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CDC Prevention Guidelines Database (Archive)


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This online archive of the CDC Prevention Guidelines Database is being maintained for historical purposes, and has had no new entries since October 1998. To find more recent guidelines, please visit the following:
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Guidelines for Health Education and Risk Reduction Activities

CDC, National Center for Prevention Services, Division of Sexually Transmitted Diseases/HIV Prevention

Publication date: 04/01/1995


Table of Contents

ACKNOWLEDGEMENTS

GENERAL CONSIDERATIONS REGARDING HEALTH EDUCATION AND RISK REDUCTION ACTIVITIES
Introduction
Core Elements of Health Education and Risk Reduction Activities
Effective Health Education and Risk Reduction program activities:
Effective Health Education and Risk Reduction evaluation activities:
Core Training for Health Education and Risk Reduction Activities
Effective training plans for Health Education and Risk Reduction sta
Community Needs Assessment
How to Conduct a Needs Assessment
How Needs Assessments Affect Program Evaluation
Collaborations and Partnerships
How Can Collaborations Help?
What Influences the Success of a Collaborative Effort?
Contracting With Community-Based Organizations

HEALTH EDUCATION AND RISK REDUCTION ACTIVITIES
Individual and Group Interventions
Street and Community Outreach
Risk Reduction Counseling
HIV Prevention Case Management
Community Level Intervention

PUBLIC INFORMATION
The Role of Public Information in HIV/AIDS Prevention
Definitions
Planning for Public Information
Staff Training in Planning for Public Information
Channel Selection
Selecting the Appropriate Channel
Educational Materials
Choose Formats for Education/Information Materials
Review Available Materials
Pretest Messages and Materials
Staff Characteristics for Materials Development and Pretesting
Using the Mass Media Effectively
Opportunities for Messages in the Mass Media
What Makes News
Working with the Mass Media
Hotlines
Why Establish A Hotline?
Quality Assurance
Guidelines for Establishing A Hotline
Staff Characteristics for Hotlines
Special Events
Community Involvement and Support
Planning Special Events

RESOURCES AND REFERENCES
Health Education
Materials Development
Public Information
Evaluation
Behavioral Risk Factors and Groups at Risk

APPENDICES
Appendix A - Street Outreach Activity Report
Appendix B - Program Assessment Form - Street and Community Outreach
Appendix C - Program Assessment Form - Community Educator
Appendix D - Program Assessment Form - Support Group Facilitator
Appendix E - Material Review Checklist
Appendix F - HIV Prevention Case Management (PCM) Checklist
Appendix G - Sample Educational Materials

GLOSSARY

POINT OF CONTACT FOR THIS DOCUMENT:

Tables
Field Safety Protocol
Example of Weekly Outreach Schedule
Standards for Effective Public Information Programs
Guidelines for Effective Public Information Programs
The Character of the Media
Media Idea List
Street Outreach Activity Report
Program Assessment Form - Street and Community Outreach
Program Assessment Form - Community Educator
Program Assessment Form - Support Group Facilitator
Material Review Checklist
HIV Prevention Case Management (PCM) Checklist
"Cleaning Your Needles" Pamphlet
"Teens and AIDS" Video


ACKNOWLEDGEMENTS

The U.S. Centers for Disease Control and Prevention (CDC) would like to thank the following persons who worked diligently over a number of years to research, write, and compile the information presented in this document. Special appreciation is extended to Susan E. Dietz, RN, MS, Chief, Training and Education Branch, Division of STD/HIV Prevention, National Center for Prevention Services. Ms. Dietz monitored this document's conceptualization and development. It is hoped that the document will prove useful to those persons working in STD/HIV disease prevention programs.

                              Octavia Brown
                           Janet Cleveland, MS
                               Amy DeGroff
                               Adolfo Mata
                         Mary Spink Neumann, PhD
                         Annie Faye Prescott, BA
                          Marise Rodriguez, MA
                            Jo Valentine, BSW
                             Mary Willingham

The following consultants reviewed various parts of the document and made many valuable suggestions. Their insightful and expert contributions are greatly appreciated.

Jose O. Arrom, MA
Midwest Hispanic AIDS Coalition

Leslie D. Baker, MS
City of Chicago Department of Health

Frankie G. Barnes, MPH
Centers for Disease Control and Prevention

James D. Beall, MA, BA
Indiana State Department of Health

Mary Ann Borman, PhD
United Migrant Opportunity Services, Inc.

Benjamin P. Bowser, PhD
California State University

Darryl Burnett, MPH
University of Maryland

Robert Darga, MD
National Association of People with AIDS

Renee L. DeMarco
Centers for Disease Control and Prevention

Alicia Diez
New Jersey Department of Community Affairs

Wilma Fajardo, BS
ASPIRA Inc. de Puerto Rico

Vicki Freimuth, PhD
University of Maryland

Mizzette Fuenzalida, MEd
Fuenzalida and Associates

Dean M. Goishi, BS
Asian Pacific AIDS Intervention Team

Marla J. Gold, MD
Philadelphia Veteran Affairs Medical Center

Yvonne J. Graham, RN, MPH
Caribbean Women's Health Association

Patricia Grindel, MA, BA
AID Atlanta

Mike Hanrahan, BS
Seattle-King County Health Department

Bill Harrison, BA
Virginia Department of Health

Ravinia Hayes-Cozier
New York City Department of Health

Marshia Herring, MPH
San Francisco Department of Public Health

Dennis Jarvis, MPH, CHES
Centers for Disease Control and Prevention

John Katz, BA
Iowa Department of Public Health

Andrew Lentz, MPA
Baltimore City Health Department

Rita LePicier
KCET-TV Educational Enterprises

Steve Lew
GAPA Community HIV Project

Lynn Lisella, MS
Centers for Disease Control and Prevention

Carol Marquez-Baines
American Indian Health Care Association

Doug McBride, BA
Texas Department of Health

Ann McLendon, MEd, CHES
Connecticut Department of Public Health

Henry Montes, MPH
Centers for Disease Control and Prevention

Henry Murdaugh
South Carolina
Department of Health and Environmental Control

Judy Norton
Arizona Department of Health Services

Tim Offutt, MPA, BS
San Francisco Department of Public Health

Lorenzo Olivas, BS, CHE
New Mexico Health Department

Concha Orozco, MA
National Coalition of Hispanic
Health and Human Services Organizations

Maurico Palacio, MSH Ed
Colorado Department of Health

Les Pappas, MPA
San Francisco AIDS Foundation

Thomas A. Peterman, MD, MSc
Centers for Disease Control and Prevention

Randall Pope, BS
Michigan Department of Public Health

Jeanne Pruyn, MS, CHE
Florida Department of
Health and Rehabilitative Services

Linda Robb, MSW
City of Philadelphia Department of Public Health

Hart Roussel, MDiv
Whitman-Walker Clinic, Inc.

Ronald M. Rowell, MPH
The National Native American AIDS Prevention Center

Idalia Sanchez, MPH
Connecticut Department of
Public Health and Addiction Services

Tonia Schaeffer, MPH
Chicago Department of Health

Carol Schechter, MA, MPH
Academy for Educational Development

John F. Schunhoff, PhD
Los Angeles Department of Health Services

Richard Scott, PhD
Philadelphia Department of Health

Michael J. Siska, MS, BS
Leo Burnett Company, Chicago, Illinois

Bonnie B. Sitko, MPH
State of Florida
Department of Health and Rehabilitative Services

Walter Smith
Austin, TX

Nancy Kay Sullivan, MPH, CHES
Mississippi State Health Department of Health

S. F. Tomajczyk
New Hampshire Division of Public Health Services

Ronald O. Valdiserri, MD, MPH
Centers for Disease Control and Prevention

Robert R. Waller, DDS, MPH
Centers for Disease Control and Prevention

Claudia Webster
Oregon State Health Division

Reginald Williams
National Task Force on AIDS Prevention

Toni Young
National Women and HIV/AIDS Project


GENERAL CONSIDERATIONS REGARDING HEALTH EDUCATION AND RISK REDUCTION ACTIVITIES

Introduction

Preventing the spread of human immunodeficiency virus (HIV) and sexually transmitted disease (STD) requires a comprehensive strategy composed of service delivery systems coupled with effective, sustained health education and health promotion interventions. These individual components of a prevention program must not operate in isolation, but must work together toward the well-being of the person at risk and the community as a whole. All education activities related to HIV/STD prevention should contribute to and complement the overall goal of reducing high-risk behaviors.

The guidelines presented in this document are written to encourage HIV/STD prevention programs to focus on developing programs and services that are based on health education and health promotion strategies. In Health Behavior and Health Education: Theory, Research, and Practice, the authors describe the ultimate aims of health education as being "positive changes in behavior" (Glanz et al., 1990, p.9). Green and Kreuter further define health promotions as ". . . the combination of educational and environmental supports for actions and conditions of living conducive to health" (Green and Kreuter, 1991). Health education is a powerful tool in an epidemic in which the behavior of using a latex condom can make the difference in whether or not a person becomes infected with HIV.

It is critically important that members of the populations to be served are involved in identifying and prioritizing needs and in planning HIV/STD education interventions. Their involvement ensures that decisions are made, purposes are defined, intervention messages are designed and developed, and funds are allocated in an informed and realistic manner. Limited educational resources can be proactively directed to specific populations, rather than reactively directed or directed on the basis of guesswork or stereotyping.

Moreover, to be effective, an education intervention must be culturally competent. Participation of client populations throughout the process of designing and implementing programs helps assure that the program will be acceptable to the persons for whom it is intended. For the purposes of this document, cultural competence is defined as the capacity and skill to function effectively in environments that are culturally diverse and that are composed of distinct elements and qualities. Cultural competence begins with the HIV/STD professional understanding and respecting cultural differences and understanding that the clients' cultures affect their beliefs, perceptions, attitudes, and behaviors.

Health departments across the country have implemented an HIV prevention community planning process whereby the identification of a community's high priority prevention needs is shared between the health departments administering HIV prevention funds and representatives of the communities for whom the services are intended. The HIV prevention community planning process begins with an accurate epidemiologic profile of the present and future extent of HIV and acquired immunodeficiency syndrome (AIDS) in the jurisdiction. Special attention is paid to distinguishing the behavioral, demographic, and racial/ethnic characteristics of the epidemic. This is followed by an assessment of HIV prevention needs that is based on a variety of sources and is collected using different assessment strategies. Next, priorities are established among needed HIV prevention strategies and interventions for specific populations. From these priorities, a comprehensive HIV prevention plan is developed.

Of the eight essential components of a comprehensive HIV prevention program that are described in the community planning guidance document issued by CDC, four relate specifically to the interventions described in these Guidelines. These are as follows:

More information on the HIV prevention community planning process is contained in the Handbook for HIV Prevention Community Planning (Academy for Educational Development, 1994) or from the HIV/AIDS Program in your local health department. All HIV health education and risk reduction activities should complement and support the priorities established in the HIV prevention comprehensive plan developed by the local HIV prevention community planning group.

For the purpose of this document, communities are defined as social units that are at least one of the following: functional spatial units meeting basic needs for sustenance, units of patterned social interaction, or symbolic units of collective identity (Hunter, 1975). Communities are selected for interventions based on their specific and identified needs and on surveillance and seroprevalence data.

The recommendations in this document recognize that while communities may have different approaches to HIV/STD prevention programs, certain basic programmatic, management, and staff requirements are common to effective health education and risk reduction activities. These Guidelines describe the core elements that are essential for success in a number of types of health education and risk reduction activities -- Individual and Group Interventions and Community-level Interventions -- and in public information activities.

These guidelines are provided to assist program planners in enhancing their health education and risk reduction activities. In some cases, specific programs of state and local health departments have advanced beyond the basic steps outlined here. In other instances, programs may benefit greatly from these suggestions. The priority activities described in this document can be used in a variety of settings and can also be applied to other health issues.

(1) Prevention marketing is CDC's adaptation of social marketing in which science-based marketing techniques and consumer-oriented health communication technologies are combined with local community involvement to plan and implement HIV/AIDS prevention programs. Essentially, Prevention marketing = social marketing + community involvement.

Core Elements of Health Education and Risk Reduction Activities

A number of core elements should be considered in health education and risk reduction program and evaluation activities.

Effective Health Education and Risk Reduction program activities:

Effective Health Education and Risk Reduction evaluation activities:

Core Training for Health Education and Risk Reduction Activities

Staff training is an important element in the development of a sound program. The suggested areas in which health education and risk reduction staff should receive training are listed below. Not all staff members should receive training in all the listed areas. The outlined training areas provide various program and management staff with the specific technical support necessary to implement their component of the health education and risk reduction program.

Effective training plans for Health Education and Risk Reduction sta

Community Needs Assessment

The HIV prevention community planning process requires an assessment of HIV prevention needs based on a variety of sources and different assessment strategies. This assessment serves as the basis for the development of a comprehensive HIV prevention plan. In addition, more targeted needs assessment may be needed for effective health education program planning for health departments and non-governmental organizations (NGOs). Tailored needs assessments enable the program planner to make informed decisions about the adequacy, availability, and effectiveness of specific services that are available to the target audience.

For the purposes of developing specific health education and risk reduction activities, a targeted needs assessment assists in the following:

The needs assessment may be informal or formal. An informal needs assessment may occur through frequent conversations and personal interactions with colleagues and clients. Staff and clientele interact with each other when services are being delivered; therefore, clients may inform them about services they find useful or unsatisfactory. Also, staff meetings are a vehicle for sharing and transferring information among colleagues. Through both of these processes, staff can usually determine whether there are gaps in services.

A formal needs assessment involves a systematic collection and analysis of data about the client population. This process may uncover needs that may not be identified through an informal process.

A formal needs assessment requires the program planner to do the following:

The program staff should review data from the HIV prevention community planning needs assessment to determine what additional information is needed. A variety of information would be useful in developing program activities, including the following:

Before conducting a needs assessment, program staff should consult with community leaders from the client or target populations. This is important in order to determine the leaders' perceptions of their communities' needs, to discuss the agency's plan for conducting the assessment, and to begin to cultivate a working relationship with the leaders in order to attain community support for the proposed avtivities.

How to Conduct a Needs Assessment

How Needs Assessments Affect Program Evaluation

A needs assessment is a component of program evaluation. Each element of a needs assessment plays a significant role in the planning, implementation, and management of effective education programs. If a program is to be evaluated, the degree to which the program addresses the needs of the target audiences must be examined.

Both qualitative and quantitative methods of data collection and evaluation are useful. Qualitative methods afford the target audiences an opportunity to express their thoughts, feelings, ideals, and beliefs. Examples of qualitative methods include informal interviews, focus groups, and public forums. These methods are designed to assist the program staff in identifying problems or gaps that the agency may not have recognized, e.g., barriers to service delivery and client dissatisfaction.

Quantitative methods render statistical information. Examples include questionnaires and surveys, results of studies of the client populations' attitudes and beliefs about HIV/STD disease, and information derived from program activities, e.g., number of condoms distributed and documented requests for services.

Note: For further reading on needs assessment, see "Chapter 5: Assessing and Setting Priorities for Community Needs," Handbook for HIV Prevention Community Planning, Academy for Education Development, April 1994.

Collaborations and Partnerships

The HIV prevention community planning process calls for health departments and affected communities to collaboratively identify the HIV prevention priorities in their jurisdictions. However, some members of these affected communities distrust health departments. They may feel that government officials have not traditionally reached out to them until certain health issues have also threatened the greater public health, i.e., the majority community. Sexually transmitted diseases, other communicable diseases, and substance abuse have long been problems in disadvantaged and disenfranchised communities. Injecting drug users (IDUs) were dying of endocarditis, hepatitis B, and drug overdose long before AIDS. For years, the tuberculosis epidemic persisted in poor African American and Hispanic neighborhoods, while prevention and treatment resources dwindled. Consequently, developing collaborative working relationships with affected communities for the purpose of HIV prevention may pose special challenges to many state and local health departments.

In the United States, public health officials frequently underestimate the strengths and resourcefulness of affected communities. As a result, state and local health departments and communities have seldom come together in partnership. In many instances, state and local health departments have not sought the support of, or consulted with, community members before designing and implementing community intervention efforts. At times, public health officials may have inadvertently stigmatized communities in their attempts to intervene and promote public health.

Affected communities are acutely aware of the peculiarities of public health as it relates to them. Some have asked, "Is this a war on drugs or on us" Despite government support for community-base and HIV prevention community planning, many communities remain wary of public health programs as they have been implemented by officials in their communities.

As if this lack of confidence were not challenging enough to state and local health departments, many communities genuinely suspect conspiracy when health officials implement programs for them. Many disadvantaged, disenfranchised persons not only distrust the government, but they may also fear it. For African Americans, the Tuskegee Study continues to cast its own specter of doubt as to whether or not public health officials are truly committed to ensuring the public's health. Hispanic farm workers continue to struggle with government pesticide regulators who seem indifferent to the dangers that farm workers face in the workplace. For Native Americans living on reservations, the quality of health is chronically poor, and life expectancy is diminished. Within many communities, there is a pervasive belief that the government "does not care," or worse, that it "will experiment on them."

Although the AIDS epidemic has illustrated the real value of developing partnerships among local and state health departments and communities, achieving communication, collaboration, and cooperation with these communities and maintaining the relationships in a climate of distrust, apathy, and even fear is daunting. Such a task will surely require cultural sensitivity, competency, respect, and the most critical of all elements, time.

In particular, for an effective HIV prevention community planning process, state and local health departments must develop strong linkages and collaborations with affected communities. A working definition of collaboration is the process by which groups come together, establishing a formal commitment to work together to achieve common goals and objectives. Collaborative relationships are also referred to as coalitions or partnerships. Regardless of the term, the concept is a crucial one.

To facilitate the formation of effective community planning groups and other partnerships, health departments need to understand not only the knowledge and behaviors of their client populations, but also their attitudes toward and beliefs about their own communities, the government, and public health. Health departments will want to assess these same issues among their own employees. In addition to this understanding, to fully achieve cultural competence, to have the capacity and skills to effectively function in environments that are culturally diverse and composed of distinct elements and qualities, health department professionals must also develop a respect for cultural differences. They must appreciate how culture and history affect their clients' perceptions, beliefs, attitudes, and behaviors, as well as their own.

For many health departments and community organizations, responding to the AIDS epidemic means long-term institutional change. Simply channeling HIV resources to affected communities through community-based and national non-go formation of real working relationships among partners who perceive each other as equal. The community planning process addresses these issues by emphasizing the importance of assuring representation, inclusion, and parity in the planning process.

An important program objective for health departments may be to gain acceptance and credibility in the communities they seek to serve. To assume that these will come automatically or even easily may demonstrate cultural insensitivity and incompetence. Respect and regard for the perceptions of those being served will help eliminate barriers to HIV prevention and will build the bridges to better health.

How Can Collaborations Help?

Collaborations can:

At the same time, public health agencies must be aware of some of the difficulties inherent in collaborative relationships:

What Influences the Success of a Collaborative Effort?

Many factors influence the success of a collaborative effort; however, the following factors are vital:

The development and maintenance of collaborative relationships are challenging and rewarding tasks. Collaborations can make positive, significant changes in communities, if they are developed in a way that is culturally competent and respectful of the people for whom interventions will be developed. Health departments must also consider whether efforts are cost-efficient, appropriate, duplicative, and accessible; they must determine where community-based organizations fit into the overall realm of prevention activities. Collaborations should be structured with long-term results in mind. They should serve as a bridge to better relations between state and local health departments and the community, ultimately effecting better health in the community.

Contracting With Community-Based Organizations

Request for Proposals
In many cases, a health department may determine that the best approach for reaching affected populations is by contracting with community-based organizations that have experience serving specific populations. In these situations, the health department may issue a Request for Proposals (RFP) from community-based organizations. The RFP should be clear and directive to assure that proposals will address the areas that have been identified as priorities. The RFP might require the following:

The RFP also should be clear in outlining the eligibility requirements. A CBO may be defined as:

The following additional points should be considered in the RFP process:

Review Process
A review panel should judge applications strictly against the criteria outlined in the RFP. Members of the review panel should include qualified persons representing the target communities who do not have a conflict of interest in reviewing proposals. Other criteria for membership to the review panel should include the following:

Technical Assistance
A person or organization (on staff or through contract) should be designated as the health department resource for technical assistance (TA) to CBOs.

Types of technical assistance should include the following:

As previously stated, linkages and coordination among organizations providing HIV/STD prevention activities are essential. This is particularly important among funded CBOs and health departments to avoid gaps in services and duplication of services. The HIV prevention community planning process plays a major role in assessing needs and identifying overlapping services.

In addition to contracting with CBOs, many health departments have full-time staff whose primary responsibility is to provide health education and risk reduction services to affected populations. The criteria outlined in these Guidelines apply consistently to services provided directly by health department staff as well as those provided through a contract with a community-based organization.

Note: For further reading on collaborations and partnerships see Chapters 1-3, "Handbook for HIV Prevention Community Planning," Academy for Educational Development, April 1994. For further reading on contracting with CBOs, see Cooperative Agreements for Human Immunodeficiency Virus (HIV) Prevention Projects Program Announcement and Notice of Availability of Funds for Fiscal Year 1993.


HEALTH EDUCATION AND RISK REDUCTION ACTIVITIES

Individual and Group Interventions

Health education and risk reduction activities are targeted to reach persons at increased risk of becoming infected with HIV or, if already infected, of transmitting the virus to others. The goal of health education and risk reduction programs is to reduce the risk of these events occurring. Activities should be directed to persons whose behaviors or personal circumstances place them at risk. Street and community outreach, risk reduction counseling, prevention case management, and community-level intervention have been identified as successful health education and risk reduction activities.

Street and Community Outreach

Street and community outreach can be described as an activity conducted outside a more traditional, institutional health care setting for the purposes of providing direct health education and risk reduction services or referrals. However, before conducting any outreach activity in a community, an agency must define the specific population to be served and determine their general needs. Based on this definition and determination, an agency can then decide appropriately where to conduct intervention efforts. Street and community outreach may be conducted anywhere from a street corner to a pool hall, from a parish hall to a school room. To determine the setting, an agency need only decide that the setting is easily, readily, and regularly accessed by the designated client population.

Outreach demonstrates an agency's willingness to go to the community rather than wait for the community to come to it. Often, agencies enlist and train peer educators to conduct the outreach activities. It is recommended that the content of the outreach activity be contingent upon the setting. The nature of activity varies in scope and intensity; the activity is best determined before an outreach team or individual educator goes out. Yet, flexibility is also very important. Remember, everything is not appropriate everywhere, all of the time. A street corner may be an appropriate place to conduct a brief HIV risk assessment, but it is not an appropriate place to conduct HIV counseling and testing.

While street and community outreach can be complementary service components of a single agency, some agencies, based on needs assessment findings and staff capacity, may choose to provide one service and not the other. Street outreach and community outreach can also be "stand alone" pieces.

Street Outreach
Street outreach commonly involves outreach specialists moving throughout a particular neighborhood or community to deliver risk reduction information and materials. The outreach specialist may set up an HIV/AIDS information table on a street corner. They may supply bleach to injecting drug users at shooting galleries and condoms to commercial sex workers and their customers at the hotels or locations that they frequent. The fundamental principle of street outreach is that the outreach specialist establishes face-to-face contact with the client to provide HIV/AIDS risk reduction information and services.

Effective street outreach staff:

Street outreach is not simply moving standard agency operations out onto the sidewalk. A number of specific issues are unique to the delivery of services through this type of outreach and must be considered before instituting a program of street outreach. These matters are usually addressed in an agency's street outreach program plan and include the following:

Community Outreach: Workshops and Presentations
Workshops and presentations are typical activities of community outreach. Because they usually follow lecture formats, they can be highly structured health education and risk reduction intervention efforts. While they supply important opportunities to disseminate HIV/AIDS prevention information, their impact on behavior change is limited because they are usually single-encounter experiences. Although they provide crucial technical information that raises awareness and increases knowledge and may be a critical first step in the change process, the information alone is usually inadequate to sustain behavior change.

To maximize their benefit, workshops and presentations should be planned carefully with knowledge goals and objectives specified before the individual sessions. To the extent possible, presenters should be informed about the setting where the workshop or presentation will take place, as well as the composition and knowledge level of the anticipated audience. The following are examples of issues the presenter might consider before conducting a presentation or workshop:

A well-planned, detailed outline, which allows flexibility, can prove useful and beneficial to the presenter and the participants/audience. Such an outline helps keep the presentation on track and focused. If a pretest evaluation is to be used, an outline can ensure that all relevant material will be covered in the lecture.

In a workshop or presentation, audience participation is to be strongly encouraged. Time must be allotted, usually at the end of the presentation, for a question and answer session. However, some questions may be so pressing, or some participants so persistent, that the presenter will have to address some questions and concerns during the presentation. The presenter should answer the questions succinctly and return to the original order of the presentation.

To increase the number of workshops and presentations they are able to provide, some agencies will elect to develop speaker's bureaus to augment their paid staff. Recruitment, training, and retention of volunteers present complex programmatic questions and are not to be undertaken lightly. Several references related to volunteers are provided at the end of this document and should be reviewed carefully.

A more detailed list of important points to consider for workshops and presentations is contained in Appendix C. The points below are relevant to agencies providing workshops and presentations either by paid staff or by volunteers in a speaker's bureaus. Effective presenters:

A few items specifically needed in a Community Outreach Program Plan are listed below.

Peer Educators
Agencies that provide street and community outreach will frequently engage peer educators to conduct intervention activities. Peer education implies a role-model method of education in which trained, self-identified members of the client population provide HIV/AIDS education to their behavioral peers. This method provides an opportunity for individuals to perceive themselves as empowered by helping persons in their communities and social networks, thus supporting their own health enhancing practices. At the same time, the use of peer educators sustains intervention efforts in the community long after the professional service providers are gone.

Effective peer educators:

Peer education can be very powerful, if it is applied appropriately. The peer educator not only teaches a desired risk reduction practice but s/he also models it. Peer educators demonstrate behaviors that can influence the community norms in order to promote HIV/AIDS risk reduction within their networks. They are better able to inspire and encourage their peers to adopt health seeking behaviors because they are able to share common weaknesses, strengths, and experiences.

Agencies often recruit and train peer educators from among their client populations. However, not everyone is an educator. The model client does not necessarily make the model teacher, no matter how consistently s/he practices HIV/AIDS risk reduction or is liked by agency staff. Peer educators should be instinctive communicators. They should be empathetic and non-judgmental. They should also be committed to client confidentiality.

Peer educators will not replace an agency's professional health educators, but they can complement the intervention team and enhance intervention efforts. Peer educators may act as support group leaders or street outreach volunteers who distribute materials to friends. They may be members of an agency's speaker's bureau and give workshop presentations.

They may run shooting galleries, keeping bleach and clean water readily available to other (IDUs). They may be at-risk adolescents who model responsible sexual behaviors. The role of the peer educator is determined by the intervention need of the client population and the skill of the peer educator.

Although some agencies will hire peer educators as paid staff, others will not. As in the case of speaker's bureaus, engaging volunteer peer educators also involves issues of volunteer recruitment, training, and retention. Several references in the list of publications included at the end of this document provide more information on this issue. In addition to the core elements identified for health education and risk reduction activities, an effective peer education program plan contains the following:

Risk Reduction Counseling

The purpose of risk reduction counseling is to provide counseling and health education interventions to persons who are at high risk for HIV infection. The interventions promote and reinforce safe behavior. The participants may range from a single individual to couples, families, groups, or entire communities.

Risk reduction counseling is interactive. Such counseling assists clients in building the skills and abilities to implement behavior change. These programs offer training in the interpersonal skills needed to negotiate and sustain appropriate behavior changes. For example, sessions could concentrate on delaying the initiation of sexual activity, on methods for avoiding unsafe sex and negotiating safer sex, and on techniques to avoid sharing injecting drug paraphernalia. Risk reduction may be implemented in a variety of formats. The interventions may take the form of role plays, safer sex games, small group discussion, individual counseling, or group counseling.

Effective risk reduction counseling sessions:

Risk Reduction Program Plans
An effective risk reduction program plan includes the following:

Conducting Groups
Groups can provide significant informational and therapeutic HIV risk reduction interventions to individuals who are ready to initiate and/or maintain specific health promoting behaviors. Groups are usually formed around common issues or problems. Some groups, originally established to provide information and skills training, may evolve into support groups, which encourage maintenance of newly acquired behaviors. Utilizing groups suggests a systems approach to intervention. Groups provide access to social networks that enable and reinforce health enhancing behavior change through peer modeling and peer support.

Although open-ended groups (e.g., support groups) may have less structure than the more close-ended kinds of groups (e.g., educational or skills-building), both types should have clearly defined goals/objectives and specifically defined processes. The structure of a group should be determined based upon the needs of the members.

At times, the open-ended group with its open enrollment and extended life is more suited to members' needs. By being open-ended, potential members are able to drop in when they need to and thus avoid the wait for new groups to form. This type of group is likely to appeal to the individual whose commitment to the group's process is initially limited. In the open-ended group, members determine their own topic of discussion at each meeting. For this reason, an open-ended model, that encourages drop-ins, is perhaps less amenable to instructional sessions which usually need to build on information presented at earlier meetings. The open model, because of its unpredictable structure and enrollment, may be more amenable to process evaluation (i.e., percentage of agency's clients attending a determined number of sessions).

The close-ended model will have a defined lifespan and is also likely to set membership limits. The closed group allows for important continuity and facilitating the development of trust among members, as they get to know each other over time. Members can expect the same individuals to be present each week, which can aid in building significant, supportive relationships. The closed group model is more suitable to the establishment of client-specific outcome objectives that can be monitored over time (i.e., self-reported reduction in number of sex partners at the end of 8 weeks of group attendance).

There are significant advantages to both open and closed models, and determination of which model to employ is based on the needs of an agency's clients and on an agency's capacity to implement the model. Whatever the model selected, the size of the group is an important consideration. Group facilitation is not crowd control. Smaller groups can be more manageable and result in enhanced group dynamics.

Group facilitators or instructors may be peers or professionals; in some instances, they may be both. They should be skilled at promoting effective group dynamics, encouraging reticent members to speak up and guiding the dominant ones. Skilled facilitators and instructors are astute observers. They not only listen to what is being said, but they also note nonverbal cues. Good observation skills are especially critical for support or therapeutic group facilitators. Skilled facilitators and instructors are able to see changes in body language, hear sighs, and catch subtle changes in facial expressions.

Groups are a naturally occurring phenomenon. People come together for a variety of reasons and left to themselves, they will develop informal but powerful supportive networks. Proactive HIV risk reduction programs can tap into this resource and enhance program effectiveness.

HIV Prevention Case Management

HIV Prevention Case Management (PCM) is a one-on-one client service designed to assist both uninfected persons and those living with HIV. PCM provides intensive, individualized support and prevention counseling to assist persons to remain seronegative or to reduce the risk for HIV transmission to others by those who are seropositive. PCM is intended for persons who are having or who are likely to have difficulty initiating and sustaining safer behavior. The client's participation is always voluntary, and services are provided with the client's informed consent.

Prevention Case Management involves the assessment of HIV risk behavior and the assessment of other psychosocial and health service needs in order to provide risk reduction counseling and to assure psychosocial and medical referrals, such as housing, drug treatment, and other health and social services. PCM provides an ongoing, sustained relationship with the client in order to assure multiple-session HIV risk reduction counseling and access to service referrals. PCM should not duplicate Ryan White CARE Act case management services for persons living with HIV.

Case managers work with clients to assess their HIV risk and psychosocial and medical needs, develop a plan for meeting those needs, facilitate the implementation of the PCM plan through referral and follow-up, provide ongoing HIV risk-reduction counseling, and advocate on behalf of the client to obtain services. HIV Prevention Case Management creates bridges to assist clients in obtaining services with which they are unfamiliar or that pose special barriers to access. Clients are active participants in developing their PCM plan for risk reduction. Prevention Case Management may be carried out in a variety of settings, including the client's home, a community-based organization's office or storefront, clinics, or institutional settings.

Referral services may include HIV counseling and testing services (CT), psychosocial assessment and care, other HIV health education and risk reduction programs, medical evaluation and treatment, legal assistance, substance abuse treatment, crisis intervention, and housing and food assistance. Additionally, HIV PCM services should assist the client in obtaining STD prevention and treatment services, women's health services, TB testing and treatment, and other primary health care services. A strong relationship with STD clinics, TB testing sites, HIV counseling and testing clinics, and other health service agencies may be extremely beneficial to successfully recruiting persons at high risk who are appropriate for this type of intervention. PCM services are not intended as substitutes for medical case management, extended social services, or long-term psychological care.

The case manager needs a thorough knowledge of available community social and medical services as well as HIV prevention, treatment, and related services. This includes specific knowledge of the scope of services available, the protocol for accessing these services, and contact persons working with local agencies. Case managers are usually skilled in providing individual or couples' HIV risk-reduction counseling on an ongoing basis. Case managers usually have an academic background or special training in psychosocial assessment and counseling (e.g., social work, drug and alcohol treatment counseling, nursing, health education). Prevention Case Management supervisors need the academic training and/or experience to adequately develop PCM protocols, case documentation, and policies. The following provides further information on counseling and testing issues: HIV Counseling, Testing, and Referral: Standards and Guidelines, U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, May 1994.

Staff Characteristics of the Prevention Case Manager
Effective case managers are:

Additionally, case managers:

Characteristics of the Prevention Case Management Program Plan:

PCM staff training plans usually include the following:

Community Level Intervention

Community Level Intervention combines community organization and social marketing -- a strategy that takes a systems approach. Its foundation is an assumption that individuals make up large and small social networks or systems. Within these social networks or systems, individuals acquire information, form attitudes, and develop beliefs. Also, within these networks, individuals acquire skills and practice behaviors.

The fundamental program goal of Community Level Intervention is to influence specific behaviors by using social networks to consistently deliver HIV risk reduction interventions. Although the intervention strategy is community-based, Community Level Interventions target specific populations -- not simply the community in general. The client populations have identified shared risk behaviors for HIV infection and also may be defined by race, ethnicity, gender, or sexual orientation.

In order to influence norms that support HIV risk reduction behavior, Community Level Interventions are directed at the population, rather than at the individual. The primary goal of these interventions is to improve health status by promoting healthy behaviors and changing those factors that negatively affect the health of a community's residents. A specific intervention may take the form of persuasive behavior change messages, or it may be a skills-building effort. Whatever its form, an intervention achieves reduced HIV risk by changing group norms to improve or enhance the quality of health for members of the client population. These norms may relate to condom use, contraceptive use, or needle-sharing. They may also focus on diagnosis and treatment of sexually transmitted diseases or HIV-anti

It takes time to change social norms. Social norms cannot be changed quickly or at the same rate that knowledge acquisition or skills development can occur. Change occurs as a result of sustained, consistent intervention efforts over time. The intervention must be implemented thoroughly throughout the social networks. A firm grounding in behavioral theory is essential to the development and implementation of Community Level Interventions.

Community-based needs assessment is critical to the development and implementation of Community Level Interventions. This phase is important for identifying and describing structural, environmental, behavioral, and psychological facilitators and barriers to HIV risk reduction. To successfully conduct this intervention, a program must identify the sources for and patterns of communication within a social network. Peer networks must be defined and described.

Note: Community Level Intervention is referred to as Community Intervention Programs in Program Announcement #300.

The following questions should be considered in designing community level interventions:

For further reading on the developmental steps of Community Level Intervention, see Cooperative Agreement for Human Immunodeficiency Virus (HIV) Prevention Projects Program Announcement and Notice of Availability of Funds for Fiscal Year 1993.

A variety of methods exists for collecting the answers to these questions. It is recommended that programs select the method that is most appropriate for their professional orientation (e.g., social work, health education). Whatever method is chosen, it is critical that the formative activity be community-based and as collaborative as possible with the client population.

The information gathered during the formative phase provides the foundation on which an effective program can be built. Completing this activity should result in culturally competent, developmentally appropriate, linguistically specific, and sexual-identity-sensitive interventions that promote HIV risk reduction.

Members of existing and relevant social networks can be enlisted to deliver the interventions. Other peer networks may also be created and mobilized to provide intervention services. This, of course, means volunteer recruitment and management. Community Level Intervention strategies offer opportunities for peers to acquire skills in HIV risk reduction and, in turn, reinforce these abilities when the peers become the teachers of these same skills to others.

In this manner, Community Level Interventions become community-owned and operated; thus, they are more likely to be sustained by the community when the program activity is completed. Social norms changed in this way are likely to have a long-lasting and effective impact upon HIV risk reduction.


PUBLIC INFORMATION

The Role of Public Information in HIV/AIDS Prevention

Public information activities alone do not represent a sufficient HIV prevention strategy. However, planning and implementing effective and efficient public information programs are essential to successful HIV/AIDS prevention efforts.

As defined here, the purposes of public information programs are to:

Public information programs craft and deliver data-driven and consumer-based messages and strategies to target audiences.

The public information program standards and guidelines set forth here are based on CDC's standards for health communication.

Definitions

CDC defines health communication as a "multidisciplinary, theory-based practice designed to influence the knowledge, attitudes, beliefs, and behaviors of individuals and communities" (Roper, 1993). Sound health communication practice is based on a combination of behavioral and communication sciences, health education, and social marketing. Current practice extends beyond information dissemination to include a variety of proactive strategies addressing both individual and societal change.

A communication (public information) program is the delivery of planned messages through one or more channels to target audiences through the use of materials.

Successful public information programs share a number of basic characteristics, which include:

Well-planned and well-executed health communication in public information programs can accomplish the following:

Public information programs should use multiple approaches to motivate and involve people and communities. Using health communication methodologies, however, is not sufficient to guarantee change. Plans for creating sustained behavior change should include information/communications in combination with other prevention strategies. In this way, effective communications can significantly enable and contribute to change. For example, public information programs funded by CDC carry out parts of CDC's overall HIV prevention strategy. Consumer-influenced messages and strategies are best achieved by a systematic approach involving research, planning, implementation, evaluation, and feedback. The purpose of this section is to offer guidelines for conducting public information programs that have been developed as integral parts of an overall HIV-prevention strategy.

In addition to planning, pretesting, and evaluating public information strategies, specific components of public information programs -- producing educational materials, working with the print and broadcast media, hotlines, and special events -- are addressed here.

Planning for Public Information

To be effective, public information programs must be consistent with and supportive of broader programmatic objectives (e.g., to inform target audiences about and motivate them to use existing HIV counseling and testing services). Therefore, public information plans should be developed as one component of the comprehensive HIV prevention plan.

During the planning process, a number of key questions should be asked. The answers, which should be derived from targeted needs assessment data, will help to assure that public information efforts will support the HIV/AIDS prevention program objectives. These questions cover the following issues:

In addition to answering these key questions, an important part of the planning process is determining the short- and long-term objectives of the public information program. Objectives could include the following:

A comprehensive program could include all of these objectives. Most communities may find that they can take on one or two objectives at a time, then add to or alter their program focus as the program develops or community needs change.

Staff Training in Planning for Public Information

Staff working in public information programs should review, discuss, and receive training based upon the CDC health communication framework or a similar planning model such as that found in Making Health Communication Programs Work: A Planner's Guide. (See Resources and References p. 74).

Staff should also be familiar with methods for tracking and evaluating public information activities.

Table B1 Standards For Effective Public Information Programs

Table B2 Guidelines For Effective Public Information Programs

Channel Selection

Communication channels are the routes or methods chosen to reach the target audiences. Types of channels include mass media, interpersonal transactions, and community-based interactions. Understanding the advantages and disadvantages of communication channels can help assure the best use of each, including the coordination of mass media activities with other strategies where beneficial. Each channel has its own characteristics and advantages and disadvantages, as listed here:

MASS MEDIA (radio, television, newspapers, magazines)

Advantages:     can reach many people quickly

                can provide information

                can help change and reinforce attitudes

                can prompt an immediate action (e.g., calling toll-free
                number)

                can demonstrate the desired action

Disadvantages:  are less personal and intimate

                are less trusted by some people

                do not permit interaction

                offer limited time and space

                offer limited opportunities to communicate complex
                or controversial information alone, usually cannot
                change behavior

                can be costly

COMMUNITY CHANNELS (schools, employers, community meetings and organizations, churches/religious institutions, special events)

Advantages:     may be familiar, trusted, and influential

                may be more likely than media alone to
                motivate/support behavior change

                can reach groups of people at once

                can sometimes be inexpensive

                can offer shared experiences

Disadvantages:  can sometimes be costly

                can be time consuming

                may not provide personalized attention

INTERPERSONAL CHANNELS (e.g., hotline counselors, parents, health care providers, clergy, educators)

Advantages:     can be credible

                can permit two-way discussion

                can be motivational, influential, supportive

Disadvantages:  can be expensive

                can be time consuming

                can have limited target audience reach

Selecting the Appropriate Channel

The appropriate channel or channels for a specific project can be selected by assessing whether the channel is:

Choosing multiple channels can help combine the best traits of each and reinforce the message through repetition. For example, a major daily newspaper may reach the most people. Adding stories in a local African American newspaper may provide credibility within that community, and publicizing the hotline in these stories can help the reader get more information tailored to his or her needs.

Educational Materials

Educational materials are learning or teaching aids. They can be used to reach masses of people, to reinforce or illustrate information given in a one-on-one setting, or serve as references to remind people of information they received earlier. Materials also teach skills by providing hands-on experience or by illustrating a step-by-step approach. Effective materials can also influence attitudes and perceptions.

Development or selection of educational materials is directed by several considerations:

Choose Formats for Education/Information Materials

In selecting formats for educational and informational materials, choice should be guided by the amount and type of information to be presented, the channels to be used, and target audience preferences. For most messages, using as many different formats as appropriate will provide more options for message promotion. Commonly used formats include:

Channel: Television

Formats: Public service announcements, paid advertisements, editorials, news releases, background or question and answer (Q and A) for public affairs programs

Channel: Radio

Formats: Live announcer copy (PSAs), taped PSAs, topic ideas for call-in shows

Channel: Newspaper

Formats: News releases, editorials, letters to the editor

Channel: Outdoor
Formats: Transit ads, various sizes
Billboards, various sizes
Ads/posters for bus stop enclosures, airports

Channel: Community

Formats: Posters for beauty and barber shops, pharmacies, grocery stores, worksites
Bill inserts: shopping bag inserts or imprints, paycheck inserts Special event giveaways: calendars, fact cards, pencils, balloons, key chains
Table top or other displays for health fairs, waiting rooms, libraries, schools
Newsletter articles for community, employer, business newsletters Fotonovelas, flyers, pamphlets, coloring books for distribution through community settings

Channel: Interpersonal

Formats: Posters for physicians' offices and clinic waiting and examination rooms
Talking points, note pads for patient counseling, presentations at schools, organizations, religious institutions
Videos for classroom use

Review Available Materials

Before developing new materials, make sure that new production is necessary. If materials are available that will meet identified program needs, expense and effort can be saved. Contact the CDC National AIDS Clearinghouse (1-800-458-5231) to find out what is available.

Use the Materials Review Checklist to assess appropriateness of existing materials. (See Appendix E.)

Determine whether appropriate materials can be used or modified:

Pretest Messages and Materials

Pretesting is defined as the testing of planned public information strategies, messages, or materials before completion and release to help assure effectiveness.

Pretesting is used to help make sure that messages and materials will work. It is important to test messages and draft materials with target audiences. Also, testing with media or other "gatekeepers" is a good idea, e.g., PSA directors or others who can influence whether messages and materials are used.

Pretesting can help determine whether messages and materials are:

These factors can make a difference in whether messages or materials contribute to meeting public information objectives.

The most frequently used pretest methods include:

Specific pretest methods will vary, depending upon:

Note: Additional information about pretesting can be found in Making Health Communication Programs Work: A Planner's Guide. (See Resources and References.)

Staff Characteristics for Materials Development and Pretesting

Staff who are involved in the development of educational materials should know the attributes and limitations of the educational materials formats to be used. In addition, they should:

Training for staff materials development and pretesting should:

Using the Mass Media Effectively

The mass media is a vast and powerful sector of our society that includes television, radio, newspapers, magazines, other mass circulation print vehicles, and outdoor advertising. For HIV/AIDS prevention public information outreach, this category also can include shoppers' weeklies, newsletters published by businesses, periodicals distributed by organizations, newsletters from major employers, school/college newspapers, closed circuit television, and broadcast radio stations.

Opportunities for Messages in the Mass Media

The media offer more than news and public service announcements:

Beyond "hard" news, consider "soft" news that you help create:

For entertainment, consider:

In addition to news or public service announcements for television and radio, ask for the following:

Editorial time and space includes:

Table B3 The Character of the Media

What Makes News

Remember that you are competing with all the other news happening on a given day. Be sure that your story has something extra to offer, such as:

Note: CDC's two guides, HIV/AIDS Media Relations and HIV/AIDS Managing Issues, provide additional information for working with the mass media. Also, the National Public Health Information Coalition (NPHIC) has prepared a "hands-on" guide for handling media interviews. (See References p. 74.)

Working with the Mass Media

Involve media professionals in planning. Like many other people, they prefer to be involved from the beginning and to feel their opinions are valued, not just their access to media time and space.

Develop a media contact list. The public information office of the state health department probably can get you started. Also, guidance is provided in CDC's Media Relations guide. (See References.)

Establish relationships with the media; concentrate on those media outlets your target population is most likely to see, hear, or read. Articulate a role for media that will contribute to objectives and capture the attention of the target population; build capacity to interact effectively with the news media.

Media relations can be labor intensive. To make sure that the efforts pay off, consider the following:

To identify media strategies, consider:

Media strategies should:

Prioritize media strategies by weighing expected benefits, resources required, and how each could be "sold" to the media. Then, work first on those with the greatest potential. Use information about the public's interest in HIV/AIDS to convince the media to participate.

Assess exposure in the media:

Ways to track media efforts:

Provide media spokesperson training for staff who work with the media. Staff training should also:

Table B4 Media Idea List

Hotlines

Because many people are uncomfortable discussing subjects that involve sexual issues and behaviors, accessing a hotline for HIV/AIDS/STD information is a viable, anonymous option. However, hotlines may not be appropriate for satisfying every program need. Information generated through a needs assessment can be used to determine whether a hotline is appropriate; provide indicators for needed hours of operation, number of staff, specialty services (e.g., for Spanish-speaking, the deaf); ascertain appropriate venues for publicizing the hotline number; identify which population(s) should be targeted; and indicate specific information needs.

If the establishment of a local hotline is not a viable option, the CDC National AIDS Hotline and the CDC National STD Hotline can be publicized.

Why Establish A Hotline?

A Hotline can do the following:

Quality Assurance

A quality assurance plan should be developed as part of the process of establishing a hotline. This plan should address the following minimum requirements:

Guidelines for Establishing A Hotline

Also consider offering an auto-attendant system to operate during off-hours and weekends. Such a system can offer a menu of pre-recorded messages for callers who do not need to speak with a counselor, but who want quick and anonymous access to information.

Staff Characteristics for Hotlines

Hotlines are staffed by information specialists who may be paid personnel or volunteers, depending upon available financial resources. If volunteers are used, the organization should commit at least one paid staff person for management purposes. A paid staff member is needed to ensure consistency and continuity of services because of the high turn over of staff commonly experienced among volunteers, the need to ensure quality services, and the need to maintain consistency in the implementation of policies and procedures. The manager should maintain and regularly update a comprehensive list of HIV/AIDS/STD services and organizations. A hard copy and/or computer-based list should be used by information specialists during work hours.

Information specialists provide information over the telephone; therefore, they require unique skills and abilities. They should always be prepared for the unexpected and act accordingly.

The successful information specialist should possess the following attributes:

Once the information specialists have been recruited, they should be comprehensively trained to meet the challenges of their positions. Consider teaming new information specialists with more experienced staff until the new person is comfortable handling calls independently.

A training plan should address the following minimum requirements:

For additional information, consult the training bulletins that the CDC National AIDS Hotline distributes to state health departments and others.

Special Events

Special events such as street fairs, job fairs, health fairs, World AIDS Day activities, and local celebrations in communities sometimes can deliver public information to large numbers of people and can gain media exposure.

Community Involvement and Support

Community groups and organizations can play an important role in implementing special events. Libraries, schools, churches, businesses, or social groups provide leadership in communities and are able to pool resources and inspire citizens to join their efforts.

The types of events that can be organized are unlimited and can be as original and varied as the ideas and resources of the people organizing them. Networking can heighten the visibility of events, resulting in greater public awareness when interested persons are identified and contacted. Efforts can begin with one or more of the following types of organizations:

Creativity is an important aspect of successful special events. A number of innovative ideas have been implemented across the country. For example, The Condom Resource Center whose goal is to reduce the incidence of sexually transmitted disease, including HIV/AIDS infection, sponsors a yearly event entitled "National Condom Week." (See References for contact information.) To distribute pamphlets and condoms, information tables are set up in public areas and in more secluded locations for self-conscious people or people who are shy about sexual matters. Additional public events are staged, such as the following:

Planning Special Events


RESOURCES AND REFERENCES

The following is a list of resources and references to help guide program design and development. They are divided into subheadings of health education, materials development, public information, evaluation, and behavioral risk factors and groups at risk. These lists are starting points for literature reviews or program design on these subjects, but they are not exhaustive.

Health Education

Cataudella M, Miles T, Spicehandler D. Mainstreaming AIDS Education via Community Based Hotlines. Abstracts of the 5th International Conference on AIDS 1989;897.

Centers for Disease Control. Guidelines For AIDS Prevention Program Operations. Atlanta, GA: U.S. Department of Health and Human Services, 1987.

Model Standards for Community Preventive Health Services: A Report to the U.S. Congress from the Secretary of Health, Education, and Welfare. Atlanta, GA:1979.

Guidelines for STD Education. Atlanta, GA:1985.

NCPS AIDS Community Demonstration Projects: What We Have Learned 1985-1990. Atlanta, GA:1992.

STD '93, Sexually Transmitted Disease Prevention/Training Centers. Atlanta, GA:1993.

Fisher JD. Possible Effects of Reference Group-Based Social Influence on AIDS-Risk Behavior and AIDS Prevention. American Psychologist 1988;43(11): 914-920.

Glanz K, Lewis F, Rimer B. Health Behavior and Health Education Theory: Theory, Research, and Practice. San Francisco: Jossey-Bass, 1990.

Green LW, Kreuter MW. Health Promotion Planning: An Educational and Environmental Approach. Second Edition. Mountain View, CA: Mayfield Publishing Co., 1991.

Hunter A. The Loss of Community: An Empirical Test Through Replication. American Sociology Review 1975;40:527-552.

Montgomery SB, et al. The Health Belief Model in Understanding Compliance with Preventive Recommendations for AIDS: How Useful? AIDS Education and Prevention 1989;1(4):303-323.

National Institutes of Health. Making Health Communication Programs Work: A Planner's Guide. NIH Publication No. 89-1493. Bethesda, MD: U.S. Department of Health and Human Services, 1989.

Office of Technology Assessment. How Effective is AIDS Education? OTA Staff Paper on AIDS-Related Issues, No. 3. Washington, DC: Office of Technology Assessment, 1988.

O'Reilly K, Higgins D. AIDS Community Demonstration Projects for HIV Prevention Among Hard-To-Teach Groups. Public Health Reports 1991;106(6): 714-720.

Parcel GS, Baranowski T. Social Learning Theory and Health Education. Health Education 1981;3:14-18.

Rhodes F, Wolitski R. Effect of Instructional Videotapes on AIDS Knowledge and Attitudes. Journal of American College Health 1989;37:266-271.

Soames Job RF. Effective and Ineffective Use of Fear in Health Promotion Campaigns. American Journal of Public Health 1988;78(2):163-167.

Solomon MZ, DeJong W. Preventing AIDS and Other STDs Through Condom Promotion: A Patient Education Intervention. American Journal of Public Health 1989;79(4):453-458.

Valdiserri RO. Preventing AIDS: The Design of Effective Programs. New Brunswick: Rutgers University Press, 1989.

Valentine, Jo. Planning and Conducting Outreach Process Evaluation. Atlanta, GA: Centers for Disease Control and Prevention, Behavioral and Prevention Research Branch, Division of Sexually Transmitted Diseases and HIV Prevention, National Center for Prevention, March 1994.

Williams T, Douds J. The Unique Contribution of Telephone Therapy. Crisis Intervention and Counseling by Telephone. Springfield, IL: Charles C. Thomas, 1973:80-88.

Materials Development

Allensworth DD, Luther CR. Evaluating Printed Materials. Nurse Educator 1986;11(2):18-22.

Centers for Disease Control. Condoms for Prevention of Sexually Transmitted Diseases. MMWR 1988;37(9):133.

D'Augelli AR, Kennedy SP. An Evaluation of AIDS Prevention Brochures for University Women and Men. AIDS Education and Prevention 1989;1(2):134-140.

Doak CC, Doak LG, Root JH. Teaching Patients with Low Literacy Skills. New York: J.B. Lippincott Co., 1985.

Ford K, Norris A. Urban African-American and Hispanic Adolescents and Young Adults: Who Do They Talk to About AIDS and Condoms? What Are They Learning? AIDS Education and Prevention 1991;3(3):197-206.

Freimuth, VS. Assessing the Readability of Health Education Messages. Public Health Reports 1979;94(6):568-570.

KOBA Associates, Inc. VD Control -- A National Strategy Under Review, Information Materials and Campaigns. Final Report, Contract No. HEW-OS-72-191, 1973.

Lohr G, Ventura MR, Crosby F, Burch K, Todd K. An Experience in Designing Patient Education Materials. Journal of Nursing Staff Development 1989; 5(5):218-224.

Mohammed MF, Bucklin. Patients' Understanding of Written Health Information. Nursing Research 1964;13(2):100-108.

National Institute of Allergy and Infectious Diseases. Report of the NIAID Study Group on Integrated Behavioral Research for Prevention and Control of Sexually Transmitted Diseases. Sexually Transmitted Diseases 1990;17(4): 200-210.

National Institutes of Health. Making Health Communication Work: A Planner's Guide. NIH Publication No. 89-1493. Bethesda, MD: U.S. Department of Health and Human Services, 1989.

Pichert JW, Elam P. Readability Formulas May Mislead You. Patient Education and Counseling 1985;7(2):181-191.

Robinson J III. Criteria for the Selection and Use of Health Education Reading Materials. Health Education 1988;19(4):31-34.

Scrimshaw SCM, Carballo M, Ramos L, Blair BA. The AIDS Rapid Anthropological Assessment Procedures: A Tool for Health Education Planning and Evaluation. Health Education Quarterly 1991;18(1):111-123

Public Information

Division of Nutrition, Center for Chronic Disease and Prevention and Health Promotion. Nutrition Intervention in Chronic Disease: A Guide to Effective Programs. New rev. ed.

Atlanta, GA: Centers for Disease Control and Prevention, June, 1994. Chapter 11, The Media.

Freimuth, V. Are Mass Mediated Health Campaigns Effective? A Review of the Empirical Evidence. Bethesda, MD: National Heart, Lung, and Blood Institute, Bethesda, MD, January, 1994.

Gaining Access to Media Resources, No. HTP-5, Holding Press Conferences, No. HTP 13, Working with Media Gatekeepers, No. HTP-6, and Writing and Sending Press Releases, No. HTP-4, Health Promotion Resource Center, Stanford Center for Research in Disease Prevention, 1000 Welch Road, Palo Alto, CA 94304-1885, 415-723-0003. (fees)

Hartman, NS. The Media and You, A Basic Survival Guide. National Public Health Information Coalition. Available from Jim McVay, Director, Health Promotion and Information, 434 Monroe Street, Montgomery, AL 36130-3017. Cost $5.00

National AIDS Information and Education Program. HIV/AIDS Managing Issues, July 1994, Atlanta, GA: Centers for Disease Control and Prevention.

National AIDS Information and Education Program. HIV/AIDS Media Relations. MS-F 59, Atlanta, GA: Centers for Disease Control and Prevention, July 1995.

National Institutes of Health. Making Health Communication Programs Work, A Planner's Guide. Washington, DC: U.S. Department of Health and Human Services, April 1992.

New York State Healthy Heart Program, New York State Department of Health. How to Conduct Special Events. January 1993, Albany, NY.

Roper, W. Health Communication Takes on New Perspectives at CDC. Public Health Reports 1993;108(2):179-183.

The Roper Center for Public Opinion Research. The Roper Center collects and stores public opinion data (e.g., knowledge, attitudes, and some behaviors or behavioral intentions) collected by a number of survey organizations. Contact: 203-486-4440; PO Box 440, Storrs, CT 06268.

Wallack L, Dorfman L, Jernigan D, Themba M, eds. Media Advocacy and Public Health, Power for Prevention. Newbury Park, CA: Sage Publication, 1993. (fee)

American Social Health Association
919-361-8400

CDC National AIDS Clearinghouse
1-800-458-5231

National Association of People With AIDS
202-898-0414
1413 K Street, N.W., 10th Floor
Washington, DC 20005

The Condom Resource Center
510-891-0455

Look for media resource guides in your public library, including:

Broadcasting Yearbook
Broadcasting Cable Sourcebook
Television Factbook
Ayer's and Bacon's Directories

Evaluation

Academy for Educational Development. Handbook for HIV Prevention Community Planning. Washington, DC: Academy for Educational Development. April 1994.

Coyle SL, Boruch RF, Turner CF, Eds. Evaluating AIDS Prevention Programs. Washington, DC: National Research Council, National Academy Press, 1989.

D'Augelli AR, Kennedy SP. An Evaluation of AIDS Prevention Brochures for University Women and Men. AIDS Education and Prevention 1989;1(2):134-140.

Kelly JA, et al. HIV Risk Behavior Reduction Following Intervention with Key Opinion Leaders of Population: An Experimental Analysis. American Journal of Public Health 1991;81(2):168.

Kirby D, Harvey PD, Claussenius D, Novar M. A Direct Mailing to Teenage Males About Condom Use: Its Impact on Knowledge, Attitudes and Sexual Behavior. Family Planning Perspectives 1989;21(1):12-18.

Kroger F, Yarber WL. STD Content in School Health Textbooks: An Evaluation Using the Worth Assessment Procedure. Journal of School Health 1984;54(1):41-44.

National Center for Prevention Services. Planning and Evaluating HIV/AIDS Prevention Programs in State and Local Health Departments: A Companion Guide to Program Announcement #300. Atlanta, GA: Centers for Disease Control and Prevention, August 1993.

National Institute of Allergy and Infectious Diseases. Report of the NIAID Study Group on Integrated Behavioral Research for Prevention and Control of Sexually Transmitted Diseases. Sexually Transmitted Diseases 1990;17(4): 200-210.

Robinson J III. Criteria for the Selection and Use of Health Education Reading Materials. Health Education 1988;19(4):31-34.

Rugg DL, et al. AIDS Prevention Evaluation: Conceptual and Methodological Issues. Evaluation and Program Planning 1990;13:79-89.

Rugg DL. Evaluating AIDS Prevention Programs. Focus 1990;5(3):1-2.

Scrimshaw SCM, Carballo M, Ramos L, Blair BA. The AIDS Rapid Anthropological Assessment Procedures: A Tool for Health Education Planning and Evaluation. Health Education Quarterly 1991;18(1):111-123.

The United States Conference of Mayors. Evaluation for HIV/AIDS Prevention Programs: Gathering Evidence to Demonstrate Results. Washington, DC: U.S. Conference of Mayors, December 1990.

Valentine, Jo. Planning and Conducting Street Outreach Process Evaluation. Atlanta, GA: Centers for Disease Control and Prevention, Behavioral and Prevention Research Branch, Division of Sexually Transmitted Diseases and HIV Prevention, National Center for Prevention Services, March 1994.

Zimet GD, et al. Adolescent's Knowledge and Beliefs About AIDS: Did the Government Brochure Help? American Journal of Diseases of Children 1989; 143(5):518.

Behavioral Risk Factors and Groups at Risk

Aral SO, Soskoline V, Joesoef RM, O'Reilly KR. Sex Partner Recruitment as Risk Factor for STD: Clustering of Risky Modes. Sexually Transmitted Diseases 1991;18(1):10-17.

Cates W. Teenagers and Sexual Risk Taking: The Best of Times and the Worst of Times. Journal of Adolescent Health 1991;12(2):84-94.

Cooper F, Bye L. AIDS Education Programs for Teenagers: Factors that Influence Behavior Change. Educator 1989;Summer:4-8.

Dawson DA, Hardy AM. National Center for Health Statistics. AIDS Knowledge and Attitudes of Hispanic Americans: Provisional Data From the 1988 National Health Interview Survey. Advance Data, Washington, DC: US Department of Health and Human Services, 1989;No.166.

DesJarlais DC, Friedman SR. The Psychology of Preventing AIDS Among Intravenous Drug Users, A Social Learning Conceptualization. American Psychologist 1988;43(11):865-870.

Kegeles SM, Adler NE, Irwin Jr. CE. Adolescents and Condoms: Associations of Beliefs With Intentions to Use. American Journal of Diseases of Children 1989;143:911-915.

Kelly JA et al. Situational Factors Associated with AIDS Risk Behavior Lapses and Coping Strategies Used by Gay Men Who Successfully Avoid Lapses. American Journal of Public Health 1991;81:1335.

Magura S et al. Correlates of Participation in AIDS Education and HIV Antibody Testing by Methadone Patients. Public Health Reports 1989;104(3): 231-240.

Magura S et al. Determinants of Needle Sharing Among Intravenous Drug Users. American Journal of Public Health 1989;79(4):459-461.

Marin G, Van Oss Marin B. Perceived Credibility of Channels and Sources of AIDS Information Among Hispanics. AIDS Education and Prevention 1990;2(2): 154-161.

Marx, R et al. Crack, Sex, and STD. Sexually Transmitted Diseases 1991;18(2):92-101.

National Institute of Allergy and Infectious Diseases. Report of the NIAID Study Group on Integrated Behavioral Research for Prevention and Control of Sexually Transmitted Diseases. Sexually Transmitted Diseases 1990;17(4):200-210.

National Institute on Drug Abuse. Community-Based AIDS Prevention: Studies of Intravenous Drug Users and Their Sexual Partners. Rockville, MD: U.S. Department of Health and Human Services, 1991.

Rickert VI, Jay MS, Gottlieb A. Effects of a Peer-Counseled AIDS Education Program on Knowledge, Attitudes, and Satisfaction of Adolescents. Journal of Adolescent Health 1991; 12(1):38-43.

Rotheram-Borus MJ, Koopman C. Sexual Risk Behaviors, AIDS Knowledge, and Beliefs About AIDS Among Runaways. American Journal of Public Health 1991;81(2):208-210.

Rotheram-Borus MJ, Koopman C, Haignere C, Davies M. Reducing HIV Sexual Risk Behaviors Among Runaway Adolescents. Journal of the American Medical Association 1991;266(9):1237-1241.

Stall RD et al. Behavioral Risk-reduction for HIV Infection Among Gay and Bisexual Men: A Review of Results From the United States. American Psychologist 1988;43(11):878-885.

Sullivan C. Pathways to Infection: AIDS Vulnerability Among the Navaho. AIDS 1991;3:241.

Valdiserri RO, Arena VC, Proctor D, Bonati FA. The Relationship Between Women's Attitudes About Condoms and Their Use: Implications for Condom Promotion Programs. American Journal of Public Health 1989;79(4):499-501.

de Zalduondo BO. Prostitution Viewed Cross-Culturally: Toward Recontextualizing Sex Work in AIDS Intervention Research. Journal of Sex Research 1991;28(2):223-248.

Zimet GD et al. Adolescent's Knowledge and Beliefs About AIDS: Did the Government Brochure Help? American Journal of Diseases of Children 1989;143(5):518.


APPENDICES

Appendix A - Street Outreach Activity Report

Example of Completed Form

Table A1 Street Outreach Activity Report

Appendix B - Program Assessment Form - Street and Community Outreach

                            QUALITY ASSURANCE

Table A2 PROGRAM ASSESSMENT FORM - STREET AND COMMUNITY OUTREACH

Appendix C - Program Assessment Form - Community Educator

                            QUALITY ASSURANCE

Table A3 PROGRAM ASSESSMENT FORM - COMMUNITY EDUCATOR


Appendix D - Program Assessment Form - Support Group Facilitator

                             QUALITY ASSURANCE

Table A4 PROGRAM ASSESSMENT FORM - SUPPORT GROUP FACILITATOR

Appendix E - Material Review Checklist

                             QUALITY ASSURANCE

Table A5 MATERIAL REVIEW CHECKLIST

* Note: A written release should be obtained from all persons pictured. The release should clearly state permission to use the photograph and the conditions for use.

Appendix F - HIV Prevention Case Management (PCM) Checklist

                            QUALITY ASSURANCE

Table A6 HIV PREVENTION CASE MANAGEMENT (PCM) CHECKLIST

Appendix G - Sample Educational Materials

Table A7 "Cleaning Your Needles" Pamphlet

Table A8 "Teens and AIDS" Video


GLOSSARY

GLOSSARY OF TERMS USED IN HIV/AIDS HEALTH EDUCATION AND RISK REDUCTION ACTIVITIES

  1. COMMUNICATION CHANNELS
    Routes or methods selected to reach target audiences with HIV/AIDS information. Types of channels include mass media, interpersonal transactions, and community-based interactions.
  2. COMMUNITIES
    Social units that are at least one of the following: functional spatial units meeting basic needs for sustenance, units of patterned social interaction, or symbolic units of collective identity.
  3. COMMUNITY THEATER
    Local community theatrical presentations used to provide HIV/AIDS awareness and educational interventions that are developed, casted by, and targeted toward school-age youth.
  4. CULTURAL COMPETENCY
    Having the capacity and skills to function effectively in environments that are culturally diverse and are composed of distinct elements and qualities. Cultural competence begins with the STD/HIV professional understanding and respecting cultural differences and realizing that the client's culture affects his/her beliefs, perceptions, attitudes, and behaviors.
  5. DEVELOPMENTALLY APPROPRIATE
    Material developed at a level that is consistent with the learning skills of the person served so as to ensure comprehension.
  6. DISTRIBUTION OF BLEACH
    The distribution of bleach is the handing out of free, small bottles of bleach for the purpose of cleaning injecting drug use needles and syringes. Bleach is usually distributed as part of outreach to injecting drug users. Needle cleaning instruction labels are usually put on the bleach bottles. Outreach staff are usually involved in filling and labeling bleach bottles. Other materials distributed to IDUs include bottle caps for cookers, cotton, alcohol wipes, and bottles of water for rinsing needles.
  7. CONDOM DISTRIBUTION
    The distribution of condoms is the handing out of free condoms as part of an HIV/AIDS educational intervention. Condoms and literature with instructions on proper use may also be distributed as an item in safer sex kits.
  8. HOTLINE
    Telephone service (local or toll-free) offering up-to-date information on HIV/AIDS and referral to related local services, e.g., counseling/testing and support groups. Hotlines may receive crisis calls; however, the intent is usually to provide information and referral.
  9. LINGUISTICALLY SPECIFIC
    Dialect and terminology consistent with the target population's native language and style of communication.
  10. MASS MEDIA
    Means by which information is conveyed to large groups of people; generally includes television, radio and print. These mass media are often used to disseminate information about HIV/AIDS and its impact on the local community.
    The use of broadcast or print media for the dissemination of information about HIV/AIDS and its impact on the local community.
  11. PAID ADVERTISING (TV, RADIO, PRINT)
    Paying for the placement of advertisements/announcements/information on radio, TV, newspapers, magazines, billboards, and bus cards/bus shelters.
  12. PEER EDUCATION
    Peer education is HIV/AIDS education provided by trained, self-identifie Peer educators usually serve as role models, demonstrating to their peers behaviors that promote risk-reduction.
  13. PEER SUPPORT COUNSELING
    Individual or group support counseling sessions facilitated by a trained, self-identified member of the target group, population, or community, i.e., a peer outreach educator.
  14. PRETESTING
    Testing of planned public information strategies, messages, or materials before completion and release to help assure effectiveness.
  15. PROFESSIONAL TRAINING
    HIV/AIDS training (lectures in basic AIDS facts, counseling and testing training, and AIDS updates/seminars/forums/workshops) provided usually for health, education, and social service professionals in the community, e.g., nurses, doctors, counselors, social workers, teachers, and law enforcement officers.
  16. PUBLIC INFORMATION
    HIV/AIDS prevention activities directed to target audiences that are designed to build general support for safe behavior, support personal risk-reduction efforts, and/or inform persons at risk of infection how to obtain specific services.
  17. RISK-REDUCTION COUNSELING
    Individual or group counseling sessions focusing on behavior change activities, such as safer sex practices, proper condom use and demonstration, and needle cleaning. Usually conducted by trained AIDS health educators/counselors. Trained peer outreach educators may also conduct risk-reduction counseling with their peers in or out of an office setting, e.g., as part of street outreach.
  18. SPEAKERS BUREAU
    A group of volunteers who have been trained to provide basic HIV/AIDS educational presentations usually targeted toward community social, cultural, and educational groups. In addition, presentations may be given in other settings where persons at high risk for infection can be reached, such as homeless shelters or juvenile detention centers. These presentations are intended to raise AIDS awareness in the community.
  19. SPECIAL EVENTS
    HIV/AIDS outreach/educational activities conducted at community events such as street fairs, job/health fairs, and local community celebrations, e.g., Black History Month, Cinco de Mayo, and Gay and Lesbian Pride Day.
  20. STREET OUTREACH
    HIV/AIDS educational interventions generally conducted by peer outreach educators on the street, face-to-face with high-risk individuals. The handing out of condoms, bleach, sexual responsibility kits, and educational materials, e.g., safer sex cards and pamphlets, is usually done as part of street outreach targeted at high-risk groups.
  21. WORKSHOP PRESENTATIONS
    HIV/AIDS educational sessions in which a speaker presents information to an audience. Depending on the audience, presentations may be given by HIV/AIDS health educators, peer outreach educators, or trained volunteers. Workshop presentations represent the most structured health education and risk reduction intervention efforts. However, their impact is limited because they are single-encounter experiences. These presentations provide technical information that could initiate the changing of norms or individual behavior.

POINT OF CONTACT FOR THIS DOCUMENT:

To request a copy of this document or for questions concerning this document, please contact the person or office listed below. If requesting a document, please specify the complete name of the document as well as the address to which you would like it mailed. Note that if a name is listed with the address below, you may wish to contact this person via CDC WONDER/PC e-mail.

DIVISION OF SEXUALLY TRANSMITTED DISEASE PREVENTION


Table Fig1

                                    Figure 1
                              Field Safety Protocol

Field safety protocols are based on program activities and are intended to provide the staff
and peer educators with guidance regarding their professional behavior.

  -  Carry picture identification (I.D.) at all times that includes name of the
     organization, name of the project, your name, and the purpose for your
     presence.

  -  Work in pairs and always know where your partner is.

  -  Establish a mechanism to keep your supervisor aware of your location and
     activities (e.g., carry a beeper, call telephone mailbox at a specified time).

  -  Establish contact with local police precincts in the area.  Leave copy of I.D.
     with the commander.  If appropriate for your program, maintain relations with
     the police; introduce the program and staff.

  -  Have contingency plans for worst case scenarios and share them with your
     partner.

  -  Make sure you have made contact with and have permission from a key person
     in the community before entering the setting in which you will conduct the
     intervention (e.g., shooting galleries, crack houses, or local high schools).

  -  Leave the area if tension or violence is observed or perceived.

  -  Avoid controversy and debate with clients and program participants.

  -  When you start your job as a peer educator in the field, get a TB skin test; you
     should be re-tested periodically thereafter.

  -  Be aware of weather conditions and be prepared for natural occurrences.

  -  Design and adhere to a schedule for outreach or peer education.

  -  Avoid drinking alcoholic beverages and buying, receiving, or sampling drugs
     while conducting outreach or peer education.



Table Fig2

                                     Figure 2
                       EXAMPLE OF WEEKLY OUTREACH SCHEDULE

              8 a.m.- 12 noon    1-5 p.m.            6-8 p.m.

MONDAY        no activity        no activity         no activity


TUESDAY       office             homeless shelter    methadone
              staff meeting      IDU outreach        clinic
                                                     client presentation

WEDNESDAY     STD clinic         city park           no activity
              waiting room       IDU outreach

THURSDAY      office             street work         no activity
              paperwork and      10th and Vine
              data analysis      IDU outreach

FRIDAY        office             motel alley         shooting
              materials          sex worker/IDU      gallery
              development        outreach            outreach

SATURDAY      no activity        city park           street work
                                 IDU outreach        10th and Vine
                                                     IDU outreach

SUNDAY        no activity        no activity         no activity


Table B1

               Standards For Effective Public Information Programs

Public information activities must support other components of health education and
risk reduction activities.

Target audiences for public information activities must be selected, based on needs
identified through the community needs assessment.

Objectives for public information must be based on a realistic assessment of what
communications can be expected to contribute to prevention.

Messages must be based on the target audience's values, needs, and interests.

Messages and materials must be pretested with the target audience to assure
understanding and relevance to their needs and interests.

Community representatives must be involved in planning and developing public
information activities to ensure community "buy in."


Table B2

               Guidelines For Effective Public Information Programs

Commit adequate time, effort, and resources to communication planning and
pretesting.

Review existing market research on the target audience to understand what will
motivate them.  (Conduct new research only when necessary.)

Make sure that messages and materials appear where the target audience will pay
attention to them.

Produce/tag existing public service announcements (PSAs) that are of high production
quality, community-specific, marketed to stations, and targeted to audiences likely to
see them when public service air time is available (such as "fringe" viewing times).

Combine PSAs with news and other uses of the mass media to increase exposure to
prevention issues.

Use a combination of the mass media and community channels that will reach the
target audience.

Work collaboratively with other organizations and/or community sectors that have
complementary strengths.  Begin to coordinate as early as possible in program
planning.

Use a two-pronged communication strategy to focus both on what an individual should
do and on factors that help enable individual change such as peer approval and
community support.

Track progress and identify when and what kind of changes are needed in public
information activities.

Set reasonable, short-term public information objectives to reach the long-term goal.
Then, commit to public information as one program component over the long term.
(Remember that "one-shot" public information campaigns are unlikely to leave a
lasting effect, and that progress toward prevention goals is incremental.)

Table B3

The Character of the Media

In general,

   Television--

     -  reaches the most and broadest range of people
     -  is not as targeted as other media channels
     -  covers issues in very short segments
     -  conveys human interest and personal stories well
     -  might have calendars of events

   Radio--

     -  stations have more narrowly defined listeners (e.g., older teens, young adults, and drivers) and
        can target more discretely
     -  can be cheaper to work with than television (e.g., can use announcer copy public service
        announcements)
     -  call-in shows offer opportunities for two-way exchange
     -  may have more frequent news coverage than other media
     -  covers issues in very short segments (e.g., 10-second sound bytes)
     -  may produce public service announcements if they perceive that there is a local interest

   Newspapers/Magazines--

    -   offer space to explain in more detail
    -   can be re-read, encouraging discussion
    -   are less emotional media than radio/television
    -   are more likely to have calendars of events
    -   may have a narrow target audience (e.g., a local Spanish-language newspaper)

   Outdoor Media--

    -   include billboards, transit advertising (in subways and bus stops, on buses and taxis)
    -   are generally used for advertising
    -   are good for "at-a-glance" reminders
    -   in some cases (inside buses) might "capture" the viewer long enough to absorb a longer message
    -   can use locations to target your audience, based on where they live or work
    -   may offer public service space

From "Working with the Media" in Nutrition Intervention in Chronic Disease: A Guide to Effective
Programs.

Table B4

                                 Media Idea List

     -  Introduce a new activity with a media breakfast.
     -  Promote participation in an activity or event.
     -  Take pictures at events, recognition ceremonies, presentations--use them to help
        place stories in local newspapers or organizational newsletters.
     -  Announce personnel changes, celebrity involvement.
     -  Recruit volunteers or program participants.
     -  Announce grant awards or major contributions.
     -  Invite the media to any celebrations or recognition ceremonies.
     -  Tie events or information to the calendar--holidays, annual HIV/health-related
        days, weeks, or months.
     -  Make statements on HIV-related public policies.
     -  Highlight local aspects of national stories.
     -  Weave media coverage (a video, audio excerpt, a slide of print coverage) into
        community presentations.
     -  Report results from an intervention or activity.
     -  Communicate a message that will reinforce community intervention topics.
     -  Promote CDC PSAs to local stations, with local tags.
     -  Produce a series of articles or broadcast news or feature segments on the topic in
        partnership with the media.
     -  Send a four-color postcard with live announcer copy for a PSA to radio stations.
     -  Produce a Q and A column or quiz for community newspapers.
     -  Seek coverage for events.
     -  Conduct a yearly campaign lasting for 3 to 4 weeks featuring activities such as
        posters or displays in the community.
     -  Seek in-kind help, such as art work, video dubbing, and PSA and slide production
        to entice a media outlet into becoming a program sponsor.
     -  Produce articles for constituent, trade, or employee newsletters.
     -  Write letters to the editor, op eds (a page of special features usually opposite the
        editorial page), articles, or guest editorials to promote your topic through another
        angle.
     -  Promote activities through media calendars of events.
     -  Produce a PSA or feature production (such as a call-in) on cable television, public
        broadcasting (PBS) channels, university radio/television departments (perhaps as a
        class project).
     -  Develop a newspaper supplement on HIV/AIDS.  The newspaper advertising
        department can help you develop it and locate businesses to advertise.
     -  Identify, duplicate, and tag with your program identification any PSA developed
        elsewhere (with permission).
     -  Meet with a newspaper editorial board. Tell them about your issue, related
        community needs, and your position; urge them to take a stand and give you
        coverage.

Table A1

                          Street Outreach Activity Report


MSM's Client                                Group4/22/92 Date
-----                                            -------

Southside Location                            A.M.X P.M.  Evening
                                            -     -     -
35        Total # of Contacts               AMR/JAV Team
---------                                   -------

Demographics of Contacts

30  # Male   5   # Female
---          ---
21  # African American   9   # Latino   1   # White   2   # Native American
---                      ---            ---           ---
 2  # Asian/ Pacific Islander   0   Other
---                             ---

Materials Distributed To Individuals        Referrals for Services

105      # of Condoms Distributed           3     # STD Clinic
--------                                    -----
2        # of Bleach Kits Distributed             # HIV C/T Site
--------                                    -----
35       # of Safer Sex Kits Distributed    0     # TB Clinic
--------                                    -----
29       # of Brochures Distributed         3     # Drug Treatment
--------                                    -----
1        # of Other poster                  0     # Family Planning
--------                                    -----

                           Materials Drop-off Sites

Type of Site:                               Materials Distributed:

Al's Place (bar)                            100 condoms, 200 brochures,
----------------                            ---------------------------
                                                  1 poster
                                                  --------
Midtown Adult Book Store                    200 condoms, 200 safer sex  cards
------------------------                    ---------------------------------
St. Mary's Homeless Shelter                 2 posters, 100 condoms, 50 bleach kits
---------------------------                 --------------------------------------
Hair Unlimited (beauty shop)                100 condoms, 50 brochures, 2 posters
----------------------------                ------------------------------------



Table A2

                                       QUALITY ASSURANCE

                                    PROGRAM ASSESSMENT FORM
                                 STREET AND COMMUNITY OUTREACH


OUTREACH SPECIALIST: ______________________

REVIEWER: ______________________

DATE: _____________

DIRECTIONS:  Check the appropriate columns to indicate degree to which the outreach
specialist met criteria:

              EXCELLENT  indicates that performance met criteria beyond fully successful.

              FULLY SUCCESSFUL  indicates performance met criteria successfully.

              NEEDS ATTN  indicates performance needs supervisory guidance to meet criteria.

              N/A  indicates this criteria did not apply to this situation.


Check only within and not between the boxes.  If undecided, use "comments" section to clarify.

                                                                                    EXCELLENT   FULLY        NEEDS       N/A
                                                                                                SUCCESSFUL   ATTN
----------------------------------------------------------------------------------------------------------------------------
 STAFF

 1.  Staff respects client's privacy and confidentiality at all times.

 2.  Staff is trained and experienced in health education.

 3.  Staff is sensitive to community norms, values, cultural beliefs, and
     traditions.

 4.  Staff advocates for the population served.

 5.  Staff acts as liaison between the community and agency.

 6.  Staff is representative of the population served.

 7.  Staff is informed about community resources and is able to use them.

     COMMENTS:

----------------------------------------------------------------------------------------------------------------------------
 PROGRAM

 1.  Program proposes realistic, measurable, and attainable goals and objectives.

 2.  Program identifies specific methodologies and activities t achieve stated
     goals and objectives.

 3.  Program defines target population by geographic locale, risk behavior(s),
     gender, sexual orientation, and race  and ethnicity.

 4.  Program ensures adequate supplies of appropriate and relevant risk-
     reduction materials before conducting outreach activities (e.g., pamphlets,
     condoms, bleach, sexual responsibility kits).

 5.  Program includes observation of potential outreach areas to determine the
     locations, times of day, and the day of the week that are most productive for
     reaching the population to be served.

 6.  Program has regular and consistent hours for outreach activities.

 7.  Program facilitates professional development of progral staff.

 8.  Program has a comprehensive and written field safety protocol.

 9.  Program has a written policy and personnel procedures to address stress,
     burn-out, and relapse among staff.

 10. Program has written procedures for the referral of clients to appropriate
     services outside the agency.

 11. Program has long-range plans for the continuation of services.

 12. Program establishes and maintains a relationship between the agency and
     other local authorities.

 13. Program identifies and develops collaborative relationships with relevant
     gatekeepers (key informants) to the target population.

 14. Program coordinates intervention services with identified gate-keepers.

     COMMENTS:

----------------------------------------------------------------------------------------------------------------------------
 EVALUATION

 1.  Evaluation plan includes process evaluation measures.

 2.  Evaluation plan has consistent, accurate data collection procedures.

 3.  Evaluation plan includes staff supervision, observation, and feedback on a
     regularly scheduled basis.

 4.  Evaluation plan provides findings for program modifications, as appropriate.

     COMMENTS:

----------------------------------------------------------------------------------------------------------------------------
 TRAINING

 1.  Training plan defines staff roles, duties, and responsibilities.

 2.  Training plan includes staff orientation to the agency (organization) and the
     community served.

 3.  Training plan includes ongoing staff professional development.

 4.  Training plan uses role play, observation, and feedback.

     COMMENTS:

----------------------------------------------------------------------------------------------------------------------------


Table A3

                                                   Appendix C

                                               QUALITY ASSURANCE


                                  PROGRAM ASSESSMENT FORM - COMMUNITY EDUCATOR


       TOPIC: _______________________  EDUCATOR:______________________________

       GROUP (TYPE & SIZE): ______________________ REVIEWER: ____________________

       DATE: _____________TIME: _____________ PROGRAM LENGTH: ______________


       DIRECTIONS:  Check the appropriate columns to indicate degree to which the educator met
       performance criteria:

                    WELL - would indicate met criteria well.

                    ADEQUATELY - would indicate met criteria adequately.

                    NEEDS ATTN - needs attention and supervisory guidance to meet criteria.

                    N/A - would indicate this criteria did not apply to this situation.

Check only within and not between the boxes.  If undecided, use "comments" section to clarify.


                                                                                                                  NEEDS
                                                                                         WELL     ADEQUATELY      ATTN     N/A
------------------------------------------------------------------------------------------------------------------------------
 INTRODUCTIONS

 1.    Introduces self by name and title.

 2.    Introduces others as appropriate.

 3.    Clearly states purpose, goals, and objectives for session.

 4.    Starts program at or within 10 minutes after starting time.

 5.    Attends to participants' physical comfort.

       COMMENTS:

------------------------------------------------------------------------------------------------------------------------------
 CONTENT

 1.    Selects program content relevant to agency goals and audience needs.

 2.    Imparts factual information.

 3.    Displays confidence in knowledge of material.

 4.    Provides background and supporting evidence to substantiate facts stated by
       participants and by self.

 5.    Organizes activities and information in clear manner.

       COMMENTS:

------------------------------------------------------------------------------------------------------------------------------
 PROFESSIONAL PRESENCE

 1.    Dresses in a manner that doesn't detract from aims of presentation.

 2.    Remembers and uses names of people, as appropriate.

 3.    Is tactful when discussing controversial topics.

 4.    Imparts attitudes and information consistent with agency goals and policy.

 5.    Avoids careless use of slang words.

 6.    Uses grammatically correct english.

 7.    Handles unexpected or difficult questions with minimal display of
       embarrassment or confusion.

 8.    Makes positive and tactful corrective statements.

 9.    Acknowledges contrary viewpoints.

       COMMENTS:

------------------------------------------------------------------------------------------------------------------------------
 STRUCTURE

 1.    Focuses attention on topic with films, pre-test, or other motivational
       techniques.

 2.    Selects teaching methods geared to audience and content (i.e., brainstorm,
       lectures, etc.).

 3.    Selects teaching materials that enhance lesson plan.

 4.    Allows sufficient time for activities.

 5.    Modifies teaching plan as indicated by audience response.

 6.    Keeps session on track, sticks to the point.

 7.    Creates opportunities for questions, comments, clarifications, and expression
       of opinions and feelings (elicits and pauses, etc.).

       COMMENTS:

------------------------------------------------------------------------------------------------------------------------------
 PROCESS SKILLS

 1.    Uses descriptive and reinforcing gestures.

 2.    Maintains eye contact with entire audience.

 3.    Adapts vocabulary level to understanding of group.

 4.    Enunciates and projects voice clearly.

 5.    Sets stage for activities and materials.

 6.    Explains materials used.

 7.    Demonstrates knowledge and skill in operating a.v. Equipment.

 8.    Uses illustrative examples.

 9.    Encourages all participants to be involved in activities.

 10.   Avoids lags in flow of presentation.

 11.   Acknowledges and accepts statements of feelings and experiences of others.

 12.   Listens actively.

 13.   Affirms information accurately.

 14.   Restates/clarifies/ emphasizes participants' comments and questions.

       COMMENTS:

------------------------------------------------------------------------------------------------------------------------------
 CONCLUSION

 1.    Summarizes major program points.

 2.    Reviews program objectives before concluding.

 3.    Helps group identify further human or material resources.

 4.    Remains available for individuals to approach them after the program.

 5.    Uses a tool to assess participants' satisfaction with program and program
       impact.

       COMMENTS:

------------------------------------------------------------------------------------------------------------------------------

COMMENTS ON CONCLUSION:









AUDIENCE RESPONSE TO SPEAKER:










OVERALL SUGGESTIONS AND REMARKS:










SPEAKER'S COMMENTS AND SIGNATURE:


Table A4

                                                   Appendix D

                                               QUALITY ASSURANCE

                              PROGRAM ASSESSMENT FORM - SUPPORT GROUP FACILITATOR


       TITLE: _______________________  FACILITATOR:______________________________

       REVIEWER: ______________________

       DATE: _____________

       DIRECTIONS:  Check the appropriate columns to indicate degree to which the facilitator met
       performance criteria:

                    EXCELLENT  indicates that performance met criteria beyond fully successful.

                    FULLY SUCCESSFUL  indicates performance met criteria successfully.

                    NEEDS ATTN  indicates performance needs supervisory guidance to meet criteria.

                    N/A  indicates this criteria did not apply to this situation.

Check only within and not between the boxes.  If undecided, use "comments" section to clarify.

                                                                                         EXCELLENT   FULLY        NEEDS      N/A
                                                                                                     SUCCESSFUL   ATTN
--------------------------------------------------------------------------------------------------------------------------------
 INTRODUCTIONS

 1.    Introduces self by name and title.

 2.    Facilitates introductions and stresses confidentiality among group members.

 3.    Clearly states purpose, goals, objectives, and ground rules for session.

 4.    Allows members to share their expectations from the group.

 5.    Starts group at or within 10 minutes after starting time.

 6.    Attends to group members' physical comfort.

 7.    Makes required administrative announcements.

       COMMENTS:

--------------------------------------------------------------------------------------------------------------------------------
 GROUP FACILITATION

 1.    Assures maintenance of group structure and schedule by promoting
       adherence to rules and guidelines.

 2.    Guides members through group processes, e.g., group dynamics.

 3.    Asks open-ended questions.

 4.    Maintains focus of discussion.

 5.    Synthesizes and abstracts pertinent information.

 6.    Creates opportunities for questions, comments, clarifications, and expressions
       of opinions and feelings.

 7.    Makes appropriate referrals and interventions, as needed.

 8.    Provides members with educational materials and information to substantiate
       discussion.

       COMMENTS:

--------------------------------------------------------------------------------------------------------------------------------
 PROFESSIONAL PRESENCE

 1.    Dresses in suitable attire.

 2.    Remembers and uses names of group members, as appropriate.

 3.    Is tactful when discussing  controversial topics.

 4.    Imparts attitudes and information consistent with agency goals and policy.

 5.    Avoids careless or inappropriate use of slang words.

 6.    Handles unexpected or difficult disclosures with minimal display of value
       judgement, embarrassment, or confusion.

 7.    Makes positive and tactful corrective statements.

 8.    Acknowledges contrary viewpoints.

       COMMENTS:

--------------------------------------------------------------------------------------------------------------------------------
 PROCESS SKILLS

 1.    Uses descriptive and reinforcing gestures.

 2.    Maintains eye contact with group members.

 3.    Speaks in vernacular that is germane to group.

 4.    Clearly enunciates and projects voice.

 5.    Sets stage for group session.

 6.    Encourages all group members to be involved in activities.

 7.    Listens actively.

       COMMENTS:

--------------------------------------------------------------------------------------------------------------------------------
 CONCLUSION

 1.    Brings group to closure in a tactful manner.

 2.    Summarizes group session.

 3.    Reviews session objectives with group members.

 4.    Helps group identify further human or material resources.

 5.    Remains available for group members' questions and comments after the
       session.

 6.    Uses a tool to assess participants' satisfaction with session and group impact.

       COMMENTS:

--------------------------------------------------------------------------------------------------------------------------------

COMMENTS ON CONCLUSION:









GROUP RESPONSE TO FACILITATOR:











OVERALL SUGGESTIONS AND REMARKS:











FACILITATOR'S COMMENTS AND SIGNATURE:










Table A5

                                                   Appendix E

                                               QUALITY ASSURANCE

                                           MATERIAL REVIEW CHECKLIST


       TITLE: _______________________  AUTHOR: ______________________________

       REVIEWER: ______________________

       DATE: _____________


       DIRECTIONS:  Check the appropriate columns to indicate degree to which the author met criteria:

                    EXCELLENT  indicates that performance met criteria beyond fully successful.

                    FULLY SUCCESSFUL  indicates performance met criteria successfully.

                    NEEDS ATTN  indicates performance needs supervisory guidance to meet criteria.

                    N/A  indicates this criteria did not apply to this situation.

Check only within and not between the boxes.  If undecided, use "comments" section to clarify.
                                                                                                        FULLY           NEEDS
                                                                                         EXCELLENT      SUCCESSFUL      ATTN       N/A
--------------------------------------------------------------------------------------------------------------------------------------
 MATERIAL REVIEW CHECKLIST

 1.    Material is clearly introduced and states the purpose of the text to the
       reader.

 2.    Major points of text are summarized at the end.

 3.    Materials are brief, concise, and in the language or dialect of the target
       audience.

 4.    Materials are written at the educational and reading level of the target
       audience.  Avoids jargon and technical phrases.

 5.    Materials use language and terms with which the target audience is
       comfortable.

 6.    Use active verbs and short, simple sentences, with one concept per
       sentence in short paragraphs.

 7.    Materials avoid  or define difficult words and concepts. Examples are used
       to clarify.

 8.    Use terms consistently (e.g., "HIV" and "AIDS virus" are not used
       interchangeably).

 9.    Materials are straightforward and clear.   (Do not use abbreviations,
       acronyms, euphemisms, symbolism, statistics, or anything else that could
       cause confusion.)

 10.   Text uses line drawings if illustrations are included.

 11.   Illustration of anatomy shows position of organs within the whole body
       (gives relative size and location reference).

 12.   Text uses lists, bullets, or illustrations instead of long discussions.  Visuals
       (overheads, slides) are used to emphasize key points.

 13.   Text is underlined, boldfaced, or "boxed" for reinforcement.

       COMMENTS:

--------------------------------------------------------------------------------------------------------------------------------------
 MATERIAL REVIEW CHECKLIST

 14.   The text dispels myths, uses acceptable channels, refers to value systems
       for reasons to change behavior or adopt a new perspective.

 15.   Materials provide a call for action.

 16.   The text illustrates manual skills from audience perspective.

 17.   The text provides reasons for changing behavior.

 18.   Materials provide current and accurate medical information.

 19.   Materials do not contain sexual preference or racial, gender, or ethnic bias.

 20.   Text offers alternative behaviors to the one(s) that put a person at risk.

 21.   Realistic and relevant examples are given.

 22.   The format of the text is not visually distracting:

       a. Small type (less than 10 point) is not used.
       b. Sentences are neither too short nor too long.
       c. Text  does not contain larger blocks of print.
       d. Right margins are justified.
       e. Only photographs that are reproducible are included.*
       f. Only professional-quality drawings are included.
       g. Technical diagrams are avoided.

 23.   Graphics are immediately identifiable, relevant, and simple.  They
       reinforce the text.

       COMMENTS:

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*    Note: A written release should be obtained from all persons pictured.  The release should clearly state permission to use the photograph
     and the conditions for use.









Table A6

                  HIV PREVENTION CASE MANAGEMENT (PCM) CHECKLIST

Develop a quality assurance plan that:
     - Establishes a minimal level of service delivery and identifies methods to monitor service
       delivery.

     - Identifies and assesses evidence of the quality and quantity of all services provided
       through the PCM program.

     - Reviews PCM protocols periodically for adequacy and relevancy and is revised
       accordingly.

     - Reviews intake and case management documents for accuracy and compliance with
       program protocol.

     - Examines the documentation of case termination and transfer.

     - Ensures regular, periodic audits of case files by the supervisor.

     - Provides for a mechanism to respond to discrepancies in performance identified by the
       supervisor.

Table A7

                                     EXAMPLE
                         "Cleaning Your Needles" Pamphlet

OBJECTIVE:  Demonstrate and remind

    WHO:        The designated audience is out-of-treatment IDUs.

    WHAT:       The specific message is "clean your needles with bleach".

    WHERE:      In their "copping" area (e.g., 10th and Vine).

    HOW:        Outreach specialists initiate conversation with people in the area,
                identify IDUs, provide instruction on needle cleaning, supply IDUs with bleach kits
                and a brief pamphlet, "Cleaning Your Needles" (illustrating the needle cleaning
                process) as a reminder of the instruction.

EVALUATION:     Process: Outreach specialists keep track of the number of hours spent at
                outreach locations, the number and demographics of people spoken to, and the
                number of people who took bleach kits and pamphlets. Outreach specialists
                observe whether people keep or discard pamphlets.


Table A8

                                     EXAMPLE
                              "Teens and AIDS" Video

OBJECTIVE:      Inform, demonstrate, and remind.

    WHO:        Sexually active teens.

    WHAT:       The message is condom use and negotiation skills.

    WHEN:       Early afternoon (after school).

    WHERE:      Neighborhood community center.

    HOW:        Outreach worker:

             -  shows video portraying situations where sex is being considered and the parties
                negotiate condom use;

             -  leads discussion to personalize negotiation;

             -  facilities role play by participants;

             -  demonstrates proper care and use of condoms and has participants practice on a
                model;

             -  supplies pamphlets outlining negotiation strategies and other pamphlets
                illustrating condom use as reminders or references.

EVALUATION:

                Process: Outreach worker documents how many presentations are done, how
                many teens attend, group demographics, the number of pamphlets distributed.



This page last reviewed: Friday, July 25, 2014
This information is provided as technical reference material. Please contact us at cwus@cdc.gov to request a simple text version of this document.
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