Name of Intervention/ Program
Vaccines Are Another Part of Growing Up: Childhood Immunization Campaign
Background and Situation Analysis
Across the United States, many children missed regular checkups with their healthcare providers during the COVID pandemic. As a result, since 2020, many children have also fallen behind on immunizations recommended by the Centers for Disease Control and Prevention (CDC), and required by local school immunization laws. Timely vaccination protects children from various infectious diseases and allows children to attend school and other activities. Additionally, immunization can protect others from infection, save families time and money that would otherwise be spent when a child is sick, and protect future generations from potentially dangerous diseases. Overall immunization rates also fell in Santa Clara County, CA during the COVID pandemic. Compared to 2019, the number of doses of required and recommended immunizations (such as measles, mumps, and rubella (MMR); diphtheria, tetanus, and acellular pertussis (DTaP); and varicella) administered among children decreased during the spring and early summer of 2022 and continued to lag slightly at the time of campaign development. Additionally, compared to 2019, the number of doses administered among children decreased in 2020 and 2021. Children from low-income African American and Latinx/Hispanic families, as well as older children, were more likely to fall behind on vaccination. There were also disparities in the distribution of the COVID and influenza vaccines based on age, geographic location, and race/ethnicity. Santa Clara County has a population of nearly 1.9 million people making it the most populous county in the Bay Area. Twenty-five percent of the population are Latinx or Hispanic, and 40.6% are Asian. A majority of residents (53.4%) speak a language other than English at home, and 39.7% are foreign-born. While Santa Clara County has historically benefited from higher vaccination rates than the national and state averages, overall vaccination rates have lagged in recent years, and there is still reluctance to vaccinate children against COVID among some populations. This positioned Santa Clara County well for a childhood immunization awareness campaign. Vaccines Are Another Part of Growing Up is a multi-media, multilingual campaign developed on behalf of the County of Santa Clara Public Health Department (PHD).
Priority Audiences(s)
Based on childhood immunization data and findings from formative research, we prioritized the following audiences for this campaign: parents and caregivers of children ages 0 to 14 in Santa Clara County who are: residents of low-income households; Latinx, of African American/African Ancestry, Filipino, Vietnamese, or Pacific Islander; reside in San Jose, Milpitas, or South County; and speak English, Spanish, and Vietnamese. In addition to the child’s age and other demographics, we also prioritized various audiences based on their zip code by targeting areas in which vaccination rates were lower at the time of campaign development.
Behavioral Objectives
The goals of the campaign were to: 1. Increase awareness of parents, caregivers, and other adults making medical decisions for children about the importance and safety of getting children vaccinated on time, including COVID vaccination. 2. Activate families to a) get their children back on schedule with routine immunizations, including COVID and b) encourage their child’s healthcare provider to offer COVID vaccines in their practice. 3. Encourage pediatric providers and other healthcare staff who serve children to enroll in the Vaccines for Children program and/or offer the COVID vaccine in their practice. 4. Strengthen the capacity of community organizations and PHD partners to support the campaign’s goals through training to address vaccine hesitancy.
Description of Strategy/Intervention
We developed the Vaccines Are Another Part of Growing Up Campaign through an extensive formative research process with community members and stakeholders. The campaign’s concept, messaging, and visual design were informed by community-based research, including focus groups with members of the priority audiences (outlined above). Through our research, we found that vaccine uptake and hesitancy among local caregivers was affected by several factors, including misinformation that is often spread through social media and other digital platforms. People have a range of beliefs about vaccines, and while the vast majority of local caregivers readily accept them, some preferred a “wait and see” approach to the COVID vaccine and planned to wait until they had a better understanding of its effects. Our aim was to reach potentially persuadable caregivers through a compelling behavior change campaign. Based on this research, we used the Transtheoretical Model of Health Behavior Change (aka “Stages of Change” framework) to develop the campaign’s concept and key messages. This framework posits that change “involves progress through six stages of change: precontemplation, contemplation, preparation, action, maintenance, and termination.” The campaign was created to reach caregivers in the “moveable middle” (those in the contemplation, preparation, and action stages). Multiple concepts were tested between January and March 2023; the final concept and selection of priority audiences were guided by the campaign goals. The campaign encourages routine childhood immunization and likens vaccination to important childhood milestones, like a child’s first words or first birthday. The selected concept utilizes emotional message framing by using sentimental memories (e.g., baby’s first word, child’s first goal in a soccer game) to position childhood vaccines in a positive light. The scenarios depicted in the advertisements have been tailored as appropriate (e.g., a child making tortillas with her grandmother, children making spring rolls with their father) to be culturally relevant. Similarly, by associating childhood vaccines with classic childhood milestones, the campaign works to normalize vaccines as a routine part of growing up. This messaging: 1) normalized routine childhood vaccinations to increase feelings of safety and trust; and 2) associated routine childhood vaccinations with happy and healthy childhoods. Key messages included: 1. Like your child’s first words, vaccines are an important milestone. 2. Routine vaccines are safe and protect your children, so they can grow up healthy, happy, and strong. 3. Talk to your child about what vaccines your child needs this year. 4. Your child is required to have certain vaccines for child care and school. Other vaccines are highly recommended to give them the best protection. Each message was adapted in English, Spanish, and Vietnamese, and distributed through a variety of communication channels including digital and traditional advertising, local outreach events, and a community mural. The team also distributed campaign-branded educational materials to community members and healthcare providers.
Implementation
In April 2023, in collaboration with the County of Santa Clara Public Health Department (PHD), we launched a multi-media, multilingual immunization campaign to address vaccination rates among children ages 0-14 in Santa Clara County. Reaching busy caregivers required interactive and engaging strategies to help them learn about vaccine safety and efficacy. From April to July 2023, campaign messages were disseminated through a strategic mix of digital and traditional media, including social media (Facebook, Instagram, YouTube), streaming platforms, digital and traditional radio, local print media, outdoor advertising, and community events, to reach families and healthcare providers. We also conducted direct outreach to key partners and stakeholders. Our team and PHD staff conducted outreach at three community events, including two local farmers’ markets and one local flea market. These community events gave families the opportunity to talk with public health staff, receive educational materials (like magnetic schedules of recommended vaccines), and participate in art activities. The campaign culminated in a community mural-painting event in a local park in partnership with Local Color, a local arts organization. The mural-painting event included various campaign-related activities for families and children were invited to help paint a mural that featured virus-fighting superheroes and celebrated happy and healthy childhoods. The completed mural was later installed at a local library in San Jose.
Evaluation Methods and Results
Due to timeline limitations, the campaign evaluation was limited to media metrics. To evaluate the Vaccines Are Another Part of Growing Up campaign in Santa Clara County, we tracked the distribution, placement, and reach of digital advertisements, traditional advertising, social media content, and campaign educational materials and resources as well as traffic to the campaign landing pages. Campaign educational materials and resources directed individuals to the campaign landing pages, www.PartOfGrowingUp.org, www.DesarrolloSano.org, and www.LonLenKhoeManh.org. This campaign was developed with several evaluation metrics in mind based on the type or stage of engagement. This social marketing campaign has helped encourage Santa Clara County residents to ensure their children get vaccinated. Across all media channels, the estimated total reach of Vaccines Are Another Part of Growing Up in Santa Clara County was over 33 million impressions, over a million of which were bonus/added value impressions. Between April and July 2023, at least 17,000 unique users visited the campaign landing pages. Digital advertising platforms, including streaming and digital video, social media, and YouTube ads, were particularly successful in reaching priority populations and saw high engagement rates. Digital advertisements also provide an added value of reaching parents and caregivers in moments where they could seek further information through their smartphone, tablet, or computer. In addition, community outreach events and the mural event were effective ways to distribute vaccine information, and allowed for the opportunity to engage with community members and have conversations about vaccines.
Entry Letter: EE