1. A Social Media Campaign to Increase
Utilization of HIV Testing in Durham, North
Carolina
DURHAM KNOWS
Kelly Carson, Josiah Graham, Natalie
Kitaif, & Melissa Muse
The University of North Carolina at Chapel Hill
2. 2
Section Page
Problem Statement 3
Target Audience 3
Channel Selection 4
Message Content and Creative Strategies 6
Plan for Message Dissemination 8
Plan for Evaluation 8
Plan for Evaluation Scale-Up 9
References 11
Appendix 1: Message Images & Social Media Mock Ups 12
Appendix 2: Social Media Page Mock-Ups 15
Contents
3. 3
The Durham Knows campaign seeks to reduce the amount of individuals affected
by HIV in Durham, North Carolina by increasing access and utilization of free HIV and
STI screenings and by reducing stigma associated with HIV and HIV testing. Although
HIV has existed in the United States since the 1970s, the stigma associated with the
disease remains high, and creates a barrier to effectively preventing its’ spread (“About
HIV/AIDS”, 2015). Despite progress, HIV infection rates remain a concern, especially in
Durham, which has the second highest rate of infection in the state (“Durham Knows”,
2015). In order to reduce the rate of HIV infection in Durham, the campaign must reach
its audience in a manner that is cost-effective, in both human and financial resources.
This is a critical component of our campaign design: creating a campaign that is not
only evidence-based, but feasible to implement.
The Durham Knows campaign plans to target youth aged 18-25. Youth have an
extremely low rate of HIV testing: data from the 2013 Youth Risk Behavior Surveillance
System showed that only 22 percent of high school students who had ever had sexual
intercourse had been tested for HIV (“HIV Among Youth”, 2016). By extension, the CDC
reports that 44 percent of HIV-positive youth did not know that they had HIV – the
highest rate of undiagnosed HIV in any age group (“HIV Among Youth”, 2016).
Additionally, in 2014, 81 percent of new HIV diagnoses among youth occurred in
persons aged 20-24 (“HIV Among Youth”, 2016). Based on this data, Durham Knows
plans to focus on the youth population beginning at age 18 in the hopes of normalizing
Problem Statement
Target Audience
4. 4
HIV testing before infection occurs. By reducing stigma and promoting HIV testing as a
routine health behavior, Durham Knows has the potential to greatly increase utilization
of testing, and thus reduce the rate of HIV infection in Durham, NC.
Within the realm of social marketing, there is an increasing body of literature that
demonstrates the effectiveness of social media messages in altering health behaviors.
In 2014, Laranjo et al., conducted a meta-analysis study which showed a positive effect
of Social Networking Site (SNS) interventions on health-behavior related outcomes.
Additionally, Young et al. conducted a study in 2015 that demonstrated results to
provide support and initial feasibility of using social networking for diffusing community-
based HIV interventions. The same study also indicated that over 60% of referrals
reported hearing about the intervention on social media and over half reported that the
referrer talked to them about changing health behaviors (Young et al, 2015).
In light of this evidence, public health campaigns have begun to focus efforts into
information sharing through social networks. Social networks are proving to be a
powerful tool not only in disseminating messages about health, but also in changing
health related behaviors.
In the same vein, social media can prove to be a powerful tool for the Durham
Knows campaign. The target population for the Durham Knows campaign is young
adults aged 18-25. According to a Pew Research study from 2015, 82% of 18-29 year-
olds use Facebook and 55% of 18-29 year-olds use Instagram. Furthermore, our
contact at the Department of Public Health, Paul Weaver, had indicated that social
Channel Selection
5. 5
media is a vehicle frequently used by individuals who reach out to him seeking testing
services.
With this information in mind, we decided to conduct our primary research at
Durham County Bus Stop, using survey-based inquiry. We conducted our research
between the hours of 2:30 and 4:00 p.m., with the conjecture that this would be the
“peak hours” for students using public transportation, and therefore we would have a
greater number of the target audience to survey.
The results of the survey were on-track with literature surrounding social media
use—76% of the survey population reported use of Facebook and 57% reported use of
Instagram (Figure 1).
Figure 1.
Additionally, our primary research indicated that the older population segment
within the target audience (23-25 year-olds) tended to only use Facebook, or use
Facebook more heavily. One 25-year-old individual surveyed stated, “I only use
Facebook.” Our primary research also indicated that the younger segment within the
target population tended to 1) be more multi-/cross-platform users of social media and
2) stressed the use of Instagram more heavily as their main social media channel.
6. 6
With the results from our primary research, the personal testimony from Mr.
Weaver, as well as previously noted peer-reviewed sources delineating and
demonstrating the benefits of using social media for health-behavior related campaigns,
we recommend that Durham Knows implement social media pages on both Facebook
and Instagram in order to disseminate messages about HIV and STI testing.
After establishing the social media platforms to be used for the Durham Knows
campaign, we began to develop the creative messages that will be disseminated. First,
we looked into the types of messages that have been promoted by other campaigns
aimed at increasing HIV testing. From looking at coalitions that succeeded and failed,
we quickly noticed a clear and common thread amongst the latter group: the messages
were damning, depressing, or disrespectful. In an effort to be attention grabbing and
controversial, most campaigns seemed to fall short of what they were setting out to
accomplish. Slogans felt aggressive as if they were attacking the audience they were
trying to reach. Based on this evidence, we opted to aim for a tone in our messages that
is casual, humorous, and informative. By utilizing an informal tone, we hope to promote
the sentiment that HIV testing is nothing to fear, and is a routine health behavior.
In order to accomplish this, we decided to develop several varieties of images to
be distributed.
Familiar Memes (See Appendix 1)
o In this context, memes are images paired with text that have circulated
the internet enough to be easily recognizable. They are often humorous, and
frequently satirical. We have taken popular memes and altered them to make them
applicable to the Durham Knows campaign. Evidence suggests that that more
Message Content and Creative Strategies
7. 7
provocative or sensational images are more likely to prompt conversation between
viewers due to their emotional response. An Australian study found that after
viewing an advertisement promoting a vaccination for the human papillomavirus, or
HPV, participants were more likely to talk with others about the advertisement if
they felt some sort of emotion after seeing it (Dunlop et al, 2015).
Original Memes (See Appendix 1)
o In addition to parodies of well-known memes, we have created some
original images based on colloquial phrases and popular media.
Testing Locations (See Appendix 1)
o Images with testing locations
Infographics & Articles
o We suggest that the campaign post any interesting and applicable
infographics or link to articles.
After developing a variety of creative messages, we set out to evaluate the
reaction they elicit from our target audience. We utilized a similar strategy to collect data
on our creative message as we did to select our channels of delivery. We were able to
interview thirteen members of our target audience. The reception of our messages was
positive overall. Individuals interviewed were not outright offended by the messages, nor
did anyone feel that the messages were too personal. Additionally, the responses they
provided were upfront and candid. This led to some surprising and mixed feedback. For
example, one potential audience member stated that the “Know Before you Netflix and
Chill” meme was too boring, however, others thought it was clever. Some participants
thought that the “Willy Wonka” meme was funny, others thought it was too wordy and
stated that they would scroll past without reading. Because no one message connected
with the people we interviewed unanimously, but every person found at least one of the
messages to be appealing, we believe that the campaign can still be successful by
increasing the volume and variety of social media messages it posts.
8. 8
Another important finding of this research was that many of the individuals we
interviewed stated that they would tag a friend or share the images they found funny.
This is a critical component for expanding the reach of the campaign, and will likely be
an important aspect of building a group of followers for the Durham Knows social media
pages.
We have created a Facebook and Instagram account for Durham Knows, as well
as a Google account to be used for management of the campaign (See Appendix 2).
Within that account’s Google Drive are all of the messages we have created.
Additionally, a Google Calendar has been created with a posting schedule for the
campaign based on the most optimal times to post messages. This will make it feasible
for anyone involved in the Durham Knows campaign to post messages from anywhere.
It is important to note that this campaign is “living” in the sense that the body of material
for creating interesting posts will need to grow. In order to accomplish this, the
campaign can utilize their existing relationships with NCCU and UNC-CH. Interns, as
members of the target audience, will be able to create new, culturally relevant material,
allowing the campaign to maintain a steady presence.
We recommend that the campaign utilize data readily available through Facebook and
Instagram, as well as routine health data to monitor the program’s outputs. By
Plan for Message Dissemination
Plan for Evaluation
9. 9
monitoring certain indicators (Figure 2) the campaign can determine whether or not their
messages are reaching their target audience:
Applause rate
or Facebook and Instagram (total number of “likes”/ total
number of posts)
Amplification rate: for Facebook and Instagram (total # shares/total # of posts)
Engagement rate
for Facebook and Instagram (people talking about this e.g.
“mentions” or “tags” + total number of fans or “followers”
HIV testing rate # of tests given to target population/target population
New “customer” rate
# of tests given to first time testers/total # of tests given
(within target population)
In addition to monitoring these indicators, we recommend that Durham Knows develop
a survey to be distributed to individuals who seek testing, which would include questions
about how they learned about the free testing through the Department of Public Health,
as well as whether or not they had seen any Durham Knows messages on Facebook or
Instagram.
If the Durham Knows campaign wishes to further investigate the spread and impact of
its social media messages, we suggest developing an experimental evaluation design.
We recommend a cluster randomized-control design. Durham Knows would recruit
participants (“seeds”), who would in turn recruit a specific number of friends to
participate (“referrals”). Groups of seeds and referrals would be randomized to be
exposed to either the Durham Knows messages via social media or a control social
Plans for Evaluation Scale Up
10. 10
media campaign, unrelated to sexual health. Participants would respond to a survey
with questions about their sexual health practices (as will as demographic data) and
whether or not they had been tested at baseline, six-, and twelve-month follow up. Data
could then be analyzed to determine whether exposure to the Durham Knows
messages have a direct impact on youth utilization of HIV testing. Additionally, survey
data on participants’ reaction to specific images could be collected throughout the study
by using online surveys. Images that were particularly impactful could remain in the
Durham Knows library of images to be recycled, and images that were less effective
could be dropped.
11. 11
About HIV/AIDS. (2015). Retrieved February 10, 2016, from
http://www.cdc.gov/hiv/basics/whatishiv.html
Dunlop SM, Kashima Y, Wakefield M. (2010). Predictors and consequences of
conversations about health promoting media messages. Commun Monogru.
77(4), 518-39.
Duggan, M. (2015, August 19). The Demographics of Social Media Users. Retrieved
April 20, 2016, from http://www.pewinternet.org/2015/08/19/the-demographics-
of-social-media-users/
Durham Knows - Durham Conoce. (n.d.). Retrieved February 10, 2016, from
http://www.healthydurham.org/index.php?page=resources_durhamknows
Centers for Disease Control and Prevention. (2016). HIV Among Youth. Retrieved April
20, 2016, from http://www.cdc.gov/hiv/group/age/youth/index.html
Laranjo, L., Arguel, A., Neves, A. L., Gallagher, A. M., Kaplan, R., Mortimer, N., Lau, A
. Y. (2014). The influence of social networking sites on health behavior change: A
systematic review and meta-analysis. Journal of the American Medical
Informatics Association. doi:10.1136/amiajnl-2014-002841
Young, S. D., Belin, T. R., Klausner, J. D., & Valente, T. W. (2015). Methods for
Measuring Diffusion of a Social Media-Based Health Intervention. Social
Networking SN, 04(02), 41-46. doi:10.4236/sn.2015.42005
Young, S. D., Cumberland, W. G., Lee, S., Jaganath, D., Szekeres, G., & Coates, T.
(2013). Social Networking Technologies as an Emerging Tool for HIV Prevention.
Annals of Internal Medicine Ann Intern Med, 159(5), 318. doi:10.7326/0003-
4819-159-5-201309030-00005
References
