Challenge | Boost vaccine confidence among wary New Hampshirites.

The New Hampshire Department of Health and Human Services (NH DHHS) wanted an evidence-based strategy for public health messaging, especially vaccines, with Covid-19 vaccines as a priority. They also wanted an all-hazard strategy for public health emergencies that they could draw from to connect effectively with communities.

Leading a team of 10 people and five work streams, I built a relationship with the media company that allowed us to feed evidence and insights directly into campaign collateral. This also enabled us to react quickly to strategic shifts from as high up as the governor's office.

Approach | I layered our audience research to start quickly and dive deeper with user testing.

In late 2022, our contract and respiratory virus season started at the same time. We needed insights from real people, particularly for vulnerable groups like older adults, rural communities, low income families, and people affected by racism. I organized the team to begin gathering rapid insights remotely, reaching out to organizations around New Hampshire that work with these groups and conducting short interviews about vaccine behavior and challenges.

Connecting with older adults in the rural North Country

Coming out of the 2022-23 Covid season, we had the spring and summer to develop a vaccine confidence strategy for state approval and develop a comprehensive campaign for the following fall and winter. To be successful, we needed to better understand the older adult population, particularly in the libertarian-leaning rural northern counties.

Leveraging relationships we had built gathering insights remotely, we conducted three focus groups and nine individual interviews with older adults in rural counties. To prioritize insights from audiences whose Covid risk was exacerbated by poverty and other health system access challenges, we held several interviews in a low income senior housing building and organized a focus group with a senior center that serves primarily low income seniors. We also conducted low-fi user testing of early campaign concepts in both focus groups and interviews.

A few important insights from this research included:

• Many participants named two groups— those with pre-existing conditions, and children— as being equal or more at risk of severe Covid as older adults (old age is the highest risk factor), indicating a risk perception challenge.
• Participants viewed risk largely in terms of risk of getting sick rather than risk of serious illness, hospitalization or death. This sometimes led to confusion or frustration around getting sick despite being vaccinated.
• Most people were still counting their vaccines (e.g. 'I've had four') rather than considering them in terms of recency, like a flu shot (e.g. 'I've had mine this year').
• Not wanting to 'miss out' on fun, special, or important moments or experiences was motivating both for getting the vaccine (to avoid missing out due to illness) and for not getting the vaccine (to avoid missing out due to side effects).
• Some people who had been vaccinated early on were not planning to get more shots due to strong negative sentiment leftover from previous Covid vaccine mandates.

Design | We worked with a media firm to mock up three behavioral insights-driven campaign concepts.

In partnership with our media partners, we designed three campaign concepts that leveraged behavioral insights critical to the decision making processes of vulnerable New Hampshirites:

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We fleshed out concept 1, but with flu and RSV in the mix.

NH DHHS chose concept 1, but the governor's office also decided they wanted all vaccine outreach resources to have a triple focus on Covid, flu, and RSV immunizations. In another round of rapid insights gathering, I went back to NH with one of my team members and conducted semi-structured interviews with 25 residents in two cities and 9 frontline practitioners in two city health departments.

In the more diverse urban parts of the state, we were focused on gathering insights that would help our campaign better serve NH's Latino and Black communities. We conducted semi-structured interviews with 25 residents in two cities and 9 frontline practitioners in two city health departments. Intent on talking to every day New Hampshirites, we recruited and interviewed people everywhere from a Sam's Club cafe to a barber shop to a Walmart parking lot.

Results | Living Free and Not Dying? We saw more shots in arms!

The final campaign launched on a range of print and digital platforms, in English and Spanish. State data indicates the campaign had an impact on interim behaviors such as requesting a mobile vaccine clinic (mobile clinic doses in rural areas rose 7x during campaign), as well as overall booster (updated vaccine) uptake, which the state estimates to have risen from 62% to 69%.

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Beyond Vaccines | More behavioral designs to improve public health!

This project involved a number of mini assignments in which my team supported DHHS to:

• Improve resources for households where a child had tested positive for elevated blood lead levels (example below);
• Boost responses to a postpartum health survey;
• Design a conversation guide for health practitioners to have trust-building conversations about vaccines;
• Create communication checklists for best practice during public health emergencies;
• Train communications professionals from across departments to integrate behavioral science into their work.

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