Max The Vax

Health Communication Program

Program Plan

HLTH 634-D01

Sherese M. Brooks
L26557877

December 17, 2015

Title of Project: Max The Vax

Author: Sherese M. Brooks
Problem/Need Statement:
Infectious diseases are a critical public health concern. The most cost-effective
preventative measure for infectious diseases is vaccines. According to Healthy People 2020,
despite the availability of vaccine-preventative measures approximately 42,000 adults and 300
children die each year in the United States from these diseases.1 Immunizations can help target
17 identified vaccine-preventable diseases in the US.1 Even though rates have improved for
children, adolescents, and adults the rates for adults remain low. Latino/Hispanic adults (18
years and older) living in Mecklenburg County, NC will comprise the primary target population.
The specificity targets individuals who are low-income and are possibly undocumented and/or
recent immigrants. They are most at risk due to significantly high rates of uninsured, lowincome, low-education, and a language barrier. Latinos are often times unaware; dont
understand the need for immunizations and/or who dont have access to them. They are shown
to often be undervaccinated and unvaccinated placing them at higher risk for outbreaks of
infectious diseases. Immunization disparities among Latino populations are evident particularly
among newer immigrants and in cities with large numbers of Latino residents.2 When
comparing the references there is consensus that vaccination gaps in adults in the U.S. are much
wider than gaps among children, with the overall adult vaccination rate under 70.2 According to
the CDC Hispanics have lower mortality rates than the overall population but are at greater risk
for chronic illness and diseases.3 One factor that is affecting them negatively is the low
immunization rates linked to low-economic status and fear of authority among new immigrants.
Hispanics had the lowest percentage (among all racial/ethnic groups) of adults aged 18 and older
who are vaccinated against seasonal influenza from 2010-2013, rates respectively 28.8, 28.3, and
30.5.1
Product Review:
Our service entails health education and promotion targeting the improvement of
immunization related behaviors.
o By utilizing a multi-step approach, we will provide strategies to partner with
local providers to implement culturally-competent services and provide
community outreach to increase awareness and demand for immunizations,
reduce health systems barriers, and increase access to vaccines.
o This education service collaborates with community partners to provide
evidence-based practices that are culturally sensitive. It also offers educational
information on immunization guidelines and recommendations, how to obtain
immunizations if you have no insurance, and will provide a free bi-lingual shot
health record to all participants.
o Vaccines For Children is a national program to help children receive
vaccines for no cost up until the age of 18. Some retail pharmacies provide
free flu-shot clinics to their community. However, currently there are very
limited resources and programs to help adult Latinos, who often are
undocumented, lack insurance, and are living in poverty.
Two unique components of our service include a free bi-lingual shot health record for

all participants and a client or family incentive rewards intervention to motivate people to
obtain recommended vaccinations. Incentives include: food vouchers for Compare Foods
International Market, discount cards for prescriptions, gift cards, baby products. The
rewards may be given when the client and/or family receive a vaccination, for keeping an
appointment, or when they complete a vaccination series.
Goals:
To reduce infectious diseases among the Latino population in the surrounding Charlotte
area of NC.
To improve immunization rates among adult Latinos in Charlotte, NC.
Increase awareness of the need for vaccines to protect yourself and your community.
Reduce social and cultural factors that at as barriers.
Increase access and resources for obtaining vaccines.
Objectives:
By the end of the program, 60% of the current unvaccinated Latino children and adults
will be up-to-date regarding their immunizations as evidence by their immunization
health record and surveillance.
By December 2017, 40% of Latino children and adults will receive the annual influenza
vaccine as measured by public health surveillance reports.
By the end of the program, 70% of participants will be able to list at least 3 places where
they can receive vaccinations and a Spanish immunization health record as measured by
data from surveys.
By July 2016, 60% of participants will be able identify 2 benefits of being immunized
and 3 preventable infectious diseases they can avoid as measured by surveys and
individual interviewing.
By July 2016, 60% of participants will be able identify 3 preventable infectious diseases
they can avoid as measured by surveys and individual interviewing.
Sponsorship agency/Contact Person:
Max The Vax
Contact: Sherese M. Brooks Rodriguez
Telephone: 704-555-8120
E-mail: info@immunizationsblog.com
Website: http://immunizationsblog.weebly.com
Partner Agency:
Our partner is the National Council of La Raza (NCLR), whom has contributed greatly to the
efforts for increasing immunization rates. Their mission is to reduce the effect and incident of
health problems in Hispanics. In addition, their focus is on implementing quality health
interventions with an emphasis on augment access to and utilization of health education and
disease prevention programs.4
Contact Person- Eric Rodriguez, Vice President
Phone: 202-785-1670
Email: info@nclr.org
Website: http://www.nclr.org/

Primary target audience:

Latino/Hispanic adults (18 years and older) living in Mecklenburg County, NC will comprise the
primary target population. The specificity targets individuals who are low-income and are
possibly undocumented and/or recent immigrants.
Components of the primary target audience
Behavioral The current percentage of adults aged 18 and older who are vaccinated
annually against seasonal influenza is 38.1%.1 Among Latinos the percentage in 20102011 was only 28.8%.1
Cultural Lack of Spanish-speaking workers at healthcare facilities. There are also
impediments to monitoring vaccination status such as a lack of coordination with Latino
countries and mobility, especially among migrant workers.5

Demographic Latinos are four times as likely as non-Latinos to be chronically

uninsured (over 30% uninsured).5 Most at risk for under immunization and vaccine
preventable disease are those marginalized because of lack of insurance, poverty, limited
English proficiency, low educational attainment, residence in areas new to Hispanic
settlement, unfamiliarity with local health resources, and insecurity related to
immigration.6
Physical According to Healthy People 2020, despite the availability of vaccinepreventative measures approximately 42,000 adults and 300 children die each year in the
United States from infectious diseases.1 Currently, Mexico does not provide a Tdap
booster, so recent immigrants will be unfamiliar with and unprotected by this vaccine. In
addition the complexity of the immunization schedule makes it difficult for parents to
track their childrens immunization records.
Psychographic Immigration issues. Undocumented immigrants fear that using clinic
services will lead to problems with the Immigration and Naturalization Service and lack
of knowledge about what health services are available for undocumented children.5 Also,
Hispanic elders often believe that adult vaccines are unimportant and that vaccines are
only necessary for children.
Primary target key strategies:
Audience
o Indicated above
Action (Message)
o Individuals and families will seek avenues to get vaccinated by contacting their
primary care physician (PCP), pediatrician, or public health departments to
schedule an immunization-only appointment.
o Adults will be their vaccines updated
Barriers
o Low-income status will inhibit them from affording vaccines (if they dont have
insurance)
o They have specific barriers that inhibit their immunization related behaviors:
complexity of todays immunization schedule, immigration issues,
misconceptions about the risk, miseducation, lack of access
o Low perceived threat
Benefits

o Each participant will receive a free bi-lingual shot health record to help them read
and understand the US recommendations.
o Vaccines are safe and effective
o Most major medical insurance cover vaccines for no cost to the patient because it
is a preventative service under the Affordable Care Act.
o The program will provide culturally component services that respect the Latinos
culture, language, and customs.
Credentials
o Partnered with a well-known national organization for helping Latinos in the US
o All staff and employees will have proper education and training in the field of
public health
o The staff will have a minimum of a bachelors degree in Public Health or a related
field and the director will have a minimum of a masters degree in Public Health
and have a certified health educator specialist (CHES/MCHES) certification
o A literature review was conducted prior to program implementation to obtain
evidence based interventions including sources such as the CDC, NFID, and
Healthy People 2020
o The Community Prevention Services Task Force made several recommendations
that were based on sufficient and strong evidence of effectiveness
Channel
o Television we will specifically market through UniVision, Telemundo, TR3s, and
UniVision Deportes (particularly soccer and boxing) channels
o Print material such as QuePasa and La Noticias publications
o Radio ads on 99.1FM, 102.6 FM
o Social media and technology tools such as: mobile texting, videos, and social
networking sites (Facebook, Twitter, Instagram).
Promotion (Selling Point)
o Did you know that adults need vaccines too! They help prevent many different
diseases that can cause sickness and even death. Our program can help link you
to services (Spanish) to get free or discounted vaccines, obtain a free bi-lingual
shot health record, and learn more about them.

Secondary target audience:

The secondary audience will be the health/support systems for these adults: health professionals,
healthcare systems, community clinics, etc.
Secondary target key strategies:
Audience
o Public Health Professionals such as: Community Health Workers, Health
Education Specialist, Public Health Officers, Physicians, Nurses, etc.
o Healthcare systems such as: Novant Health and Carolinas Healthcare System
o Community Health Clinics/Centers: Mecklenburg County Health Dept., Williams
Community Health Center, Matthews Free Medical Clinic
Action (Message)

o To implement evidence-based practices and implement culturally-competent

services to promote community outreach to increase awareness and demand for
immunizations, reduce health systems barriers, and increase access to vaccines
o Utilize strategies such as: recall and reminder systems, immunization-only visits,
bi-lingual immunization health record, incentive component, bi-lingual medical
staff, and bi-lingual print material (posters, brochures, etc).
Barriers
o Lack of interest to invest in their own agency/organization
o Lack of financial resources to reduce the price of vaccines for Latinos
o Lack bi-lingual staff to fulfill staff responsibilities
Benefits
o More accessible resources for residents
o Most services at community health clinics are provided at a reduced or no cost
o Will provide education around the importance of immunizations at each visit
o Provide each participate a free bi-lingual shot health record
o Establish a better relationship with Latino residents and health professionals
Credentials
o Regulated by government requirements for licensures and certifications
o Appropriate levels of educational attainment has been achieved and ongoing
education is typically mandated (CEUs)
Channel
o NC DHHS: Division of NC Public Healths publications, manuals, and brochures
o Local public health department meetings and quarterly newsletters
o Interpersonal communication with medical offices and community clinics
especially in the East Charlotte area
Promotion (Selling Point)
o This health education and promotion service will support you reaching out to
Latinos in your community by understanding their unique barriers and ways to
improve access to services. Learn strategies that are evidence-based and culturally
component for Spanish speaking individuals.

Pretest strategy (trial of primary target message/channel):

Concept Testing: Focus Groups
o Perform focus groups with Bi-lingual and Spanish-only participants
o Obtain information about the awareness and need for improved vaccine rates
o Collect data on the target populations beliefs, values, attitude, and knowledge
around immunizations
Concept Testing: Individual interviews
o Deliver the programs material, messages, and marketing methods to at least 20
adult Latinos in the Charlotte area
o Reviews will be obtained to receive feedback relating to appeal and attention
grabbing, the ease of reading and understanding the message, appropriateness of
the interventions, etc.
o Make necessary edits and changes to the promotional material or methods

Theoretical foundation:
I chose the Health Belief Model as an effective model or framework to achieve my programs
objectives. Janz and Becker study found substantial empirical support for usefulness of the
Health Belief Model (HBM) particularly for preventative-health behaviors (PHB) such as
immunizations.7 Perceptions are emphasized within this model due to their impact (directly and
indirectly) on health-related behaviors. This model is a major organizing framework for
explaining and predicting acceptance of health and medical care recommendations.7 In addition,
the two basic components of psychological and behavior theory are important. In which the
participants are able to measure the desire to avoid illness and the belief that a specific health
action (getting immunized) will prevent illness. Within the perceived susceptibility construct it
refers to the individuals perception of the risk of contracting a condition (i.e. vulnerability).
Next, the perceived severity concept related to the seriousness of contracting an illness or
infectious disease. A persons beliefs regarding the effectiveness of the immunizations (action)
in reducing the disease threat is described as perceived benefits. Any potential negative aspects
that act as impediments to undertaking the preventative behavior is depicted as perceived
barriers. Another advantage of choosing this model is the cue to action which acts as a
stimulus to trigger the decision-making process. This can be internal via symptoms or external
such as interpersonal interactions, reminder postcards from healthcare providers, and mass media
communications, all of which are included in the Max The Vax program.7 Lastly, the model has
been extended to include motivation factors and self-efficacy, both of which help an individual
to make a decision to act (i.e. get immunized). In summary, perception of benefits and barriers is
a powerful determinate of health behavior.
Management Chart:

Timetable

Tasks

Responsible
Persons

1 year prior to
implementation

Conduct Needs Assessment

Research Team

11 months prior to
implementation

Identify problem/need and target

population

Research Team

11 months prior to
implementation

Identify national partner and key

local stakeholders

Research Team and

Program Coordinator

10 months prior to
implementation

Literature Review

Program Coordinator

10 months prior to
implementation

Conduct Focus Groups

(assess their beliefs, values,
knowledge and attitudes towards
immunizations)

Program Coordinator

9 months prior to

Develop preliminary program design

Program Coordinator, Staff,

and Volunteers, and The

implementation

National Council of La
Raza

9 months prior to
implementation

Connect and establish a relationship

with local healthcare systems,
providers, and community health
clinics

Program Staff and Health

Educator

9 months prior to
implementation

Identify local partners and sponsors

Program Staff

8 months prior to
implementation

Develop detailed marketing plans

Program Staff, Marketing

Volunteer, The National
Council for La Raza

6 months prior to
implementation
5 months prior to
implementation

Release first public service

announcement
Build and pretest the program design
and marketing methods through
individual interview reviews

The National Council for La

Raza
Program Coordinator, Staff
and volunteers

5 months prior to
implementation

Finalize enlisted resources and events

such as conference, flu mobile, etc.

Health Educator

4 months prior to
implementation

Finalize program design including

marketing methods

Program Coordinator and

Staff

3 months prior to
implementation

Develop all print material including

poster, brochure, educational
handouts, etc.

Health Educator

2 months prior to
implementation

Order operational supplies and

equipment such as office material, bilingual shot health records, etc.

Program Staff

1 month prior to
implementation

Launch blog website for the new Max Program Staff and
The Vax program
volunteers

1 month prior to
implementation

Provide all print material (posters,

brochures, bi-lingual shot health
records, etc) and resources
(incentives) to providers and
community health clinics

Health Educator

Communicate the need to exhibit the

materials in preparation
1 month prior to

Assess what level each provider has

Health Educator and

implementation

made in establishing immunizationonly appointments and hiring more

bi-lingual medical staff

Program Staff

1 month prior to
implementation

Submit all marketing material to all

channels

Program Coordinator and

The National Council for La
Raza

Launch Day

Continue PSA for radio, television,

and online avenues

The National Council for La

Raza

Collaborate with Latin American

Coalition for Latin Festival for
Launch Day celebration

Program Coordinator, Staff

and Volunteers

Launch Day

Begin new bi-lingual reminder and

recall system and incentive
component

Providers and Community

Health Clinics

Launch Day

Start marketing all messages and

material via various channels (online,
radio, and television)

Marketing Sources

Budget:
The following table presents the estimated costs for the Max The Vax program for a one
year projection. Personnel will be needed to carry on the administrative tasks of the program
itself as well as manage and coordinate program activities and resources. The use of
advertisement is vital within this health communication program to help spread the word.
Therefore, bi-weekly ads will be ran for radio advertisement on 2 stations, television ads will run
bi-weekly as well on 4 channels, and social media ads will run continually for 1 year of the
program implementation. The office supplies such as the printer and computer will be utilized to
create and design the educational and promotional material such as: brochures, posters, and
flyers. The two biggest budget items are personnel including fringe benefits (40%) and direct
cost (33%) to help implement, market, and promote the Max The Vax program to the
community. The National Council of La Raza (partner) plan to contribute 50% towards the
facility rental cost ($12,000) and 30% for marketing specifically for television ads ($7,300). The
Mecklenburg County Public Health Department has agreed to sponsor a Flu Mobile to run for
the month of November at no cost to the participate. Travel will include gas for local
transportation (majority) due to the programs focus in Charlotte, NC. Training is important
because the community partners and staff must learn culturally competent skills and knowledge
to work with a diverse population. Some program employees such as the Health Educator will
be working part-time. Likewise, the Program Coordinator will utilize other resources for income.
The printing cost will include print material in both Spanish and English and the bi-lingual shot
records each participant will receive. Resources that will be utilized include:

office/administrative supplies, program volunteers, program facility, print material, training site
and curriculum, cardstock, laminating machine, etc.
Budget Items

Cost

PERSONNEL SALARIES
Project Coordinator (Lead Site Coordinator)
Health Educator (Must be bi-lingual)
Staff/Volunteers (at least 50% must be bi-lingual)
Subtotal:

$ 20,000
$ 8,000
$2,000
$ 30,000
24% of total salaries

EMPLOYEE BENEFITS
Workmans Compensation
Vacation
Health Insurance
Payroll Taxes
Subtotal:
INDIRECT COST
Travel/Gas (local)
Training (site and curriculum)
Equipment (3 computers, 2 tablets, 2 printers, 5
telephones, recall/reminder system software, 1 camera, 1
voice recorder, 1 projector, 1 laminating machine & sleeves)
Program Supplies (office supplies: pencils, pens,
paper, 2 flash drives, files, ink, stationary, envelopes, and fax
paper, cardstock)
Printing/Duplication (bi-lingual shot health records)

$ 7,200

$ 1,800
$ 2,500
$ 5,000
$ 1,800
$ 1,200

Subtotal:

$ 12,300

DIRECT COST
Marketing/Promotion (television: bi-weekly ads for

$ 22,000

30 seconds on 4 channels = $8,000; radio: bi-weekly spots on

2 stations for 30 seconds = $ 7,000; social media ads:
monthly = $ 3,000; educational brochures: 10,000 copies =
$4,000.

Subtotal:

$ 5,000
$ 2,500
$ 29,500

Subtotal:

$ 12,000
$4,000
$ 16,000

Total:

$ 95,000

Operating related cost

Other

OTHER
Facility Rental
Miscellaneous

Issues of concern/potential problems:

Getting Latino adults to understand the risk and threat involved with infectious diseases
Latinos have excessive high rates of no insurance, therefore if funding assistance isnt
adequate they cant afford to get their vaccines updated
Hiring and recruiting enough translators (hired staff and volunteers) to promote the
program
Engaging enough providers and community health clinics to participate in the program
due to the investment of hiring more bi-lingual staff, receiving training, implementing
new strategies, etc.
How to reach recent immigrants

Evaluation strategies:

Evaluation Questions: It is critical that the questions of significant stakeholders have been
heard and, where appropriate, addressed. The evaluation questions will be developed by
using the program objectives. For example, Did the immunization program increase the
number of Latino children and adults who were vaccinated by at least 60% after one year
of implementation? Also, What percentage of Latinos received an annual influenza
vaccine between January-December 2017? The immediate, intermediary, and ultimate
objectives will be evaluated.
Evaluation Team: Due to the ethnic diversity among the program participants there is a
need to create a multi-ethnic evaluation team to better understand and increase the
chances of hearing the voices of the underrepresented Spanish-speaking participants. The
identified the evaluator or evaluation team will be fully aware of and responsive to the
participants and stakeholders culture, particularly as it relates to and influences the
program. The evaluator will be an independent consultant whom will perform all
necessary task.
Type of Evaluation:
o Process evaluation- This will allow us to describe and assess our program
activities and link our progress to outcomes. To assess the process evaluation
while the program is in operation the evaluator will conduct surveys (with the
implementation team and participants) to gain information about the status of the
program and to make any necessary changes during implementation. We will be
able to evaluate if the participants are progressing towards achieving the program
objectives.
o Outcome evaluation- This will allow us to document health and behavioral
outcomes and identify linkages between an intervention and effects. This
summative evaluation will provide information about the programs effectiveness
and will be performed at the conclusion of the program. Both short-term and
long-term outcomes/effects will be evaluated. The impact evaluation will be
conducted at least 7-10 years after the program conclusion. A cost-effective
analysis will be conducted to assess the cost versus benefits in an attempt to
produce outcome effects. In addition, the design of the evaluation will include a

control group, in which another metropolitan city in NC will be chosen. This

group will also have a high Latinos population and high rates of underimmunized
and/or unimmunized Latinos.
Data Collection Methods: We will develop and pretest data collection instruments prior
to implementation. The evaluation design will collect data at multiple times to examine
the degree in which participants behavior changed as a result of the projects
intervention. For the outcome evaluation it will include behavioral surveys, direct
observation, surveys of the participants and providers, face-to-face interviews with
providers, and monitor tracking system to measure the number of participants. Likewise,
a pre-test and post-test will be conducted in the public prior to the programs
implementation and after the completion to gauge the extent of changes in knowledge,
attitudes, behaviors, etc. The participants will be completing questionnaires while in the
waiting room and after their immunization visit. Lastly, public health surveillance
reports will be used to quantify the data for prevalence of immunization. These methods
will measure the effectiveness of various aspects of the program: immunization-only
visits, bi-lingual immunization health record, reminder and recall systems, incentive
component, bi-lingual medical staff, and bi-lingual print material (brochures and posters)
Analysis Plan: A logical model will be developed at the beginning of the program and it
will help guide the evaluation plan. The logical model will include: inputs, activities,
outputs, and outcomes (short-term and long-term). The data collected from various
methods will help answer all the evaluation questions. The evaluation report will provide
qualitative and quantitative results of the program. Organizing the data will help the
evaluators to enter the data into an evaluation software package. They will use statistical
techniques to identify significant relationships in the data. The report will be outlined
into sections explaining what we did, why we did it, what worked, and what should be
improved in the future. In addition, it will provide information about the programs
effectiveness in achieving the objectives and share data about the programs
achievements and limitations.
Use, dissemination and sharing plan: We will actively meet with stakeholders and discuss
preliminary findings to help guide the interpretation phase, increase transparency and
validity of the process and conclusions. It is important there are a few stakeholder
interpretation meetings to review interim data and further refine conclusions.
Community groups will probably want to use the evaluation results to help them find
ways to modify and improve your program or initiative. Grantmakers and funders will
most likely be making decisions about how much funding to give us in the future, or even
whether to continue funding the program at all. The final evaluation report will be
completed and disseminated immediately after close of the program. An evaluation
report will be developed and disseminated to the program implementation team,
stakeholders, and funding decision makers via a presentation. The evaluation findings
will be shared with the public through various communication channels. To help reach
my intended audience the report will be available in Spanish and a few dissemination
tools will be utilized including: videos, fact sheets, oral presentations, visual displays, and
storytelling (success stories).

References:
1. Immunization and Infectious Diseases. Healthy People 2020 website.
http://www.healthypeople.gov/2020/topics-objectives/topic/immunization-and-infectiousdiseases. Update October 28, 2015. Accessed October 29, 2015.
2. Adorador A, McNulty R, Hart D, Fitzpatrick JJ. Perceived Barriers To Immunizations As
Identified By Latino Mothers. Journal of the American Academy of Nurse Practitioners. 2011;
23 (9):501508. doi: 10.1111/j.1745-7599.2011.00632.x
3. Building Our Understanding: Cultural Insights. Communicating with Hispanic/Latinos. Center
for Disease Control and Prevention website.
http://www.cdc.gov/nccdphp/dch/programs/healthycommunitiesprogram/tools/pdf/hispanic_latin
os_insight.pdf. Updated November 4, 2014. Accessed November 13, 2015.
4. A Report on Reaching Ethnic and Minority Populations to Improve Adolescents and Adult
Immunization Rates. National Foundation for Infectious Diseases website.
http://www.nfid.org/publications/reports/adolescent-adult-white-paper.pdf. Updated October
2002. Accessed October 29, 2015.
5. A Report on Reaching Ethnic and Minority Populations to Improve Pediatric Immunization
Rates. National Foundation for Infectious Diseases website.
http://www.nfid.org/publications/reports/pediatricwhitepaper.pdf. Published October 2002.
Accessed November 5, 2015.
6. Immunizations. Migrant Clinicians Network website.
http://www.migrantclinician.org/issues/immunizations. Accessed November 5, 2015.
7. Janz NK, Becker MH. The health belief model: A decade later. Health Education Quarterly.
1984; 11(1):147.