Sunday, December 10, 2006

Influenza Ignorance: The Massachusetts Dept of Public Health 2006 Flu Campaign’s Inability to Effectively Educate the Commonwealth – Sarah Lane

Massachusetts Department of Public Health (MDPH) creates an annual influenza education campaign for the public. This year’s campaign aims to arm residents with information about seasonal flu, avian flu and pandemic flu in order to raise levels of preparedness statewide. However, the attempt at widespread outreach falls short. The campaign’s message is jumbled and unclear, materials are translated into only three languages, and the website is ineffective and poorly utilized as an educational tool. The 2006 MDPH influenza campaign, Flu Facts – What You Need to Know, fails meet its goals of effectively educating the people of Massachusetts about influenza.

Partnering with many businesses and other organizations to help spread the word, translating materials into Spanish and Portuguese, and utilizing multiple media types and outlets, Flu Facts – What You Need to Know is one of the largest educational undertakings to date by Massachusetts or any New England state. The campaign consists of handcards, posters, MTBA posters, public service announcements (radio and TV), a 30- minute special for public access television, and a coloring book. A website,, has also been created, and a hotline (1-877-MASS FLU) set up. The website has information about seasonal, avian and pandemic flu divided into ‘For the Public’ and ‘For Providers’ categories. All printed materials feature the tag line and logo: Flu Facts – What You Need to Know, and direct people to the website and hotline. They also contain these five recommendations to “help protect yourself and your family:”
1. Wash hands often with soap and water or use a hand sanitizer
2. Cover your mouth when you cough or sneeze
3. Talk with your doctor about getting a yearly flu vaccine
4. Make a family emergency plan
5. Volunteer in your community
Handcards and posters have been translated into Spanish and Portuguese.

The campaign fails to clearly and concisely clarify the difference between pandemic, avian and seasonal flu and the proper preparation for each. Instead of talking about the three as a continuum, (bird flu as a type of influenza, seasonal flu as the yearly influenza season, pandemic flu as a influenza season/strain that happens all over the world at the same time (, accessed November 30, 2006) Including emergency preparedness tips under the guise of helping with seasonal flu seems to be a little extreme. As Jane Q Public, the first three items for protecting me and my family seem very reasonable and something that we could actually put into practice. The next two I find surprising, and somewhat disconcerting. What does a family emergency plan have to do with getting the flu? Is flu really going to be that bad in Massachusetts this year? Shouldn’t MDPH be doing more to prevent that? Maybe I should take my kids out of school and avoid public places this winter? How is volunteering going to keep me from getting sick? Going to the website doesn’t exactly alleviate my fears because it’s hard to find information. Attempting to use the flu campaign as a platform to educate the public about pandemic and avian flu in the limited space of five bullet points on a 9” x 4” placard was already overreaching. Trying to combine emergency preparedness as well was just asking for trouble. The message became unclear, and the recommendations for protecting yourself should have been limited to immediate influenza protection, 1 -3. The emergency plan and plug for volunteerism should have been associated with a separate preparedness campaign, or as part of the more specific pandemic flu information on the website. One of the most simple and effective things they could have done is to focus on having a clear message. (Pechmann, 2000)

While many printed materials have been translated into Portuguese, and most into Spanish, there hasn’t been much of an effort towards reaching out to other language and cultural groups. More translated materials are available via the website, but internet access is probably low amongst these groups. (Lonergan, 2000) The DPH website, which includes the flu website, is only available in English. Translated materials can be ordered from the website, but a working knowledge of English is necessary to navigate to the order page. Translating posters, handcards, and schedules of area (especially neighborhood specific) flu vaccine clinics is a key step to informing the Commonwealth. Extending outreach by providing materials in as many languages as possible and placing those materials in community centers, T stations, and other identified areas is especially important for getting the maximum number of people the flu shot. This could also be a great piggyback opportunity for a program to get this vulnerable population up to date on all of their vaccinations.

Flu Facts – What You Need to Know fails to utilize the Internet effectively. Websites are proven tools for effective public health education and intervention (Low et al 2006, McPherson et al 2006). The website is difficult to navigate. There are no graphics, and the layout has the feel of a governmental website. Rigid and dry, it does not engage the user in learning nor does it facilitate further exploration of the website. Most of the information is presented as links to PDF files, which can be time consuming to load and difficult to read. There are no interactive tools or games that make learning interesting or to help clarify complicated scientific information. All of these factors are not only problems within themselves, but also serve to further jumble the campaign message. Written only in English is another mark against the website. As previously discussed, that immediately creates barriers to use for non-English speaking MA residents, which in turn limits the accessibility of the website. (Vernon, 2003) In failing to make the website more user-friendly, MDPH missed out on a great opportunity to reach and educate the public.

The entire campaign seems based on the theory of reasoned action. They are trying to stir up strong feelings (succeeding only in creating fear) along with a smattering of information and a clear list of behaviors. (Salazar MK, 1991) By encouraging people to think they should be following these 5 steps, MDPH is hoping that people will follow them. It is presented as a series of reasonable, and fairly easy to achieve steps that will then prevent you and your family from getting the flu. Anyone who sees the campaign will intend to follow the steps. However, intention towards a behavior is a poor indicator of actually undertaking that behavior. (Marks, 1996) The campaign tries to both educate and persuade people to adopt these five behaviors. If it had focus on one approach or the other, the resulting product would have definitely been more cohesive, and quite probably more effective.

The Massachusetts Department of Public Health does deserve credit for attempting a large scale far-reaching education campaign about a difficult and confusing disease that affects all population groups. There is no excuse, however, for having an unclear message, few translated materials, and a poorly designed website. While Flu Facts – What You Need to Know had the best intentions, it failed in three critical, and fairly simple, ways to effectively reach the greatest number of citizens possible.


Low KG, Charanasomboon S, Lesser J, Reinhalter K, Martin R, Jones H, Winzelberg A, Abascal L, Taylor CB. Effectiveness of a computer-based interactive eating disorders prevention program at long-term follow-up.Eat Disord. 2006 Jan-Feb;14(1):17-30.
Marks DF. Health psychology in context. Journal of Health Psychology. 1996, I91) 7 - 21

Massachusetts Department of Public Health’s 2006 Flu Education Campaign. Flu Facts: What you need to know. Various materials, received on November 8, 2006.

McPherson AC, Glazebrook C, Smyth AR. Educational interventions – computers for delivering education to children with respiratory illness and to their parents. Paediatric Respiratory Reviews, Volume 6, Issue 3, September 2005, Pages 215-226

McPherson TL, Cook RF, Back AS, Hersch RK, Hendrickson A. A field test of a Web-based substance abuse prevention training program for health promotion professionals. Am J Health Promot. 2006 Jul-Aug;20(6):396-400.

Pechmann C, Reibling ET. Anti-smoking advertising campaigns targeting youth: case studies from USA and Canada. Tob Control. 2000;9 Suppl 2:II18-31.

Salazar MK. Comparing the four behavioral theories: A literature review. AAOHN Jounral, March 1991. 39:3

Vernon R, Lynch D. Consumer Access to Agency Websites: Our Best Foot Forward? Journal of Technology in Human Services, 2003, 21, 4, 37-51, accessed November 30, 2006


Anonymous Anonymous said...

Sarah, interesting paper. I haven't seen the campaign, but it sounds like it needs some help. It also speaks to the limitations on public health dollars. My experience is that DPH is willing to translate materials, but they are often short on cash. However, can you put a dollar amount on prevention? Rodney

6:09 PM  
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