Creativity in Health Communication to Promote Blood Lead Testing in Children

Using Creativity to Promote Blood Lead Screening

For a decade beginning in 2012, elevated blood lead level screening among U.S. children younger than 6 years remained relatively stable at only 17.5% (Centers for Disease Control and Prevention [CDC], 2021). These continued low screening rates among pediatric populations brought increased federal-level focus on blood lead poisoning prevention as well as state-level attention in Texas, where screening and reporting levels remained persistently lower than national averages at about 13% with the additional burden of uneven and incomplete state-level data to precisely track the scale of the issue (Texas Department of State Health Services [DSHS], 2020).

To help counter this challenge, professionals from the Texas DSHS, the University of Texas at Austin, and TheoryPraxis communication agency collaborated on a multipronged, creativity-focused approach to better understand and more effectively address low blood lead screening rates and elevated blood lead levels among children in Texas.

From 2018 to 2022, we conducted a series of in-depth interviews with parents, providers, and DSHS staff to better understand the determinants of low testing numbers in the state, looking for themes and observations that could drive advertising-style outreach to garner needed attention to blood lead testing, following best practices from advertising-agency campaign development. This foundational research was compiled into a white paper and delivered to DSHS in Year 1 before being adapted into a research article (Pounders et al., 2020).

The research found that both parents and providers are generally aware of blood lead poisoning but do not see it as a concern, with many stating the general belief that lead poisoning was a problem in the past but is no longer a common issue. Based on the theme of lead poisoning being an archaic issue, the focus of this community-based project was to use that insight to increase awareness of blood lead poisoning as an important health concern in locally relevant ways, sparking communication between parents and providers and ultimately directing stakeholders to existing high-quality educational materials.

In the early research, a brief online survey of parents suggested a humor appeal might break through the volume of health messages people receive daily to get attention and promote engagement, and which was deemed congruent with the DSHS brand voice of sharing positive health messages. Accordingly, our message strategy leveraged humor to garner engagement with the issue of lead poisoning and promote it as a pediatric health priority, encouraging parents and providers to seek information and inspire clinical action around lead poisoning during well-child visits or other pediatric exams.

Developing the humor appeal involved creating and testing several iterations of messages with the DSHS communications team and a small sample of parents. The final message design compared extinct animals with lead poisoning, building from the research indicating that the general population did not see lead as a contemporary serious issue. The final message design capitalized on children’s frequent enthusiasm for large and extinct animals such as dinosaurs so these creatures can be top of mind for parents as well—and thus engaging during social media scrolling—while also cognitively promoting positive recall of charming moments with their young ones.

Large, cartoon animals such as saber tooth tigers, wooly mammoths, and Tyrannosaurus rex accompanied by their babies were used to capture viewer attention on social media feeds (see the appendix). The images used the bright and easily recognizable colors of the DSHS brand palette to increase perceptions of message authenticity, as well as to encourage the humorous and nonthreatening appeal to get parents to stop scrolling momentarily to read.

The messaging read “Tyrannosaurus rex is extinct. Lead poisoning isn’t.” Combined with the informational tag of “Lead is especially harmful to children under the age of 6,” the messaging directs viewers to consider that younger children are most at risk from lead poisoning while evoking feelings of protectiveness to encourage and engage parents. Finally, a call to action (“Ask your doctor if your child should be tested”) directed viewers to seek professional medical advice about testing and complete the image. Doctors were chosen as the focus for medical assistance due to the high degree of trust and existing habits of regular childhood exams established within the target audience. Along with the images, subtext was included for each post to direct viewers to additional lead poisoning resources. The hashtag “#GetLeadCheckedTexas” was developed specifically for the campaign and featured prominently in each post to encourage engagement and promote future DSHS campaigns and play off strong regional affection toward the state of Texas.

In addition to the extinction imagery, each post also contained themed text and links to relevant resources accessible through either hyperlinks or easily recalled web addresses. The post body messages were coordinated with the daily topics laid out in the CDC National Lead Poisoning Prevention Week (NLPPW), ranging from lead poisoning sources in the home to resources available for non-English speakers. The resources were drawn from the DSHS or CDC’s websites, selected by the team as most appropriate and useful to the topic of the day. Posts also included additional hashtags to promote awareness of the campaign in related online communities that might use focused search terms or tags.

Campaign Design

To raise awareness and promote screening in children younger than 6 years in Texas, a social media campaign during NLPPW in October 2020 was identified as an opportunity to reach key stakeholders, including parents and providers. The “#GetLeadCheckedTexas” “Extinction” Social Media Campaign was developed based on insights from the DSHS team, research conducted by the team members from the UT-Austin Center for Health Communication, and expertise from TheoryPraxis strategic communication agency, who developed final messaging and graphics. The campaign was designed in conjunction with the DSHS communications team and run on their social media channels to ensure brand consistency with their standards and practices.

The campaign prioritized parents and providers living in Texas during NLPPW October 26 to 30, 2020. This campaign sought to (1) make community members aware of blood lead poisoning as a health concern and (2) direct stakeholders—including parents, providers, and caregivers—to high-quality informational materials, including on the DSHS website.

Engagement with social media posts and the DSHS website were the primary forms of evaluation; however, it should also be noted that this particular late-October week furnished additional challenges for garnering engagement considering its proximity to the November 4, 2020, election in the United States and the first year of the Covid-19 pandemic.

Impact on Blood Lead Resources

Pageviews for October 2020 showed an increase compared with previous years with more views for the homepage and the Providers Educational Materials as well as general lead information pages. Downloads from the DSHS website were heavily focused on provider-specific documents with Educational Materials the second-most downloaded category, followed by Data and Surveillance and Reporting. The total number of downloads was highest at the beginning and middle of the week (Monday and Wednesday), bookending the social media post with the highest engagement rate on Tuesday; it is possible that these patterns of early week engagement reflect initial enthusiasm by viewers following kick-off events for NLPPW that may happen in clinical spaces. The top four most downloaded items were provider and educational material documents, and the most downloaded was the Screening Guidelines.

Surprisingly, the campaign seemed to engage with providers more than parents considering we developed and tested the messaging primarily with parents. However, this may be due to the channels used (DSHS official social media) and the decision to release our campaign during NLPPW, when lead poisoning is likely receiving more attention across provider-focused media. Future efforts should consider reaching out to successful parent health influencers and/or popular parenting online groups for support and amplification.

Discussion and Conclusion

Well-targeted and tailored social media campaigns focused on the humanity of intended audiences can provide a low-budget, straightforward way for health departments to raise awareness with their audiences for a specific issue or cause. Blood lead levels can present a particular opportunity for progress because many children—even in geographies with low testing levels—are up-to-date with checkups and have access to care. Our work has implications for designing effective awareness campaigns and also for increasing collaboration between state-level public entities and the private communication sector to pursue shared objectives and connect with key audiences essential to promoting health transformation by better understanding audiences and expanding the kinds of messages promoted to the public, much as commercial brands do. Commercial advertising tactics can be adapted into health promotion, including communication agency–style research to understand audience perceptions, barriers, opinions, and opportunities for engagement; using appropriate humor as a public health communication tool to break through clutter and gain attention as viewers scroll social media feeds; and focusing on the humanity of key stakeholder groups to gather attention first as opposed to pushing facts without context or humanity.