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Case Study
Recruiting Rural Hard-to-Reach Populations for a Public Health Study
This case study, conducted by The Henne Group (THG) and the Prevention Access Campaign (now "U=U plus" ), focuses on a public health intervention among Men Who Have Sex with Men (MSM) in Mississippi and Alabama
Background: The Challenge of HIV in the Deep South
HIV/AIDS remains a major public health threat in the United States , with the southern states disproportionately affected.
Emotional Barriers
How do you engage and build trust with individuals holding hesitant or uncertain views about a health intervention, a group often wary of research and difficult to screen accurately? We needed to uncover the reasons behind their decisions.
Securing Experts
The difficulty of recruiting high-demand, time-constrained professionals like Physicians/Specialists and key professional sub-segments, such as Pediatricians, whose input is invaluable.
Geographic & Cultural Barriers
Rural communities, while diverse, often share a cultural context of self-reliance and skepticism towards outsiders. This, combined with geographic isolation, makes it difficult to build the trust necessary for a sensitive health study. Traditional recruitment methods often fail to reach these communities.
Accessing Small Groups
The need for hard minimums in small, often geographically isolated population segments like Native populations and Rural residents, alongside 20% quotas for major minority groups.
Ensuring Data Validity Against Respondent Bias
Automated and low-touch recruitment methods often attract participants who are motivated by speed rather than sincerity. These behaviors create a critical threat to data validity, as the responses don't reflect genuine attitudes or experiences.
The Intervention:
Social Media and Peer-to-Peer Engagement
The goal of this three-month communication and advertising campaign in 2021 was to build awareness, believability, and acceptance of the U=U message among MSM in Mississippi and Alabama.
Social Media Advertising
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Where: Executed in both Alabama and Mississippi.
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When: Three waves ran from April 9th through June 6th, 2021.
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Content: Three unique characters (Dee, Kaleb, Fernando) were featured in separate ads, each running for 18 or 19 days in sequence. The core message was: "[Character Name] is undetectable so she/he can't pass HIV to anyone".
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Channels: Social media platforms included Grindr, Jack'd, Scruff, Growlr, GBT Pages, and Facebook/Instagram.
Peer-to-Peer (P2P) Engagement
- Where: Exclusively in Mississippi.
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When: A 14-week period, from February 22 to May 28, 2021.
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Method: Three trained, full-time Prevention Access Campaign (PAC) ambassadors disseminated information, held online meetings, and built coalitions. The engagement was primarily virtual due to the COVID-19 pandemic.
Assessment and Key Findings
A longitudinal study was conducted among MSM in both states to evaluate the campaign's effectiveness, surveying 801 individuals in the pretest and 504 in the post-test.
Metric
Total Increase
+22%
This figure represents the overall increase in U=U awareness across the entire sample of MSM in both Mississippi and Alabama combined. The combined effect of the social media advertising and the peer-to-peer engagement (in Mississippi) resulted in an overall awareness increase of 22 percent from the pre-test to the post-test.
Mississippi Increase
+28%
Mississippi experienced the largest increase in U=U awareness, rising by 28 percent. This greater positive change is attributed to the fact that Mississippi received the full, multi-component intervention: both the social media advertising and the 14-week peer-to-peer engagement component. This suggests that the inclusion of P2P engagement significantly augmented the effectiveness of the communication campaign.
Alabama Increase
+19%
Alabama's U=U awareness increased by 19 percent. Since the campaign in Alabama consisted only of the social media advertising and did not include the peer-to-peer component , this figure demonstrates the independent effectiveness of the properly-designed social media advertising campaign alone. The difference between the two states confirms the hypothesis that the peer-to-peer component resulted in a larger positive change in awareness.
Key
Results
1- Peer-to-Peer Impact: As expected, Mississippi, which received the P2P component in addition to social media, saw a significantly greater increase in overall U=U awareness (+28%) compared to Alabama (+19%). This suggests that adding a P2P strategy can further increase awareness.
2- Advertising Effectiveness: Only 26% of MSM recognized a character from the social media ads. However, those who did recognize a character showed higher levels of U=U understanding:
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Awareness: 73% vs. 50% for those who did not recognize a character.
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Believability: 78% vs. 68%.
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Acceptance: 59% vs. 38%.
3- The Role of Social Perception: The study found that 78% of those who believed other MSM would accept the U=U message also believed it themselves. This indicates that perceptions about peer acceptance are crucial to believability and personal acceptance.
4- Access to Healthcare: U=U awareness was higher among MSM who saw a healthcare provider. Critically, 58% (or 6 in 10) of MSM in the study were not seeing a healthcare professional. This finding highlights that access to care may play a major role in raising U=U awareness.
Conclusion and
Replication
The research demonstrates that well-designed and executed social media campaigns are effective at increasing U=U awareness. When these campaigns are augmented by a peer-to-peer engagement component, they lead to an even greater increase in awareness. Furthermore, encouraging HIV-negative MSM to seek a healthcare provider is suggested as a method to increase U=U awareness.
All of these components are potentially easily replicated in other locations
