Using Formative Research and Audience-Centric Intelligence to Develop the #JustBe Digital Magazine: An mHealth Strategy to Improve Adolescent Sexual Health
" Journal of Applied Research on Children: Informing Policy for Children at Risk: Vol. 8 : Iss. 1
Using Formative Research and Audience-Centric Intelligence to Develop the #JustBe Digital Magazine: An mHealth Strateg y to Improve Adolescent Sexual Health
Opportunities for Teen Pregnancy Prevention 0 1 2
Kimberly Johnson-Baker 0 1 2
Honora I. Swain-Ogbonna 0 1 2
Maribel Cruz 0 1 2
0 University of Texas Health Science Center at Houston , USA
1 University of Texas Health Science Center at Houston School of Public Health , USA
2 University of Texas Health Science Center , USA
Sharon Edwards Recommended Citation
See next page for additional authors
Follow this and additional works at: http://digitalcommons.library.tmc.edu/childrenatrisk
Using Formative Research and Audience-Centric Intelligence to Develop
the #JustBe Digital Magazine: An mHealth Strategy to Improve
Adolescent Sexual Health
Kimberly Johnson-Baker, Honora I. Swain-Ogbonna, Maribel Cruz, Jorge Cruz, Sharon Edwards, and Susan
Emphasis is increasing to deliver teen pregnancy prevention education in
innovative ways to at-risk populations – older teens, ethnic minority youth,
LGBTQ (lesbian, gay, bisexual, transgender, queer) youth, school dropouts,
and high-risk males – that are not reached through traditional programming
channels, which include schools, clinics, and community-based
organizations.1 Digital strategies may help to overcome the challenges of
reaching these populations. According to the Pew Research Center, 93%
of US youth are online daily, and 75% have a mobile phone.2,3 Moreover,
80% of US youth say they cannot imagine a day without technology.4
However, questions remain regarding the feasibility and long-term effects
of mobile health interventions for contraception use.5-9 Specifically, these
strategies may not target youth, may not be culturally specific for ethnic
minority youth, and may not provide information on the most effective
contraceptive methods. A recent systematic review of mobile phone apps
for teen pregnancy prevention found that although several evidence-based
mobile strategies are available, most miss opportunities to provide users
with information on the most effective contraception methods, including
long-acting reversible contraception (LARC).10 Furthermore, it was found
that 72% of apps did not target any race/ethnicity, and only 10% explicitly
targeted youth.10 As part of a community-based demonstration project, we
developed a strategy to reach hard-to-reach youth in an engaging and
culturally relevant way. In this article, we describe the three steps used to
develop #JustBe, a digital magazine, to engage and inform youth on
contraception, sexual health, consent, and healthy relationships.
Step 1: Planning Group Development and Engagement
When an intervention is developed, it is essential that planning groups
include members of the target population and experts in the field.11 Thus,
we developed two types of planning groups: youth in our target population
and experts on social media and marketing. Before selecting a final
strategy, we engaged these planning groups essentially to “think outside
the box” to generate innovative ideas.
Engagement with youth. To engage youth as partners in the development
of a strategy, we hosted paid high school summer interns, conducted focus
groups, and engaged in regular feedback sessions during every step of the
development phase. As part of this effort, we conducted training in sexual
health education; survey development and interpretation; presentation
development; formative research, such as PhotoVoice and focus groups;
and human subject protection.
Engagement with marketing and social media experts. To obtain ideas and
advice on strategies for targeting hard-to-reach populations, we interviewed
and engaged marketing firms from across the nation. After realizing that
many marketing firms are not familiar with sexual health education and that
we needed a data-driven approach to arrive at a final strategy, we
contracted with CentraForce, an audience-centric marketing firm. We
worked with CentraForce to gain a better understanding of our target
audiences – namely, young women and their influencers; integrate our
formative research and data sets with secondary data sets and social media
monitoring; define the marketing area and build deep, hyperlocal data sets;
develop audiences and their personas; and develop messaging and media
strategies for these personas. Social marketing strategies, such as
audience segmentation techniques, may help focus interventions and
identify effective delivery channels.612-14
Persona development with audience-centric intelligence. Persona
development has gained traction as a useful strategy to help researchers,
program developers, and stakeholders understand the needs and desires
of target users of an intervention.15 In addition to demographic data (ie, age,
race/ethnicity, and socioeconomic status), personas are a valuable
resource because they include the skills, attitudes, motivations, frustrations,
and goals of specific subgroups, mostly within geographic boundaries.15
Input from our youth engagement process clearly indicated that we should
use a digital strategy to engage hard-to-reach youth. The suggestions from
marketing experts varied from implementing a Web site strategy to buying
mobile vans that sold beauty products in high-risk neighborhoods. To
narrow our options, we relied on CentraForce to generate audience-centric
intelligence. Based on their analysis of audience-centric marketing data,
census data, and health behavior data, CentraForce developed personas
for young female teens (aged 12-17 years), young female adults (aged
1829 years), young male teens (aged 12-17 years), and young male adults
(aged 18–29 years) (Table 1).
Step 2: Strategy Development
Based on the planning group activities, we refined goals, identified
messaging strategies, developed youth-centered content, and selected
dissemination channels that were most feasible for youth and young adults.
Collectively, the following lessons and specifications were gleaned from
1. A digital strategy should be used to engage hard-to-reach
2. Information should be “chunked” to help youth process it. Chunking
is an information processing technique that allows learners to
memorize and retain information.16 Because information in a
multimedia form can quickly create cognitive overload, it is important
to use information processing strategies such as chunking to
overcome these barriers.9
3. Information should be presented in a relevant or contextual way in
relation to the learner’s experience.17 The planning groups
suggested the use of real-life stories and struggles. Story elements
could include voices of people who are credible, compelling images
that resemble youth in their community, powerful symbols, and social
math to show the extent of the problem.11
4. Humor should be used to engage and entertain target audiences. In
addition to grabbing attention, humor can make something
memorable, change attitudes and knowledge, and foster
dissemination of the intervention.18-20
5. Content should include sexual minority youth’s and males’
perspectives of relationships, sexual health, and contraception.
Step 3: Program Production and Implementation
Based on formative evaluation, audience intelligence analysis, and planning
group input, we developed a digital magazine strategy entitled #JustBe.
This strategy focuses on user-centered digital content that targets critical
subgroups to provide engaging and informative education on contraception,
sexual health, consent, and healthy relationships. Additionally, we based
the “look and feel” of this strategy on the results of persona development
(Table 1). Specifically, we structured many of the magazine articles as “tips”
or “steps” instead of traditional articles, and we created designs that were
edgy with limited juvenile imagery to ensure the magazine connected with
our target population’s needs: taking small actionable steps; seeing real
people; and feeling valued as young adults, not youth.
Initial content included youth subculture topics such as fashion, beauty, and
fitness. However, through an iterative process that used feedback from
ongoing listening groups, we refined content to focus solely on sexual health
and contraception (Figure 1). Youth in our listening groups reported
spending more time on those sections and sharing articles related to sexual
health and contraception with their peers. From these listening groups, we
also learned the importance of including the perspectives of males and of
LGBTQ youth on relationships, sexual health, and contraception (Figure 2).
We successfully implemented the #JustBe digital magazine in two
participating high schools located within our demonstration project
community. We conducted multiple outreach activities during school lunch
periods, which included interactive games and group activities, to market
the magazine and its message. The two high schools had a combined
student population of approximately 2000 students. Implementation goals
were met, as viewership remained contained within our target population
with approximately 1899 unique readers (Figure 3).
In this article, we describe the preliminary steps used to develop #JustBe,
a user-centered digital strategy for ethnic minority older youth and young
adults with a specific focus on teen pregnancy prevention.
Technologybased strategies such as #JustBe offer advantages over traditional
face-toface methods by using a confidential way to retrieve sexual health
information that may be sensitive and potentially embarrassing. Research
has shown that technology-based strategies appeal to youth10; induce
specific and measurable health behavioral changes in sexual risk taking21;
and improve contraception uptake, specifically for those at high risk for
We learned several important lessons from the development of #JustBe.
First, health literacy in particular and literacy in general should be
considered when digital education is delivered. Content, especially that
presenting medical information, must be provided in a manner that is
engaging, interesting, and easily digested. Second, various marketing
strategies that are user-centered and based on audio-centric marketing
behavior (eg, timing and placement of social media ads, modification of
layout to include design thinking strategies that encourage behavior
change) are needed to target different subgroups within a target community.
Lastly, given the importance of technology in the lives of youth, digital
strategies such as #JustBe warrant further investigation. Our preliminary
results from this community-based demonstration project indicate the need
to evaluate the influence of #JustBe on health behavior, including the use
of reproductive health services and contraception.
1. Adolescents, technology and reducing risk for HIV, STDs and
pregnancy. Centers for Disease Control and Prevention.
https://www.cdc.gov/std/life-stages-populations/adolescentstech.htm. Updated April
. Accessed September 22, 2017.
2. Lenhart A, Kahne J, Middaugh E, Macgill A, Evans C, Vitak J. Teens,
video games and civics. Pew Research Center: Internet &
http://www.pewinternet.org/2008/09/16/teens-videogames-and-civics. Published September 16, 2008. Accessed
September 22, 2017.
3. Lenhart A, Purcell K, Smith A, Zickuhr K. Social media and young
adults. Pew Research Center: Internet & Technology.
http://www.pewinternet.org/2010/02/03/social-media-and-youngadults/. Published February 3, 2010. Accessed September 22,
4. Consumer Electronics Association. Teens and technology study.
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5. Smith C, Gold J, Ngo TD, Sumpter C, Free C. Mobile phone-based
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Actively insert themselves into
conversations and have a desire to
belong to a group.
Currently sorting out who they want
to be, what kind of career they want
to have, and how to achieve all their
Learning to navigate the ways
technology affects real-life
relationships and choices.
Proud, informed, “hooked in,” and
surrounded by a crowd, offering a
polished point of view that their peers
respect and emulate.
Aren’t “wowed” by celebrities; they like
to see real people making real choices.
Actions or interventions should be
broken down into easy wins, so that
they don’t lose hope or sight of the
goals they want to achieve.
Addressing them as young adults –
while understanding their limited
worldview – will help them feel
respected and appreciated.
An authentic approach to being cool
and hip will resonate.
Journal of Applied Research on Children: Informing Policy for Children at Risk, Vol. 8 , Iss. 1, Art. 10
Figure 2. Snapshot of topics for digital magazine #JustBe.
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21. Jamshidi RM , Robinson J , Burke AE . The effect of the Bedsider.org Web site on contraceptive use within an urban gynecology clinic . Obstet Gynecol . 2015 ; 125 ( Suppl 1 ): 79S - 80S .