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California Poison Control System
Health Education Program
An Overview of Research,
Development and Implementation

Since its inception in 1997, the California Poison Control System’s (CPCS) toll-free treatment advice and referral service has responded directly to over one million callers. In an effort to mirror and leverage this achievement, the CPCS has initiated a remarkable phase in the expansion of its education and outreach by choosing one simple focal point – the consumer.

UNDERSTANDING OUR CONSUMERS

By placing consumer needs and customer satisfaction at the center of the outreach process, the CPCS has concluded that answering “Who will consumers listen to?” is more relevant than asking “Who will to talk to consumers on our behalf?” The first question leads to results, the latter to exhausted resources, and atrophied endeavors.

Although consumers may be somewhat aware of poison centers, few understand how, or why, such services fit into their lives. An investigation into consumer perceptions revealed not only a lack of comprehension, but also an image of poison centers as remote, dispassionate and unapproachable. This image was often inadvertently perpetuated by alarmist, brusque and confusing messages that further distanced consumers.

Our objective was to employ market research methods to understand the communication needs of consumers, particularly low-socioeconomic status (at or below Federal poverty guidelines) parents regarding poison exposure and treatment and to determine market position and communication strategies for the CPCS and its hotline.

OVERVIEW OF RESEARCH METHODS

Generative research

We started with a broad, open-ended exploratory process. Projective tools, such as image collage, were employed to aid users, in this case educators, in expressing the critical attributes and perceptions of our service. Knowledge gained from this process guided the development of a design framework that set the tone for the entire process.

Evaluative research

This next phase was more focused, detail-oriented and conducted once the initial framework and preliminary concepts had already been developed. We aimed to assess whether particular concepts, such as the ubiquitous “call in case of a poison emergency”, were useful, usable, and/or desirable to target users. Evaluative tools, such as focus groups and questionnaires, were used to record feedback regarding the concepts being tested. Knowledge gained from the evaluative guided the design refinement process.

The CPCS research and development plan included:

• One round of qualitative focus groups across California
  • Evaluative research on logo concepts and taglines
  • Evaluative research on current communications materials
  • Generative research on end-user behaviors and attitudes towards poisonings
  • Generative research on tools, messages and vehicles for encouraging poison center use
    
• One round of quantitative research across California via intercepts (for statistically projectable data)
  • Evaluative research on logos, taglines and communications materials
  • Gather demographic, attitudinal and behavioral information specific to poison center use and development of services (provided baseline for evaluating effectiveness of new materials and messages in the market)

The Fist Step: Audience analysis:

We examined the California consumer by reviewing demographic data and investigating additional characteristics such as lifestyle, behavior and attitudes. CPCS call data were studied to determine if a picture of a “typical’ consumer could be realized. Data proved inconclusive for meaningful characteristics, and we chose to instead focus on the general mandate of Poison Control Centers to direct attention and resources to “identified at risk populations”. If children under the age of 5 account for the majority of poison exposures, we asked ourselves who are their parents, where do they live, how do they behave and how do we reach them?

Existing research pointed out that children born to low-income and low socio-economic status (at or below Federal poverty guidelines) parents have a higher probability of childhood injury. We created different groups, thus creating our market segments, by identifying consumer characteristics such as:

Demographics/Geographic

Urban/ Rural
Ethnicity and Language
Household size and occupants/number of children
Education and Income
Religion

Lifestyle/Behaviors

Home environment
Technology usage
Media habits
Shopping
Education venues: Where, what kind, child?
Leisure activities
Community participation and activities
Trusted relationships
Government/Community program involvement
Healthcare

Attitudes

Healthcare
Use of services by phone
Injury management
Parenting/childcare
Family roles and responsibilities
Receptiveness to health information
“ How to market to” info
Community

Benchmarks

Successful health programs
Successful brands
Successful campaigns and methods
Why were they successful?
What factors contributed to their success?
What can we learn?

Second Step: Market segmentation

• Define a segment of the population as our perceived and likeliest typical user that could also function as a control group
• Segment the target market of low-SES parents, whose children at greater risk of childhood injury, by geographic, demographic and psychological variables, including
  • Income level, insurance status, frequency of Emergency Room visits, and presence of children under the age of 5 at home
    

• Four market segments were identified
  • Mainstream suburban families in Northern and Southern California (current users)
    13.7% of CA pop., defined as having a household income between 30,000-74,999
  • Low-SES African-Americans
    6.7% of CA pop, 29% poverty rate, 2 largest concentrations in Los Angeles County (40% of total pop) and Alameda County (9.3% of total pop) (source: U.S. Census 2000)
  • Low-SES Bilingual (English-preferred) and Monolingual, or low-English proficiency, Latinos:
    Latinos comprise 32.4% of CA population and have the lowest median income of any group (Source: California Research Bureau, California State Library), concentrated in L.A., Orange and San Diego counties

Third Step: Consumer feedback

Essentials of formative market research

• Concept testing and message design to define tone of voice and market position
• Pre-testing of materials with target audience to determine relevance, comprehension, and motivation
  
  FOCUS GROUPS
• Qualitative research was carried out in each market segment to investigate the terms poisoning and poison emergency
  • 2 focus groups in each market segment, 4 cities, 64 participants recruited by a professional facility, 2 hour sessions with a professional moderator
  • Participants were provided disposable cameras and asked to take pictures of various areas and objects in their home, including telephones, refrigerator, emergency contact lists, under the sinks, and any things they considered dangerous or hazardous to their young children.
  • A video of a simulated unintentional poisoning was shown and participants were asked for their reactions, feelings, and measures they might take
  • Potential solutions identified by the participants (911, ED, etc.) were discussed and ranked according to their efficacy, usefulness, and perceived benefit
  • Participants were asked to evaluate new concepts for the poison center identity, name and tagline. They were also asked to assess our current identity and the national Poison Help™ logo.

Results

Participant responses across all focus groups:

• “Emergency” was defined as a life-threatening situation, rather than any circumstance requiring urgent action
• “Poison emergency” (a frequent reference on educational materials) was perplexing, and participants could not distinguish this from any other urgent situation, nor did they see a good reason to do so.
• Participants projected that they would respond to a perceived emergency by taking urgent measures (911/ED) and to seemingly less threatening incidents by administering a home remedy, or taking no action.

Low-SES participant responses

• Some low-SES African-American parents expressed fear over being accused of neglect and suspicion that poison centers with allied with social services that might take away their children.
• This group also frequently mentioned relying on family and friends in order to avoid using social services.
• Latino parents expressed concern over not having a direct physical examination of their child in case of a poisoning.

Mainstream Suburban Mom responses

• Participants were unlikely to think this could happen to them, many felt they had taken adequate precautions.
• Some participants appeared contemptuous of mothers who would not be smart enough to keep dangerous products, such as cleaning supplies, out of reach of children.
• Suburban moms were more likely to rely on services offered by their health plan, such as an advice nurse line

In most cases of mild to moderate exposure participants, although indicating a strong desire to alleviate their anxiety, participants said they would take only low-level action, such as calling a friend or relative, or no action.

QUANTITATIVE RESEARCH

428 face-to-face interviews were conducted with individuals fitting the demographic profiles of our focus groups participants in the same geographical regions.

Selected Results

The questionnaires were designed to lead to the specifics about poisoning prevention and knowledge about local poison control center, but the first set of questions were general home injury prevention questions.

What do parents worry the most in regards to home safety?

Across all socio-demographic groups, parents revealed that they were most worried about sharp objects, in order of concern, cleaning supplies were second and electrical cords and outlets were third.

What type of home injury prevention methods do parents use?

The most common response among all groups was: “Keeping child in sight at all times” followed by “Saying no to the child”.

Prevalence of poisonings

48% of all 428 respondents reported at least one poison incident in the past year. This approximate 50% rate of reported poison incidents in the last year was consistent for all socio-demographic groups.

Poison Center Awareness

Only 51% of all respondents had heard of the Poison Center. Only 48.1% of all low-income parents had heard of the Poison Center where 59.9% of all higher income mothers had heard of it.

The breakdown of Poison Center awareness for the low-income group resulted in the following:
53.3% of African American parents had heard of the Poison Center.
46.0% of Hispanic bilingual parents had heard of the Poison Center.
45.5% of Hispanic monolingual parents had heard of the Poison Center.

How did parents hear about the Poison Center?

The majority of parents had learned about the Poison Center through their pediatricians, only the Hispanic Monolingual group reported having heard about it through the Women, Children and Infants (WIC) programs.

What is the most important characteristic of the Poison Center?

All groups concurred that knowing that the Poison Center staff are “trained experts in poisoning” was the most important feature.

MESSAGE DEVELOPMENT -- “DON’T GUESS. BE SURE”©

Core message shifts from “call in case of a poison emergency” to “call if you’re not sure”.

When asked to describe what an emergency is, focus group participants indicated this was any situation they perceived as life-threatening. An emergency equaled impending tragedy, instinctively precipitating a call to 911, or a trip to the ED. However, they indicated they had few dependable resources to help manage potentially unsafe situations quickly, appropriately and without fuss at home. The CPCS can fill this void, offering consumers the rapid expert help and reassurance they seek.

Advancing a compelling, accurate reflection is critical in positioning the CPCS service within the consumer’s frame of reference.

Developing a new visual identity specifically targeting the end user to cultivate a consistent, recognizable image that advanced our core message was critical. This identity addressed consumer perception and harnessed universal themes so as to resonate across social, economic and cultural lines.

Understanding bilingual and monolingual Latino consumers

Resources were invested in qualitative testing to identify significant variations between these two groups. Monolingual and low-English proficiency Latino consumers indicated they would use the service if they had a more robust understanding of precisely what happens when you call. Although consumers from other target groups expressed a general desire for more information, Monolingual and low-English proficiency audiences sought more detail and reassurance about the call-in process. To learn more about understanding these consumer groups click here.

DISTRIBUTION

No organization should be assumed a natural ally.

Identifying credible sources for the dissemination of our core message is an essential part in securing consumer confidence.

A clear, systematic and critical assessment of prospective partners is crucial.

Prospective organizations were and continue to be assessed based on their mission, organizational structure and effectiveness, program objectives, scope and frequency of services, funding source, process, methodology and perceived image. The education program has defined a manageable number and category of organizations that closely match the CPCS mission, serve its target audiences, operate efficiently and have earned the respect of those they seek to serve.

Two partnership categories - Education service and Hotline service

In researching potential allies, two categories of partnership were identified – education service and response, or “hotline” service. Education service partners are those whose mission includes preventing childhood injury and/or teaching preventive strategies. These organizations are provided with thorough, on-going consultation on incorporating CPCS poison prevention information within their existing platform. Consultations with individual partners determine customized tools and methods for effective delivery of the CPCS message. In helping education partners achieve their own missions, the CPCS accomplishes its goal of becoming the leading source for poison prevention information in California, both the public and health professionals.

The response, or “hotline”, service supplies standard materials to organizations with accessible distribution networks whose customers are part of the CPCS target audience.

In order to achieve its goals for awareness and utilization, the CPCS has harmonized activities and institute unified outreach initiatives. Strategic associations with key partners, who are credible sources of poison prevention information with existing distribution networks, access to our target audience, and sound organizational structures, are critical to success. In alignment with this new strategy, the education program has a tighter focus - building relationships, ranking, prioritizing and realizing opportunities, targeting activities, and allocating resources so as to make the best use of time and money.

© CPCS and Regents, University of California. 2000-2006
Disclaimer: This web site is designed to be informational and educational. Under no circumstance is this web site meant to replace the expert advice of a qualified poison specialist or physician. In the event of a poison emergency, call the nearest poison center immediately by diaing 1-800-222-1222 or contact 9-1-1 emergency services.