Using Marketing Strategies to Increase Use of a Teen Health Center

Summary

Impact Statement:

Although located in an area with significant need for teen family planning services, a public health teen clinic in Spartanburg County had low rates of use. The South Carolina Department of Health and Environmental Control followed a Plan-Do-Study-Act (PDSA) approach and used QI tools to understand how best to redirect its marketing efforts. Awareness and use of the clinic increased among teens, which was the first step in increasing the use of contraceptive methods and decreasing teen pregnancy in the county.

Summary:

The aim statement for this initiative stated that by November 30, 2012, the South Carolina Department of Health & Environmental Control (SC DHEC) will increase the average number of units (1 unit = 15 minutes) appointed per day at the teen center by 13- to 19-year-olds from 44 in February 2012 to 58 (or 80% of our current capacity). In March 2012, before formally initiating the quality improvement (QI) project, SC DHEC made two changes in hopes of increasing utilization: It began using a pre- and post-provider model, and added an outreach coordinator 3 days per week. In May 2012, SC DHEC formally began the QI project, completed a root cause analysis, and then determined the most appropriate marketing strategies to increase awareness and use of the center. SC DHEC used a survey to measure how new patients heard about the center. After some renovations to the center that tripled capacity, SC DHEC held reopening events for both the local community and partners. SC DHEC also focused much of its efforts on improving the referrals from the main health department since it found that most teens had heard about the teen center through the staff at the main health department. These internal efforts included presentations at a variety of staff meetings (across program areas and reaching front line staff and management), ensuring that marketing materials are available in clinic areas, and assessing staff attitudes towards the teen center and frequency of making referrals. Other efforts included working with the City of Spartanburg and the Department of Transportation to erect directional signs on the main roadways near the center, adding signage to the exterior of the building with the clinic's name, and encouraging community partners to promote the center and refer their clients to the center. This QI initiative has highlighted the development of a formalized marketing plan for the teen health centers.

Organization that conducted the QI initiative:

South Carolina Department of Health & Environmental Control

Citation:

McKinzie, M. Public Health Quality Improvement Exchange. Using Marketing Strategies to Increase Use of a Teen Health Center. Thu, 11/07/2013 - 15:09. Available at http://phqix.org/content/using-marketing-strategies-increase-use-teen-health-center. Accessed April 18, 2024.

Background and Aim

Aim statement:

By November 30, 2012, SC DHEC will increase the average number of units (1 unit = 15 minutes) appointed per day at the teen center by 13- to 19-year-olds from 44 to 58 (or 80% of its current capacity).

Need For The QI Initiative:

SC DHEC has a site that solely provides family planning services to teens. This site has had historically low rates of use (60% of its capacity in July 2011) despite being located in an area of significant need. SC DHEC was interested in testing various methods and processes of marketing that would increase site use, therefore reducing teen pregnancy. Targeting the teen population for family planning services requires novel approaches that are not necessarily used in traditional, governmental public health settings. While SC DHEC provides services to teens, it is not accustomed to specifically targeting them in outreach efforts. SC DHEC realized it cannot approach this endeavor like many other initiatives, and that SC DHEC can have a significant impact on the teen pregnancy rate within the county with a more effective marketing process.

Area for Improvement:

Teen pregnancy is a significant problem in Spartanburg County. In 2009, the teenage pregnancy rate was 37.8 (725 pregnancies). This rate exceeds the South Carolina rate of 34.4, which exceeds the national average. The rates of live births in Spartanburg County are similarly high (30.1) when compared to the state (26.2) and the national average. The costs to the county are astronomical; teen childbearing costs taxpayers more than $13 million annually. Additionally, teen mothers are more likely to develop prenatal complications, have higher school dropout rates, and live in poverty. SC DHEC must take steps to reduce the costs and consequences of teenage pregnancy. SC DHEC has a site that solely provides family planning services to teens and it intends to provide services to more teens at that site. This site has had historically low rates of use (60% of its capacity) despite being located in an area of significant need. SC DHEC believed that improving marketing efforts to reach more teens would result in increased use of the center, which would ultimately impact teen pregnancy rates in the county.

Root Cause:

Limited ability to make clinic "teen friendly"; privacy issues (no wall); small waiting room; one exam room, one provider; many people do not know about the teen clinic; main health department staff are not promoting the clinic; no signage; perception of neighborhood where clinic is located is negative; people are accustomed to going to the main health department for services.

Planning and Execution Details

QI Implementation:

First, SC DHEC developed the team charter so that everyone understood the purpose of the project, what each person's role was, the scope of the project, what SC DHEC aimed to accomplish, and the timeline for completion. SC DHEC then completed the suppliers-inputs-process-outputs-customers (SIPOC) chart to understand who the customers and stakeholders were; this would direct marketing efforts. SC DHEC completed the fishbone diagram to understand the root causes behind low use of the teen center. Then SC DHEC developed the action plan that outlines what it was going to do, who the lead was on each action item, when it should be completed, the status of the action item, potential barriers to implementation, solutions to those barriers, and how the data would be collected. The action plan was updated at each team meeting. SC DHEC used the marketing survey with new clients at the teen center to understand how they heard about the center. SC DHEC used the staff survey to understand staff members' attitudes toward the teen center and how often they refer teens to the center. SC DHEC had planned to use the mystery shopper to assess how well and how often the Central Appointing Center was referring and scheduling teens at the center. Finally, each month SC DHEC gathered data on the use of the clinic and charted those data over time. Through the marketing survey that SC DHEC implemented to assess how clients at the teen center were hearing about the center, SC DHEC found that most clients heard about the center through friends, family, and the main health department. Because of this, SC DHEC began promoting the center at a variety of staff meetings, both to front line staff and management staff. The community partners refer teens they encounter to the teen center and they promote the teen center through their social media outlets in hopes of increasing the number of ways in which teens hear about the center. The outreach coordinator continued to attend a variety of community events and health fairs, providing marketing materials to both organizations and the community at large. SC DHEC completed renovations to the center, which expanded its capacity threefold; after that, SC DHEC held reopening events for the local community and for partnering agencies. Staff began working with the City of Spartanburg, the Department of Transportation, and the Spartanburg Housing Authority (which owns the building in which the center is located) to erect signage immediately outside the building as well as on the main roadways leading into the center. The team also added a link to the SC DHEC Web site and to the teen center's Web page. The October employee newsletter included extensive coverage of the renovations at the teen center and information on teen pregnancy. Staff meetings were held at the teen center to expose staff from the main health department to the center. In the fall, the outreach coordinator began building relationships with area colleges and giving presentations to college classrooms, where she thought she had more of an impact because of the smaller group setting. She also set up information tables in the lobby of the main health department to promote the center to clients. Last, SC DHEC began discussion with the SC Campaign to Prevent Teen Pregnancy to develop a formalized marketing plan for the center. It is difficult to estimate how many people were exposed to the initiative—it reached approximately 100 staff members at the main health department and more than 4,200 people through outreach events; in collaboration with 65 community partners, SC DHEC provided 573 family planning services to teens at the teen health center between May and October 2012.

Focus activities

Maternal and Child Health Services:

Family planning

Other Public Health Services:

Access to care

QI Methods:

PDCA/PDSA Cycle (Plan, Do, Check/Study, Act)

QI Tools:

Other QI tools:

SIPOC

QI Tool Documentation:

Staff attitudes survey

Materials distributed through outreach

Number of people reached through outreach

Hits on Web site

Initiative Dates:

3/1/12 to 12/10/12

Initiative Duration:

Between 6-12 months

Methods of evaluation:

The primary measure of the impact of the QI initiative was the average number of units (1 unit = 15 minutes) appointed per day. These data are captured daily in the appointing system. SC DHEC chose this measure because the number of appointments scheduled is directly related to how well the team has educated the public about the services available. Because some appointments take longer than others, SC DHEC chose to look at the number of units appointed each day to rule out variables such as the type or length of the appointment. SC DHEC measured how new clients heard about the teen center through a marketing survey administered at the beginning of the client's first visit. The results of the survey were recorded in a database by one of our community partners. SC DHEC measured staff attitudes and frequency of referring teens to the center through another survey, and SC DHEC plans to do this survey again in 6 months to obtain pre- and post-data. The outreach coordinator entered information on the number of people reached, the number of materials distributed, and the events she attended in a database, and the team was able to generate monthly reports. SC DHEC was able to track hits on the Web page each month through a reporting mechanism of the service provider.

Supplemental Materials:

Promotional materials

Initiative photo(s)

Publication (e.g., news story, journal article)

Storyboard

Supplemental Files:

Attachment	Size
Copy of Picture 042.jpg	5.47 MB
2012-09-17_16-00-57_757.jpg	1.32 MB
Revamped.doc	37 KB
CR-010350_with addresses_PRINT.pdf	829.66 KB
The Point at Tobias Storyboard.pdf	503.74 KB

Results

Measurable QI Outcomes:

The average number of units appointed per day at the teen center increased by 32% from an average of 44 units appointed per day in February 2012 to 52 units appointed per day in October 2012. The best performing month was April 2012 with 74 units appointed. The average number of units appointed per day over the course of the QI initiative was 61 units. After the first month of surveying new clients, SC DHEC found that 67% had heard about the center through the main health department, 33% through the SC DHEC Web site, 33% through family members, and 11% through friends (some clients selected more than one option). By October, 33% had heard about the center through friends, 27% through family members, and 30% through the main health department. This increase in referrals from friends and family members may be in part due to efforts of the outreach coordinator, who reached more than 4,200 people through various events, health fairs, and presentations. By October, SC DHEC found through its staff survey that 100% of staff surveyed were knowledgeable about the center, 73% of preventive health staff were referring at least three out of four teens to the teen center, and 90% of all staff thought it was important to refer teens to the teen center. The number of hits on the Web page increased by 400% between March and October.

Lessons Learned, Observations and Insights:

Successes: The aim was to improve access to health care services for teens. To achieve this goal, teens must first be aware of services available to them. As more teens become aware of the services provided, SC DHEC expected to see an increase in the use of the teen center. This increase should result in more teens using hormonal methods of contraception, which will ultimately decrease the teen pregnancy rate in Spartanburg County. SC DHEC expected that targeted marketing would result in an increase in the site's utilization, so it was pleased when it met the goal of increasing the average number of units appointed per day from 44 to 58. SC DHEC closed the clinic in August to complete renovations that expanded the clinic from one to three exam rooms and added an additional provider, so the number of units appointed is expected to keep increasing. Because of this initiative, SC DHEC now has strong relationships with other organizations that provide services to teens and their support in promoting the teen center and referring their clients to the center. SC DHEC has been able to examine where education and awareness of the center to have the most impact—and it found that it needed to focus on staff at the main health department since they are a primary referral source for the teen center and that outreach efforts are more effective in small group settings such as college classrooms. SC DHEC is now working with one of its community partners to develop a formalized marketing plan and a referral tracking system so that it can build upon the gains that have been made this year and better understand how clients are hearing about the teen center. Difficulties: Despite not using social media marketing and radio ads, SC DHEC found effective ways to promote the center including the use of the resources of the community partners. SC DHEC was also challenged with delays in the renovations, which were originally scheduled to take place in June and were not completed until early September. SC DHEC was unable to implement the mystery shopper assessment because of scheduling problems with the shopper. This assessment would have provided information on how well and how often the centralized appointing center is scheduling and referring teens to the teen center for services. SC DHEC plans to implement this assessment in the next few months as part of the next rapid cycle improvement. Ethical aspects: All efforts were made to ensure the privacy of clients; SC DHEC took care not to include any identifying information in the surveys and clearly indicated to clients that refusing to complete the survey would in no way impact the services they received at the center. In marketing, SC DHEC did not use outside the agency photos of any individual without their permission.

Future Plans:

Marketing experts at the SC Campaign to Prevent Teen Pregnancy are developing a formalized marketing plan for the teen health center. They have added signage to the exterior of the building and are in the process of adding signage to the main roadways, which will increase awareness to the community of the teen center. One of the community partners is developing an incentivized referral tracking system using text messaging codes. SC DHEC plans to use additional rapid PDSA cycles to implement and evaluate the effectiveness of future marketing efforts for the teen center. SC DHEC plans to ensure that all main health department staff are educated on the importance of promoting the teen health center and that they have marketing materials in areas where they serve clients. The outreach coordinator plans to focus her efforts on small group settings, where she feels she has a greater impact than at large community events because the more intimate setting allows young people the opportunity to ask questions. SC DHEC will continue to collect data through the marketing survey to assess how clients are hearing about the center and track the center's use. SC DHEC believes that through the assistance of the SC Campaign to Prevent Teen Pregnancy, it will be able to maintain the gains that it has made and continue to see increases in the center's use over the next several years.

Training and Preparation

Information about the Community

Information about the Health Department

QI Staff Information

Accreditation Details

Contact Information of the Submitter

Submission Status:

Completed

Comments

Web presence

First, thank you for sharing this QI project. There is excellent information and results here that we all may learn from. The collected data on in your increased web traffic is significant, congratulations. Has your marketing plan sought to include any additional online marketing tactics? If research has revealed most clients of the clinic learn of the place and services through word of mouth, increasing conversation or link-ability to your webpage could be (additionally) helpful. Social media is one method that comes to mind. I admire your efforts on this area of needed improvement!

Thank you for sharing your

Thank you for sharing your experience. I appreciate you including barriers to the project. We are currently in the tail end of a Teen Health Center reconstruction grant (federal funding). Our site is located in the school itself and will soon be looking at implementing a marketing campaign to promote utilization and inform the community. I am interested in learning whether your project implmented the text messaging component of your future plans and getting an update on the overall marketing campaign. What venues did you use and how effective were they?

Sarah Oleniczak, MPH, MCHES
Deputy Health Officer
DHD#10

Link to the resource where this submission is also published:

No.

Using Marketing Strategies to Increase Use of a Teen Health Center

Summary

Background and Aim

Planning and Execution Details

Results

Training and Preparation

Information about the Community

Information about the Health Department

QI Staff Information

Accreditation Details

Contact Information of the Submitter

Comments

Web presence

Thank you for sharing your

QI Spotlight

quality improvement together.

Search form

You are here

Using Marketing Strategies to Increase Use of a Teen Health Center

Summary

Background and Aim

Planning and Execution Details

Results

Training and Preparation

Information about the Community

Information about the Health Department

QI Staff Information

Accreditation Details

Contact Information of the Submitter

Comments

QI Spotlight