Planning, Organization, and Evaluation of the Effectiveness of a Communication Campaign for Mass Prevention of Iodine Deficiency in the Northwestern and Ural Federal Districts

The dissertation is devoted to the problem of planning, organizing, and evaluating the effectiveness of communication campaigns aimed at mass prevention of iodine deficiency. The study focuses on the Northwestern and Ural Federal Districts, where the problem of iodine deficiency remains highly relevant. The author treats communication campaigns as an instrument of social marketing in healthcare, directed not only at raising public awareness but also at changing behavior in favor of preventive actions, primarily the consumption of iodized salt.

The work analyzes the state of the iodine deficiency problem in Russia and abroad, examines the level of public awareness of the risks of iodine insufficiency, and develops and tests communication materials. Special attention is given to the school-family technology of communication interaction, as well as to qualitative research methods applied to campaign planning. The research results were implemented in a number of pilot organizations and used in the educational process.

Relevance of the topic: The economic realities of the past two decades have particularly sharpened the issues of public health formation and public responsibility for one's own health. (Vyalkov A.I., Shchepin V.O., 2001). Formation of desirable behavior of people toward their health, i.e., directed toward the preservation and strengthening of health, is the most important task of public health. A major role in this process belongs to the conduct of communication campaigns. The concept of "communication" programs or campaigns is increasingly replacing the concept of "informational" campaigns/programs. (Healthcare 11.2000).

A communication campaign, unlike an informational one, aims not so much at raising the awareness of the target audience as at changing the behavior of the target audience in a desirable direction. "Desirable" in public health is preventive behavior that contributes to the elimination of various components of diseases (ICD 2001). The organization and conduct of communication campaigns is an integral part of the modern market process in healthcare. Being part of social marketing, communication programs in healthcare are a cost-effective instrument contributing to the improvement of public health (Hinman A.R., 1996).

In particular, since 1980, no studies of the knowledge, attitudes, and practices of the population related to the prevention of iodine deficiency diseases have been conducted in our country. Neither have campaigns been conducted to inform the population about the consequences of iodine deficiency and the use of iodized salt for their prevention.

According to the World Health Organization, more than 2 billion people in the world face an increased risk of insufficient iodine intake, and 40 million people suffer from intellectual disability as a result of iodine deficiency (WHO, 1993).

According to the Endocrinological Scientific Center of the Russian Academy of Medical Sciences and the Center for Iodine Deficiency Diseases, the entire territory of Russia is subject to iodine deficiency of varying degrees of severity. Therefore, practically the entire population of Russia (more than 95%) experiences iodine deficiency. The goiter morbidity rate in the European part of Russia currently amounts to 10–15% in urban districts, 13–35% in rural areas, and in some regions (Tuva, Buryatia) reaches up to 45%. Iodine deficiency diseases exert a serious impact on all those affected, and the well-known goiter is by no means their only manifestation (Gerasimov G.A., Fadeev V.V., Sviridenko N.Yu., Melnichenko G.A., Dedov I.I., 2002).

The entire civilized world, as in its time the Soviet Union, addresses this problem through mass production and consumption of iodized salt. After 1990, programs for the elimination of iodine deficiency in Russia practically ceased to be implemented due to the collapse of the country. The cessation of iodized salt production in the mid-1980s led to an increase in iodine deficiency.

A public opinion survey conducted by NPO "Interregional Center of Public Health and Development" in 2000 for the United Nations Children's Fund (UNICEF) showed that the overwhelming majority of the population wants to know about the prevention of iodine deficiency, and 96% would definitely consume iodized salt and recommend it to their acquaintances if they knew about the dangerous consequences of iodine deficiency. That is, informing the population about the prevention of iodine deficiency through the consumption of iodized salt is an urgent issue.

The Government of Russia adopted Resolution No. 1119 on October 5, 1999, "On measures for the prevention of diseases associated with iodine deficiency," which defined radical measures for the elimination of iodine deficiency on the territory of the country. Iodized salt (IS) is recommended for mass prevention of iodine deficiency in Russia, in accordance with WHO requirements (Dedov I.I. et al., 2004).

Unfortunately, this resolution is not being fully implemented. To date, there is no legislative regulation of mass production and consumption of iodized salt (IS). Domestic salt producers have repeatedly declared their readiness to establish IS production in the required volume. The only obstacle to this is the insufficiently high demand for IS. (Materials of the National Salt Producers Conference. Moscow, 2002).

Under these conditions, informing the population about the use of iodized salt for the prevention of the dangerous consequences of iodine deficiency is an urgent task of public health.

Research objective. To develop and evaluate the effectiveness of a communication campaign aimed at raising awareness of the risks of iodine deficiency and the benefits of iodized salt consumption among the population of the Northwestern and Ural Federal Districts.

Research tasks:

1. To analyze the effectiveness of iodine deficiency prevention programs in the Soviet Union, the Russian Federation, and abroad from 1980 to 2004 (literature analysis).

2. To study the awareness of the Russian population regarding the problem of iodine deficiency and iodized salt consumption.

3. To plan, organize, and conduct a communication campaign in the Northwestern and Ural Federal Districts; to develop communication materials and conduct their pretesting.

4. To evaluate the effectiveness of the communication campaign for mass prevention of iodine deficiency in the pilot districts.

Scientific novelty of the research:

For the first time in the Russian Federation:

- The level of public awareness regarding iodine deficiency and iodized salt consumption in the Russian Federation was studied, and the effectiveness of a communication campaign (CC) for mass prevention of iodine deficiency was evaluated according to two groups of criteria: awareness and behavioral change of target audiences in the pilot districts;

- Qualitative research methods were used for planning the CC for iodine deficiency prevention in the Northwestern and Ural Federal Districts.

The planning and organization of mass prevention of iodine deficiency in Russia were carried out taking into account the five components of social marketing:

1) product (the idea of using iodized salt for the prevention of iodine deficiency); 2) production and supply of iodized salt; 3) acceptable price of the product; 4) informing the population about the advantages of consuming the product (iodized salt);

5) place, i.e., the territory where all the preceding four factors are present (the Northwestern and Ural Federal Districts).

- Preliminary testing of communication materials on iodine deficiency prevention was conducted among representatives of target audiences using the focus group method.

- A school-family communication interaction technology was used for mass prevention of iodine deficiency.

Practical significance of the research: lies in the scientific substantiation of the necessity of conducting communication campaigns on the benefits of iodized salt consumption as part of the social marketing of mass prevention of iodine deficiency in Russia.

An information package for the press was developed and tested at press conferences and press seminars in Moscow, St. Petersburg, Yekaterinburg, Krasnodar, and Pskov.

A training module for school teachers on iodine deficiency prevention was developed. Classes based on the developed training module were conducted in schools of the Northwestern and Ural Districts.

Implementation into practice.

The research results were used in the work of a number of organizations in the pilot regions and Moscow:

The Center for Iodine Deficiency Diseases of the Ministry of Health of Russia, the Sverdlovsk Regional Family Planning Center, the Interregional Association "Healthcare of the Northwest," the International Confederation of Consumer Societies, NPO "Quality Assurance" in Yekaterinburg, the social marketing and communications agency "MarKom."

The materials of this dissertation research were used in the educational process at the Department of Public Health with a preventive medicine course of the Faculty of Advanced Training of the Moscow Medical Academy named after I.M. Sechenov.

Main provisions for defense:

1. The planning, organization, and evaluation of the effectiveness of a communication campaign for mass prevention of iodine deficiency in Russia have a number of organizational and methodological features associated with the necessity of applying qualitative research methods and pretesting of communication materials.

2. When planning and organizing a communication campaign, it is necessary to take into account the different level of awareness of target audiences regarding the risks of iodine deficiency among urban and rural populations and in different age groups.

3. The technology for planning, organizing, conducting, and evaluating the effectiveness of communication campaigns for mass prevention of iodine deficiency makes it possible to significantly increase the effectiveness of preventive programs.

Working hypothesis: Under conditions of insufficient funding and weakening of state control over disease prevention, the use of communication campaigns is an effective means of changing the attitudes and behaviors of target audiences through raising their awareness of health protection issues.