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Pink Book - Making Health Communication Programs Work

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Stage 3: Implementing the Program

Questions to Ask and Answer
Preparing to Implement Your Program
Maintaining Media Relations After Launch
Working with the Media During a Crisis Situation
Managing Implementation: Monitoring and Problem Solving
Maintaining Partnerships
Common Myths and Misconceptions About Program Implementation
Selected Readings

Questions to Ask and Answer

  • How should we launch the program?
  • Should we use a kickoff event?
  • How should we develop and sustain media coverage? Partner involvement? Audience interest?
  • How should we manage a press conference?
  • How should we work with the media during a crisis?
  • How can we ensure that our program operates according to plan?
  • How can we use process evaluation?
  • How can we find out whether we are reaching the intended audience with our information?
  • How can we find out whether they are responding favorably to our message and materials?
  • Are we maintaining good relationships with our partners?

Preparing to Implement Your Program

Before you launch the program, plan for distribution, promotion, and process evaluation. Make sure you also develop a launch plan, produce sufficient quantities of materials, and prepare your staff for the work ahead.

Program Launch

You may choose to launch your program quietly, starting activities on a limited basis in one geographic area or with just one partner to test the program. Using a limited approach will permit you to make adjustments before you fully commit your resources. This can be particularly useful for a large-scale program or for programs using a new technique or involving a new intended audience. Or, you may choose to launch with a kickoff event.

Launch Checklist
  • Are our partners prepared for the launch?
  • Have we invited reviewers, gatekeepers, and others who have been involved in program development?
  • Have we prepared (or trained, if necessary) our staff and spokespeople?
  • Are program-related services (e.g., a hotline, screening facilities) in place?
  • Do we have a list of the media outlets we need to contact?
  • Are all of our promotional materials ready?
  • Do we have enough materials to start the program (e.g., PSAs and media kits) and respond to inquiries (e.g., leaflets for the public)?
  • Are reordering mechanisms in place?
  • Do we have mechanisms in place to track our program’s progress and to identify potential problems?
  • Are health professionals and other service providers in the community aware of our program and prepared to respond if their clients ask about it?

Kickoff Event

A kickoff event can create broader awareness of the program and promote community involvement. Kickoff events are an excellent way to develop relationships with people who may be willing to get involved in the program. Scheduling an event also creates a deadline, which will help your program avoid unnecessary lag time or protracted preparations.

To begin with a kickoff event, you might:

  • Plan an event to celebrate the start of the program.
  • Tie the kickoff to newsworthy happenings, such as the Great American Smokeout, Talk About Prescriptions Month, or the announcement of the results of a major study.
  • Tie into community events, such as sporting events, church activities, shopping mall promotions, or holiday happenings.
  • Work with partner organizations to fund events that the intended audience already participates in and that have broad media interest.

To enhance media coverage of your kickoff event:

  • Create a news "hook" or angle that makes the event newsworthy
  • Use a checklist to track preevent, event, and postevent activities. These may include room arrangements, speakers, expenditures, media kits, refreshments, transportation, equipment, and follow-up actions.
  • Inform the media of your event in a timely way. Ask about their schedules, if possible, to avoid holding an event that conflicts with other media activities. Conflicts might prevent you from getting media coverage.
  • Don’t forget to include specialized media, such as community newspapers, cable TV stations, radio, health-related publications (the trade press), foreign-language publications or broadcast media, Internet "zines" and Web sites, and organization publications. These media may have a greater incentive to use your story than general newspapers or regular TV stations, and they can ensure an audience at a press conference if the mainstream media don’t show up.
  • Launch activities in multiple locales on the same date to make them more newsworthy.
  • Create media kits to facilitate accurate reporting of the issue.
  • Invite spokespeople who support your program and who may attract media interest.
  • Hold the event in a location that is connected to your message and involves members of the intended audience. This might be a youth center for a program aimed at teenagers, a grocery store for a program about nutrition, or a neighborhood where screening will be offered. Make sure the location has sufficient space for the media and their equipment.

Holding a Press Conference

One effective kickoff event is holding a press conference.Your health communication program launch is unlikely to get much media attention if you just set up a press conference. News media have many opportunities to attend events and at the same time are finding it easier to get information electronically. This means that you must stand out to attract media to your event. Tying the program’s launch to important health news can help. Such news could include announcing the results of a recent health study, releasing new statistics on your topic, or announcing the start of a comprehensive or multiorganization health program of which your program is a part. Even more attractive is announcing such news plus having representatives of the intended audience or other individuals tell compelling personal stories.

The following are tips for planning and conducting a successful press conference.

Invitations

Be realistic about the media you invite. Local press people and those with whom you already have a relationship are more likely to attend than representatives from national newspapers or TV stations. Don't forget the health-related trade press, which often needs news and will help bolster attendance. Give reporters three to four days' notice. If yours is a major story, call wire services to have the event put on their daybooks. Remind the staff person responsible for contacting the media to call reporters the day before the event to pitch its importance.

Speakers

Decide who will announce which aspects of your news. In general, select people for their recognizable names. If they are not familiar with your program, you can brief them, provide materials, and have knowledgeable people on hand to answer questions your main speakers cannot. Don’t overlook the opportunity for personal testimony by patients, physicians, and family members. You may want to pretape their statements at their homes or in the hospital (you will usually need a written release from patients). Remember that all speakers, including patients, will need to be available during the day of the press conference to answer press inquiries and be interviewed.

Timing

The conventional wisdom is to hold press conferences between Tuesday mid-morning and Thursday afternoon. However, it is important to know the schedule of the media you’ve invited. Reporters from afternoon newspapers have morning deadlines and may not be able to attend a late morning or early afternoon conference. Try to limit your press conference to 15 minutes or less, including plenty of time for questions. Emphasize to speakers the need to keep their remarks short and simple, to avoid scientific jargon, and to focus on the action you want your intended audience to take.

Logistics

Assign a staff person to arrange a suitable room and any equipment you may need, including a "mult box" that allows the media to connect their equipment to the public address system for better sound quality. The staff person should also arrange for parking, tell people where to park, and put up signs to help reporters find your room.You should also plan to have another person who has media experience on hand to distribute media kits, show media representatives where they can set up their equipment, answer questions, and point out who is available for follow-up interviews.

Media Kits

At a minimum, include:

  • A press conference agenda
  • A press release
  • Local, state, and national statistics about your issue
  • Background information
  • Biographies of your speakers
  • Reproducible copies of charts or graphs used in your speakers’ presentations
  • Copies of other program materials or reports
  • Name and telephone number of someone who can be called to answer questions or verify information

To increase the usefulness of your kit to television reporters, include broadcast–quality stock video (B–roll). If you have invited non–English–language media representatives to attend, provide materials in their language (have the materials prepared and reviewed by people fluent in the language).

Follow Up

Deliver your new release or press kit in person to key reporters who didn’t attend the press conference. Explain why your news is important.

Maximizing Media Coverage of Your Program

To maximize media coverage, be sure to:

  • Know what different publications, stations, and shows typically cover, and which staff, editors, and reporters are responsible for what. Giving your story to the right outlets and the right people shows your understanding of their work and can improve the likelihood of coverage.
  • Understand your media market. Some media, such as those in the Washington, DC, area, see themselves as providers of regional or national rather than local coverage, which makes it more difficult for local stories and issues to receive attention. In similar situations, pitch your story with a regional or national slant to increase the possibility of coverage.
  • Respond quickly to requests for information. If you are able to give answers or statements within an hour of a request, media outlets will continue to call.
  • Provide information the media can use.
  • Be honest about your issue, your organization, what you know, what you can do for the media, and what you want from them. If you don’t know the answer to a question they ask, tell them so and offer to get the answer quickly.
  • Work personally with the media to help them understand your issue; just sending them news releases or PSAs is much less effective. Provide background information so that when a story breaks they have accurate facts on hand.
  • Ask for something the media can give besides coverage. For instance, they may be able to provide data about their audience to help you decide which media to use, or help produce broadcast segments or PSAs, or cosponsor an event.

Maintaining Media Relations After Launch

Support your program’s messages by encouraging media to cover your program after launch. To get continuing coverage of your program, you must develop an ongoing relationship with the media. These steps can help ensure continuing media coverage.

  1. Make a list of key media contacts, establish relationships with them early, and nurture the relationships throughout the life of your program. Many people can help you identify media contacts. Begin within your own organization. Ask whether staff or volunteers have media contacts or know media figures such as owners of newspapers or broadcast stations. Outside your organization, talk with partners; people you know at media outlets, public relations/advertising firms, and on the public relations staff of business firms; members of professional associations (such as chapters of the Public Relations Society of America); and people in public relations or marketing programs at local universities. Other sources include reference books in your local library that list local and national media contact information. Update your media lists regularly; using an incorrect name or title can mean the media won’t cover your message.
  2. Develop a plan for periodic media coverage of your program and make your program newsworthy. Your plan should include your program’s objectives, the messages you want to communicate to the media (including why your program or message deserves coverage), any promotional activities you plan to sponsor, and a schedule for media contact (when it will occur and who will initiate it).
  3. Identify and train media spokespeople. It is a good idea to select no more than three spokespeople. Be sure that all of them are providing the same information about your program by giving them written briefing points. The media usually prefer spokespersons with authority in your organization. The person who regularly handles media relations may not have that status. Some spokespersons will be savvy about working with the media and need only a briefing on your program. Others may need training on how to give interviews, respond to media queries during crisis or "bad news" situations, or how to be effective on TV or radio.
  4. Track media coverage. This includes coverage of issues generated by your media relations efforts as well as coverage that occurs independently. Monitoring all types of coverage can provide important process evaluation data. It will enable you to identify and take steps to correct misstatements and errors, determine the impact of your media activities and whether changes are needed, identify other media representatives interested in your issue, and find out whether your organization is being overlooked. Media coverage can be measured in terms of quantity (how much space did a story get and how often are stories published?); prominence (does it appear on the front page or not?); slant (is coverage positive or negative?); accuracy of content; and type of story (is the story an editorial or hard news?).
  5. Capitalize on breaking news. When something happens that is related to your program, call news outlets and offer them an expert opinion. If a negative event occurs, take the opportunity to explain how the changes advocated by your organization could help prevent similar problems in the future. For example, when the story about traces of poisonous substances in Chilean grapes received widespread coverage, tobacco control activists used the event to point out that larger amounts of those same substances are found in a single cigarette.
Process Evaluation Tracks Effectiveness of Media Launch for Clinical Trial Start-Up

In 2001, the National Cancer Institute kicked off a large national clinical trial on prostate cancer using an extensive media launch, including national, local, and Spanish-language press releases as well as a professionally produced video news release (VNR). The launch employed extensive outreach to news outlets designed to make the media aware of the clinical trial. The hope was that these outlets would then report on the trial and that eligible participants would be encouraged to volunteer. The following process evaluation activities were used to measure the effectiveness of the media push in distributing the launch messages:

  • Monitoring use of the VNR through Nielsen’s SIGMA® encoding
  • Tracking calls about the trial to the Cancer Information Service’s toll-free information line (1-800-4-CANCER), which was promoted in the media materials
  • Observing print coverage of the trial through LexisNexis
  • Monitoring traffic to NCI Web sites describing the trial
  • Surveying each study site about its specific media efforts
  • Monitoring the total accrual rate to the trial

Findings showed that the full-fledged media push produced nearly 1,000 print and broadcast hits in the month following the launch and that the messages were successful in reaching the intended audiences. Men in the correct age range, for example, called the 1-800 information line in numbers far exceeding their usual number. The data also indicated that the media were effective in both reaching and motivating potential minority participants. Calls from minority men to the toll-free number were substantially higher than for previous trials and roughly equivalent to their proportion in the population.

Understanding the Media

What Do the Media Like?

  • Stories with audience appeal
  • Issues that stimulate debate, controversy, or conflict
  • Stories that create higher ratings and larger audiences
  • Fresh angles or twists on issues that will attract public interest
  • Accurate background information

What Do the Media Dislike?

  • Covering old topics
  • Duplicating stories reported by competitors
  • Reporting inaccuracies or an incomplete picture
  • Receiving numerous calls when on a deadline
  • People who persist when a story idea is rejected
  • Organizations that believe their story is interesting simply because it is theirs or that convey the attitude that the importance of the story is obvious

Working with the Media During a Crisis Situation

If a crisis develops related to your health topic, your organization, or your program, the media will likely contact you. The following suggestions will help you work effectively with the media in these situations:

Be Prepared

  • Identify a spokesperson to handle media inquiries.
  • Train the spokesperson to handle routine inquiries, interviews, media appearances, and crises. A professional media consultant can help with this training.

Take Control

  • Stay calm. Show your staff and the public that you are on top of the problem and are taking steps to resolve it.
  • Respond quickly. Help reporters who call you meet their deadlines and call them if no one calls you.
  • Tell the truth. Admitting mistakes and taking responsibility for them is important for your credibility. Crisis situations can work to your advantage by showing your ability to take charge under difficult circumstances.
  • Be well informed. Get the facts you need to understand the situation and develop a response.When talking to reporters, focus on the main message you want to send.
  • Track incoming calls. Keeping a record of who called, from where, why, and how the information you gave them will be used will give you a list of names to call if new information becomes available (and provide a good resource for the future).
  • Say, "I don’t know" when you cannot answer a reporter’s question. Promise to get the answer quickly and follow through.
  • Consider preparing a short statement with comments from your organization’s leadership.

Managing Implementation: Monitoring and Problem Solving

Managing a health communication program is much like managing any other project. Key activities include monitoring activities, staff, and budget; problem solving; process evaluation; measuring intended audience satisfaction; and revising plans and operations.

Your communication plan should indicate how and when resources will be needed, when specific events will occur, and at what points you will assess your efforts. Once implementation is under way, however, contingencies may arise. Periodically, assess whether:

  • Activities are being completed at scheduled times
  • Your intended audiences are being reached
  • Certain activities or materials are more successful than others
  • Certain aspects of the program need to be altered or eliminated
  • Your expenditures are within budget

You can often correct problems quickly if you can identify them. For example, if you ask the public to call you for more information, you should provide a simple form (electronic or manual) for telephone operators to use to record the questions asked and the answers given. Frequently review responses to identify inquiry patterns, to be sure that correct or adequate information is being given, and to find out whether more or different information may be needed.

Process Evaluation

Process evaluation takes place during implementation and monitors the functioning of program components. It includes assessment of whether messages are being delivered appropriately, effectively, and efficiently; whether materials are being distributed to the right people and in the right quantities; whether the intended program activities are occurring; and other measures of how well the program is working. Use process evaluation to track the following:

  • The functioning and quality of your program
  • Partner/coalition involvement
  • The effectiveness of publicity, promotion, and other outreach efforts
  • Media response
  • intended audience participation, inquiries, and other responses
  • Adherence to schedule
  • Expenditures and adherence to budget
  • Contractor activities:
    • Are seasoned professionals doing the creative and managerial work?
    • Is the contractor devoting enough time and money to your project?
    • Are deadlines being met?
    • Are performance and deliverables in keeping with the contract?
    • Are the hours billed reasonable for the work performed?
    • Are there problems in the relationship?
Examples of Process Evaluation Measures

Dissemination

  • Amount of time
    given to your message by radio and television stations and what the estimated size/demographics of the audiences are
  • Print coverage and estimated readership
  • Quantities of educational materials distributed
  • Number of speeches and presentations given
  • Number of special events
  • Size of audiences at presentations and events

Response

  • Number of telephone, mail, and e-mail inquiries (how people heard of the program, what they asked)
  • Number of people visiting Web sites or Internet services
  • Number of organizations, businesses, or media outlets participating in the program
  • Response to presentations (measured by completed participant feedback forms)
  • Number of publications requested and distributed

Audience

  • Demographic or other characteristics of the responding audience (to find out whether the intended audience responded)

The following are examples of ways to gather the information needed for process evaluation:

  • Use activity tracking forms.
  • Monitor the volume of public inquiries and requests for information.
  • Ask callers what prompted their call.
  • Use clipping services to gauge media coverage.
  • Gather feedback cards from or make follow-up phone calls to television and radio stations.
  • Review telephone responses for accuracy.
  • Follow up with teachers, physicians, or other gatekeepers to check their preparedness and
    interest.
  • Gather regular status reports from staff, contractors, and partners.
  • Meet in person or by telephone with partners to review your program’s progress.
  • Track traffic to project Web sites.
  • Review publication requests and distribution.

Measuring Audience Satisfaction

Audience satisfaction surveys are an important tool for both process and outcome evaluations of health communication programs. Use surveys to help you identify the following:

  • The characteristics of those you reached—how well do they match the characteristics of your
    intended audiences?
  • How the intended audience reacted to your materials and services—were materials easy to
    understand? Useful?
  • How the intended audience used your materials—were materials read? Passed on to others?
    Saved? Were events attended?
Using Process Evaluation to Make Midcourse Corrections
By tracking call frequency, one regional Cancer Information Service (CIS) office found that calls increased when certain PSAs were run, thus showing the CIS office how to maximize its promotional efforts. Tracking showed that men of all ethnicities and African-American women were not well represented among the callers. The CIS office also found that special promotions increased the call rate among African-American women, but did not prompt more men to call. As a result, the office stopped trying to reach this intended audience through PSAs and explored other ways to reach it.

Note. From "Effect of the mass media in promoting calls to the Cancer Information Service," by Arkin, E. B., Romano, R. M., Van Nevel, J. P., & McKenna, W. (1993). In The Cancer Information Service: A 15-year history of service and research (Monograph of the Journal of the National Cancer Institute, No. 14).

This information will help you determine whether you are reaching your intended audiences, whether your materials or activities need to be revised, and whether your materials are being used as you intended. Some managers also use these surveys to learn what information intended audiences would like to receive in the future. See Appendix A for an example of a user survey. The survey example, the Breast Cancer Risk Assessment Tool Evaluation from NCI, includes a summary of the responses as an example of the range of information you can glean from surveys like these.

Making Adjustments

The implementation stage will not always proceed as you expect. Materials may be delayed at the printer, a major news story may preempt your publicity (or focus additional attention on your issue), or a new priority may delay community participation. A periodic review of your planned tasks and time schedules will help you revise any plans that might be affected by unexpected events or delays. There is nothing wrong with altering your plans to fit a changed situation. In fact, you may risk damaging your chances of success if you are not willing to be flexible.

Maintaining Partnerships

If your organization has partnered with others, you will need to work to maintain a good relationship between your organization and your partners. Frequent two-way communication is essential to productive partnerships. If partners hear from you only when you need something or you hear from partners only if problems arise, the relationship will suffer.

To keep partners involved:

  • Periodically call to find out how your partners’ work is progressing. Offer to help when appropriate, congratulate them on their accomplishments, and show an interest in them that mirrors the interest you hope they take in your program.
  • Involve them whenever it is reasonable (and they are interested) in your activities, such as special events or process evaluation.
  • Give them regular updates on the program. Some organizations formalize this task by sending out newsletters or reports. Others handle it informally through calls, meetings, or letters. Tell partners about any changes in program activities that may impact their organization.
  • Give them credit in your news releases and other publicity. If you generate a story that mentions them, send them a copy.
  • Share new materials and information (e.g., about breaking stories relevant to their organization).
  • Notify them of program results, whether positive or negative.
  • Share feedback from your process evaluation.
  • Explore opportunities for further collaboration.

Continue to Consider New Opportunities For Partnering

You may have planned to use one or several media, interpersonal, organizational, and community channels for your program. Before you implemented your program, you likely partnered with appropriate organizations. Once your program is under way, however, other organizations may want to get involved, or you may find that you need a new partner to reach a certain segment of your intended audience. Partners that have fulfilled objectives may step aside.

Common Myths and Misconceptions About Program Implementation

Myth: People need the information we are providing, so we will have a large number of requests for our materials.

Fact: "If we print it they will come" holds true only if you are printing money. For most programs, effective promotion is critical to getting materials into the hands of those who need them. Disseminating printed products is as challenging, and as important, as developing them.

Myth: Working with the media is more trouble than it is worth. They take statements out of context, don’t bother to check facts, and care only about sensationalism.

Fact: Although is possible to have bad experiences with the media, if you pay attention to your work with them, you can help foster positive outcomes. Learn which reporters are responsible journalists and develop relationships with them. Then provide accurate background materials and offer to check their stories for technical correctness. Respect their need for stories of interest to the public and try to help them by thinking of positive, attention-getting angles for your program. If your topic is controversial, you may want to provide media training for your spokespeople to help avoid giving statements that could be misinterpreted or taken out of context.Work with the media to correct inaccuracies.

Myth: When the press conference is over, we can relax.

Fact: The longevity of news can be measured in days—if not minutes. Single channels or even the entire mass media are unlikely to reach all intended audiences, and one event or activity is not enough. Just as health messages need repetition and reinforcement, so do promotions.Your job isn’t over until the warehouse is empty (unless you create enough demand for a second printing) or until you have met all of your objectives.

Myth: We have partners, so we don’t have to worry as much about implementation. They’ll do a lot of the work for us.

Fact: Partners can help with implementation, but they are unlikely to reduce your workload. Developing and maintaining partnerships is itself very labor intensive, and your role in leading, coordinating, and monitoring program operations is essential.

Myth: If a program is not an immediate success, it is a failure.

Fact: All change takes time. Even the best–planned health communication programs have to make midcourse corrections. The information you get from process evaluation can help you recognize where improvements are needed and get back on track. Each time you learn more about your intended audience, your own processes, and the barriers you face, you increase your likelihood of success.

Myth: It is unseemly for a government/nonprofit health program to spend money to promote itself.

Fact: By promoting your program, you are promoting your issue and your message. The more people who know about what you have to offer, the more the community will benefit. Having your organization recognized lends credibility to your program and will help you recruit supporters, partners, volunteers, and funding sources when you need them. As long as you keep the focus on your communication objectives and not on your office (or yourself!), program promotion is a legitimate, integral aspect of health communication.

Selected Readings

Agency for International Development, Academy for Educational Development. (1992). Results and realities: A decade of experience in communication for child survival. Washington, DC.

Arkin, E. B., Romano, R. M., Van Nevel, J. P., & McKenna, W. (1993). Effect of the mass media in promoting calls to the Cancer Information Service. In The Cancer Information Service: A 15-year history of service and research (Monograph of the Journal of the National Cancer Institute, No. 14).

Center for Substance Abuse Prevention. (1994). Following specific guidelines will help you assess cultural competence in program design, application, and management. [Technical Assistance Bulletin].Washington, DC: U.S. Government Printing Office.

Center for Substance Abuse Prevention. (1994). You can increase your media coverage [Technical Assistance Bulletin]. Washington, DC: U.S. Government Printing Office.

Dignan, M. B., & Carr, P. A. (1992). Program planning for health education and health promotion (2nd ed.). Philadelphia: Lea & Febiger.

Jernigan, D. H., & Wright, P. A. (1996). Media advocacy: Lessons from community experiences. Journal of Public Health Policy, 17, 306–330.

Wallach, L., Dorfman, L., Jernigan, D., & Themba, M. (1993). Media advocacy and public health: Power of prevention. Thousand Oaks, CA: Sage.

Wallach, L., Woodruff, K., Dorfman, L., & Diaz, I. (1999). News for a change: An advocate's guide to working with the media. Thousand Oaks, CA: Sage.