Using Text-Messaging and Computer Animation to Educate

Youth about Sexual Health Issues

Alwyn Cohall, MD

Mari Millery, PhD

Kirby Bumpus, MPH Candidate

Affiliations

• Harlem Health Promotion Center

• Columbia University

• Funding sources: Abbott Laboratories, Health Monday, Robinhood Foundation

• Partnerships: NYC Department of Health, NYC Department of Education, AIDS Institute, Centers for Disease Control

What is Project STAY?Harlem Health Promotion Center (HHPC) is one

of 35 Prevention Research Centers funded by the CDC.

– Project STAY (Services to Assist Youth), the service arm of HHPC, provides medical and psychosocial services for youth living with HIV/AIDS as well as high-risk youth

• For the latter we provide free health education workshops for high schools and community based organizations throughout New York City. Our team is made up of health educators, health care providers and social workers, all of whom have experience working with youth and young adults.

Outline • Background• Clip of the Prototype of Cells in Da Hood• The Evaluation of the prototype

– Focus group methodology

• Survey Results• Proposed Revisions• Clip of Revised Cells in Da Hood• Next Steps• Questions?

Background• Youth of color at high risk for STIs and HIV

– Nationwide, while Black young adults between the ages of 13 and 19 comprise only 17% of the population, they represent 68% of HIV/AIDS cases reported in 2005.

– Rates are similarly disproportionate in New York City and while only 28% of New Yorkers are Black, half of adolescents with HIV are Black

• Young people are at greater risk for STIs and HIV– 68% of gonorrhea and Chlamydia cases occurring in 15-24 year

olds

Background

• Teens harbor many misconceptions about the topics, as well as lack of information about where to seek confidential, youth friendly services

• Lack of culturally relevant health education materials, particularly for young men of color

Background

• Adolescents, in general, savvy consumers of media and technology

• Can we harness the potential of new media and apply it to health promotion?

• Text messaging - unique form of communication• “cool factor”

• Users insulated by distance and relative anonymity facilitate open, blunt communication

Development of concept

Cells in Da Hood• a series of computer animated vignettes (about 5

minutes each) depicting conversations between young people texting about their sexual health issues such as condom utilization and STI testing

• The vignettes are kept current by using the latest slang to connect with the audience. The health goals aimed to address are and comprehensive and pertain to sexual health: condom utilization, STI and HIV testing, Emergency Contraception utilization, hormonal birth control utilization and risk reduction

Why animation?• Try something different

• Address “Prevention fatigue”

• Youth drawn to cartoons, comics

• Practical• Low cost• Able to edit easily

• New information becomes available• Phrases/slang changes quickly

• Animation = more depth• Colors, pictures, icons• captures attention, symbolizes movement and enhances relevancy

Theoretical Constructs

• Youth Development

• Entertainment Education– Narrative Storytelling

• Peer Influence

• Social Normative Theory

Formative Process of Vignette Development

• HHPC has a history of utilizing Community Based Participatory Research to connect with its target population on its outreach projects.

• Teens in the target population have been involved in content generation as well as initial production of the vignettes – Conversations in the Cells in Da Hood Series have been

created utilizing CBPR to include teens in the development of the storyline and language.

Youth Development

In what ways does Project STAY interact with teens?

• Mobile Health Educators visit schools and CBOs

• Project STAY clinic

• Myspace page

• Text messaging for appointment reminders

Entertainment-Education Model• Approach to health education which uses media entertainment to

promote pro-social norms and behaviors (Singhal and Rogers, 2004)

• Viewer, engages with the story, assesses advantages and disadvantages of various actions, and feels involved (Davin, 2000)

• Involvement increases attention and comprehension (Celsi and Olson, 1988)

• Hopefully, stimulates attitudinal change and action

• Models are imitated most frequently when viewers perceive the model as similar to themselves.

Edutainment

• Additionally, cartoon messages about safe sex have shown promise in bringing about changes in attitudes and subjective norms

• Bakker, A. B. (1999). Persuasive communication about AIDS prevention: need for cognition determines the impact of message format. AIDS

Education & Prevention 11(2): 150-62.

Key Messages• STIs/HIV are common• Youth (that look/sound/act like me) are at risk• Condoms reduce risk• Routine screenings are important• Confidential, adolescent-friendly resources are

available• Address the concerns regarding accuracy of

rapid HIV tests• Using condoms, finding a clinic, getting screened

are health-promoting behaviors endorsed by peers

Clip from Cells in Da Hood Prototype!

Methods:• Design: Convenience Sampling • Sample: N=50.

– 17 female 33 male

• Data Collection Sites– 6 CBOs throughout New York City, all of which are

partner sites of Harlem Health Promotion Center• Hetrick Martin Institute, Andrew Glover Youth Program,

Friends of Island Academy, Center for Community Alternatives, Year Up, and the Inwood House Mother/Child Foster Care Small Group Home.

Age Range of Respondents

Ages 14-17 N=22

Ages 18-20 N=22

Ages 21-24 N=3

Age not given N=3

Objectives of the Study

1. The response to Cells in the Hood from the perspective of the target population: young people aged 14-24 in an urban setting.

2. How teens presently access sexual health information

3. Types of media and sources teens prefer to utilize for accessing sexual health information

Data from surveys

Q: Did the video inform you where to get STD/HIV/pregnancy services?

Key:1 Yes2 No

Q: This video would motivate me to get tested for HIV or other STDs

Key: 1 Agree Strongly2 Agree Somewhat3 Neutral4 Disagree Somewhat5 Disagree Strongly

Mean= 2.0

Q: This video would motivate me to tell a friend to get tested for HIV or other STDs

Key: 1 Agree Strongly2 Agree Somewhat3 Neutral4 Disagree Somewhat5 Disagree Strongly

Mean= 1.86

Q: On a scale of 1-10 how realistic did you think the storyline was?

• 88% of participants rated the storyline as 5 or higher

What teens are saying

• “The video was motivating, it seems easy to get to the clinic and get things done”.

• “Interesting because makes you worry just as much as females do; more realistic for younger people”

• “The situation was realistic”• “I can admit that at first I thought the video was whack, but as I watched it, I

became interested and it turned out to be funny and informative”• “Language was relatable”• “I have been through similar situations”• “I learned about Project STAY”• “It was funny. Kinda helpful. It was some good advice. I enjoyed it”

• “I was in a similar situation with one of my friends who had Chlamydia”

• “Well I thought it was kinda funny how they had it setup, but it reminds me of real life”

• “It was different. It was informational yet short. It got to the point quickly and that was a good thing”

• “Background, music, smiley faces were cool”

Recommended revisions to prototype based on feedback from teens

• More humor• Contact information made more prominent • Explicit statement that Project STAY is

free for everyone• Several respondents wanted to see the

actual faces of the texters• The video length should remain the same

or made slightly shorter

Healthy Monday Campaign• The goal is to end chronic preventable disease in the

U.S. by offering people and organizations a weekly prompt to start and sustain healthy behaviors, intentions, actions and initiatives

• HHPC wanted to introduce additional content into the vignette

• Examples include: – Meatless Monday– Quit and Stay Quit Monday– Monday Mile

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Restock Monday

• New focus on STIs and pregnancy prevention

• Also “Check Yourself Monday”

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www.ec123.org

• Site where teens can find teen friendly clinics and emergency contraception (aka Plan B)

Revised Cells in Da Hood

http://vimeo.com/9757194

Youth Recommendations for Future Vignettes

• Show the main character at the clinic and follow the actual process of testing and counseling

• Two young women talking about a pregnancy scare

• Address specific questions (ie transmission methods, STI treatment) between two friends and one educates the other by sharing what they learned from a Project STAY counselor who visited their school

Next Steps – Project STAY

• Outreach events at high schools and CBOs

• Currently, provide education and off-site screening to about 20 different venues

• Due to logistics and staffing, only get to certain sites every 3-4 months

•“Cells” will be incorporated into future outreach events•Clips to be placed on YouTube and linked to program website (www.ProjectSTAY.net)

Thank You

Questions and Comments?

Presenter: Kirby Bumpus klb2137@columbia.eduMari Millery mm994@columbia.edu Alwyn Cohall atc1@columbia.edu