Old Dominion University

Transcription

1 Case Study: Old Dominion University Project Overview Old Dominion University (ODU), in Norfolk, Virginia, designed a multi-faceted public awareness campaign that surrounded students with messages about chlamydia and the importance of screening. 7 Messages were featured in residence halls, classrooms, the health center, electronic campus communications, and through student organizations. This comprehensive project, created by ODU Student Health Services, featured a media campaign, direct access testing through the student health center, sexual health education through residence halls and university courses, and partner referrals for non-odu students to the Norfolk Department of Public Health (NDPH). The project was designed to increase the number of students who were screened for chlamydia. The project also included the development of the Tidewater Chlamydia Coalition to provide a forum for addressing chlamydia within the broader Tidewater region, which includes five other colleges/universities, that collectively serves over 40,000 students. To guide the Coalition s development, ODU established partnerships National Chlamydia Coalition Case Study: Old Dominion University 1

2 PROJECT OVERVIEW with the NDPH and Planned Parenthood of Southeastern Virginia. In addition, NDPH agreed to provide partner therapy to non-odu students and also served as a source of free testing for any community members. During the project period, the percentage of students screened for chlamydia increased by 27.9% compared to the prior year. While direct access testing was offered, in which an appointment is not required, only 5% of students selected this testing option. Instead, the vast majority of students (95%) were tested through an appointment scheduled with a provider. The Challenge The percentage of ODU students testing positive for chlamydia is nearly three times the national rate among college students, as reported by the American College Health Association (ACHA) Annual Pap and STI survey. In 2009, 13.3% of the ODU students tested for chlamydia had positive results, while the national rate was 4.3%. In addition, the number of ODU students being screened for chlamydia was very low, with approximately 5% being tested in The Context and Setting ODU is a public, four-year university with approximately 20,000 students attending the main campus. Located in southeastern Virginia, ODU is part of an urban community and is considered to be one of the most diverse campuses in the state. In the fall 2008, 21% of the Norfolk campus students were African American. Chlamydia screening is offered at ODU Student Health Services, which is located in the Student Union. Students are also informed that free testing is available at the local health department. Due to staff and spacing constraints, appointments at ODU can sometimes be limited for students. Maintaining and promoting optimum health for all students through health education activities across campus is central to the mission of Student Health Services. Typically, the health educator works directly with the resident assistants (RAs) in the dorms, peer educators, and leaders of selected courses to train them to deliver sexual health education. National Chlamydia Coalition Case Study: Old Dominion University 2

3 THE CONTEXT AND SETTING In an urban environment in which students often develop relationships with non-odu students, it was important to create awareness and encourage chlamydia screening amongst the larger Tidewater community. Core Project Components Key project components included: 1. Partnership-building with ODU staff in various departments and with external organizations. 2. Securing student input and feedback throughout campaign design. 3. Producing the chlamydia awareness media campaign, including four posters and a bulletin board kit for residence halls. 4. Providing sexual health education through RAs and university courses. 5. Direct access testing without an appointment, as an option for asymptomatic students. 6. Partner testing and therapy for non-odu students through the local health department. 7. Establishing the Tidewater Chlamydia Coalition. THE ROAD MAP Action steps for the project included: 1. Partnership-building with ODU staff/departments and external organizations a. Establish partnerships with many ODU departments and programs to implement the project campus-wide. Primary partners included a graphic design student and staff from the departments of residence life, health center, and Information Technology. Through these collaborative efforts, the project was made available in the residence halls, student courses, the health center, and online campus communications. b. Create partnerships with two primary external organizations the Norfolk Department of Public Health (NDPH) and Planned National Chlamydia Coalition Case Study: Old Dominion University 3

4 THE ROAD MAP Parenthood. Given their extensive work within the Tidewater area, both agencies helped establish the Tidewater Chlamydia Coalition and recommended local organizations for participation. The NDPH also offered free testing to students at its site, as well as testing and treatment of partners who are non-odu students. 2. Secure student input and feedback during campaign design a. Hold student focus group. During 2009, a focus group was held with ODU student leaders to explore the issue of chlamydia on campus, how to raise student awareness, and how to increase the number of students who are screened. The focus group results helped shape the plan to tackle chlamydia on campus. b. Secure ongoing student input. During campaign development, student input was also solicited to help ensure that materials were attractive, appealing and effective. Focus groups and individual interviews were held to solicit feedback on a variety of posters. Student opinion guided the selection of the final poster that would be released each quarter. 3. Produce the chlamydia awareness media campaign a. Develop the creative approach and core messages. The centerpiece of the ODU project was a series of catchy and humorous talking clam posters that featured attention-getting graphics and seasonal themes. This campaign promoted facts about chlamydia, and encouraged students without symptoms to take advantage of the direct access testing that was now available at the student health center. Core messages also included: You can have chlamydia and not even know it. It s often a silent infection. Chlamydia is very common. Know your status so that you can be safe in the future. A student graphic artist, who was in touch with the preferences and trends of the target audience, created the designs. National Chlamydia Coalition Case Study: Old Dominion University 4

5 The Road Map b. Issue a new poster each quarter that ties in with the seasons or holidays. This phased roll-out helped sustain student awareness of chlamydia and reminded them to get screened throughout the year. Four different posters were displayed in locations across campus, including residence halls, the health center, and campus center. In addition, the posters were integrated into the daily electronic announcements provided to all students. In total, 500 regular posters and 280 laminated posters were produced. Headlines included: Fall: Spread Knowledge, Not Chlamydia. The Student Health Center offers $13 chlamydia screening and FREE treatment. Winter: Protect yourself from the elements and chlamydia. Valentine s Day: Conversation hearts can lead to more than talking. Listen to the clam and get an exam. Spring: Catch a Wave, Not Chlamydia. 4. Offer sexual health education through residence halls and university courses a. Integrate education about chlamydia into RA orientation before the start of the academic year. The Health Education Coordinator and peer educators informed all 110 RAs about the new chlamydia project, and how to promote chlamydia screening and answer students questions. These briefings were designed to build support for the new project and to request the RA s active participation by displaying the posters and hosting sexual health education talks. b. Deliver sexual health presentations to students in the classroom, which increase awareness of chlamydia and the availability of direct access testing. The 45-minute interactive talk featured an ice breaker, along with a question and answer period. Originally, University 100-level courses were the target. However, after the successful marketing of the project to other professors, an ODU health educator was invited to give the presentation to additional National Chlamydia Coalition Case Study: Old Dominion University 5

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7 The Road Map classes, including University 110 classes and selected women s studies classes. Presentations were delivered in four classroom sessions. c. Implement a residence hall initiative, which included 28 sexual health presentations by peer educators and/or the Health Education Coordinator in each residence hall. RAs encouraged students to attend and campaign posters were featured on bulletin boards throughout the year. Fourteen special bulletin board kits were made available to the residence halls. 5. Provide direct access testing at Student Health Center a. Create new testing system for students without symptoms. Given staffing and space constraints, the availability of appointments for screening can be limited at times. To help increase access to care, the ODU Health Center implemented direct access testing in which an appointment was not required. Chlamydia testing also continued to be available through regularly scheduled appointments. For either method, students were charged $13 per test. b. During regular business hours, a student could purchase a direct access testing kit from the front desk. It included an instruction sheet, a Centers for Disease Control and Prevention (CDC) chlamydia fact sheet, a specimen cup with biohazard bag, and labels. Without an appointment, the student could then provide a urine sample at the clinic during regular clinic hours. Those who tested positive were notified, an appointment was scheduled for free treatment, and they were given the option of additional STI testing and counseling. 6. Organize partner testing and therapy for non-odu students Establish a referral system for non-odu partners. Within the Tidewater area, it is not uncommon for ODU students to be sexually involved with people who are not ODU students. To reduce re-infection from untreated, non-odu partners, a partnership was established with NDPH to provide special testing and treatment services for this population. Together, ODU National Chlamydia Coalition Case Study: Old Dominion University 7

8 The Road Map and the health department produced a business size card that was offered to ODU students who had chlamydia and a non-odu partner(s). When the card was presented to NDPH, the individual could be tested and treated the same day. However, for the general population, the department offered limited testing hours each day. 7. Establish the Tidewater Chlamydia Coalition a. Since the Tidewater region has a high prevalence of chlamydia, a regional coalition was formed to address this sexually transmitted infection within the community at large. In collaboration with Planned Parenthood and the NHDHP, nineteen individuals participated in the one hour meeting, which featured an overview of the mini-grant along with group brainstorming about potential coalition members, barriers to screening, and effective message strategies. b. Organizations represented at the first meeting included ODU, the Urban League of South Hampton Roads, Planned Parenthood of Southeastern Virginia, Norfolk State University, Hampton University, State of Virginia Department of Public Health, NDPH, Portsmouth Department of Public Health, and the Peninsula Department of Public Health. c. Following the meeting, all participants were surveyed regarding their interest in coalition leadership and involvement in subcommittees. As an outgrowth of the meeting and survey, four subcommittees were established: funding, partner notification services, removing testing stigma, and community communications. The full coalition will meet semi-annually, while the subcommittees will meet at least quarterly. Project Results During the project period, the percentage of students screened increased by 27.9% compared to the prior year. The project exceeded its original goal of increasing the percentage of students screened for chlamydia by 20%. Of the 1,165 students screened, 17.5% tested positive for chlamydia. National Chlamydia Coalition Case Study: Old Dominion University 8

9 PROJECT RESULTS Interestingly, only 5% of students opted to be screened using the new direct access testing. Ninety-five percent elected to be screened during regular appointments. However, the prevalence of chlamydia among those using the direct access kit was 22%, suggesting that students at higher risk might have preferred this method. ProCess OBJECTIVES. The project successfully established the Tidewater Chlamydia Coalition, securing the involvement of many local and state organizations, along with universities. Through the coalition, ODU s existing partnerships were strengthened with Planned Parenthood and the NDPH, while a new partnership was established with the Virginia State Health Department. As a result, the state health department included ODU as one of four sites in its grant application to the Centers for Disease Control and Prevention (CDC) for supplemental funding for chlamydia and gonorrhea screening. With the awarded grant funds, the ODU student health center will offer free chlamydia testing once per week for the full academic year, and the state health department will provide a free, mass screening at ODU once during the upcoming academic year. This represents the first time that ODU has worked in partnership with the state health department, which all began with a cold call to invite the agency to join the new coalition. The project did establish some other process objectives that were not achieved. However, their lack of achievement did not appear to have a negative impact on achieving the outcome objectives. One objective was that 50% of randomly sampled students would recognize at least one poster. However, of the 2400 students surveyed via , only 64 responded, which represented a response rate of only 2.6%. Low response rate to the survey was attributed to a lack of incentive and a lengthy, complicated survey tool. However, of the respondents, 38% recalled seeing a chlamydia message. And, of those who saw a message, 96% believed that unprotected sex could cause chlamydia, and 100% felt that screening was important for people who were having sex. Fifty-five percent reported taking some action as a result of the campaign, including making an appointment to be screened, talking to a friend about chlamydia, and/or using condoms consistently. National Chlamydia Coalition Case Study: Old Dominion University 9

10 ProJECT RESULTS Another goal was to increase the number of phone calls to the ODU automated chlamydia hotline by 40% by the end of the project. Call monitoring revealed no significant changes in call volume. The reasons for a lack of change in call volume were not explored or apparent. Another measurable objective was that 25% of partners who are non-odu students would be tested and treated at the NDPH. Since clinical staff at the SHC felt that the majority of patients did not need the referral information, only 17 cards were distributed. None of these cards were received by the NDHP. With so few cards distributed, it was not possible to determine the effectiveness of this partner treatment strategy. Since many of these non-odu partners came from a variety of locations, including other local universities, the military, and regions outside of the Tidewater area, accessing testing and treatment at the NHDP might not have been necessary or convenient. Difficulties OR OBSTACLES ENCOUNTERED Only a few difficulties were encountered during project implementation. The primary challenge related to the direct access testing methodology. Students failure to follow the directions on how to collect a urine sample resulted in the need to recollect some samples and the use of additional staff time to call students and track results separately. Other problems included a low response rate to the student survey about the media campaign, and the overall challenge of completing all facets of the grant within one year, given the staffing levels. LESSONS LEARNED When asked to describe lessons learned, the project directors cited the following: The highly popular media campaign, with catchy graphics and humorous appeals, was the cornerstone of the project. Toward the end of the project period, several students asked when the next edition of the poster would be released. Some students even collected the posters because they thought they were cool. Seeking feedback from the target audience was essential to the project s success. Even when time feels limited, securing audience response National Chlamydia Coalition Case Study: Old Dominion University 10

11 LESSONS LEARNED whether it s through focus groups or informal, individual interviews is a key step in the process. Bringing the right people on board for project implementation was key to its success. Without the graphic design student, the Information Technology staff, the residence life staff, the health center staff, and community partners, it would not have been possible to implement such a comprehensive, effective project. The approach to referring non-odu partners for testing and treatment was considered ineffective. Since the Student Health Services clinical staff independently concluded that most partners did not need this referral information, they only distributed 17 cards. A better approach might have been to ask clinicians to give a referral card to EVERY student who tested positive for chlamydia, regardless of whether the student mentions a non- ODU partner. If cards were distributed to all 204 students, it would have been possible to better assess the success of this strategy. A small percentage of students took advantage of the direct access testing option. While the kits were considered successful since 13 asymptomatic students were found to have chlamydia, the project directors expected more students to use this new testing method. Perhaps the $13 cost of the test was a barrier to its use. Informal feedback from both students and clinicians indicates that cost continues to be barrier for some students. While all elements were completed, it was difficult to ensure that each project component received sufficient time and effort. In the future, the project directors said it would be a good idea to include the media campaign messages about chlamydia in the condom bags that are sold or provided to students. Also, in the future, the testing protocol would be modified. Given the high prevalence of chlamydia on campus, clinicians would be encouraged to ask every patient if he/she would like to be tested for chlamydia, regardless of the nature of his/her visit. National Chlamydia Coalition Case Study: Old Dominion University 11

12 Conclusion ODU s comprehensive, multi-faceted campaign, in which students were surrounded with messages from the media and interpersonal communications, led to a 27.9% increase in chlamydia testing compared to the prior year, an increase in condom sales, and the establishment of the Tidewater Chlamydia Coalition. Through its new partnership with the Virginia Department of Health and the resulting grant, ODU will now be able to offer free chlamydia screening to students one day per week during the next academic year, along with a mass, free screening day on campus. Materials Available Click here to access materials produced by ODU that you can adopt or modify for your program. National Chlamydia Coalition Case Study: Old Dominion University 12