Social marketing interventions for the prevention and control of neglected tropical diseases: A systematic review

BACKGROUND

Social marketing is an approach to behavior change that contributes to disease prevention and control. This study aimed to understand how social marketing interventions have addressed neglected tropical diseases (NTDs). It examined the characteristics, breadth of coverage, and outcomes of social marketing interventions focused on the prevention and control of these diseases.

METHODOLOGY/PRINCIPAL FINDINGS

Studies published in any language between January 1971 and April 2017, targeting at least one of the 17 NTDs prioritized in the World Health Organization (WHO) NTD Roadmap were considered. Included studies had interventions that applied both, at least one core social marketing concept, "social behavioral influence", and one social marketing technique, "integrated intervention mix", described in the Hierarchical Model of Social Marketing. This review is registered with PROSPERO CRD42017063858. Twenty interventions, addressing eight NTDs, met the inclusion criteria. They focused on behaviors related to four of the five WHO public health strategies for NTDs. Most interventions incorporated the concepts "relationship building" and "public / people orientation focus", and the technique "insight-driven segmentation". All the interventions reported changing behavioral determinants such as knowledge, 19 reported behavior change, and four influenced health outcomes.

CONCLUSION/SIGNIFICANCE

Evidence from this study shows that social marketing has been successfully used to address behaviors related to most of the five public health strategic interventions for NTDs recommended by the WHO. It is suggested that social marketing interventions for the prevention and control of NTDs be grounded on an understanding of the audience and adapted to the contexts intervened. Building stakeholder relationships as early as possible, and involving the publics could help in reaching NTD outcomes. Elements of the intervention mix should be integrated and mutually supportive. Incorporating health education and capacity building, as well as being culturally appropriate, is also relevant. It is recommended that ongoing discussions to formulate the targets and milestones of the new global Roadmap for NTDs integrate social marketing as an approach to overcome these diseases.

The gender responsiveness of social marketing interventions focused on neglected tropical diseases

Background: Gender is a determinant of health that intersects with other social stratifiers to shape the health and well-being of populations. Despite the recognition of gender in the global health agenda, limited evidence exists about the integration of gender considerations in interventions, including social marketing interventions, for the prevention and control of neglected tropical diseases. Social marketing is an ethical approach to behavior change aiming to benefit individuals, communities, and society. Since behaviors are gendered and affect disease transmission and healthcare patterns, one would expect social marketing interventions to be gender responsive.Objective: This study aims to understand the extent to which social marketing interventions focusing on neglected tropical diseases are gender responsive.Methods: This study uses data from social marketing interventions collected in a systematic review, this study examined 20 interventions addressing eight neglected tropical diseases in 13 countries. A modified version of the World Health Organization Gender Assessment Tool (GAT) was used to determine the gender responsiveness of the interventions, which was complemented by coding for intersectional sex and gender data. These results are presented in 12 themes.Results: One schistosomiasis intervention implemented in China was assessed as gender responsive. It was not possible to answer many questions from the GAT due to limited data reported in the publications describing the interventions. Despite this, strengths and limitations were found in all the interventions in relation to the use of sex and gender concepts, the disaggregation of data, the consideration of environmental factors, and the involvement of women or men in the different stages of the interventions.Conclusions: Many interventions showed positive actions towards gender responsiveness. However, only one was classified as gender responsive. Others failed to supply enough data for assessment. Recommendations about how sex and gender could be integrated into social marketing interventions are provided.

Engagement of stakeholders in the development of a Theory of Change for handwashing and sanitation behaviour change

A Theory of Change (ToC) is an approach to map programmes aimed at inducing change in a specific context, with the goal of increasing their impact. We applied this approach to the specific case of handwashing and sanitation practices in low- and middle-income countries and developed a ToC as part of a systematic review exercise. Different existing sources of information were used to inform the initial draft of the ToC. In addition, stakeholder involvement occurred and peer review took place. Our stakeholders included methodological (ToC/quantitative and qualitative research) and content experts (WASH (Water, Sanitation, Hygiene)/behaviour change), as well as end-users/practitioners, policy-makers and donors. In conclusion, the development of a ToC, and the involvement of stakeholders in its development, was critical in terms of understanding the context in which the promotional programmes are being implemented. We recommend ToC developers to work with stakeholders to create a ToC relevant for practice.

Promoting a Hand Hygiene Program Using Social Media: An Observational Study

Background

Hand hygiene is an important component in infection control to protect patient safety and reduce health care-associated infection.

Objective

Our aim was to evaluate the efficacy of different social media on the promotion of a hand hygiene (HH) program.

Methods

The observational study was conducted from May 5 to December 31, 2014, at a 2600-bed tertiary care hospital. A 3-minute video of an HH campaign in 8 languages was posted to YouTube. The Chinese version was promoted through three platforms: the hospital website, the hospital group email, and the Facebook site of a well-known Internet illustrator. The video traffic was analyzed via Google Analytics. HH compliance was measured in November 2013 and 2014.

Results

There were 5252 views of the video, mainly of the Chinese-language version (3509/5252, 66.81%). The NTUH website had 24,000 subscribers, and 151 of them viewed the video (connection rate was 151/24,000, 0.63%). There were 9967 users of the hospital email group and the connection rate was 0.91% (91/9967). The connection rate was 6.17% (807/13,080) from Facebook, significantly higher than the other 2 venues (both P<.001). HH compliance sustained from 83.7% (473/565) in 2013 to 86.7% (589/679) in 2014 (P=.13) among all HCWs.

Conclusions

Facebook had the highest connection rate in the HH video campaign. The use of novel social media such as Facebook should be considered for future programs that promote hand hygiene and other healthy behaviors.

Sustained improvement in hand hygiene at a children's hospital

A quality improvement project was conducted to improve hand hygiene at a children's hospital. Interventions included education, performance feedback, an incentive program, and a marketing campaign. There were 9,322 observations performed over a 5-year period. Hospital-wide adherence increased from 39.9% to 97.9%. Adherence of 95% or greater was sustained for over 3 years.

Fostering change in back pain beliefs and behaviors: when public education is not enough

Mass media campaigns designed to alter societal views and individual behaviors about back pain have been undertaken and evaluated in multiple countries. In contrast to the original Australian campaign, subsequent campaigns have been less successful, with improvements observed in beliefs without the corresponding changes in related behaviors. This article summarizes the results of a literature review, expert panel, and workshop held at the Melbourne International Forum XI: Primary Care Research on Low Back Pain in March 2011 on the role and interplay of various social behavior change strategies, including public education, law and legislation, healthy public policy, and social marketing in achieving a sustained reduction in the societal burden of back pain. Given the complexities inherent to health-related behaviors change, the Rothschild framework is applied in which behavior change strategies are viewed on a continuum from public education at one end through law and health policy at the other. Educational endeavors should likely be augmented with social marketing endeavors and supportive laws and health policy to foster sustained change in outcomes such as work disability and health utilization. Practical suggestions are provided for future interventions aimed at changing back pain-related behaviors. Evaluation of previous back pain mass media campaigns reveals that education alone is unlikely to foster positive and persisting behavioral change without concomitant strategies.

Observation-based evaluation of hand hygiene practices and the effects of an intervention at a public hospital cafeteria

BACKGROUND

Hand hygiene is important before meals, especially in a hospital cafeteria where patrons may have had recent contact with infectious agents. Few interventions to improve hand hygiene have had measureable success. This study was designed to use a poster intervention to encourage hand hygiene among health care workers (HCWs) and hospital visitors (HVs) upon entry to a hospital cafeteria.

METHODS

Over a 5-week period, a poster intervention with an accessible hand sanitizer unit was deployed to improve hand hygiene in a hospital cafeteria. The dependent variable observed was hand hygiene attempts. Study phases included a baseline, intervention, and follow-up phase, with each consisting of 3 randomized days of observation for 3 hours during lunch.

RESULTS

During the 27 hours of observation, 5,551 participants were observed, and overall hand hygiene frequency was 4.79%. Hygiene attempts occurred more frequently by HCWs than HVs (P = .0008) and females than males (P = .0281). Hygiene attempts occurred more frequently after poster introduction than baseline (P = .0050), and this improvement was because of an increase in frequency of HV hand hygiene rather than HCW hand hygiene.

CONCLUSION

The poster intervention tool with easily accessible hand sanitizer can improve overall hand hygiene performance in a US hospital cafeteria.

A practical tool to identify and eliminate barriers to compliance with evidence-based guidelines

A practical tool provides an interdisciplinary approach to identify barriers to guideline compliance and implement actions to eliminate or mitigate the effect of the barriers.