This document lays out the communications goal, objectives, target
audiences, and key strategies and tactics to support the National Plan to Eliminate
Syphilis from the United States. Depending on resources for
syphilis elimination communication activities, work with certain segments
of the target audiences may need to be phased in over time. This plan is
based on a review of the syphilis elimination plan; the literature on
syphilis prevention and elimination; media coverage of the syphilis
elimination program launch; key informant interviews; and meetings with
CDC communications staff from the National Center for HIV, STD, and TB
Prevention (NCHSTP), Office of the Director (OD), Division of STD
Prevention (DSTD), and meetings of the DSTD Health Communications Working
Group.
It is important to keep
in mind the following points:
The objectives,
strategies, and tactics all relate to communications. They
identify where communication can contribute to the overall syphilis
elimination program. Programmatic objectives are included in the
document only to provide context. Not all programmatic objectives will
require communication activities. However, in some instances,
programmatic strategies are discussed and may need to be conducted in
order to implement the communication objectives.
The communication
plan, while national in scope, focuses primarily on the geographic
areas with the most syphilis morbidity (high morbidity areas - HMAs)
and those areas where the potential for syphilis re-emergence is high
(potential re-emergence areas - PRAs). As in the syphilis
elimination program plan, HMAs may need to focus on all or a majority
of the communication objectives. PRAs may need to primarily focus on
activities in the enhanced surveillance and rapid outbreak response
categories.
The communication
plan must be dynamic and flexible to allow for changes over time.
It must be responsive to changes in syphilis morbidity, to scientific
advances in testing and treatment, to changes in resources available
for elimination efforts, and to feedback generated throughout the
implementation of the communication plan.
The strategies
and tactics proposed are by no means exhaustive. They provide a
framework for action, and are based on experience working with other
federal, state, and community-based health communication programs, as
well as current available resources. They can be expanded and added to
as additional resources become available.
The
implementation of the syphilis elimination communication plan will
require the commitment and involvement of many individuals and
organizations. Especially important will be the involvement of
staff from state and local health departments, staff from various
branches and units within DSTD, NCHSTP, and CDC Office of
Communications, as well as national and local partners
Policy "Influencers" at National, State, and Local Levels
*Rationale: For syphilis elimination to become a reality, policymakers and community leaders, including leaders from communities affected by syphilis, need to advocate for community involvement, support, and ownership of syphilis elimination - becoming leaders in the war on syphilis. To ensure sustainability of the syphilis elimination effort, they must advocate for resources to address unmet needs. Without the resources to address the syphilis elimination plan's five strategies, syphilis elimination will continue to elude the United States. Policymakers must understand the importance of and the need for syphilis elimination, and should be armed with the tools to become effective spokespersons for it.
Communication Objectives for Policymakers
The following
objectives are clearly interrelated, and must be addressed
simultaneously. Similarly, the strategies and tactics are
interwoven, and support the objectives to varying degrees.
Objective
1a:To increase national and local visibility and
salience of the syphilis elimination program and the overarching
goal of syphilis elimination. The visibility of the syphilis
elimination program must be raised in order to ensure reaching the
program's goal. The key points of the elimination plan must be
disseminated widely. In order for policymakers to increase the
program's visibility, they must "buy" into it. They must
be able to state the program's goal and why syphilis elimination
must happen now.
Objective
1b:To encourage national and community support for the
program. Partnerships with a variety of constituencies need to
be cultivated and sustained around the issue of syphilis
elimination. National and community support for the program will
come from such strategic partnerships. Partners need to
"own" and provide leadership on the issue.
Objective
1c:To increase programmatic resources both nationally
and locally. Policymakers are linchpins in the process of
increasing programmatic resources.
Objective
1d:To encourage support for new testing methods and
practices (year two and beyond). Policymakers will be essential
in garnering support for new syphilis testing methods and practices.
Communication Strategies for Policymakers
Facilitate networking among policymakers in HMAs.
Encourage state health officers to dialogue with legislators
and community leaders, especially leaders from communities
affected by syphilis.
Increase the issue's profile with national and state legislators
(e.g., National Conference of State Legislators, Congressional
Black Caucus).
Maintain ongoing, systematic communication with policymakers.
Policymaker Tactics
To meet the policymaker communication objectives and to implement
the audience strategies, the following tactics are necessary.
Steps are listed under each tactic.
Tactic 1a:Develop routine and
coordinated communication to state health officers, STD prevention
leaders, and other policy influencers on syphilis elimination
efforts.
A tiered-system of communication is useful for this tactic,
since some information must be widely disseminated, while other
information should be targeted only to HMAs and PRAs. Material
communicated to key policymakers can include recently released
studies, relevant op-eds, and updates on program successes to
keep them informed about the plan's progress. Recommended activities
include:
Create or enhance existing mechanisms to rapidly disseminate
syphilis information. The frequency and the method of
communication must be tailored to the needs of each target
audience segment.
Utilize members of the Advisory Committee on HIV and
STD Prevention (ACHSP) to serve as ambassadors and spokespersons
to assist in marketing and promoting the national plan.
Identify a communications contact person in each of the
HMA state health departments.
Network with the National Public Health Information Coalition
(NPHIC) and enlist the organization to deliver key messages.
Assist the HMAs and PRAs to identify and utilize coordinated
communication mechanisms within their state for disseminating
syphilis information (e.g., California STD Controller Association
newsletter).
Identify or create DSTD communication resources for syphilis
elimination information (e.g., STD Division routine letter,
NCHSTP Quarterly Newsletter, and Thursday Report e-mails
from the DSTD Program Development and Support Branch).
Conduct an inventory of available channels.
Determine priority channels and strategy for each target audience.
Create a systematic, yearly plan to highlight syphilis
elimination activities at conferences, meetings, and events
attended by policymakers and STD prevention leaders.
Tactic 1b: Work with state health
officers and STD prevention leaders who have expressed an interest
in developing strategies and approaches that other states can
use.
Gather information about successful syphilis elimination
activities and use it to develop tools that other states
can use. Examples of tools might include: best practices
information; newsletter articles; op-ed pieces; summary results
of a brief telephone survey asking what is and is not working
in the HMAs.
Host a meeting or session at the National STD Prevention
Conference, APHA Annual Meeting, and other key national conferences
to showcase best practices and lessons learned, and to disseminate
tools so other states can replicate effective action.
Tactic 1c :Develop partnerships
with national organizations.
Partnerships help integrate the campaign's messages into the
partner organizations' programming, communication vehicles, and
advocacy programs, and help to institutionalize them. Partnerships
provide the opportunity to extend the messages beyond the life
of the program. Criteria for the selection of partner organizations
are valuable and might include: organizational credibility with
the target audiences; organizational reach; ability of the organization
to leverage or mobilize its network; extent to which the campaign
can complement and enhance the organization's existing programs
and activities. The level of customized communication programming
for each organization will be dictated by programmatic resources.
Via environmental scan, including a scan of the existing
STD Prevention Partnership members, create a list of the top
10 national organizations to work with on syphilis elimination.
Identify key players within the top 10 national organizations,
initiate contact, and assess each group's level of interest
and ability to commit to working on the communication campaign.
Work with each national organization to customize key program
messages and to develop specific partnership initiatives. Get
input from partner organizations before campaign materials
are finalized.
Construct a database of partner organizations' capabilities,
plans, and avenues for collaboration on communication activities.
Health Care Providers and Associations - Audience
segments include:
Public and Private Health Care Providers
State and Local Health Department Staff
Professional and Medical and Nursing Specialty Organizations
Public and Private Clinical Laboratories
Relevant Federal Agencies
*Rationale: The syphilis elimination plan calls
for enhanced surveillance as a cross-cutting strategy designed
to evaluate and direct the intervention strategies of rapid outbreak
response, expanded clinical and laboratory services, and enhanced
health promotion. Enhanced surveillance requires that health care
providers are aware of the importance of syphilis screening, are
familiar with testing and reporting procedures, and are motivated
to test individuals who are at risk because of their own or their
partners' sexual behaviors. It also requires that they report syphilis
cases to the health department in a timely fashion, so that a sensitive
and accurate surveillance system can be maintained. Providers may
need to be educated about the prevalence of syphilis in their practice
areas, about the signs and symptoms of syphilis, and about procedures
for reporting syphilis cases, as well as the vital role they play
in the process of syphilis elimination. Public and private laboratories
need to understand the importance of their role in promptly reporting
positive test results to their health departments.
Communication Objectives for Health Care Providers
Objective 2a: To increase health care providers'
awareness of the need to screen and to test individuals at-risk
for syphilis. Health care providers may be unaware that
syphilis is a problem in their communities.
Objective 2b: To enhance health care providers'
ability to provide high-quality syphilis services. Health
care providers must be prepared to appropriately identify, test,
treat, and counsel individuals at risk for syphilis.
Objective 2c: To enable reporting of syphilis
cases within one day of test results. Effective interventions
and services are based upon surveillance data that are prompt
and accurate.
Communication Strategies for Health Care Providers
Inform providers about the importance and benefits of appropriate
detection and prompt reporting of syphilis cases.
Provide clinical and didactic syphilis training to providers
in HMAs and PRAs.
Increase interaction between providers and state and local
health departments.
Identify community models for increasing prompt reporting
of syphilis cases.
Health Care Provider Tactics
To meet the health care provider communication objectives and
to implement the audience strategies, the following tactics are
needed. Steps are listed under each tactic.
Tactic 2a: Develop messages to motivate health
care providers to appropriately screen, test, and promptly report
positive test results.
Conduct formative research to determine health care providers' perceptions of the barriers to and the facilitators of syphilis screening, testing, and reporting.
Conduct focus groups to determine providers' knowledge, attitudes, and beliefs about syphilis.
Examine national survey information to obtain information to help tailor provider messages.
Summarize the information collected and distribute to HMAs and PRAs to support their interventions with health care providers.
Examine the National Laboratory Training Network (NLTN), run by the Association of Public Health Laboratories in collaboration with CDC, for opportunities to involve laboratorians in influencing health care providers to promptly report positive test results.
Alert health care providers in HMAs about the prevalence of syphilis in their practice areas.
Provide feedback to health care providers, and showcase how their reporting efforts have benefitted the syphilis elimination efforts in their areas.
Prepare messages about prompt test reporting for inclusion in the rapid response action plan.
Utilize the structures and communication vehicles of "influencers" of health care providers (e.g., managed care organizations, medical and nursing societies, local chapters of professional organizations) to get the message out about syphilis testing and reporting protocols.
Exhibit and present information on syphilis screening, testing, and reporting at national medical and laboratory meetings.
Tactic 2b: Utilize the STD/HIV Prevention Training Centers to provide clinical and didactic training to providers' in HMAs and PRAs. The training will focus on enhancing providers' skills to diagnose and treat syphilis.
Tactic 2c: Develop and test strategies for making syphilis reporting easier for health care providers.
Utilize information collected in Tactic 2a. to develop strategies for easier reporting.
Pilot test the ideas and mechanisms in two HMAs.
Community Representatives - Audience segments include:
Community-based Organization Staff
Community Leaders, Stakeholders, and Gatekeepers
Community Legislators
Local Health Department Staff
*Rationale:
Syphilis elimination will not be possible without significant community
buy-in, support, and involvement. One of the plan's cross-cutting
strategies is to foster strengthened community involvement and
partnerships to facilitate the implementation of rapid outbreak
response, expanded clinical and laboratory services, and enhanced health
promotion interventions. State and local health departments must build
support for the plan within affected communities, develop mechanisms for
ongoing communication with community organization staff, community
leaders, and community legislators, and encourage the community to join
in the elimination effort.
Without community
buy-in, there can be no community partnerships. These groups must be
equal partners in the process and can provide the necessary linkages
between the federal, state, and local efforts (i.e., direct message
carriers and communication agents). Community groups will help define
community needs and assets, how those needs can be appropriately and
effectively addressed, and how assets can be deployed. Community leaders
need to be kept informed about syphilis elimination efforts in their
communities and actively engaged in identifying what steps need to be
taken to support these efforts.
Health care providers
and public health department staff should be part of community
partnerships and can provide valuable health information to community
leaders and community-based organizations. However, they should be a
member of a community partnership and should not assume the leadership
role.
Communication Objectives for Community Representatives
Objective 3a:To raise awareness and salience of the syphilis elimination plan
among community representatives. A lack of communication and
understanding between communities affected by syphilis and public
health institutions will impede the success of interventions.
Community leaders and groups can carry messages forward, and can
validate the importance of the program.
Objective 3b:
To encourage community dialogue about how to address syphilis
elimination. Community dialogue about syphilis elimination will be
key to gaining acceptance, support, and involvement of community
constituents.
Objective 3c:
To encourage community participation in syphilis elimination
activities. State and local health departments need tools and
strategies that will help them gain community participation in their
syphilis elimination activities. Community groups will help define
community needs and assets, and how best to address and utilize them.
Objective 3d:
To encourage individuals with high-risk behaviors to be tested and
treated, as appropriate. To achieve syphilis elimination,
individuals at risk for syphilis must seek testing and clinical
services. Credible community leaders, stakeholders, and gatekeepers
can play important roles by delivering messages and distributing
materials that promote health care-seeking behavior among at-risk
populations.
Communication Strategies for Community Representatives
Build capacity at the community level for increased dialogue and involvement.
Identify and promote models of community participation and best practices.
Link with organizations that can encourage community participation (e.g., 100 Black Men, NAACP, Jackson State, etc.).
Develop capacity for community participation in outbreak responses.
Increase capacity among community representatives in HMAS to develop and deliver effective health care-seeking messages and materials to at-risk populations.
Community Representative Tactics
To meet the community representative communication objectives and implement the audience strategies, the following tactics are necessary. Steps are listed under each tactic.
Tactic 3a: Develop
consistent and routine communication on community participation with
state and local health departments.
Create a
communication vehicle to provide information to this target
audience (e.g., listserve, broadcast fax, or broadcast email). Keep
all communications strategic. Use every communication to refer
recipients to additional resources and tell them how they may be
used. Make it as easy as possible for the recipients to take the
information and use it.
Explore the
possibility of a CDC clearinghouse on syphilis-related health
communication and community participation materials.
Tactic 3b: Create
unifying syphilis elimination messages and a tool kit for states.
Disseminating
unified, consistent messages about the syphilis elimination program is
more likely to result in those messages being heard and embraced by
community representatives. The tool kit will contain "how
to" materials, including: press releases, message points, media
outreach tips, community organizing tips -- all of the things
necessary to spread the word on the program. The kit will be
re-engineered as the communications campaign unfolds to keep the
information current and the approach fresh.
Conduct
formative research with community representatives to develop
strong community involvement messages
Conduct
research to determine if HMA personnel think a visual identity for
the syphilis elimination campaign would be useful. If so,
conduct formative research and create the identity materials.
Develop a
prototype tool kit, guided by the qualitative research findings,
and pretest materials. Enlist key community representatives in
strategizing, creating, and reviewing contents of the tool kit.
Tactic 3c:
Provide support to state and local health departments in their efforts
to engage community representatives in syphilis elimination
activities.
Create
mechanisms for dialogue on community participation between
community representatives, health departments, and the CDC (e.g.,
community consultations, listservs, discussions at HIV Community
Planning Groups [CPGs]).
Research
different models for conceptualizing, planning, and implementing
community input mechanisms (e.g., town halls). Identify which
models will work for the syphilis elimination program.
Examine the use or adaptation of the Popular Opinion Leader (POL) HIV/AIDS prevention intervention package for syphilis elimination.
Host small meetings to learn what works in states.
Capture lessons from RECAP.
Create a set
of materials (e.g., a slide show presentation, informational
factsheets, and brochures) that can be used by health departments,
as well as by community leaders, to inform community groups, CPGs,
managed care organizations, and provider groups about the syphilis
elimination effort.
Tactic 3d: Equip
community representatives with information to assist them in
developing interventions and materials that promote syphilis testing
and treatment services to at-risk individuals.
Conduct
formative research with at-risk individuals to determine their
knowledge, attitudes, and beliefs about syphilis. Research is
needed to determine:
What do people know about syphilis and its sequelae?
What motivates people to be get tested and to seek treatment for syphilis?
What messages resonate?
What are people's perceptions of getting tested for syphilis?
Review and incorporate relevant information gleaned from National HIV Testing Day efforts.
Summarize the qualitative research results and suggest possible interventions based on the findings. This information can be included in the tool kit for community representatives noted in Tactic 3b.
Develop and implement a health communication training/technical assistance strategy for community representatives in HMAs and PRAs. Training courses that can enhance syphilis elimination activities include RECAP, EPI-Info, CDCynergy, and PRIZM data analysis. Such training will enhance health communication capacity in the local areas and will extend beyond the syphilis elimination effort.
