Success Stories

Why Is This Ulcer Sufferer So Happy? Because Most Ulcers Are Caused by an Infection that Can be Cured.

Centers for Disease Control and Prevention

Situation

A National Institutes of Health Consensus Conference in 1994 concluded that 90 percent of stomach ulcers are caused by the bacterium Helicobacter pylori (H. pylori) and can be cured with antibiotics. More than two years later most consumers were still unaware that an infection—not stress or spicy foods—was the real cause of ulcers, and many doctors were not treating ulcers as an infectious disease.

In 1996, Congress directed the Centers for Disease Control and Prevention (CDC) to inform the public and health care professionals about H. pylori’s role in ulcer disease. CDC, in partnership with other government agencies, academic institutions and industry, launched a national education campaign in Fall 1997 to address this important public health issue, which affects 25 million Americans and represents $6 billion annually in health care costs.

Research

CDC included questions about the perceived cause of ulcers in a national consumer study called the Health Styles Supplemental Survey, administered in April 1997. Results revealed that 60 percent of consumers thought that ulcers were caused by too much stress and 17 percent thought eating spicy foods was the cause. Only 27 percent of respondents correctly blamed a bacterial infection.

CDC conducted qualitative research in mid-1997 with the target audience of ulcer sufferers to explore their awareness of H. pylori, and to evaluate potential message concepts. Results provided further evidence that this group had no or little awareness of the real cause of ulcers. They showed disbelief, even incredulity at the news. Many self-diagnosed and self-medicated with over-the-counter antacid medication. They took a fatalistic view about the chronic nature of their ulcers, and were resigned to a life of pain and a cycle of flare-ups, treatment and relief. They said they would be so happy if they could get rid of their ulcer once and for all and, most importantly, that learning that their ulcer may be caused by a bacterium was good news. These acknowledgments became the cornerstone of a communications program to reposition ulcers from a chronic condition to an infectious disease and communicate the news of a cure by introducing the "good news infection" from CDC.

Research also included a review of past advertising campaigns for gastrointestinal products. It was determined that humor was an effective, accepted tone for this subject and was incorporated into the campaign.

Looking at the health care provider audience, national surveys conducted in 1994 and 1996 by the Baylor College of Medicine indicated that primary care physicians were treating approximately half

of patients with first-time ulcer symptoms with antisecretory agents without testing for H. pylori.

Planning

Changing behavior in both the consumer and health care provider audiences required a push/pull strategy, simultaneously "pushing" health care providers to treat ulcer patients for H. pylori, and motivating consumers to "pull" doctors by asking about the new cure for ulcers. Planning for a multi-layered campaign began in July 1997, the launch occurred in October 1997, and a second wave was done a year later.

Target Audiences

• Ulcer sufferers, 35-60+ years old, some emphasis on higher affected African-American and Hispanic groups
• Health care providers (primary care physicians, nurse practitioners, physician assistants, pharmacists)

Objectives

• Increase the number of consumers who understand that ulcer disease is caused by an infection which can be cured.
• Increase the number of physicians who know about H. pylori, its link to ulcer disease, and how it can be successfully diagnosed and treated.
• Improve communication between patients and doctors about ulcer disease, H. pylori and its successful treatment.

Strategies

• Use the mass media to inform consumers and physicians about the link between H. pylori and ulcers.
• Provide health care professionals information about diagnosis and treatment of H. pylori, and materials to help them talk to their patients about the new cure for ulcers.
• Deliver information to ulcer sufferers through a key opening—the pharmacy where they purchase over-the-counter medications to self-treat their ulcers.

Budget

CDC is not releasing exact budget figures, but the communications campaign was funded at just under $1 million. This covered all materials and audience research, development, distribution, outreach, personnel, etc.

Execution

Basic tactics included the following:

• Mass Media Communications: To address the public’s misconceptions about the cause of ulcers, a mass media strategy combined media relations, public service advertising and enter-education.
• News Media Relations: To educate national media that ulcers are caused by an infection, a media briefing was held at the National Press Club on Oct. 23, 1997. To increase the news value of the story, CDC issued a special report on H. pylori based on the Health Styles research, followed by a nationwide media kit mailing to English- and Spanish-language media. State public information officers received implementation kits to enlist their support in local media relations efforts. To further target the Hispanic audience, a week-long radio series on H. pylori was produced for "Cuidando su Salud," syndicated by the nation’s leading Spanish language stations. Additional news was developed and distributed during the second wave.
• Public Service Advertising: Television, radio and print public service advertisements were distributed nationwide in two flights. The first wave focused on the good news that ulcers are a curable infection, with a humorous "Happy Ulcer Sufferers" approach. This tone carried through all PSA materials, including the teaser packaging. The second wave focused on ulcer sufferers hearing about this good news "Over and Over" from their doctors. To address higher infection rates in African Americans and Hispanics, materials were multi-ethnic, and produced in English and Spanish. CDC’s toll-free line (1-888-My-Ulcer) and web site, were referenced in materials.
• Enter-Education: A third, more non-traditional way to reach consumers combined entertainment and education. H. pylori and ulcer information was delivered to soap opera producers and writers in Hollywood, with the objective of embedding messages about H. pylori into set designs and/or storylines.
• Outreach to Physicians and Health Care Providers: To improve communication between ulcer sufferers and physicians, special information kits were created, including a physician fact sheet, waiting room poster and consumer brochure. The kits were mailed to more than 780,000 English-speaking and Spanish-speaking health professionals. In addition, several pharmaceutical partners distributed materials through their sales representatives.
• Outreach to Pharmacists: Because many ulcer sufferers self-medicate with over-the-counter products, pharmacists were determined to be a primary information source for consumers. A pilot program was created with 236 CVS pharmacy stores in the Washington, D.C., area to test the effectiveness of reaching patients through this key point of contact for information and products. Participating stores received kits including consumer brochures; pharmacist fact sheet; counseling tips and commonly-asked questions; brochure holder; and shelf-talker.

Evaluation

Results are achieving campaign objectives, as demonstrated below.

• Objective 1: Increase the number of consumers who understand that ulcer disease is caused by an infection which can be cured.
• More than 209 million consumers have been reached through PSAs and news media coverage in English and Spanish.
• More than 16,000 people called the toll-free line for more information, and there have been 42,000 hits to the web site.
• Follow-up focus groups with ulcer sufferers indicated that the campaign strategy was on target, and that the message was clear and motivational. Participants reported having seen the PSAs or news coverage of the issue.
• Objective 2: Increase the number of physicians who know about H. pylori, its link to ulcer disease, and how it can be successfully diagnosed and treated.
• More than 780,000 physicians and other health professionals received informational mailings.
• More than 2.8 million brochures, posters and fact sheets have been requested and distributed.
• In follow-up focus groups with physicians, most became more aware recently of H. pylori, and several had seen CDC’s materials.
• More CDC information is being sent to pharmacists by the American Pharmaceutical Association and National Association of Chain Drug Stores to expand awareness among this key information channel for patients.
• Objective 3: Improve communication between patients and doctors about ulcer disease, H. pylori and its successful treatment.
• Several doctors in the physician follow-up focus groups reported that their patients were asking about H. pylori.
• Participants in the consumer follow-up focus groups said that they were motivated to see their doctor.

The H. pylori campaign is motivating consumers and health care providers to change their behavior from merely treating ulcers over a lifetime to curing them once and for all. To continue reinforcing these behavior changes to address this important public health issue, CDC is planning an annual awareness effort, in addition to further research.