The University of Maine Center on Aging completed activities in the U.S. Administration on Aging Funded Project, “A Whole Woman Strategy and Action Plan to Raise National Awareness About Osteoporosis” in June of 2004.
The Center on Aging was one of three organizations awarded a grant by the U.S. Administration on Aging (AOA) for this project. Collaboration with the other two grantees, the National Osteoporosis Foundation (NOF) and the Foundation for Osteoporosis Research and Education (FORE), was an integral part of the work.
The Problem: Osteoporosis is a debilitating loss of bone mass affecting approximately 10 million people of all races in the United States, primarily women. The National Institutes of Health (NIH) Osteoporosis and Related Bone Diseases National Resource Center reports that the estimated national direct expenditures (hospitals and nursing homes) for osteoporotic and associated fractures were $17 billion in 2001, or $47 million each day. In March of 2000, the NIH identified directions for future research into osteoporosis prevention, diagnosis, and therapy. They specifically stated a need to determine the most effective method of educating the public and health care professionals about the prevention, diagnosis and treatment of osteoporosis. Previous attempts at educational campaigns designed to increase awareness of the disease have documented an increase in knowledge about osteoporosis, but minimal impact on osteoporosis prevention-taking behaviors.
Project Goals and Benefiting Audiences: The goal of this project was to develop a strategy and action plan for a comprehensive national osteoporosis awareness campaign that will increase osteoporosis prevention-taking behaviors among diverse subpopulations of post-menopausal women in the United States. Goal achievement adhered to the following unique perspectives:
Underscoring a “whole person” philosophy of understanding women's aging; Utilizing multiple methods and venues to transmit and enact the message; Sensitizing diverse health care professionals to the issue; Emphasizing the importance of open communication between women and their health care providers; Underscoring a philosophy of personal empowerment and responsibility among older women; Reflecting state-of the art marketing technology in transmitting the message; Emphasizing education for underserved older women; And making maximum use of the existing aging network infrastructure and affiliated organizations for plan development and implementation.
Methodology: The project was completed in three phases:
Phase I—Health Information Focus Groups: Focus groups were conducted with 147 ethnically and racially diverse older women around the country (Maine, New York, Pennsylvania, California, and Kansas) to determine where older women obtain their health information, what they consider reliable and unreliable informational sources, and where they’ve gotten information in the past that has resulted in changes in their health behavior.
Phase II—Research of Existing Osteoporosis Education Programs: The second phase focused on researching existing osteoporosis education programs and previous or ongoing campaigns to ascertain what programmatic elements have been most and least effective. Sixteen telephone and three in-person interviews were conducted with professionals throughout the United States having special expertise in the field of osteoporosis education, and working with aging and underserved populations. In addition, informal discussions were held with a large number of other individuals while in attendance at the two FORE Summits and through e-mail.
Phase III— Focus Group Feedback on Mock Marketing Campaigns: Phase three entailed obtaining feedback from 13 focus groups with 122 ethnically and racially diverse older women around the country (California, Illinois, Georgia, Maine, and New York), concerning mock brochures, graphics, and messages for the campaign as well as ideas about spokespeople and promotional items. The mock brochures and graphics and conceptual foundations for informing the campaign were developed in consultation with marketing and design consultants.
Study Findings: Phase I— Health Information Focus Groups
Sources of Health Information: Although elder women get their health information from a variety of sources, some sources emerged from the focus groups as being particularly important. Results were consistent among groups, with the only major exception of print media not being as important to the women with visual impairments.
The most frequently cited sources: Health Providers, Publications, Broadcast Media, Formal Health Lectures, Family, Internet, and Telephone Information Lines.
Sources Considered Reliable: Health providers (Physicians, Pharmacists, & Nurses); Internet; Publications (Books, Magazines-particularly “Prevention”, Newspapers, Newsletters-particularly insurance company generated); Family; Formal health lectures-particularly hospital based; Television; Radio.
Sources Considered Unreliable: Ads, commercials, infomercials; Some friends, family, neighbors; Some newspaper articles, magazines and tabloids; Anything published by pharmaceutical companies.
Sources of Information Resulting in Changed Health Behavior: Health professionals; Self-initiative; Media; Family/Friends; and Health lectures.
Past or Current Behavior to Reduce Impact of Osteoporosis: Followed physician’s recommendations; Had bone density testing; Take calcium supplements; Exercise regularly; Try to practice good nutrition; Take hormone replacements; Attend health fair screenings; Listen to own body.
Motivation to change health behavior: Fear; Desire to be healthier and feel better in general; Family; Self-efficacy; Desire to support spouse’s personal health care plan; Simplicity and cost of recommended treatment.
Study Findings: Phase II— Existing Programs
Although osteoporosis educational information and programs are plentiful, it is clear there are a significant number of elder women who have not had access to such material and programming for various reasons. The need to offer a wide variety of venues and channels for communication was evident from the interviews:
Making use of elder women themselves to help reach their peers emerged as an inexpensive and potentially highly effective model.
Targeting health care professionals to help them understand the importance of bone density screening for this age group
Potential national professional organizations and associations were identified for collaboration.
Partnering with existing social service and ethnic networks will help to reach diverse groups of women.
Study Findings: Phase III— Focus Group Feedback on Mock Marketing Campaigns
Mock Brochures: The majority of respondents stated they made their brochure selection based on the message rather than the graphic; Color was a factor frequently, though less often than the message; Very few respondents reported making the choice based on the graphic alone.
Graphics (The design concept featured skeleton x-rays performing various activities): The two full skeleton pictures were preferred over the partial skeleton ones;The whimsical nature of the preferred graphics appealed to many, but other women found them silly or inappropriate for this kind of campaign; The full skeleton graphics, for the most part, did catch participants’ attention.
Messages (The messages generally represented plays on words, again in an attempt to attract a woman’s attention): These messages elicited a wide variety of reactions from laughter to confusion to, in two cases, irritation; “Tone Your Bones” and “Bone Up on Bone Loss” were the most popular, and many felt they conveyed a positive self-efficacy message; Most participants felt messages should be concise and to the point. This was felt to be particularly true for women with English as a second language;
Females were overwhelmingly preferred over males; Participants preferred someone their general age; Of the five choices for spokesperson category, “physician” was most popular and “politician” Least; There was a strong feeling that a spokesperson should be one with personal experience with osteoporosis or decreasing bone density; Many participants preferred an “ordinary woman” over a celebrity as their choice of spokesperson.
Project Management: Co-Principal Investigators for this project were Lenard W. Kaye, D.S.W.,Director and Professor, UMaine Center on Aging, and Clifford Rosen, M.D., Director, Maine Center for Osteoporosis Research and Education. Two highly respected expert national steering committees on osteoporosis, aging, and older women, and a local advisory committee, informed the construction and content of the action plan and guided the direction and output of the project, respectively. Marketing and strategic design experts insured that the plan had high target penetration capacity and maximally impacted the attitudes, values, and behaviors of older women and their health care professionals.