Developing and evaluating a college diabetes prevention and awareness campaign.
Abstract: This article provides an overview and evaluation of a diabetes prevention and awareness campaign. The purpose of this project was to involve students and faculty across multiple disciplines in order to develop public service announcements (PSAs) targeting young adults aged 18-24. These PSAs were designed to promote diabetes prevention activities among African American college students. To this end, we assembled a 7-member team (3 faculty and 4 students) that included two Health Education faculty, one Communication Arts faculty, three Health Education majors, and one Communication Arts major to create the JCSU Diabetes Prevention and Awareness Campaign, "Get the Picture". The plan included development of two video PSAs (60-second and 30-second), a 30-second audio PSA, a campaign brochure, and campaign website. We then evaluated the impact of the brochure and 60-second PSA on students in terms of design and content, value affirmation, scope, and intended behavior changes. The authors describe the project in terms of cross-disciplinary collaboration, student involvement, production processes, and evaluative methodology.
Subject: Universities and colleges (North Carolina)
Diabetes (Prevention)
Public service advertising
Medical testing products
Authors: Butler, Karen L.
Mead, Antonia S.
Pub Date: 09/22/2010
Publication: Name: American Journal of Health Studies Publisher: American Journal of Health Studies Audience: Professional Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2010 American Journal of Health Studies ISSN: 1090-0500
Issue: Date: Fall, 2010 Source Volume: 25 Source Issue: 4
Topic: Event Code: 290 Public affairs Computer Subject: Company public relations
Product: Product Code: 8220000 Colleges & Universities; 7310400 Public Sector Advertising NAICS Code: 61131 Colleges, Universities, and Professional Schools; 5418 Advertising and Related Services SIC Code: 8221 Colleges and universities
Organization: Government Agency: United States. Centers for Disease Control and Prevention; North Carolina. Department of Health and Human Services
Geographic: Geographic Scope: North Carolina Geographic Code: 1U5NC North Carolina
Accession Number: 309069161
Full Text: INTRODUCTION

Disparities between the overall health status of African Americans and other minorities and of the U.S. population as a whole have been well documented (Office of Minority Health Resource Center, 2009). Racial and ethnic health disparities are seen in almost all major health conditions and causes of death.

Recent media reports have highlighted a trend in the number of Americans being diagnosed with diabetes. 14.7% of African Americans aged 20 and older have diabetes compared to 9.8% for non-Hispanic whites. In 2006, diabetes was listed as the 7th leading cause of death in the United States among adults. It is a costly and devastating chronic condition when left untreated. Annual cost of diabetes for the United States is estimated at $174 billion (Centers for Disease Control and Prevention [CDC], 2007).

At the state level, diabetes was the 7th leading cause of death in 2006. North Carolina has the 10th highest rate of prevalence of diabetes in the nation. The national average is 7.3%, and the prevalence in North Carolina is 8.5% (NCDPH, 2009). Diabetes prevalence has increased by 102% over the last decade, from 4.5% of the state's population in 1995 to 9.1% in 2006. This increase exceeds the national average increase of 70.4 % in the same time period. An estimated 600,000 people in North Carolina were living with diabetes in 2006. African American adults had the highest rate of diabetes with a percentage of 13.3. Mortality from diabetes increased 30% between 1994 and 2000 (North Carolina Department of Health and Human Services [NCDHHS], 2007).

In Mecklenburg County, there was a 59% increase in the prevalence of diabetes among African Americans between 1995 and 2003. Ethnic minority death rates increased 89% from 1982-2002 while Caucasian death rates only increased 69%. What is interesting is that an estimated 145,700 individuals in Mecklenburg County have never had a diabetes test (NCDHHS, 2007). These numbers show the need for health communication activities.

Diabetes is associated with a number of other serious health conditions as well. People with diabetes are two to four times more likely to develop heart disease and stroke and die from those conditions. Pregnant women with diabetes and their children are at risk of developing complications, especially during the perinatal period. In addition, acute metabolic complications and infections are more common in people with diabetes. Diabetes is also the leading cause of blindness, kidney failure and lower-limb amputations in those patients. Yet, many complications caused by diabetes can be prevented by effective self-management and evidence-based care (NCDHHS, 2008).

Data show that there is a problem with diabetes in Mecklenburg County. Research has shown that diabetes is a health disparity for African Americans. Given the risk factors associated with the disease ethnicity, first degree family history, and obesity, prevention messages should begin while individuals are developing life long health habits. The college years are a time when these habits are formed. The county currently does not have any media prevention activities targeting this age group.

HEALTH COMMUNICATION

Health communication involves a variety of communication strategies employed to inform and influence health-related decisions at the individual and community levels. Health communication has contributed to a wide variety of issues in disease prevention and health promotion and is relevant in a number of contexts including individuals' exposure to, search for, and use of health information; the construction of public health messages and campaigns; and the dissemination of individual and population health risk information (National Cancer Institute, 1989; Piotrow, Kincaid & Rimon, et. al, 1997; Jackson & Duffy, 1998).

Media-based health campaigns can deliver information and contribute to a deeper insight into personal health behaviors (Wartella & Middlestadt, 1991). Health communication can markedly affect the understanding and acceptance of new health behaviors since people worldwide often respond to messages to improve their health (Zaman & Underwood, 2003). Health communication efforts have become a major component of health education nationally (USDHHS, 2005) and internationally (World Health Organization, 2009). Recent studies of health communication strategies have explored a variety of health issues such as healthy lifestyles (Baxter, Egbert & Ho, 2008; Wang & Gantz, 2007), anti-smoking campaigns (Cohen, Shumate & Gold, 2007), responsible drinking (Pilling & Brannon, 2007), eliminating health disparities Friemuth & Quinn, 2004), stroke prevention among African Americans (Pratt, Ha, Levine & Pratt (2003), cardiovascular health (Brannstrom & Lindblad, 1994), and diabetes (Shulz, Sprague, Brane & Lambeth, 2001; Bowman, Gregg, Williams, Engelgau & Jack, 2003).

The purpose of this project was to involve students and faculty across multiple disciplines in order to develop public service announcements (PSAs) targeting young adults aged 18-24. These PSAs were designed to promote diabetes prevention activities among African American college students. Funding for the project was provided through the United Negro College Fund Special Programs Corporation Division of Public & Community Health's "Enhancing Health Promotion and Disease Prevention at HB-CUs through Health Communications and Social Marketing Campaigns" Program. This project impacted students by providing them with information regarding diabetes risk factors, prevention strategies, and testing information.

PROGRAM DEVELOPMENT

We assembled a 7-member team in order to create the JCSU Diabetes Prevention and Awareness Campaign, "Get the Picture". The team consisted of seven members that included two Health Education faculty, one Communication Arts faculty, three Health Education majors, and one Communication Arts major. The plan included development of two video PSAs (60-second and 30-second), a 30-second audio PSA, a campaign brochure, and campaign website. Campaign products and information regarding our efforts were disseminated in a variety of ways.

Weekly team meetings were conducted where we brainstormed ideas, determined team assignments, strategized as to how to recruit participants, locating filming venues, developed the storyboards and audio text of the messages, and established our timeline for completion. A team of two students and one faculty member was formed for each product. In each group, one student served as the leader and the other as the assistant and the students determined the content, format, and layout of each product. The timeline encompassed a span of eight weeks and each product was broken down into a series of component parts.

STORYBOARD OVERVIEW

The 60-second video PSA showed a student engaging in health habits that might put him at risk for developing type 2 diabetes. In the first scene, he sees that the weight room is open. He opens the door but then decides he will go the next day. In the second scene, he is shown eating a high fat, calorie & sugar meal (double cheeseburger, supersize fries, 32 oz. cola). He then appears in a doctor's office, concerned about his family history and the test results he is about to get. Facts about diabetes were then shown with the statement, "get tested" along with the campaign logo.

The 30-second video PSA shows the impact of type 2 diabetes on the family. The PSA shows a collage of pictures of a student with her grandparent. The voice overlay is the student talking about her grandparent's illness and death. Risk factors for diabetes are listed shown at the end with the statement, "see your doctor today" then the campaign logo.

The 30-second audio PSA presented statistics about diabetes in North Carolina and directed listeners to a state website (www.ncdiabetes.org) for more information. Similarly, the brochure is titled "Diabetes and You! Are You at Risk for Type 2 Diabetes?" and includes information about what diabetes is, symptoms, risk factors, and treatment. Websites are listed for as resources for more information and a diabetes risk self-assessment. The team members and sponsoring organizations are listed on the back.

IMPLEMENTATION & DISSEMINATION

The products were used in the Personal Health course (HED 121) as part of the unit on minority health disparities. Personal Health is a freshman-level general education requirement for all students with the exception of those in the Honors Program. The brochures were distributed through the Counseling and Testing Center, the Student Health Center, and the Department of Health & Human Performance. We then adapted an evaluation form intended to provide us information regarding our effectiveness and the overall impact of the products.

METHODOLOGY

PARTICIPANTS

Evaluation participants consisted of students enrolled in three sections of Personal Health (HED 121) which is a general education requirement. These courses were chosen in order to include a variety of majors and classifications that may more accurately represent the larger student population.

The enrollment in each course was as follows: HED 121 A: 29, HED 121 B: 29, HED 121 C: 28. Of the 86 total students enrolled, 72 students participated in the study. All 72 students evaluated the brochure and 44 students evaluated the PSA. Students who were absent the day the surveys were administered were not included in the study. All students were unable to evaluate the PSA due to technical difficulties.

INSTRUMENTATION

The instrument used to evaluate the effectiveness of the health communication products was developed from three existing instruments that had been used in a variety of contexts. It consisted of four sections: general design and content, values affirmation, scope of tool, and demographics. Students were asked to complete evaluations for the brochure and the 60-second video public service announcement. The instrument was created after reviewing various media evaluation assessments and determining what data we wanted to obtain, we created our evaluation tool. The questions that were part of the general design and content section addressed layout, read ability of text, graphics, design, navigation, accuracy of content, grammar, and content engagement. A Likert scale was used for this section ranging from extremely to not at all. A non applicable option was included since this tool was used for both print and video tools. The second section looked at values. Questions asked if the item made participants emphasize the importance of making informed choices, accuracy of medical facts, identification with heritage and culture, presentation of information from target audience perspective. A 5-point Likert scale was utilized for this section as well. The third part was scope. Seven questions were asked if the resource empowered the participant to seek more information, obtain a family history, increase physical activity, analyze diet, seek medical treatment, inform others, and engage in preventive activities. Categorical values of yes, no, and does not apply were chosen for this section. The final portion of the instrument asked demographic questions of age, gender, and classification.

DATA ANALYSIS

Data analysis was performed only on the brochure and video PSA. IBM SPSS Statistical 17.0 was utilized to analyze the results from the evaluation tool. Chi square analysis was used to compare gender and classification to the scope questions. T-test and ANOVA was used analyze general design and content questions as well as values affirmation questions. Significance was set at 0.05.

RESULTS

SAMPLE

Fifty-one evaluations were completed for the PSA and 72 for the brochure. Demographic questions asked their gender, classification, and age. The female: male ratio was very close however there were slightly more females. As stated earlier, the Personal Health course was utilized to implement as well as evaluate the health communication tools. The majority of individuals were underclassmen and were age 19 or under. This information is presented in Table 1.

DESIGN AND CONTENT & VALUES AFFIRMATION

A design scale was created utilizing eight questions addressing design and content. The scale could range from 8 to 40. Higher responses indicated that participants were extremely satisfied with the design and lower scores indicating not at all. Students had higher scores for the design and content of the brochure than the PSA (M=30.45 vs. M=24.92). A values affirmation scale was created utilizing four questions addressing informed choices, accuracy, culture identification, and perspective. Participants were asked if the resource affirmed, expressed, implied, or contradicted a particular value. The scale's range was from 4 to 20 with higher scores indicated extremely satisfied and lower scores indicated not at all. The brochure appeared to have more of an impact than the PSA ([M.sub.PSA] = 13.83, [M.sub.brochure] = 16.20). The information is presented in Table 2

Mean scores of the values affirmation scale and the design content scale were assessed. Independent t-t-test found a significant difference between freshman and sophomores and values affirmation (t(92) = 3.03, p = 0.03) and design/content (t(93) = -2.15, p=0.03). A significance was found when comparing freshman and the rest of the classifications as well ([t.sub.design] (75) = -2.68, p = .009; [t.sub.values] (65) = -3.37, p = .001). When looking at each individual classification, an ANOVA was performed. Due to the smaller levels of participation from juniors and seniors, the two were collapsed together, creating three categories (freshman, sophomore, junior and seniors). Freshman differed significantly from each of the other classifications in terms of the general design scale [F(2,111) = 3.113, p = .05] and the values affirmation scale [F(2, 110) = 4.502, p = .01]. When looking at the PSA only a significance was still found between the freshman and the other students on design [F(2, 45) = 3.863, p = .03]. There was significant difference in the values affirmation scales when the brochure were analyzed only [F(2, 63) = 5.295, p = .01].

SCOPE

Chi-square analysis was performed looking at gender, classification breakdown (freshman vs. sophomore; junior vs. senior; freshman vs. other classmen) and the scope questions. No significant different was found between the groups with the exception of two questions. The proportion of females that were likely to increase their physical activity as a result of the communication tools was significant differently from the males ([chi square] = 6.179, p = .046). The proportion of freshman that were likely to seek more information about type 2 diabetes as a result of the communication tools was significant differently from the other classifications ([chi square] = 7.278, p=.026). After running analysis on the health communication products separately, neither was found to be significant.

CONCLUSION

Given that young African Americans are disproportionally represented in diabetes statistics, developing health communication messages represents a creative approach to traditional health promotion outcomes. Engaging students in active learning can have important benefits for students and faculty (Barkely, Cross & Major, 2005). According to Lenning and Ebbers (1999), benefits for students such as higher academic achievement, greater satisfaction with college life, improved quality of thinking and communicating, and a better understanding of self and others can impact their health behaviors and lifestyle choices. Allowing students to dictate processes and content associated with the message ensures relevancy to the target group. Overall, the process of developing the communication tools was successful. A larger data set is needed to accurately determine the impact of the communication tools. Qualitative data is also suggested as this type of data will elicit more emotional responses. Researchers also need to take in account previous exposure to topic can impact responses. Significant differences between freshman and other students may indicate prior exposure or knowledge.

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Karen L. Butler, PhD

Antonia S. Mead, PhD

Karen L. Butler, PhD, is a Professor of Health Education, Johnson C. Smith University. Antonia S. Mead, PhD, is an Assistant Professor of Health Education, Johnson C. Smith University. Please address all correspondence to: Karen L. Butler, Johnson C. Smith University, Health & Human Performance Department, 100 Beatties Ford Rd., UPO box 2453, Charlotte, NC 28216, phone: 704.378.1247, fax: 704.378.1170, e-mail: kbutler@ jcsu.edu
Table 1. Demographics (N = 123)

Gender           n    %

  Male           58   47.2
  Female         64   52.0
  No response    1    00.8

Classification

  Freshman       49   39.8
  Sophomore      53   43.1
  Junior         10   8.1
  Senior         9    7.3
  No response    2    1.6

Age

  18             50   40.7
  19             44   35.8
  20             15   12.2
  21             6    4.9
  22             2    1.6
  23             5    4.1
  No response    1    0.8

Table 2. Scales (N = 123)

                             mode   M       S.D.    N

Overall

  General Design & Content    25    28.11   5.455   116
  Values Affirmation          16    15.20   3.810   114

PSA Only

  General Design & Content    20    24.92   4.941   49
  Values Affirmation          14    13.83   4.397   48

Brochure Only

  General Design & Content    30    30.45   4.580   67
  Values Affirmation          16    16.20   2.978   66
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