1. This week, we learned about the balanced scorecard and dashboar

1. This week, we learned about the balanced scorecard and
dashboard reporting, performance measurement, sources of
revenues for different types of healthcare organizations, and
financial and strategic planning initiatives. For your Unit 3
Complete assignment, write a narrative essay (minimum 1,200
words) in which you first discuss the use of the income
statement, in general, for decision-making. Then, calculate the
net operating income and operating margin for this year and last
year using the table information below and discuss what these
figures mean for the company (i.e. what ‘story’ do they tell the
reader). Use at least three scholarly sources and remember to
demonstrate a thorough understanding of the READ and
ATTEND sections in your essay. Cite your sources using APA
format.
Table 3
HEALTH CAMPAIGNS:
CREATING & EVALUATING
Day 33
Review
Ch. 8 Review
Activity
Homework
AGENDA:

1.
2.
3.
4.
Public Health
Public health: prevention of disease and illness among groups of
people.
Creation of public policy regarding health issues and tracks
diseases
_________________
Public health services (CDC)
(Lillie; Mattson & Hall, 2011)
Health Campaigns
Health campaign
Seeks to promote public health
Targets beliefs, attitudes, or behaviors
________- acceptance of something as
true or not
______- positive or negative feeling
about something
________-actions
____________
Goes beyond health education to involve
health information and environmental

support/resources for health
Messaging Model for Health COM Campaigns
4 phases of the health campaign process
1. Establish a working group and ____________
2. Strategic planning from____________
3. _________________ and evaluation
4. ______________on process evaluation and outcome
evaluation
Messaging Model for Health COM Campaigns
(Mattson & Hall, 2011, p. 253)
Phase 1: Establish a
Working Group
_________: core team for
strategic planning and advising
Includes stakeholders, health
experts, organizational
officials, community partners

_________: orgs and
businesses who have an interest in
the campaign
Provide resources:
Phase 2: Strategic
Planning
Strategic plan: campaign goal and
plan of action
_______ analysis:
S_______ and
w______of campaign team
(internal to team)
O_____ and t______
(external to campaign)
Ex. grassroots support or
resistant audience
__________: research to
form strategies, select target
audiences, and develop marketing
strategies

Phase 2: Strategic
Planning
CONT.
Needs assessment: process to
understand and determine a
community’s/population’s
health issues
Pre-campaign gather info from
Key informants
community forum
survey
_________: already
existing statistics
Phase 2: Strategic
Planning
CONT.
Messaging process: after determining
baseline attitudes, beliefs, and behaviors of
target groups, the team can design messages
Messages should be:
______: encourage the intended
audience to notice
_______: encourage the audience to
act or not
__________: determine if suggested
behavior can be done successfully in
his/her community

Response-efficacy: promotes that a
strategy works
Self-efficacy: promotes an individual’s
confidence in their ability to perform
a recommended task
Phase 2: Strategic
Planning: Messages
should be (CONT.)....
Environmental, con’t
________: what individuals
believe other people normally think
or do
_________: refers to the
impact of norms on behavior; most
prefer to fit in
________: message have to be
culturally sensitive and encourage
behaviors that the population accept
__________: considers if the team
has resources to create and
disseminate the message
Phase 2: Strategic
Planning (CONT.)....

Testing & Retesting Messages
Once designed, you need to test
the message
Then tweak
Then redesign
Message strategies:
_______: messages pushed
out to the audience; all info
provided
_______: messages
designed to entice the audience
to seek more info “for more
info, call XXXX”
Phase 3:
Implementation &
Evaluation
Implementation activities:
Message production
Message dissemination
Campaign team meetings
with staff, working groups,
and partners
_________: ongoing
tracking and evaluation of
campaign activity

Outcome evaluation
Phase 4: Correction
Loop
The team reflects on
what went well, what
could be improved
How the campaign is
evaluated should be part
of _____ in that phase,
they should determine
what are important
markers of success;
actually do that
measurement in _____
Wednesday
Read
Haas et al. (2011)
RA 19 Due
April 7th (WED) by 11:59 pm ET

“Flirting is Not Consent.
Ask Everyone, Every Time”
Designing, Implementing, and Evaluating a Health
Communication Campaign to Prevent Sexual Violence
CASESin PUBLIC HEALTHCOMMUNICATION &
MARKETING
Peer-Reviewed Case Study
Suggested citation: Haas, E.J.; Mattson, M.; Wilkinson, K.
“Flirting is Not Consent. Ask Everyone,
Every Time”: Designing, Implementing, and Evaluating a
Health Communication Campaign to Prevent
Sexual Violence. Cases in Public Health Communication &
Marketing. 2011;5:47-74. Available from:
www.casesjournal.org/volume5.
Volume V, Winter 2011
Emily Joy Haas, MA 1
Marifran Mattson, PhD 2
Kathlyn Wilkinson, MPH 3
www.casesjournal.org
1 Purdue University, Indiana Campus Sexual Assault Primary
Prevention Project
and Brian Lamb School of Communication
2 Purdue University, Brian Lamb School of Communication
3 Purdue University, Student Health Center
Corresponding Author:

Emily Joy Haas, Purdue University Student Health Center,
601 Stadium Mall Drive, West Lafayette, IN 47907-2052.
Email: [email protected]
48
Abstract
Research shows that sexual assault is one of the most pervasive
problems on college and university campuses. Some research
also
indicates that sexual assault is the most common violent crime
committed in campus communities. This case study describes
and
analyzes the development, implementation and evaluation of a
social marketing campaign for a university committed to the
pri-
mary prevention of sexual violence. The Health Communication
Campaign Framework provided theoretical and practical
guidance
for the working group during all phases of the campaign
process.
Campaign messages were designed to educate students about
what
consent is and to increase their comfort level in obtaining
verbal,
sober consent before having sex. The campaign also is critically
analyzed with recommendations for how to address a sensitive
is-
sue, such as sexual violence, in messages displayed throughout
a
campus community.

Key Words: Social Marketing, Health Communication
Campaign
Framework, Sexual Violence, Primary Prevention, Message
Design
49
Introduction
Sexual violence is one of the most pervasive
problems on college and university cam-
puses,1 and the most common violent crime
committed in campus communities.2 Sexual
violence encompasses a range of offenses
that are perpetrated against someone’s will,
including a completed, nonconsensual sex
act; an attempted nonconsensual sex act;
and an abusive sexual contact.3 Every two
minutes someone is raped in the United
States (U.S.) and the chances of being raped
are four times greater for a female college
student than any other individual.4 Re-
search suggests that 3% of college women
are raped during a nine month academic
period and 20-25% of women experience a
completed or attempted rape during their
four to five years spent in college.5 Also,
a study of experiences among college stu-
dents found that 27% of females reported
unwanted sexual attention and 5% reported
unwanted sexual contact in their lifetime.6

Often, campus sexual violence is associated
with high-risk drinking and other drug
use.7
The “Clery Act,” originally known as the
Campus Security Act, requires that Insti-
tutions of Higher Education (IHE) disclose
information about crime on and around
their campuses.8 However, since these
sex offenses are underreported,9 the issue
sometimes is not warranted as problematic.
The following survey data provides a more
specific, localized indication of this problem.
In spring 2006, 13 campuses in Indiana
participated in the Core Survey (n=6,000).10
In the results, 5.2% of the respondents re-
ported forced sexual touching, 3% unwanted
sex, and 1.9% both forced sexual touching
and unwanted sex. In another survey in-
volving eight Indiana campuses (n=7,530),11
7.3% of respondents reported being sexu-
ally touched without their consent while
enrolled as a student on their campus; 2.8%
an attempted or completed sexual penetra-
tion without their consent; and 4.2% report-
ed being taken advantage of sexually while
drinking or using drugs. These surveys
render consistent results regarding sexual
offenses within IHE in the state.
Recently, IHE were encouraged to adopt
policies and other prevention efforts to end
sexual violence.5,9 To help address violence
comprehensively, Centers for Disease Con-
trol and Prevention (CDC), in partnership

with the state’s health department, provides
funding in the form of a Rape Prevention
and Education (RPE) grant to prevent
the occurrence of sexual violence on cam-
puses.12 Recognizing that beliefs and atti-
tudes regarding sexual violence are formed
early,12 CDC encourages a focus on promot-
ing healthy relationships and non-violent
norms. Besides federal funding to support
sexual violence prevention, a modification to
current legislation, the Campus SaVE Act,
was introduced in April 2011.13 If passed,
this legislation will mandate that IHE cre-
ate and implement a comprehensive strat-
egy to both prevent and respond to sexual
violence.13 The Act is calling for awareness
campaigns as a best practice to prevent
sexual violence,13 indicating the timeliness
of this case study.
This case study demonstrates how health
communication provides a foundation for
primary prevention campaigns by discuss-
50
ing the development, implementation, and
initial evaluation of a campus-based social
marketing campaign to prevent sexual
violence. Primary prevention efforts aim to
prevent first-time perpetration and vic-
timization.3,9,12 In accordance with CDC

philosophy, more health campaigns are
emphasizing primary prevention strate-
gies instead of secondary and tertiary
prevention approaches.12 Social marketing
campaigns are one method to create large,
behavior-changing initiatives on cam-
puses.14 Social marketing and media cam-
paigns have been used as prevention tools
for a variety of health behaviors including
bystander intervention14 and motorcycle
safety.15 Social marketing campaigns work
particularly well on campuses because they
are designed to reach large numbers of
people with targeted messages.16-17
51
Background: Framing a Sexual Violence
Primary Prevention Campaign
The Sexual Violence Primary Prevention
Campaign (SVPPC), which targets college
students, is framed by an adapted version
of the Health Communication Campaign
Framework (HCCF) shown in Figure 1 (next
page).18-19 The objectives of this case study
include: analysis of the SVPPC campaign
as it progressed from initial steps in forma-
tive research, to reveal a primary problem
contributing to sexual violence on campus,

into developing its strategic plan to address
the problem, through the message develop-
ment and implementation of the campaign,
culminating with initial evaluation and
lessons learned. Following is a summary of
the HCCF’s four phases which are further
addressed with respect to the SVPPC.
Health Communication Campaign Framework
The SVPPC was framed by an extension of
Mattson and Basu’s18-19 Message Develop-
ment Tool (MDT) which utilizes messag-
ing elements derived from communication
theory and is consistent with social market-
ing.20 The first phase includes convening a
working group and strategy development,
which sets the foundation for the cam-
paign.14,18-19 The second phase consists of
a needs assessment followed by developing
and testing of messages and materials for
proven messaging elements including be-
ing stimulating, motivational, contextually
and culturally consistent, and concordant
with the constraints of organizational
resources.18-24 The third phase involves
implementing the campaign to the target
audience through appropriate communica-
tion channels and events. The final phase
is to evaluate the campaign’s effectiveness,
and if necessary, make corrective or mid-
course changes, at relevant points in the
campaign’s lifecycle, usually by measuring
audience knowledge, attitudes, and behav-
iors. Now that the theoretical framework

has been summarized, we illustrate how
it was applied in practice to design, imple-
ment, and initially evaluate the SVPPC at a
university.
52
Figure 1. Health Communication Campaign Framework
(Adapted from the
Message Design Tool by Mattson & Basu; 2010a, 2010b)18-19
Phase 3 – Implementation & Evaluation
(Re)Implement Strategy/Disseminate Campaign Messages
Process Evaluation-tracking system to assess program deliv-
ery and utilization
Outcome Evaluation-comprehensive assessment of campaign
effectiveness
• Pre-test/Post-test surveys
Phase 4 –
Correction Loop
“Correct” Campaign
based on Process and
Outcome evaluation
and cycle back through
Phases 2 and 3.
Phase 1 – Convene Working Group/Committee
Who?

• Health Issue Experts
• Public Health/Communication Specialists
• Community Partners
• Funding Sources
What?
• Create Problem Statement
Correction
loop
Phase 2 – Strategic Planning from Formative Research
Needs Assessment
• Research
• Statistics
• Target Audience(s)
-Pre-test-existing knowledge, attitudes, and behaviors
Messaging Process
• Develop/revise campaign messages taking into account
proven messaging elements including:
• Stimulating - attention-getting, salient
• Motivational - risks, susceptibility, fear
• Contextually Consistent - response efficacy and self-
efficacy,
subjective norms, costs/benefits
• Culturally Consistent - values, traditions, roles,
rules, power structure
• Resource-Dependent - quality, reach
• Pre-test DRAFT messages using focus groups with target
audience
• Revise messages according to feedback
Marketing Mix
• Product
• Price

• Placement
• Promotion
53
Methods
Phase One: SVPPC Working Group
Phase 1 of the HCCF involved convening
a working group that was concerned about
or had an interest in the issue being ad-
dressed. The SVPPC working group con-
tained several people from the university
and surrounding community. The group
consisted of the project director, the leader
of the group, who recruited relevant part-
ners on campus including representatives
from the university’s Student Wellness Of-
fice (SWO), Women’s Resource Office, Cam-
pus Safety, Residence Life, the community’s
Rape Crisis Center, and students. Their
first task was to write a problem statement
that would guide the group to develop a
campaign after which a needs assessment
was conducted to inform the problem and
target audience.14,18-19,25
Needs Assessment
Before finalizing a targeted, accurate prob-
lem statement, needs assessment research
was conducted. The needs assessment gath-

ered specific University and state data to
better understand sexual violence locally,
including who the problem affected and
what behavior changes were needed.26 The
working group examined University data
from the Student Wellness Survey,27 campus
safety data, and solicited student input in
several diverse classes. Results of the Stu-
dent Wellness Survey,27 implemented online
to the University student population, in-
cluded questions about violence experienced
on campus. Of the participants (n=4,264),
1.9% experienced a sexual assault on cam-
pus within the past 12 months and more
than 15% were forced to have sexual contact
within the past 12 months. National data
discussed previously indicated the preva-
lence of sexual violence in the U.S., and
although higher than the local data gath-
ered, both signify that sexual violence is
common on college campuses.7,28-29 Further,
the campus’s safety data revealed that the
majority of reports from students regarding
rape were acquaintance rapes. Discussions
with students after sexual health presenta-
tions, requested by instructors and residence
life staff, indicated that alcohol contributed
to the lack of consent exchanged before sex,
and that alcohol was involved in almost all
of the assaults reported.
The needs assessment revealed that stu-
dents on campus support a date rape cul-
ture, i.e., an environment that fosters rape
attitudes and increase risk factors for

sexual violence.30 Date rape cultures form
as a result of rape myths, which are preva-
lent on many campuses. The perpetuation
of rape myths foster victim blaming and
minimization of injuries experienced by vic-
tims.31 Examples of rape myths perpetuated
on college campuses include: the type of
clothing people wear suggests how willing
they are to have sex; when someone is raped
it often is because the way they said “no”
was unclear; if a woman engages in kiss-
ing or lets things get out of hand, she wants
to have sex; and someone who is sexually
assaulted while drunk is somewhat re-
sponsible.32 Some of these rape myths were
assessed in Indiana’s College Relationship
54
Survey (n=7,530),11 which found that 42.4%
of participants agreed or strongly agreed
that someone who is sexually assaulted
while drunk is somewhat responsible and
28.7% agreed or strongly agreed that the
type of clothing people wear suggests how
willing they are to have sex. This assess-
ment supported the need to focus on rape
myths, specifically the concept of consent,
to prevent acquaintance rapes and assaults
that occur on campus. The working group
gathered, reviewed, and analyzed enough
relevant information to formulate the fol-

lowing problem statement:
A majority of students on campus do
not ask for consent before engaging
in sexual activity. They do not ask
for consent because they are either
embarrassed to ask, or do not know
what consent is and is not. The lack
of obtaining consent is contributing
to a portion of acquaintance sexual
assaults on campus. In response, it
is necessary that students on campus
become more familiar with what con-
sent is, and become more comfortable
obtaining and communicating verbal,
sober consent before proceeding to
sex.
Focusing on consent among the target audi-
ence has also been a method used among
speakers and other campaigns to prevent
sexual violence, such as The Date Safe
Project33 and The Consensual Project.34 In
addition, sexual activity among late ado-
lescents without clear consent is an aspect
of violence that needs to be addressed on
campuses.35 Often sexual activity is never
clearly given or verbally stated and instead,
implied.35-36 Therefore, the working group’s
problem statement aligned with current
practices to prevent sexual violence by
focusing on strengthening the communica-
tion between two people before engaging in
sexual activity.

Strategic Planning
Based on the problem statement, the work-
ing group created a strategic plan to guide
their activities. After consulting University
data and talking with students after the
presentations referenced above, the working
group realized that the SVPPC needed to
target the entire undergraduate population
on campus. Representatives of the student
population, i.e., first-year students through
fifth-year students, student-athletes, fra-
ternity and sorority members, and health-
related majors, provided consistent feedback
and stories about their friends’ experiences
regarding sexual violence on campus, fur-
ther confirming the need to target everyone.
Strategic planning was enhanced by us-
ing CDCynergy,37 an online tool that in-
cludes a step-by-step process of creating
social marketing campaigns starting with
a detailed timeline. The timeline for the
SVPPC spread across a calendar year, with
deadlines corresponding to each phase of
the HCCF. First, the project director, who
was awarded the grant, participated in a
social marketing and focus group train-
ing provided by a RPE grant coordinator.
The training allowed the project director to
develop a timeline, with deadlines sensitive
to the academic calendar. After the fall 2009
training, the remainder of the semester was
55

spent conducting the formative research and
needs assessment previously discussed. Dur-
ing the spring 2010 semester, the working
group drafted messages, tested those mes-
sages in focus groups, revised the messages,
and tested them again. During the summer,
the messages were finalized, the visual im-
ages desired by students were purchased,
and proofs were requested from the printing
company. Because students are most suscep-
tible to sexual assaults in the first six weeks
of the academic year,38-40 it was imperative
to have the campaign implemented when
students arrived on campus in August 2010.
Finally, initial evaluations of the campaign
were conducted at the end of both the fall
2010 and spring 2011 semesters.
A precise budget for campaign activities
was developed by using the marketing mix,
i.e., product, price, placement, and promo-
tion.20 Although the promotional aspect
of the marketing mix expanded during
campaign implementation, other aspects of
the marketing mix were determined early
during strategic planning. For example,
the working group decided what products
and mediums would be used to disseminate
the campaign message, within the $2,000
budget provided. Additional aspects of the
marketing mix are discussed during the
implementation section.

Phase Two: Drafting and Testing Messages
The messaging process within Phase 2 of
the HCCF consisted of three stages. First,
the working group drafted messages based
on the needs assessment and the message
effectiveness elements. Second, the drafted
messages were tested in focus groups with
the target audience. Third, based on itera-
tive feedback, messages and promotional
items were revised and finalized.
Stage One
In the first stage of the messaging process,
the working group drafted 12 messages
that not only were aligned with the problem
statement, but were also in keeping with
effective messaging elements in that they
were stimulating, motivational, consistent
with the context and environment, and
culturally appropriate.21-24 When drafting
messages, the working group paid attention
to the recommendations of the HCCF by
making the messages stimulating in order
to break through the clutter of messages
students receive. Forming a message that
attracted attention may motivate students
to change their behavior and begin asking
for consent.
In terms of the cultural consistency of the
messages, the working group drafted mes-
sages that might appeal to both men and
women on campus. It was important not to
put all of the pressure to obtain consent on

one gender within the interaction. Besides
being an equal responsibility, the working
group did not want to depict men as being
56
in a position of greater power. Instead, a
goal of the campaign messages was to put
men and women on a level playing field, be-
ing able to respectfully communicate with
each other.
Stage Two
After a variety of messages were drafted
based on effective messaging elements, they
were tested. Two focus groups41 were con-
ducted to test the written messages without
images. The working group did not want to
contaminate student’s initial viewpoints of
the written messages by biasing them with
images. However, feedback was requested
from participants regarding what images
might resonate with students and comple-
ment the written messages.
Students were recruited to participate in
one-hour focus groups via the University’s
electronic flier board system, the Univer-
sity television network, and by members
of the working group personally recruiting
students. One focus group of communica-
tion majors was offered extra credit by their

instructor for their participation. The other
focus group was provided dinner for their
participation and were student members of
the campus safety department. The focus
groups occurred between March 31 and
April 4, 2010, with 8-15 students participat-
ing in each discussion which is a typical
number of participants.41 The first focus
group was facilitated by the grant coordina-
tor so that the project director could observe
the facilitation process and lead subsequent
discussions. The note taker for each focus
group was a graduate assistant in SWO who
was in the SVPPC working group. Student
participants were asked a series of ques-
tions about each of the 12 draft messages,
e.g., “Would the message stand out on cam-
pus?”; “What do you like/dislike about the
message?”; “Who does the message target?”;
“Will the message change personal behav-
ior?”; and, “How can we make the message
more clear?”. Since the second focus group
provided similar feedback to the first focus
group and was a different student demo-
graphic, the working group felt confident to
move forward with revising the messages.
Stage Three
The third stage of the messaging process
was iterative and involved taking the focus
group feedback and revising draft messag-
es. To illustrate this process, examples are
provided in the following sections.
Draft Message 1. The working group draft-

ed the message, “Consent? [email protected]? Flirting is
not consent. We ALL have the right to say
yes,” using text message lingo. Some mem-
bers of the working group thought that uti-
lizing text messaging language would appeal
to students and attract attention over other
messages. To their surprise, focus group
participants said that the text language was
difficult to understand. Specifically, they
thought the “Consent? [email protected]?” was confusing.
Some working group members were sur-
prised while others thought the message was
confusing, but because they did not text, did
not comment on the initial draft. However,
participants communicated that the last part
of the message was powerful and should be
used without the first part of the message.
57
Draft Message 2. Because the needs assess-
ment found that students often are embar-
rassed to ask for consent, the working group
thought that infusing the messages with hu-
mor may help ease the tension in situations
where consent is necessary. So, a series of
messages were drafted which played off
the concept of Global Positioning Systems
(GPS). One draft message was, “There’s
no GPS for sex. Ask for consent every step
of the way.” This message was perceived
as too silly. Participants commented that

it would become a joke on campus. Others
expressed that the message had a connota-
tion of getting lost, which is not an enjoy-
able experience. Participants expressed
dislike for linking sex with getting or need-
ing directions. Although some participants
thought the message could be modified to
resonate better with students, the risk of
consent being laughed at instead of taken
seriously prompted the working group to
table these messages. Because these drafts
required extensive modifications, they could
not be utilized during this grant period
and campaign. However, the working group
liked this series of messages and based on
some positive student feedback, stored these
drafts for potential modification, testing,
and future use.
Draft Message 3. The needs assessment
revealed that students often interpret other
signs or nonverbal cues, such as flirting,
as consent. With this in mind, several
drafts targeted these behaviors as not
being consent. Many draft messages con-
tained phrases such as, “Flirting is not
consent,” and “Not sure if he/she’s into it?
Ask!” Participants unanimously liked the
message “Flirting is not consent” stating it
was strong, simple, direct, accurate, and a
powerful statement. They also appreciated
that this shorter message could be read as
they frequented campus buildings. Working
group members also appreciated the suc-
cinctness of this message.

Draft Message Slogan
Development of the campaign slogan serves
as another example of the messaging pro-
cess. The draft slogan was, “Everybody,
Every time, Everywhere” indicating the im-
portance of always asking for consent, even
if consent was previously gained. Partici-
pants liked the concept of this message but
felt that it lacked a call to action and was
too long. After revisions and feedback from
the second focus group, the final campaign
slogan informed by students became “Ask
everyone, every time.” This message was
shorter and had a blatant call to action that
students could remember.
Unanticipated Message Barriers
The working group encountered construc-
tive feedback that had to be addressed.
For example, an unanticipated barrier to
developing and testing these messages was
that several of the original drafts were
interpreted as promoting sex, as well as
promoting consent. The working group did
not initially notice this contradiction until
alerted by focus group participants. When
testing phrases such as, “It may not be easy
but it’s worth it! Get consent.” and “Nothing
gets things started like getting consent,”
participants stated that these messages im-
plied people would eventually say yes to sex.
After noticing this aspect, messages that

58
were interpreted this way were not used
in the final message testing since others
tested much better and were not perceived
as promoting sex. The working group was
cognizant of this issue during the remain-
der of the messaging process.
Images
After the text was finalized, images were
needed. The first two focus groups recom-
mended that two people, i.e., a couple, were
needed to clearly depict the consent mes-
sage. Participants insisted that the concept
of consent becomes confusing when alcohol
is involved in the scenario, so a bar-like
setting with alcohol needed to be present in
at least one image. Because the needs as-
sessment also showed that alcohol impairs
the ability to obtain and provide consent,
the working group agreed. However, par-
ticipants also said that images of couples
talking and playfully flirting would assist
in depicting the message. Images without
alcohol also were necessary because half of
the target population is under age 21 and
not legally allowed to drink alcohol.
Based on this feedback, images were found
on istockphoto.com and tested with a new
focus group of eight participants recruited
and facilitated through the same methods
described previously. These participants

provided feedback, including: the couples
appeared to be too old or too young; it was
not evident if they were flirting; they ap-
peared to be too far into the physical in-
teraction and consent already should have
been obtained; the image complemented
the message and reflected the students on
campus.
Final Message
Towards the end of the third stage of the
messaging process, participants approved
several messages and images. However, the
working group decided to implement one,
consistent message. One call to action was
deemed appropriate to change this specific
behavior and also tied the campaign togeth-
er. The SVPPC message became, “Flirting
is not consent. Ask everyone, every time.”
To resonate with the entire target audience,
students recommended depicting a variety
of couples to represent the main demo-
graphic groups on campus. The three rep-
resentative istockphoto images chosen for
the campaign, coupled with the same mes-
sage included a Caucasian couple flirting
at a bar (Figure 2), an African American
couple flirting (Figure 3), and a homosexual
couple flirting (Figure 4). Drafting, test-
ing, revising, and finalizing messages was
a time-consuming process but the iterative
feedback from students assisted in creat-
ing campaign messages specifically for the
target audience.

59
Figure 2. Flirting is Not Consent Message
with Bar Couple
60
Figure 3. Flirting is Not Consent Message with
African American Couple
61
Figure 4. Flirting is Not Consent Message
with Homosexual Couple
62
Campaign Implementation
After the messages were completed, the

working group consulted the budget and
decided how they could implement the
campaign. Before classes began in August
2010, 750 campaign posters were ordered
from printing services for $436.00 and dis-
seminated to every residence hall, sorority,
fraternity, campus building, athletic locker
rooms, community apartments, and city
bars. The distribution of these posters was
carefully considered. Consistent with the
concept of audience segmentation empha-
sized in the HCCF18-19 and CDCynergy,37
the working group targeted which campaign
posters would be delivered to each building.
For example, the African American frater-
nity only received the poster with the Afri-
can American couple and the homosexual
fraternity only received the poster with the
homosexual couple. The bars surrounding
campus received posters of the couple at a
bar. Working group members placed posters
in their respective buildings and monitored
their exposure. To the group’s knowledge,
no posters were vandalized. However, one
11x17 poster was stolen from a board in the
health center and replaced. All of the uni-
versity’s electronic advertising systems were
used to disseminate the posters, including
exposure before movies for three months at
the University’s Union for $60.
The messages also were advertised during
October 2010 within the city’s public trans-
portation bus system. Three tail signs were
purchased for the back of busses that navi-

gated the campus and surrounding commu-
nity for $705. Also, 120 interior bus signs
were displayed in all 60 busses of the public
transportation company for $773. Univer-
sity students use these busses frequently as
they travel throughout the campus and to
and from their apartments and houses. The
final cost to print and disseminate the mes-
sages totaled $1,974.00.
The working group determined it was es-
sential not only to post messages around
campus, but to also be available to discuss
the campaign face-to-face with students.
The project director stayed alert for events
occurring around campus during which
distributing campaign posters would be ap-
propriate and attended these events. Collab-
oration increased the campaign’s exposure
and the direct communication with students
provided outlets to discuss the campaign’s
message and answer questions. Venues
where the campaign message was present
included Take Back the Night, National
Preparedness Safety Day, Pan-Hellenic
Council meetings, Campus/Community Bar
Retail Coalition Meetings, and YWCA com-
munity events. Through all these methods
of implementation and message distribution,
the scope of the campaign continued to have
considerable breadth and depth. The cam-
paign continued for the remainder of the
academic year knowing that a target audi-
ence member must recognize a message up
to three times before they keep it in mind.42

63
Initial Evaluation
Campaign evaluations typically measure
the effectiveness of the campaign and
provide feedback for making mid-course
corrections to the campaign.18-19,26 This
case study highlights two initial campaign
evaluations; a survey that was conducted 12
weeks after the SVPPC was implemented
in December 2010 and then again in April
2011. The purpose of these surveys was to
fulfill requirements of the granting agency,
which included a report discussing satura-
tion and any potential behavior change 12
weeks after implementation and again dur-
ing the spring semester. The project direc-
tor used one student worker and one student
volunteer from SWO to survey their peers.
The working group avoided conducting the
evaluations in order to prevent social desir-
ability bias among the respondents.
The volunteers randomly surveyed students
they did not know who were walking alone
on campus in various locations, e.g., resi-
dence halls, academic buildings, fraternity/
sorority houses, athletic locker rooms, and
agreed to be surveyed. Although not sys-
tematic, this approach of surveying students
who were alone was selected to avoid any

potential social desirability biases associ-
ated with asking questions among a group
of friends and to minimize any pressures or
time constraints while answering questions.
Students were surveyed on four separate
occasions during each one-month evaluation
period.
In December 2010, 117 students were
randomly intercepted and if available,
answered questions while the volunteers
checked off their peer’s responses on an Ex-
cel tracking sheet. The number of students
originally approached was not recorded.
However, the surveyors did not experience
resistance from students to participate in
the survey. Each participant was shown the
series of messages and asked if they saw the
messages. If the participants had not seen
the messages prior to the survey, they were
done with the survey. If participants had
seen the message, the following questions
were asked: “Where did you see the mes-
sage?”, “Did you read the message when you
saw it?”, “What is the message about?”, and
“Will this message contribute to behavior
change of students on campus?” Each par-
ticipant’s year in school and gender were
also requested, which demonstrated a wide
range of students, i.e., 45% males, 55% fe-
males, 24% first-year, 23% sophomore, 32%
junior, and 21% senior. Students reported
seeing the messages in a variety of places
including the student health center, movie
ads, residence halls, fraternity houses, the

bus, campus events, and staff offices. The
diversity of outlets for this message was
successful in reaching students, illustrating
the importance of planning the marketing
mix.
Of the 117 students surveyed, 76% (n=89)
both saw and read the campaign message,
indicating a broad reach. Further, 81%
(n=72) of those 89 students who saw and
read the message answered “yes” to the
question, “Do you think this campaign will
contribute to behavior change on campus?”
Although the measure of behavior change
only is a prediction among students, the
campaign message was viewed as accurate
in addressing a campus health issue and
64
persuasive enough to alter students’ behav-
ior. Although 117 is not a large sample (un-
der 1% of the total student population), this
initial evaluation encouraged the continua-
tion of the campaign.
Short, qualitative responses to the evalua-
tion question “Briefly, what is the message
about?” indicated comprehension of the
campaign message. Students’ responses con-
sisted of a few words and therefore, could
easily be coded into themes by the project

director and grant director and then quan-
tified. Thirty-four percent (n=40) stated
the message is about asking for sex; 14%
(n=16) stated it is about being aware and
protecting yourself; 14% (n=16) stated don’t
interpret flirting as “yes”; 8% (n=9) stated
it is about communicating consent; 4% (n=5)
stated it is about safer sex; and 3% (n=3)
said it is about being careful when drinking
alcohol.
In April 2011, the same student volunteers
assessed the comprehension of the message
again through the exact intercept meth-
ods described above. Of the participants
(n=113), 28% were males, 72% females, 16%
first-year, 13% sophomore, 41% junior, 27%
senior, and 3% were graduate status. Of the
113 students, 48% (n=54) both saw and read
the campaign message. Further, 27% (n=16)
of those 54 students who saw and read the
message answered “yes” to the question,
“Did this message change your behavior?”
This question was an assessment of behav-
ior change whereas the initial evaluation in
December inquired if the students thought
the message would change behavior. The
lower number of students who saw the mes-
sage was not surprising, since the budget
for the campaign allowed for three months
of advertising, which ended in December
2010. During the spring 2011 semester, only
the posters were displayed in print and elec-
tronically as described previously.

Of the 113 participants, 91 (80%) answered
the question, “Briefly, what is this mes-
sage about?” These short responses were
again coded. Forty percent (n=36) stated the
message was about rape or rape awareness;
31% (n=28) stated don’t interpret flirting as
“yes”; 18% (n=16) stated it is about commu-
nicating consent; 7% (n=6) stated it is about
alcohol and sex; 2% (n=2) said it is about
sex at parties; 1% (n=1) said safer sex; one
said it is about respecting boundaries, and
one said sexual harassment.
These qualitative responses during both
evaluations indicated a general understand-
ing of the campaign message, providing
additional support for the HCCF strategy
of thoroughly testing messages for clarity
before implementation. The campaign will
be re-implemented through new media out-
lets in Fall 2011, and in Spring 2012, will
undergo an impact evaluation.
In addition to the initial evaluations con-
ducted, a relevant event occurred on cam-
pus that merits mention. At the beginning
of the semester during which the SVPPC
was implemented, a sex position of the week
cartoon was printed in the campus newspa-
per titled The Prestige. The cartoon showed
a couple having sex doggy-style, when the
man sneaks out and, without the woman’s
knowledge, is replaced by another man.

65
This cartoon promoted non-consensual sex
which, by definition, is rape. Many students
expressed being appalled to see this car-
toon in the newspaper. The editor stated
in an apology the following week that she
received and responded to multiple angry
e-mails and phone calls regarding the car-
toon.43 In addition, students sent editorials
in response to the cartoon, of which over
a dozen were published. For example, one
student wrote the following: “…This comic
essentially portrays sexual assault; engag-
ing in intercourse with someone who is for
whatever reason not able to consent (intoxi-
cated, or in this situation, not able to see) is
sexual assault...”.44 Another student wrote,
“This week’s sex position is in all actuality,
sexual assault. If two people are having sex
and one of those people switches out with
someone else, without the other’s consent,
that is rape…”.44 All editorials had a simi-
lar theme. Although we cannot be certain, it
is possible that the campaign message about
consent cued students to act on and com-
plain about the printing of the cartoon.
66

Lessons Learned for Campaign Practice
After progressing through the HCCF to de-
velop, implement, and initially evaluate the
SVPPC, there are three recommendations
for campus health practitioners and working
groups to consider during their own cam-
paign processes. The first recommendation is
to apply the HCCF as a systematic process to
develop a health campaign in order to avoid
and/or address unanticipated barriers. Ap-
plying this framework may help proactively
address an issue before it becomes a problem.
A systematic framework, such as the HCCF,
may also provide credibility when responding
to administration concerns, which is ad-
dressed in the next recommendation.
The second recommendation concerns the
ability to effectively address a sensitive
campus health issue through messaging.
Addressing sexual violence can be challeng-
ing. The reason for this often is two-fold.
First, when using prevention messages
that specifically state the words “rape” or
“sexual assault” students may tune-out be-
cause the message may not seem applicable
to them. For example, a message that says,
“Sexual assault- not understanding no”
is persuading students to obtain consent,
much like the SVPPC messages. However,
using the term sexual assault might cause
students to ignore the message, thinking
that it does not apply to them, particularly
if they never assaulted anyone or were

sexually assaulted. Second, even if students
responded to these types of messages, it is
possible to experience backlash from cam-
pus administration who may not perceive
sexual violence to be a significant issue
on campus. Although this type of feedback
did not occur on this campus, the work-
ing group was prepared with current data
collected during the needs assessment to
demonstrate that sexual violence occurs.
In response to the challenges that can occur
when attempting to design and implement a
sexual violence campaign, softer language
may initially be used to create messages
and images that appropriately address the
problem. For example, instead of referring
to negative aspects of relationships, such
as not committing a sexual assault, mes-
sages can focus on positive aspects of rela-
tionships, such as communicating about or
respecting relationship boundaries. Rein-
forcing these positive behaviors through
messaging may help frame sexual violence
as an issue that can be talked about and
prevented in campus communities. Students
and administration may be more receptive
to messages that encourage keeping com-
munication lines open, maintaining healthy
relationships, and being aware of their
actions. Even though the vocabulary in the
messages may differ, the same behaviors
are targeted as messages that use more con-
troversial terms, such as rape. For working
groups that are similarly trying to combat a

negative health behavior that may be sensi-
tive to address, thinking creatively in terms
of messaging is recommended.
The final recommendation is to take advan-
tage of any opportunity to promote the cam-
paign whenever and wherever appropriate.
For example, after the newspaper printed
the cartoon described above, the project
director contacted the newspaper, framing
this situation as a teachable moment. The
newspaper accepted the invitation to print
67
a cover story about the SVPPC, discussing
the connection between consent and sexual
assault. Relevant incidents and events such
as the one just described may occur on
campus during campaign implementation.
It is the responsibility of the working group
to remain vigilant and consider ways to
collaborate with others to further reinforce
and promote campaign messages.
Limitations
We are aware that steps can be taken to
improve the campaign and ensure the mes-
sage is truly having an impact on behavior.
First, the selection of focus group partici-
pants was not random nor representative

of the entire campus body; a convenience
sample of students from one communica-
tion course and a campus safety department
participated. The importance of identify-
ing ways to ensure broader representation
in future formative research is recognized.
Second, the survey format was not an ideal
evaluation method and could have obtained
biased feedback about the effectiveness of the
messages. For example, although the student
volunteers who conducted the initial evalua-
tions were instructed to select students who
were walking alone at random, it is possible
that they approached students more selec-
tively, for example, based upon an assess-
ment of a students’ potential receptivity. It
is also possible that although the intercept
interviews were anonymous, and the students
who participated did not know the surveyors,
their responses may have been biased either
by wanting to provide a socially desirable
response, or potentially by the interviewers.
Lastly, asking students who were exposed to
a campaign message whether it will or did
change behavior is not a true evaluation of
the effectiveness of the campaign messages.
These are acknowledged limitations that will
be improved upon in a more formal impact
evaluation planned for April 2012. As cur-
rently envisioned the impact evaluation will
utilize an online survey and focus groups
to more formally evaluate the visibility and
effectiveness of the SVPPC and if necessary,
engage in the correction loop of the HCCF.

Finally, future modifications of the cam-
paign will include formative research about
the gender differences present in sexual
violence experiences, including the issue of
power and control in relationships. Previous
research on sexual violence shows that gen-
der-related norms and power and control in
relationships are influential factors in de-
termining sexual violence perpetration.45-46
Power and dominance are more common in
intimate partner relationships and stranger
rapes.46-47 However, since in the college
population acquaintance assaults are more
likely to occur, mainly because of the pres-
ence of alcohol7 and implied consent,35-36
this campaign focused on these aspects of
prevention. In the future, attention to gen-
der and power may result in an expanded
campaign that additionally targets couples
or students in longer term intimate partner
relationships, thus, reaching out to prevent
sexual violence in another campus audience.
68
Conclusions
This case study serves several objectives
from a pragmatic perspective, while being
grounded in communication theory. The
HCCF guided the working group through
the necessary phases to design, implement,

and initially evaluate a health communi-
cation campaign by highlighting crucial
steps, such as needs assessment and mes-
sage testing. As this case study illustrates,
even those who are social marketing novices
can come together and learn how to prog-
ress through a theoretical model to help
ensure a targeted and effective campaign
that addresses a pervasive health issue for
students.
69
Acknowledgements
This social marketing campaign was funded by the Indiana
Cam-
pus Sexual Assault Primary Prevention Project and the Indiana
State Department of Health through a CDC cooperative
agreement.
The authors wish to thank Dr. Nancy Maylath, the Director for
the
Indiana Campus Sexual Assault Primary Prevention Project, for
her assistance in this campaign.
70

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74

Author Information
Emily Haas is a PhD candidate studying health communication
at Purdue University and a coordinator for the Indiana Campus
Sexual Assault Primary Prevention Project. Emily contributed to
the conceptual design of the social marketing campaign, as well
as
guided and provided technical assistance during each phase of
the
HCCF, particularly the analysis of data collected, and
manuscript
writing.
Marifran Mattson is a professor of communication at Purdue
Uni-
versity. Marifran contributed to the conceptual design of the
social
marketing campaign, offering expertise in how the HCCF can
guide
the creation of a social marketing campaign, and manuscript
writ-
ing.
Kathlyn Wilkinson is the Sexual Health Educator at Purdue Uni -
versity and the project director for the Sexual Violence Primary
Prevention Campaign. Kathlyn progressed through and guided
the
campaign working group through the HCCF, which included
gath-
ering local data, drafting, testing, and finalizing messages, and
eventually implementing the campaign on campus. She served
as
the campaign practitioner and was the point of contact if anyone

had questions about the campaign.

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