hitesh tolani: dental health · university of washington mcdm ... this project will explore the...

1 HITESH TOLANI: DENTAL HEALTH

H ITESH TOLANI : DENTAL HEALTH

Sophia Agtarap I Janae Gerard I Li Li I Janna Quedado

University of Washington MCDM

Autumn 2009

COM529: Strategic Research

Client Delivery #4 – REVISED

Abstract

This research project proposes a preliminary strategy to provide insights into how the client, Hitesh Tolani, an advanced pediatric dentistry student at the University of Washington, can leverage an iconic public dental health campaign with an integrated social mobilization strategy. Although dental public health campaigns currently exist, they are rare and have not been as successful as other public health campaigns such as Smokey the Bear, AIDS, and Breast Cancer.


Source: ADA

OVERVIEW

This project will explore the media strategies of successful public health campaigns to provide insight

into how a successful dental health campaign can be leveraged to preclude highly preventable pediatric

oral health issues. The goal is to provide a strategy based on preliminary research to foster positive

behavior change in early childhood oral health.

BACKGROUND

Early Childhood Caries (ECC), also known as Baby Bottle Tooth Decay, currently stands as the most

common chronic disease of childhood. Caused by sweet liquids clinging to an

infant’s teeth for extended periods of time, ECC can cause extensive tooth

destruction (American Dental Association, 2009).

Approximately 80 percent of caries is concentrated in 25 percent of U.S.

children – mostly low income children – with even higher levels found in African‐

American and Hispanic children (United States Surgeon General, 2000). According to the Dental Health

Project, Native Indian and Native Alaskan preschoolers are five times more likely to have caries and three

times more likely than their peers to have the disease.

Fortunately, the decay is highly predictable, preventable and suppressible. The American Dental

Association (ADA) has outlined six prevention areas that should be addressed in order to educate

caregivers about EEC.

1. Role of Bacteria: How it spreads and how it can be contained

2. Nutrition: How what the mother and child eat affects the health of their teeth

3. Bottle Feeding: Regulating intake of sugary liquids while in bed


4. Breast Feeding: Regulating nocturnal breastfeeding after eruption of the child's first tooth

5. Use of a Cup: Children should be encouraged to drink from a cup by their first birthday

6. Home Care: Cleaning infant's teeth, regular dental visits

Although dental health campaigns already exist, such as the Access to Baby and Childhood Dentistry

Campaign (ABCD), they fail at being commonly identifiable and consistently available. According to the

client, the ABCD campaign “has definitely helped with the epidemic in Washington State, yet a high

prevalence of dental disease continues and people are still unaware” (Tolani). The challenge here is to

create an iconic and recognizable enough campaign to significantly decrease childhood dental disease

through educated prevention.

CLIENT ISSUE

Tolani outlines his ultimate goals as making people aware of the epidemic and providing preventative

information. To achieve this, Tolani would like to create a media campaign that includes an iconic image

that will naturally be associated with oral health. He identifies success as an increase in parents taking their

children to see dentists and for the logo to be iconic enough that the average person could look at the image

and identify the associated message. The project currently has no budget restrictions, but an economic

approach would be more likely to be implemented.

RESEARCH QUESTION

What are the most effective messaging strategies and media devices which may be used to create a campaign

that produces behavior change resulting in the increased prevention of poor childhood oral health?

PRELIMINARY RESEARCH STRATEGIES

Graduate School � 12/2/09 4:19 PM

Graduate School � 12/2/09 4:45 PM

Comment: I would have like to have seen a bit more regarding some ideas on where the research would lead in terms of answering your research question of "what are the most effective messaging strategies and media devices..."

Comment: It would help the reader to have an framing sentence right after "Preliminary Research Strategies" section that stated something like...In the next section we articulate 3 key areas that need to be addressed and the accompanying for each area. The 3 areas include, "Isolate the Audience, Ascertain the Influencers. and Identify Best Media Devises and Messaging Strategies."


Though Dr. Tolani stated in his presentation that there have been successful national health campaigns

(think: Smokey the Bear, AIDS awareness, The More You Know, breast cancer), dental public health

campaigns have been infrequent, mostly local and lack common and identifiable branding. Due to the

successes of these campaigns at the national level, we recommend the following preliminary research

strategies: 1.) Isolate the audience; 2.) ascertain the influencers; and 3.) identify the best local and national

media devices and messaging strategies. This section will describe in detail the extent to which each of

these strategies and their accompanying research tools provide a research‐based foundation for the multi‐

faceted campaign.

ISOLATE AUDIENCE

Dr. Tolani’s presentation identified children who are minorities and of low socioeconomic status as

high‐risk populations. To effectively promote prevention, outreach should extend beyond the high‐risk

populations, to include other young children, their caregivers and healthcare professionals. Research

should be conducted to understand the effected population and how they interrelate. By understanding

these relationships, a more encompassing approach to prevention can be implemented.

Research Tools

• Literature Review: Researchers may have already identified barriers and audience

segments. Conducting a literature review enables us to use the vetted research to inform us

of existing issues and areas still in need of exploration.

• Ethnography: Spending time with our target audience in this semi‐structured environment

allows us to gather information in a less formal atmosphere, and may be the only way we

are able to get uninhibited information. Candid information by our target audience will

allow us to better reach them and fully identify the best ways to inform them about

childhood dental health.


• Survey Local Healthcare Providers: Surveys are an efficient way to cover a lot of ground

once we have established what the likely responses will look like. The responses of local

healthcare providers give insight into the types of individuals who are affected by ECC and

how they respond to the issues when they receive medically‐grounded information.

ASCERTAIN THE INFLUENCERS

To best reach our target audience, we need to research who they trust for health advice and where they

currently receive information. By understanding these sources of information for our target audience, we

are able to reach out to them more effectively. For example, does our audience rely on information from the

Internet, schools, family, neighbors, or healthcare professionals? Understanding the influencers will assist

us in identifying the channels from which we leverage the information and may also isolate additional

members of our audience.

Research Tools

• Literature Review: Other scholars who have researched similar issues may have already

identified crucial information about those who influence our target audience. This will

provide us with an educated starting point in understanding who our audience trusts to

receive their preventative health information.

• Focus Group: Once the audience is isolated, we can use focus groups to better understand

who influences them and how they seek and receive information. Focus groups in particular

will allow us to get our audience’s perceptions and attitudes about various outputs of

information delivery. We are able to actually see our audience’s reactions in ways that

literature and surveys do not allow us to do. Research shows that the use of focus groups to

obtain “customer” views of health campaigns and products and to test messages before


launching, reveals the positive influence of marketing (Ling, Franklin, Lindsteadt &

Gearon, 1992).

IDENTIFY BEST MEDIA DEVICES AND MESSAGING STRATEGIES (LOCALLY AND NATIONALLY)

Seek commonalities among successful local and national campaigns and glean (and/or modify) to suit

the needs of Dr. Tolani’s efforts. Identify ways to work with those involved in current efforts. Additionally,

conduct research to identify new media channels such as social media that can effectively be applied to the

campaign.

Research Tools

• Literature Review: A number of local and national campaigns have published their

campaign strategies and results as case studies. Equipping ourselves with this information

allows us to develop strategies that have some proven success in our audience context. We

can learn from our the successes and failures of those who preceded us in public health

campaigns.

• Interview Campaign Staff: Campaign staffs are a primary source of information regarding

media devices and messaging strategies. They have large amount of experience that we can

draw from when developing our own campaign. Though audiences differ across regions,

these strategies may be adapted or transferred.

CONDUCT MARKET RESEARCH

Once we identify the best media devices and messaging strategies, we can test their effectiveness on

our target audience. The focus of this research would be to find out what it would take for parents,

guardians and children to frequently visit the dentist and change their oral healthcare habits. Knowing the

mindset and attitudes of the audience aids in creating targeted and relevant messaging.


Research tools:

• Focus Groups: This is an efficient way to provide groups of parents the opportunity to talk

about challenges getting dental care, especially since we are in the process of identifying

these obstacles to care.

• Surveys: This tool provides an opportunity to test our findings on a larger sample of the

identified population.

• Participant Observation: This tool allows us to better understand the habits and practices

of our audience and best identify effective strategies to reach these populations.

RESEARCH BASED PRELIMINARY STRATEGY

Using the findings from preliminary research, a campaign can be created for a local pilot audience. Once

success has been reached with the pilot audience, the campaign can expand first to state, then to national

scopes. By utilizing a highly integrated social mobilization strategy, a campaign that is both economic and

expandable in scope can be created to effectively inhibit highly preventable pediatric oral health issues.

The ability to expand the scope of these campaigns has greatly been enabled by the broadly accepted

social media tools that support and accelerate cooperation and action. Utilizing the social media tools to relay

the public health message allows large groups to collaborate, by taking advantage of nonfinancial motivations and

by allowing for wildly different levels of contribution (Shirky). Though social tools don’t create collective

action, they remove the obstacles to increase the size of the audience and the ease of contact. As Shirky

described, “revolution doesn’t happen when society adopts new technologies – it happens when society

adopts new behaviors.” Social media is an outlet from which the campaign message can be disseminated. As


a result of its use, the spread of information and its value as a coordinating force increase dramatically

(Shirky). The following section outlines a preliminary strategy the dental campaign can implement in order to

successfully combat the issue at hand.

1. Capitalize on Existing Campaigns and Events

Several public health campaigns have set precedence for successfully rallying people behind the

need for positive behavior change. In 2004, Vermont conducted a social marketing campaign that

included traditional media (radio, television and print) ads that launched during “back to school”

time. Using school‐related themes like “Tooth Tutor,” the school‐based initiative tied in preventive

health messages. (Center for Health Care Strategies, 2004).

By following in the footsteps of previous campaigns that have already paved the way, a

successful campaign can be created for preventative childhood dental health. Similar to Vermont’s

successful campaign, the dental campaign should get in touch with school districts and community

event planners. This partnership could be tied in with familiar events, such as creating New Year’s

Resolutions, Back to School preparation, or contests held at school.

2. Conduct Market Research

Public service campaigns are only effective if your audience pays attention. To understand the

habits and motivations of the target population, hold focus groups in different neighborhoods of

Seattle, where the needs are greatest. The Vermont Case Study offers an excellent example of focus

group questions to consider: 1.) What are the barriers to parents/caregivers seeking and keeping

appointments for appropriate dental services for their children?; 2.) What are the baseline beliefs,

attitudes and behaviors around this subject?; 3.) What are parents/caregivers preferred resources and

distribution materials? (Center for Health Care Strategies, 2004). Based on these responses, build a

targeted social marketing campaign. Furthermore, employ best practices and model frameworks


that other practitioners have identified (American Association for Community Dental Programs,

2006 and State of Missouri Department of Health and Senior Services), and modify them as needed

for the goals of this campaign. If the populations targeted include communities of color, refer to

research that addresses culturally competent media campaigns (Oong).

3. Create an Assessment Tool

Based on the goals of the campaign, identify assessment tools to monitor success and areas of

improvement. Some tools may include: pre and post assessment (using the focus group questions);

brand recognition analysis (i.e. did they recognize characters like Tooth Tutor). Additionally, enlist

the help of dental care providers to help conduct informal and formal assessments of frequency of

visits and child and parent/caregiver knowledge of oral care and habits.

CLIENT DISCOVERY FOLLOW UP

In order to clarify various directional aspects of the campaign, we created a follow up questionnaire for

the client. The following represents his responses to our questions.

1. How do you, the client, define and measure success?

This would be measured by asking patients if they are aware of the issue and by seeing a decline in

childhood caries.

2. Do medical professionals already aggregate data that would help track success of the campaign?

Yes, there is data that can be accessed to see the number of cases of ECC.

3. How do you foresee interactions with existing dental health campaigns?

By raising awareness and the need for prevention, this campaign would increase peopleʼs willingness

to use and take advantage of the other resources provided by those campaigns.

4. What are the feasible budget projections (best and worst case scenario)?

$10,000.


5. Are there specific campaigns on which you would like to model this campaign? What aspects of

these campaigns made them successful to you?

a. Smokey the Bear

b. Breast Cancer

c. AIDS

These campaigns have established an image. When you see Smokey the Bear, you already know

PREVENT FOREST FIRES. I would like this campaign to be so well known that people can identify

something with oral health.

6. Can we interview you on video as a component of our final course presentation? If so, what is your

availability?

Of course

WORK PLAN

STAFFING & FACILITIES

Research Lead: Hitesh Tolani

Research Associates: 3 Associates

Facilities: Dr. Tolani is currently student at the University of Washington and therefore, we are assuming

he has access to and will utilize the free resources available to the University community. Some of these

resources include room rentals, equipment rental, access to scholarly databases and technology. This will

dramatically affect his budget, keeping his bottom line cost low.

BUDGET & TIMELINE


Month 1 & 2: Isolate Audience

Weeks 1 & 2: Literature Review

Cost: 2 Research Assistants, 40 hours/week at $12/hour

Total: $960

Weeks 3 & 5: Ethnography


Total: $1,440

Week 6: Survey Local Healthcare Providers

Cost: 1 Research Assistant, 40 hours/week at $12/hour

Total: $480

Month 3: Ascertain the Influencers



Total: $960

Weeks 3 & 4: Focus Group


Total: $960

Month 4: Identify Best Media Devices and Messaging Strategies (Locally and Nationally)



Total: $960

Weeks 3 & 4: Interview Campaign Staff


Total: $960


Months 5 & 6: Conduct Market Research

Weeks 1 & 2: Focus Groups


Total: $1,440

Weeks 3 & 4: Surveys

Cost: 1 Research Assistant, 40 hours/week at $12/hour

Total: $480

Week 5&6: Participant Observation


Total: $1,440

GRAND TOTAL: $10,080

CONCLUSION

In this deliverable, we proposed the following research question: “What are the most effective

messaging strategies and media devices which may be used to create a campaign that produces behavior

change resulting in the increased prevention of poor childhood oral health?” Although the question cannot

be fully answered without completing the research methodology outlined in section titled “Preliminary

Research Strategies,” a broad literature review has provided a starting point from which qualitative and

quantitative research may continue. The following are our initial takeaways from the literature review.

Social Marketing through Integrated Social Media

The idea of borrowing techniques from commercial and social marketing to promote health campaigns

is not new. Research conducted over a decade ago pointed to the place of social marketing in public health,

and its emergence as a recognized practice as new communication methods and media are able to reach


isolated communities (Ling et al., 1992). Public health practitioners and advocates consistently recognize

that social marketing can positively influence health behavior (Public Health Nutrition). Exemplified in

campaigns ranging from tobacco cessation to cancer screening, social marketing bases itself on the idea

that selling behavior change can be thought of in the same way as selling commercial products, as a

voluntary exchange of costs and benefits (Grantmakers in Health). Additionally, social media has enabled

word‐of‐mouth marketing to continue in virtual spaces, enabling messaging to spread at much faster rates

through diverse social networks.

Approaching the campaign with a consumer mindset, marketers are able to step outside their own

experience into that of the consumer, and learn to view the world through the eyes of the people that they

are trying to reach. Utilizing the social media tools to relay the public health message allows large groups to

collaborate, by taking advantage of nonfinancial motivations and by allowing for wildly different levels of

contribution (Shirky). Further, using social media to relay the message can further the acceptance by the

target audience. The 2008 Edelman Trust Barometer study found that people trust information about

companies when it bringing accuracy to audience analysis as more precise demographic information leads

to more appropriate message design, delivery and reception by the public—the recipients of these public

health measures. New media strategies and the lowering of barriers to entry and access are ushering public

health education campaigns to a new era. By beginning the campaign with a solid research‐based

foundation grounded in a hybrid of market research and literature reviews, the campaign is sure to expose

the best strategies to leverage current efforts.

REFERENCES


American Association for Community Dental Program. (2006). A Model Framework for

Community Oral Health Programs: Based Upon the Ten Essential Public Health Services.

Retrieved October 22 from http://www.aacdp.com.

Prepared by the American Association for Community Dental Programs, this policy document

describes the “integration for oral health into the 10 essential public health services”, providing a

nationally regarded framework indentifying the core functions for healthy living. Each of the 10

essential public health services are supported by numbered lists, identifying oral health activities

that demonstrate the reach of oral health in the larger context of public health. A document such

as this is invaluable to a team looking for best practices and strategies for a local campaign.

American Dental Association. (2009). Oral Health Topics. Retrieved October 25, 2009 from

http://www.ada.org/public/topics/decay_childhood.asp

The American Dental Association is a leader in advocating for oral health. The site provides

information to help three groups: dental professionals, the general public, and the dental

association members. For the general public specifically, consumers, teachers, and media can

access details about oral health topics, learning tools to aide in educating others about oral health,

career resources and more.

Center for Health Care Strategies, Inc. (2004). Vermont’s Campaign to Improve Children’s Oral

Health. Retrieved October 22, 2009 from

http://www.chcs.org/publications3960/publications_show.htm?doc_id=623284.

Summary of lager case study that identified the successes of Vermont’s campaign to improve

childhood oral health. In addition to identifying specific implementation strategies, challenges are

also addressed. Provides a thorough summary with links to related case studies and initiatives

that Dr. Tolani’s campaign may be interested in exploring.


Fitcher, D (2008) Social Media Metrics: Making a Case for Making the Effort. Volume 32, Issue 6.

December 1, 2009 from http://offcampus.lib.washington.edu/login?url=http://search.

ebscohost.com/login.aspx?direct=true&db=a9h&AN=35157403&site=ehostlive

Fitcher’s article discusses several approaches to measuring the success of social media as it relates to

usage by a public library. The author explains that “As libraries across the board become more attuned,

by desire or necessity, to the importance of assessment, we should turn the same critical eye to our

social media efforts.”

Grantmakers in Health (2004) Selling Healthy Lifestyles: Using Social Marketing to Promote Change

and Prevent Disease. Issue Brief No. 20. October 24, 2009 from http://www.gih.org/usr_doc/

Selling_Healthy_Lifestyles_Issue_Brief.pdf.

Grantmakers in Health’s mission is to serve the trustees and staff of health foundations and corporate

giving programs. This article in particular sums their findings when asked to discuss the application of

social marketing principles to health promotion and chronic disease prevention. The text stresses that

social marketing has proven effective in motivating people to make difficult health behavior changes.

Hitesh, T. (2009). Early Childhood Caries: The Public Health Campaign [PowerPoint Slides].

Retrieved October 22, 2009 from

http://mediaspace.washington.edu/ms/mediaspace/pg/file/group:5570112.

“The Public Health Campaign” is a presentation prepared by our client, Hitesh, with the intention to

inform the members of the MCDM Research Strategy course about the oral health issue and his

intentions to create a campaign. The slides note information about Early Childhood Carries and Hitesh’s

current plan of action, in its early stage.

Ling, C. J. , Franklin, B. A. K, Lindsteadt, J. F., Gearon, S. A. N (1992). Social Marketing: Its Place in

Public Health. Annual Review of Public Health, 13: 34162. Retrieved on November 30, 2009 from

http://arjournals.annualreviews.org.


Though written over 15 years ago, this journal article outlines strengths as well as concerns and

weaknesses of a social media approach to public health that are still relevant. It identifies a broad

approach to social marketing integration as a vehicle for social change and education around public

health concerns. Its inclusion of examples of social marketing from developing countries provide a

matrix of public health programming, organizational involvement and length of time dedicated to these

projects that may be relevant for rural U.S. communities looking to transition to multimedia as a vehicle

for messaging.

Minnesota Head Start Association. (n.d.). Minnesota’s Early Head Start Oral Health Campaign

[PowerPoint Slides]. Retrieved October 22, 2009 from www.mnheadstart.org/AAPHD.ppt.

Presentation authored by David Born, PhD of the University of Minnesota School of Dentistry,

Christopher Okunseri, BDS, MSc, Marquette School of Dentistry and Gayle Kelly, BS, MS, Minnesota

Head Start Association, Inc and presented at the 2006 National Oral Health Conference in May, 2006 in

Little Rock, Arkansas. Identified Head Start (HS) and Early Head Start (EHS) goals for low‐income

families, outlined Minnesota’s EHS Oral Health Health campaign goals as well as resources to educate

families. Provides a comprehensive overview of campaign goals, staffing needs, survey and risk

assessment samples and next steps, serving as a model for an early childhood oral health campaign,

similar to Dr. Tonali’s.

Oong, E. M. (n.d.). Oral Care Access Scholar Project Summary: Planning for an Effective

Culturally Competent Media Campaign in the Brox, Washington Heights and East Harlem

[PowerPoint Slides]. Retrieved October 21, 2009 from

http://www.einstein.yu.edu/uploadedFiles/Hispanic_Center_Of_Excellence/Oral%20Care%

20Access%20Scholar%20Project%20Summary.ppt.

Powerpoint presentation of by Ella M. Oong, DMD, MPH, Fellow and Resident with the Harvard

School of Dental Medicine in Boston, MA that addressed specific goals of planning an effective


culturally competent media campaign. The presentation provides steps in preparing a culturally

competent communication strategy for minority populations, including audience segmentation,

identification of current campaigns, and the identification of operational concerns. Because Dr.

Tolani’s audience is comprised of communities of color, this presentation provides insight

regarding preliminary research strategies and considerations.

Purdue University Online Writing Lab (OWL). (October 9, 2009). APA Formatting and Style

Guide. October 13, 2009, from http://owl.english.purdue.edu/owl/resource/560/01/.

The Purdue University Online Writing Lab provides writers with writing resources and instructional

materials. The site gives students, members of the community, and users of worldwide web in general

instructional information to assist with various writing projects. The free services offers explanations,

examples, and many other tools that assist in writing.

Shirky, C. (2008). Here Comes Everybody: The Power of Organizing Without Organizations. New

York: Penguin Press.

Here Comes Everybody: The Power of Organizing Without Organizations discusses how blogs, wikis,

and other web applications are revolutionizing social order. The author Shirky deconstructs

various socially viral events to help his readers understand the digital culture shift that we are

currently living through. He contextualizes the digital networking age of today with a classic

philosophical, sociological, economic and statistical theory approach.

State of Missouri Department of Health and Senior Services. (n.d.). Tools and Resources for

Campaigns and Promotions. Retrieved October 23, 2009 from http://www.dhss.mo.gov/

InterventionMICA/OralHealth/CampaignsandPromotions/index.html.

This list of resources identifies various aspects of the campaign and promotion cycle in the context

of an oral health campaign. This list is a component of the Missouri Department of Health and


Senior Services’ site that provides education regarding the implementation of intervention

strategies with various populations. These evidence‐based strategies include action steps and

additional considerations in planning and implementing and oral health campaign from the

individual to the global level. Topics include: With whom should I work to create the best message

for my oral health intervention?; How do campaigns and promotions impact oral health related

behaviors?; What are mass media campaigns and how can I use them in my oral health

intervention?; What are campaigns and promotions strategies?

United States Surgeon General. (n.d.). National Call to Action to Promote Oral Health: A Public

Private Partnership. Retrieved October 24, 2009 from

http://www.surgeongeneral.gov/topics/oralhealth/nationalcalltoaction.html

The Surgeon General’s call to action underscores the importance of oral health campaigns nationwide,

as a means of intervention. It identifies a clear vision and goals and provides specific action items,

suggested next steps and a list of partnerships, ranging from academies, to non profits, to state dental

providers. The document will serve Dr. Tolani’s efforts in providing a national context for local efforts.

United States, & National Institute of Dental and Craniofacial Research (U.S.). (2000). Oral health in

America A report of the Surgeon General. NIH publication, no. 004713. Rockville, Md: Dept. of

Health and Human Services, U.S. Public Health Service. Retrieved October 23, 2009 from

http://purl.access.gpo.gov/GPO/LPS13826.

In addition to a lack of awareness of the importance of oral health among the public, the report found a

significant disparity between racial and socioeconomic groups in regards to oral health and ensuing

overall health issues. Based upon these findings, the Surgeon General called for action to promote

access to oral health care for all Americans, especially the disadvantaged and minority children found

to be at greatest risk for severe medical complications resulting from minimal oral care and treatment.

hitesh tolani: dental health · university of washington mcdm ... this project will explore the...

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