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[Announcer] This podcast is presented by the Centers for Disease Control and Prevention. CDC - safer, healthier people.

[Dr. Anderton] Welcome to this edition of CDC’s Health Marketing Matters. I’m your host, Dr. John Anderton. Today my guest is Alan Janssen, Health Communication Specialist with CDC’s National Center for Immunization and Respiratory Diseases. Alan, welcome to Health Marketing Matters.

[Alan Janssen] John, thank you for inviting me today.

[Dr. Anderton] Can you give us some background on CDC’s seasonal influenza vaccination campaign?

[Alan Janssen] John, currently in the United States roughly 218 million people should receive influenza vaccine, based on the recommendations of our Advisory Committee on Immunization Practices, or ACIP. Those recommended groups include persons who are at high risk from medical complications from influenza and those persons who are close contacts of those high risk persons. Each year, the campaign must reach out to these groups and encourage them to get flu vaccine. The influenza vaccine, while not perfect, is the best means to prevent influenza.

[Dr. Anderton] Every year, I hear messages that encourage people to get vaccinated to reduce the number of new influenza cases. So tell me why health marketing and communication’s so important for this kind of campaign?

[Alan Janssen] Each year, on average in the United States, an estimated 36,000 people die from complications of influenza and 200,000 are hospitalized. Most of the deaths occur among the young and the old with persons with select chronic diseases. The marketing program promotes influenza vaccine recommendations to reduce this annual toll. Past surveys have indicated that many people’s perception of the seriousness of influenza isn’t as acute as it probably needs to be and there’s a lot of misconceptions about influenza and influenza vaccination. In addition, many people who should receive an annual flu vaccine aren’t always aware that they are included in the recommended groups.

[Dr. Anderton] So then, what were the key messages for this year’s campaign?

[Alan Janssen] John, our first overarching message is that influenza is a serious disease. We really have, this year, put special emphasis on the young, which is a population at risk from influenza, along with our historically recommended groups - the over 65 group. We have always targeted Hispanic and African-American audiences to reduce the disparities that we find among that group– particularly those that are over 65 of that group.

Our second overarching message was that getting a flu vaccination every year is the best way to protect yourself and the ones that you care for from influenza.

Our third message was that when you receive a flu vaccine, you protect not only protect yourself, but you protect those people around you.

And our fourth message is that the time to get a vaccine starts as soon as the vaccine is available and extends into the winter, through February or later, when influenza season usually peaks.

[Dr. Anderton] Tell me about the types of research that you’ve conducted to develop the messages for this year’s campaign?

[Alan Janssen] John we start off in March with a national survey of U.S. adults that we take a look at their health behaviors, especially among those in terms of seeking influenza vaccine, their knowledge, their attitudes, and their perceptions about flu vaccine. We then follow-up with a second survey in August 2007 to look for emerging issues and give us an opportunity to look for trends in terms of what’s occurred over those previous surveys. And then we also conduct a series of focus groups, in English and Spanish, with members of the general public to test our messages that we develop each year to make sure that they’re effective. We’ve taken a special look this year in terms of health workers and why they don’t receive vaccination. We did a four study survey in terms of doing that in addition to that we also do a lot of in-depth interviews with physicians and influenza experts to use the key informant technique to ensure that our techniques are scientifically appropriate.

[Dr. Anderton] So that’s the research agenda. Tell us about the channels that you used to deliver all of these messages to your targeted audiences.

[Alan Janssen] John, we used traditional print media and electronic channels, such as posters, web sites, public service announcements - both on radio and TV, press announcements, satellite tours, matte articles, and talking points for our partner groups. We also used several “new” media channels, like MySpace, video clips, webinars in order to reach our various target audiences.

[Dr. Anderton] Talk to me a little bit about evaluation models used in your health marketing efforts.

[Alan Janssen] Well John, I think one of the things we need to talk about is that evaluation just doesn’t come at the end. Evaluation is an important part of every phase of your project. We start off with formative research – we use both qualitative and quantitative measures, in terms of developing our campaign messages and materials. We use process evaluation or monitoring as we go through our project. We monitor the media to make sure that our messages are getting out there and then we do impact evaluation to assess, to the extent possible, if we’ve been able to make a difference in the public perception of when folks should be vaccinated.

[Dr. Anderton] So you use several forms of evaluation. Talk about the larger picture of evaluation in seasonal influenza vaccination campaigns, in general.

[Alan Janssen] John, our formative research includes both a pre-season survey of vaccine intentions and then we use focus groups to drill down and explore the perceptions of audience members. During the campaign, the process evaluation measures told us if we were reaching the audience. Data from the National Health Interview Survey and the National Immunization Survey will tell us if we’ve made an impact on increasing vaccines given in December and later.

[Dr. Anderton] We have flu season every year, but speak to me a little bit about the unique challenges of this particular campaign.

[Alan Janssen] Every flu season is unique; it’s been said if you seen one flu season- then you’ve seen one flu season. Influenza is very unpredictable and much of what impacts us is beyond our control – such as when flu starts circulating, how severe the disease will be, those kinds of things. In addition, influenza vaccination is more complex than it appears. Because the influenza virus is easily changed, a new vaccine is required every year. The annual vaccine production makes us susceptible to manufacturing problems, such as virus mismatches, delays, or even shortages when not enough vaccine is made. Because of this uncertainty, we have had to have contingency communication plans prepared, in addition to our regular communications messages.

[Dr. Anderton] Talk to us a little bit more and give an example of the health marketing strategies associated with this part of the campaign.

[Alan Janssen] Well John, as mentioned before both surveys and focus groups were used in determining the messages. Then we concept test the messages and materials prior to release. Over the past several years of communication research, we’ve observed that there’s a clustering of where people receive influenza shots. This clustering is primarily demographic in nature, but this year, we’re looking at a more complex model using PRIZM which is a marketing database to better understand and segment those persons who occasionally get flu shots in order to increase their uptake of this vaccine. We know that among certain groups, convenience or ease of vaccination is a major factor in getting vaccinated. This segment analysis allows us to better reach these audiences with our vaccination messages and even encourage placement of vaccination clinics in locations that makes it more convenient for them.

[Dr. Anderson] Thanks Alan for talking with us about the seasonal influenza vaccination campaign; I’ve enjoyed speaking with you.

[Alan Janssen] John, always a pleasure.

[Dr. Anderton] For more information on health marketing, call 1-800-CDC-INFO or visit www.cdc.gov/healthmarketing.

We want to hear your thoughts about this podcast. Please email us at NCHMInfo@cdc.gov. If you have any additional questions or comments that you’d like to share with Alan about the seasonal influenza vaccination campaign, please email him at Alan.Janssen@cdc.gov. Thanks for joining us on Health Marketing Matters.

[Announcer] For the most accurate health information, visit www.cdc.gov or call 1-800-CDC-INFO, 24/7.