At posttest, intervention county participants were significantly more likely to recall messaging and to report receiving contraceptive information from Whoops Proof S.C (t(1533)= - 8.466, p < .0001). Participants who saw ads more than once per week reported a significant increase in awareness of IUDs and the implant (F(6,1532) = 5.571; p < .001). Participants in intervention counties reported a significant increase in positive attitudes toward IUDs (t(616) = - 1.740; p = .041) and the implant (t(603)= - 1.665; p = .048). DISCUSSION: The Whoops Proof S.C. campaign offers strategies to campaign planners and health care providers to optimize exposure and recall frequency to increase awareness of and positive regard for highly effective contraceptive methods. Campaign planners should test messages and focus on communication channels to increase engagement and avoid saturation.

It's Your Place: Development and Evaluation of an Evidence-Based Bystander Intervention Campaign.

Preventing sexual assault on college campuses is a national priority. Bystander intervention offers a promising approach to change social norms and prevent sexual misconduct. This study presents the implementation and evaluation of a theory-based campaign to promote active bystander intervention. The theory of planned behavior (TPB) served as a conceptual framework throughout campaign development and evaluation. Formative research published elsewhere was used to develop campaign strategies, communication channels, and messages, including "It is your place to prevent sexual assault: You're not ruining a good time." The It's Your Place multi-media campaign fosters a culture of bystander intervention through peer-to-peer facilitation and training, as well as traditional and new media platforms. A cross-sectional post-test only web-based survey was designed to evaluate the campaign and test the TPB's ability to accurately predict intention to intervene. Survey data were collected from 1,505 currently enrolled students. The TPB model predicted intention to intervene. There was a significant effect of campaign exposure on attitude, subjective norms, and perceived behavioral intention. This theory-based communication campaign offers implications for promoting active bystander intervention and reducing sexual assault.

Integrating Pregnancy Ambivalence and Effectiveness in Contraceptive Choice.

Approximately 70% of pregnancies among young unmarried women living in the United States are unintended. Unintended pregnancy results in negative health and economic outcomes for infants, children, women, and families. Further research into the decision-making process of contraceptive selection is needed to meet young women's contraceptive needs in the United States. Overall, 53 women ages 18-24 years completed in-depth qualitative interviews. Researchers used analytical techniques from grounded theory and HyperRESEARCH 3.5.2 qualitative data analysis software to identify emergent themes. Problematic integration theory provided a theoretical lens to identify young women's probabilistic and evaluative orientations toward contraception. Researchers identified two profound values at stake to participants regarding their contraceptive decisions: avoiding pregnancy in the present, and protecting future fertility. Participants resisted long-acting reversible contraception (LARC) methods (e.g., the intrauterine device and the implant) due to concerns about safety and fears about infertility. Participants experienced ambivalence toward the idea of pregnancy, which complicated contraceptive decisions, especially regarding long-term methods. Uncertainty led participants to rationalize their use of less effective methods and reduced information seeking. Findings from this study offer practical suggestions for practitioners and health communication campaign planners. Contraceptive access campaigns should focus on the effectiveness, safety, and convenience of LARC methods. Messages should help young women make contraceptive choices that better fit their needs in order to reduce unintended pregnancy.

Social sides of health risks: stigma and collective efficacy.

Health threats may not occur in a vacuum; one may need others' support to address a given health condition. For example, in Namibia, parents dying from AIDS-related illnesses leave their orphaned children in need of adoption. If people do not feel threatened by HIV personally, social threats might motivate them to action. We extend the extended parallel process model (Witte, 1992) to include 2 social perceptions: (a) stigma and (b) collective efficacy. We found that Namibian respondents (n = 400) who did not feel threatened by HIV personally showed a relationship between these social perceptions and their willingness to support those living with HIV and their willingness to adopt AIDS orphans. These effects appeared for those who did not assess HIV as a health threat, suggesting that social threats, combined with efficacy, may motivate intentions to adopt recommended actions. Practical applications and intervention designs are discussed.

Formative research on adolescent and adult perceptions of risk factors for breast cancer.

This study uses the Health Belief Model (HBM) as a framework to guide formative research of the lay public's perceptions of risks associated with breast cancer. Data were collected from adolescent females and adult females across four counties in Michigan, US. Ten focus groups (N=91) were conducted and analyzed with a coding scheme based on the HBM. Participants' responses to focus group questions (N=5168 thought units) reveal beliefs about severity, susceptibility, and efficacy pertaining to breast cancer, nutrition, activity, environment, and the role of government and industry. Chi-squares examined the distribution of statements across categories between adult females and adolescent females. Results revealed that both adolescent and mother groups recognized gender and heredity as relevant risk factors related to susceptibility, and detection as a strategy to decrease severity of breast cancer through early treatment. Beliefs about environmental factors were characterized by uncertainty for both groups. Also, while adolescent girls communicated more about efficacy issues, mothers focused significantly more than adolescent girls on the role of government and industry in breast cancer prevention and treatment. Representative qualitative thought units are included based on their frequency, salience, and relevance to HBM message design guidelines. Formative research is the first phase in the development of health campaigns, informing the creation of health messages for target audiences.