SMQ-Tailoring Messages

PLEASE SCROLL DOWN FOR ARTICLE

This article was downloaded by: [Hennink Kaminski, Heidi]On: 24 November 2009Access details: Access Details: [subscription number 916998982]Publisher RoutledgeInforma Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK

Social Marketing QuarterlyPublication details, including instructions for authors and subscription information:http://www.informaworld.com/smpp/title~content=t713846174

Tailoring Hospital Education Materials for The Period of PURPLE Crying:Keeping Babies Safe in North Carolina Media CampaignHeidi J. Hennink-Kaminski; Elizabeth K. Dougall

Online publication date: 18 November 2009

To cite this Article Hennink-Kaminski, Heidi J. and Dougall, Elizabeth K.(2009) 'Tailoring Hospital Education Materials forThe Period of PURPLE Crying: Keeping Babies Safe in North Carolina Media Campaign', Social Marketing Quarterly, 15:4, 49 — 64To link to this Article: DOI: 10.1080/15245000903348772URL: http://dx.doi.org/10.1080/15245000903348772

Full terms and conditions of use: http://www.informaworld.com/terms-and-conditions-of-access.pdf

This article may be used for research, teaching and private study purposes. Any substantial orsystematic reproduction, re-distribution, re-selling, loan or sub-licensing, systematic supply ordistribution in any form to anyone is expressly forbidden.

The publisher does not give any warranty express or implied or make any representation that the contentswill be complete or accurate or up to date. The accuracy of any instructions, formulae and drug dosesshould be independently verified with primary sources. The publisher shall not be liable for any loss,actions, claims, proceedings, demand or costs or damages whatsoever or howsoever caused arising directlyor indirectly in connection with or arising out of the use of this material.

http://www.informaworld.com/smpp/title~content=t713846174

http://dx.doi.org/10.1080/15245000903348772

http://www.informaworld.com/terms-and-conditions-of-access.pdf

Tailoring Hospital EducationMaterials for The Period ofPURPLE Crying: KeepingBabies Safe in North CarolinaMedia CampaignBY HEIDI J. HENNINK-KAMINSKI AND ELIZABETH K. DOUGALL

ABSTRACT

The social marketing approach recognizes the need to tailor message and channel

strategies to effectively reach the full range of individuals whomust act or exert influ-

ence to bring about knowledge, belief, and behavior change. However, repurposing

health education materials for additional target audiences and communication chan-

nels may at times be rationalized as a necessary response to budgetary constraints.

Furthermore, when the materials in question are the outcome of rigorous testing,

the experts involved may be reluctant to accept the need for tailoring those materials.

This study demonstrates how a rigorously designed and tested shaken baby syn-

drome prevention program comprising a 10-minute DVD and an 11-page brochure

delivered in-hospital to parents of newborns by specially trained health care workers

was adapted for a media campaign targeting additional audiences and channels.

Focus group research determined which messages and images from The Period of

PURPLE CryingDVD and brochure were most salient. Participants were surprised

to learn about the normalcy of prolonged infant crying, embraced the PURPLE

label, and were keen to share this new knowledge. The volume and quality of advice

new parents receive emerged as important. Two campaign concepts, including key

messages and visuals, were tested using focus groups and intercept interviews. The

normalcy of infant crying as a developmental stage rather than an indication of

caregiver incompetence or an unhealthy child resonated with respondents and was

adopted for the campaign. This approach underscores the value of tailoring and

message testing to provide evidence-based guidance for media campaign decisions.

Downloaded By: [Hennink Kaminski, Heidi] At: 20:58 24 November 2009

Introduction

Shaken baby syndrome (SBS) is the leading cause of serious head injury and

death in children ages 2 and younger in the United States (Keenan et al.,

2003). Caused by violent shaking, sometimes combined with impact on a

hard surface, SBS is also known as abusive head trauma. Shaking results

in head trauma, retinal hemorrhages, and rib fractures, often with little

or no evidence of external injury. About 20% to 25% of SBS victims die

(Keenan et al., 2003; King, MacKay, Sirnick, & Canadian Shaken Baby

Study Group, 2003). Of those who survive, 80% have significant, life-long

brain injuries (King et al., 2003). The costs associated with the care for vic-

tims of SBS are therefore substantial (Corso & Lutzker, 2006; Dias et al.,

2005).

Current medical research confirms the central role of infant crying in

triggering shaking by caregivers; anecdotally, inconsolable crying is the

most common explanation given by abusers (Barr, Trent, & Cross, 2006;

Lee, Barr, Catherine, & Wicks, 2007). A multiagency leadership team

from the University of North Carolina, the Center for Child & Family

Health, National Center for Shaken Baby Syndrome, and the University of

British Columbia is implementing and evaluating an SBS-prevention pro-

gram across the state of North Carolina using the social marketing

approach. The goal is to reduce the number of children hospitalized or dying

from SBS in North Carolina by at least 50% over the next 5 years. Under-

pinning this program is The Period of PURPLE Crying curricula developed by

the National Center on Shaken Baby Syndrome to educate parents about

normal infant crying patterns, safe caregiving strategies, and the dangers

of shaking.

The hypothesis underpinning this program is that achieving a wider under-

standing of the normalcy of early infant crying and its role as a trigger for shaking

will bring about a sustainable reduction in SBS. Launched in 2007, The Period of

PURPLE Crying: Keeping Babies Safe in North Carolina initiative comprises three

phases: in-hospital education for parents of every newborn at all 86 hospitals and

birthing centers in North Carolina; reinforcement in community settings such as

prenatal visits to health departments or well-care visits to primary care providers;

and a media campaign.

The Period of PURPLE Crying (PURPLE) parent education materials include

a 10-minute DVD and an 11-page companion booklet that address the risk of

shaking through understanding early infant crying (Figure 1). These materials

were comprehensively tested and refined with parents of newborns in the United

THE PERIOD OF PURPLE CRYING

50 SMQ | Volume XV | No. 4 | Winter 2009


States and Canada. This research demonstrated that the PURPLE DVD and

11-page companion booklet are:

& Educational and attractive to parents of newborns.

& Contain clear, memorable, salient, meaningful, attractive, and positive messages.

& Acceptable to relevant health workers.

& Affordable and easy for parents to share with all who may be caring for their child

(Barr, Barr, et al., 2009; Barr, Rivera, et al., 2009).

The social marketing process consists of six major steps or tasks: initial plan-

ning, formative research, strategy development, program development and

pretesting, implementation, and evaluation (Grier & Bryant, 2005). This article

focuses on program development and pretesting of materials for the media

campaign component of the North Carolina-SBS prevention program, the goals

FIGURE 1

In-Hospital Education Materials

Original in color.


SMQ | Volume XV | No. 4 | Winter 2009 51


of which are to reinforce the PURPLE message among parents and raise

awareness of The Period of PURPLE Crying among friends and family members

who also serve as caregivers or provide emotional support to parents of newborns.

Specifically, the article discusses each step in the development of the media

campaign including:

& Concept testing with nonparent audiences of the PURPLE DVD and booklet.

& Media campaign concept development and message testing.

& Concept refinement and final message testing.

& Corresponding research findings.

Program Development: The Media Campaign

Reducing the incidence of SBS among infants in North Carolina will require

more than the prevention of infant shaking by parents. Peers, family members,

neighbors, and health care providers are just some of the people who play impor-

tant roles as key influencers in the lives of infant caregivers. The social marketing

approach explicitly recognizes the need to identify and reach the full range of

individuals who must act or exert influence to bring about knowledge, belief,

and behavior change (Kotler & Lee, 2008). Additional promotional tools for

these audiences needed to be created and tested for the media campaign for

two reasons.

First, the PURPLE DVD and booklet were developed and tested solely

with parent audiences in Vancouver and Seattle. As part of the initial planning

for The Period of PURPLE Crying: Saving Babies in North Carolina

intervention, the PURPLE DVD and booklet also were tested in focus groups

with parents in North Carolina (Runyan et al., 2009=this issue). However,

little was known about how nonparental caregivers, peers, and family members

would respond to key PURPLE messages. Creating infant crying messages

that will be salient to nonparent as well as parent audiences is a challenge

but also essential to influencing knowledge and beliefs about infant crying

and shaking behavior.

Second, advertising messages must be more concise than the 10-minute

DVD and 11-page booklet used during in-hospital education. Translating this

information into a format that can quickly capture attention and break through

the clutter of other media messages is essential. Thus, tailoring the existing PUR-

PLE messages for use with other target audiences in a new format was necessary

to accomplish the goals of the program.




Concept Testing of PURPLE with Nonparent Audiences

The process began with testing the existing PURPLE in-hospital education

materials (DVD and booklet) with nonparent caregivers and the friends and

family of parents of newborns. Focus groups were conducted to guide the devel-

opment of media campaign concepts which would be further tested. This study

posed the following questions:

RQ1: What key message(s) do participants take away from the PURPLE DVD and

booklet?

RQ2: What content do participants find to be most surprising?

RQ3: With what content do participants most identify?

RQ4: What content do participants believe to be most important to share with caregivers

of infants?

RQ5: What do participants see as potential barriers to believing, adopting, and sharing

the PURPLE message with others?

Method

Participants

Participants were recruited based on four criteria: age (18þ), gender, geo-

graphic location, and current role as full-time caregiver (e.g., nannies and

day care employees) or occasional caregiver (e.g., babysitter, friend, family

member) to infants or young children under the age of 5 years. To focus on

participant responses from a caregiver’s perspective, those who reported having

a child under the age of 2 living in their own home were ineligible. Parti-

cipants were recruited with the assistance of pediatrician offices, local YMCA

chapters, and notices posted to craigslist.com. Participants received a $50 gift

card to participate.

Ten focus groups were conducted across North Carolina in six different

locations to capture the richness and diversity of the state: Asheville, Charlotte,

Durham, Fayetteville, Goldsboro, and Winston-Salem. One focus group was

male-only, two focus groups were comprised of both males and females, and

seven focus groups were female-only. Focus groups ranged in size from 6 to 10

participants, with a total of 84 North Carolina residents participating.

Interview format and protocol

A focus group guide was developed following the guidelines for a semistructured

interview as outlined by Kvale (1996). This format allows the researcher to




uncover specific information about key topics while still providing opportunities

for other relevant content to emerge and for participants to explain and discuss

their responses. Topics explored in the focus groups included participants’ general

perceptions of infant crying, impressions of the PURPLE brochure and DVD,

and media usage habits.

Pilot study

Pilot studies are an important component of the qualitative research process

because they help to determine whether the interview protocol will uncover

the desired information (Lindlof & Taylor, 2002; Mariampolski, 2001).

Prototype testing of an initial draft of the protocol revealed several opportunities

for improvement. Minor adjustments were made to the wording and order of

questions based on these insights.

Analysis

All ten focus groups were tape-recorded and professionally transcribed. Tran-

scripts were then analyzed using the constant comparative method, also known

as grounded theory (Charmaz, 2007; Glaser & Strauss, 1967). This approach is

used to identify patterns or trends in the data and to discover relationships

between ideas or concepts. All transcript review, coding, and data reduction were

performed by the authors.

Results

Overwhelmingly, focus group participants embraced the PURPLE messages as

important and clear. Many responded positively to being able to recognize the

period of inconsolable infant crying as a normal developmental stage and to be

able to give that period a label (Figure 2). Furthermore, participants expressed

relief at discovering that the inability to soothe an infant during this period

was not an indication of inept caregiving or an unhealthy child. Knowing that this

period would end in a few months time was also important.

Most surprising

Communication research has established that surprising information is often a

successful strategy for capturing attention (e.g., Belch & Belch, 2009). Unlike

in-hospital education with a captive parent audience, the media campaign will

need to attract the attention of audiences for whom crying information may

not be immediately salient. Although a few participants continued to doubt that




someone would actually shake a baby, particularly his or her own child, the

balance of participants identified the following content as most surprising:

& It is normal for all infants to cry more between 2 weeks and 4 months of age.

& There may be nothing physically wrong with a baby who cries that much.

& You’re not a bad parent or caregiver if you can’t calm your baby.

& Shaken baby syndrome has consequences other than death (e.g., blindness, learning

disabilities) and that children can die years later from being shaken as an infant.

& It’s okay to walk away from a crying infant to calm yourself down.

Most emotionally touching

The ability to identify emotionally with human models or sources is also a com-

mon creative strategy used to capture attention and connect with the target audi-

ence (Belch & Belch, 2009). Participants identified four things that most tugged

at their heartstrings:

1. The feelings of guilt, helplessness, and failure experienced by parents and caregivers

when unable to soothe an infant.

2. The facial expressions of the crying babies and frustrated parents.

3. The sounds of an inconsolable crying infant.

FIGURE 2

PURPLE Acronym

Original in color.




4. Stories of parents whose children died of SBS and how death destroys the life of the

parent, as well as that of the child.

In some cases these responses were empathetic, as participants recounted

their own experiences with crying infants. In other cases, participants shared

stories they had heard from friends or family members who had experienced

frustration with infant crying.

Most important for caregivers to know

Achieving the objectives of the 5-year prevention program will require more than

just capturing attention. The creative strategy must convey the most critical infor-

mation. Participants identified the following as the most important for caregivers

to know:

& All babies cry more between 2 weeks and 4 months of age.

& This period of increased infant crying will end.

& Parents and caregivers should expect to get frustrated during this period and should

plan ahead for how to seek relief.

& Action steps (carry, comfort, walk, and talk), particularly the last step of putting the

baby in a safe place and taking a break.

Potential barriers

Equally important was the identification of important obstacles to sharing the

PURPLE messages with others, including cynicism of those who have no personal

experience of inconsolable crying, fear of being judged as inadequate parents, con-

cern about scaring away caregivers, failing to recognize the action of taking a break

is acceptable, and resistance to taking and giving advice. Following are the key

themes that emerged from the analysis.

According to participants, parents and=or caregivers may be reluctant to ask

for help or advice because they fear that others will question their parenting

or caregiving abilities. This fear can hinder opportunities for others to share

PURPLE messages and=or ask for support.

I feel like people are a bit hesitant to tell other people about the issues they may have

with their kid’s [crying] because they might be scared it makes them look bad, like

they’re not doing enough. (Female, Asheville, NC)

Although participants noted the importance of parents being upfront with

caregivers about the specific crying patterns of the child to better prepare the care-

giver, they also noted that this may scare away caregivers.




I think [preparing caregivers] might be hard for some people. Nobody wants to be like,

‘‘Thank you for watching my child for a couple of hours and just so you know, they are

going to scream the entire time.’’ (Female, Asheville, NC)

Participants noted that it may be more difficult for caregivers than parents to

walk away and leave the baby in a safe place.

I would feel horrible if the parent comes home, the baby is screaming, and I’m reading

a magazine. I’d feel bad because I’m getting paid to care for that baby. It feels weird

saying you’re caring for a baby when you’re doing something else that has nothing to do

with the baby. (Female, Winston-Salem, NC)

The fact that you can walk away and calm yourself down and come back to the situ-

ation [surprised me]. That’s like, ‘‘Whoa,’’ because in childcare they don’t normally

expect you to walk away from a child. They expect you to coddle that child. Hold

it. If it’s crying, go get it. Feed it. Do something. (Female, Fayetteville, NC)

Although word-of-mouth from family and friends was noted by many

participants as an important communication channel, participants in many of

the sessions talked about resenting caregiving advice, particularly from family

members. At the same time, participants often shared stories about the most

ridiculous advice they had received, prompting laughter and the exchange of

additional stories.

In sum, three key insights emerged from the focus groups: normalcy, advice,

and the importance of storytelling.

1. Normalcy. Parents and caregivers should experience increased infant crying between 2

weeks and 5 months of age. While caregivers should attempt to soothe the child, such

efforts may not eliminate the crying. This does not mean that there is something

wrong with the baby, nor does it imply that the caregiver is doing something wrong.

It’s just a normal stage of development.

2. Advice. The volume and usefulness of advice new parents receive emerged as an impor-

tant issue. Virtually all participants shared examples of ridiculous advice. Although

participants bemoaned friends’ and family member’s insistence on giving advice, part-

icipants still found the humor in it. Interestingly, this theme also arose in the parent

focus groups for the PURPLE DVD and booklet (Barr, Barr et al., 2009; Barr, Rivera

et al., 2009). As a result, the giving of advice on how to quiet a crying infant was a

common thread among parents and other caregivers, providing a universal point of

entry for a message strategy.

3. Storytelling. Storytelling is important. Real people with lived experiences make the

connection with people, not the scientific information about crying itself. Participants




across all focus groups identified with the stories of the parents on the DVD and in

the booklet.

Development and Testing of ‘‘Advice’’ and ‘‘Normal’’ Concepts

The professional services of CAPSTRAT, a Raleigh-based strategic communication

firm, were secured to assist with the development of creative concepts. In response

to the focus group findings, five broad creative approaches were developed and pre-

sented to themembers of the leadership team. From those discussions, two campaign

concepts emerged: ‘‘Advice’’ and ‘‘Normal.’’ Both the ‘‘Advice’’ and ‘‘Normal’’ con-

cepts included a story-telling component. ‘‘Advice’’ ads took a testimonial approach,

including a photo and quote from a real parent in North Carolina (Figure 3). The

‘‘Advice’’ concept leveraged parent and caregiver experiences with unsolicited advice

and used humor to capture attention and engage the target audience. Conversely,

attention and emotional connection with the target audience were achieved in

the ‘‘Normal’’ concept through dramatic images of caregivers frustrated with crying

infants. Copy points for both concepts addressed the normalcy of infant crying, as

well as the link between crying and shaking and the dangers of shaking.

Three print ads, a storyboard, and a website home page for each concept were

developed for testing. Each concept included one print ad that featured a female

caregiver, one print ad that featured a male caregiver, and one ad located in a pub-

lic setting in which a stranger is reacting to the infant’s crying. All concept ads

used stock photography, imposing some unavoidable limitations on infant age,

caregiver characteristics, and venue.

Method

A multimethod approach was used to test the two campaign concepts: ‘‘Normal’’

and ‘‘Advice.’’ Focus groups were conducted to probe for and capture rich, reflec-

tive responses. Individual intercept interviews were conducted to elicit responses

within a context similar to that in which advertisements would typically be

encountered and processed. Messages were evaluated as to whether participants

understood the main message, thought it was relevant, trusted the source, and

were not confused or offended. The messages were also expected to be attractive,

readable, informative, and compelling emotionally (McCormack Brown,

Lindenberger, & Bryant, 2008).

Focus groups

Participants were recruited based on age (18þ), sex, geographic location, and their

role as a caregiver to young children. These parameters yielded participants who




were parents, full-time caregivers (nannies and day care employees), and

occasional caregivers (babysitters, friends, and family members). Three focus

groups were conducted in North Carolina in two separate locations: Durham

and Goldsboro. One focus group was male-only and two focus groups were

female-only. Focus groups ranged in size from 8 to 10 participants, yielding a

total of 27 participants. Participants in each focus group were shown both cam-

paign concepts, and presentation order was rotated to avoid bias. Participants

received a $50 gift card to participate.

FIGURE 3

‘‘Advice’’ Print Ad Concept

Original in color.




Intercepts

Intercept interviews were conducted with 60 participants at YMCA and family

health clinics in Goldsboro, Durham, and Raleigh. Forty-four participants were

shown both campaigns and the presentation order was rotated. As a cross-check,

8 additional participants were shown just one campaign to rule out testing effects.

Results

The ‘‘Normal’’ campaign was preferred overwhelmingly by participants in two of

the three focus groups and by 65% of the intercept participants. These parti-

cipants embraced the direct and self-explanatory nature of the message and con-

nected with the emotional duress of trying to soothe a crying infant. Participants

also raised several concerns to be addressed during concept refinement:

& A sense of hopelessness that may be demotivating.

& The use of small-font body copy reminiscent of ‘‘cigarette warning labels’’ that

discourage full reading of the text.

& The potential misinterpretation that all crying is normal when, in reality, some crying

may be an indication of illness or extreme discomfort.

& Lack of visual connection between the question (Is this normal?) and the answering

‘‘Yes.’’

Although most participants noted the attractiveness and eye-catching nature

of the bright colors and large speech bubbles in the ‘‘Advice’’ campaign, the humor

did not translate. Most participants interpreted the hyperbolic advice as the impor-

tant take-away message, rather than a humorous approach to attract attention and

engage the audience. As a result, they often cited the ‘‘advice’’ in the ad as the new

information learned. Furthermore, participants often did not read past the speech

bubble and quotation, likely contributing to low recall of the key messages.

Concept Refinement and Final Message Testing for ‘‘Normal’’

The ‘‘Normal’’ campaign, which positions infant crying as a normal developmen-

tal stage rather than an indication of caregiver incompetence or an unhealthy

child, was selected and refined based on participant feedback. Criteria for

model-casting was established: a multiracial looking mother; a child within the

appropriate age range; and preferably a real-life mother=child pairing. Two

mother=child model teams were identified as meeting the criteria and photos

were circulated for review and comment by the leadership team. A mother=child

child team was selected and scheduled for the photo shoot.




Ad copy was refined to address the concerns raised in the message testing. To

address the concern that all infant crying is not normal, but rather could be

attributable to sickness, an asterisk and instructions for parents to see a doctor

if concerned were added to the bottom of the advertisement. A brighter color

palette was used during the photo shoot to create a visual sense of hopefulness

and the body copy was increased by several point sizes to improve readability.

The ‘‘Is this normal’’ question mark was placed upon a darker portion of the ad

to achieve better prominence and stimulate a tighter connection to the ‘‘Yes’’

response (see Figure 4 for the final version of the print ad).

FIGURE 4

Final ‘‘Normal’’ Print Ad

Original in color.




Twenty individual intercept interviews were conducted at grocery stores

in Durham and Pittsboro to test the revised ‘‘Normal’’ print ad using the same

criteria as the previous round of intercepts: comprehension, attractiveness, rel-

evancy, believability, acceptability, persuasiveness, and usefulness. Participants

included 10 males and 10 females between the ages of 18 and 44. Responses

indicated significant improvement in the areas of concern identified in the

concept testing.

The ‘‘normal’’ print ad now serves as the starting point for developing materi-

als for additional media channels. The artwork is prominently featured on the

home page of the www.purplecryingnc.info website and will be incorporated into

a number of social media initiatives. Further, the body copy from the ad has been

adapted for a 60-second radio spot. The media campaign is scheduled to launch

across North Carolina in Fall 2009 and may be adapted further for other markets

outside of North Carolina.

Conclusion

To bring about a reduction in SBS, The Period of PURPLE Crying: Keeping Babies

Safe in North Carolina prevention program must effectively reach beyond the hos-

pitals to touch the full range of individuals whose actions and influence matter.

This formative research was necessary to guide the tailoring of PURPLE mes-

sages for a media campaign to reach both parent and nonparent audiences.

One of the strengths of social marketing is its emphasis on audience segmen-

tation, tailoring, and message testing. In an increasingly fragmented media

environment and amid unprecedented budget cuts, it is more important than ever

that health communication messages, products, and distribution decisions be

grounded in appropriately designed research.

About the Authors

Heidi J. Hennink-Kaminski, Ph.D., is an assistant professor in the School

of Journalism and Mass Communication at the University of North Carolina

at Chapel Hill. Hennink-Kaminski’s research focuses on social marketing and

health communication. Prior to transitioning to academia, Hennink-Kaminski

accumulated 15 years of professional experience in senior marketing communica-

tions roles in both corporate and agency positions. She has written book chapters

on telecommunications marketing and transnational advertising and most

recently published in the Journal of Current Issues and Research in Advertising, Jour-

nalism and Mass Communication Quarterly, Journalism and Mass Communication

Educator, and Proceedings of the American Academy of Advertising.




Elizabeth K. Dougall, Ph.D., is an associate professor in the School of Journal-

ism and Mass Communication at the University of North Carolina at Chapel

Hill. Dougall’s research applies the longitudinal analysis of media coverage to

describe the increasingly complex public opinion environment comprising issues,

organizations, influencers, and activists. Her 20-plus-year career includes exten-

sive professional experience in strategic communication management and coun-

seling. Dougall’s research has most recently been published in Journalism and

Mass Communication Quarterly, Newspaper Research Journal, International Journal

of Strategic Communication and Public Relations Review.

Acknowledgments

The authors would like to acknowledge the efforts of Lindsey Bennett, vice presi-

dent and associate creative director at CAPSTRAT, a Raleigh-based strategic

communication firm. The authors are grateful for the assistance of several gradu-

ate research assistants in conducting this research: Greg Efthimiou, Sarah

Whitmarsh, Courtney Woo, and Erica Yamauchi. Members of the North

Carolina and National Leadership Teams provided invaluable direction through-

out the entire process. This research was funded in part by grants from the

Doris Duke Charitable Foundation, the Duke Endowment, and the Centers

for Disease Control and Prevention.

ReferencesBarr, R. G., Barr, M., Fujiwara, T., Conway, J., Catherine, N., & Brant, R. (2009). Do educational

materials change knowledge and behaviour about crying and shaken baby syndrome? A randomized

controlled trial. Canadian Medical Association Journal, 180, 703–704.

Barr, R. G., Rivera, F. P., Barr, M., Cummings, P., Taylor, J., Lengua, L. J., et al. (2009).

Effectiveness of educational materials designed to change knowledge and behaviors regarding cry-

ing and shaken baby syndrome in mothers of newborns: A randomized, controlled trial. Pediatrics,

123, 972–980.

Barr, R. G., Trent, R. B., & Cross, J. (2006). Age-related incidence curve of hospitalized Shaken

Baby Syndrome cases: Convergent evidence for crying as a trigger to shaking. Child Abuse and

Neglect, 30(1), 7–16.

Belch, G., & Belch, M. (2009). Advertising and promotion: An integrated marketing communication

Perspective. New York: McGraw-Hill.

Charmaz, K. (2007). Constructing grounded theory: A practical guide through qualitative analysis.

Thousand Oaks, CA: Sage.

Corso, P. S., & Lutzker, J. R. (2006). The need for economic analysis in research on child maltreat-

ment. Child Abuse and Neglect, 30, 727–738.




Dias, M. S., Smith, K., DeGuehery, K., Mazur, P., Li, V., & Shaffer, M. L. (2005). Preventing

abusive head trauma among infants and young children: A hospital-based, parent education

program. Pediatrics, 115, 470–477.

Glaser, B. G., & Strauss, A. L. (1967). The discovery of grounded theory: Strategies for qualitative

research. Chicago: Aldine Publishing Company.

Grier, S., & Bryant, C. (2005). Social marketing in public health. Annual Reviews of Public Health,

26, 319–339.

Keenan, H. T., Runyan, D. K., Marshall, S. W., Nocera, M. A., Merten, D. F., & Sinal, S. H.

(2003). A population-based study of inflicted traumatic brain injury in young children. Journal of

the American Medical Association, 290, 621–626.

King, W. J., MacKay, M., Sirnick, A., & Canadian Shaken Baby Study Group. (2003). Shaken

baby syndrome in Canada: Clinical characteristics and outcomes of hospital cases. Canadian Medical

Association Journal, 168, 155–159.

Kotler, P., & Lee, N. R. (2008). Social marketing: Influencing behaviors for good (3rd ed.). Thousand

Oaks, CA: Sage.

Kvale, S. (1996). Interviews: An introduction to qualitative research interviewing. Thousand Oaks,

CA: Sage.

Lee, C., Barr, R. G., Catherine, N., &Wicks, A. (2007). Age-related incidence of publicly reported

shaken baby syndrome cases: Is crying a trigger for shaking? Journal of Developmental and Behavioral

Pediatrics, 28, 288–293.

Lindlof, T., & Taylor, B. (2002). Qualitative communication research methods (2nd ed.). Thousand

Oaks, CA: Sage.

McCormack Brown, K., Lindenberger, J. H., & Bryant, C. A. (2008). Using pretesting to ensure

your messages and materials are on strategy. Health Promotion Practice, 9, 116–122.

Mariampolski, H. (2001). Qualitative market research: A comprehensive guide. Thousand Oaks, CA:

Sage.

Runyan, D. K., Hennink-Kaminski, H. J., Zolotor, A. J., Barr, R. G., Murphy, R. A., Barr, M.,

et al. (2009=this issue). Designing and testing a shaken baby syndrome prevention program: The

Period of PURPLE Crying – Keeping Babies Safe in North Carolina. Social Marketing Quarterly,

15(4), 2–24.




Documents

SMQ-Tailoring Messages