This 8-page report describes communication activities supporting adult diphtheria immunisation efforts undertaken as part of a broader health communication programme in Russia. It evaluates the impact of these activities by assessing vaccination coverage data in two project sites - Novgorod and Voronezh. As articulated in the below excerpts from the report, Novgorod experienced a very modest increase in adult coverage (two or more doses). In Voronezh, with a stronger communications component, coverage increased significantly (from 20% to 80%). As the authors point out, although it is not possible to disentangle completely the effects of communications from other aspects of oblast immunisation programmes, the data detailed and discussed in this report "suggest that health communications can play an important role in Russia’s ongoing mass immunization efforts."

Excerpts from the report follow:

"The diphtheria communication interventions discussed in this article were undertaken through a collaborative Russian-American program involving BASICS (Basic Support for Institutionalizing Child Survival, a project funded through the United States Agency for International Development), the Russian
Ministry of Health, and the former State Committee for
Sanitary and Epidemiologic Surveillance. The overall aim of BASICS' work in Russia was to strengthen the capacity to plan, implement, and evaluate public health communication programs both at the federal level and in selected oblasts (regions). The primary focus was on technical and training assistance in
communications research, strategic planning, and campaign implementation. The actual implementation of communication activities was carried out by public health agencies involved in
diphtheria-control efforts in Novgorod City, Voronezh Oblast, and the city of Yekaterinburg. Although some communication support was given to childhood immunization programs, city and oblast-level activities concentrated on adult immunization. The emphasis was on using local media, especially radio and television, to inform adults of the need for second and
third doses of tetanus-diphtheria toxoids vaccine and to positively influence their more general attitudes toward diphtheria vaccination....

[Specifically,] the planning teams settled on several key message points:

• Diphtheria is dangerous, but it is preventable through vaccination.
• The vaccine is safe and effective.
• Individuals are responsible for being sufficiently vaccinated (second and third doses offer complete protection) and should consult their doctor about their vaccination status.

These messages were incorporated into a variety of media products: television and radio public service advertisements (PSAs), print advertisements, posters, leaflets, and transit cards.

Four television PSAs were produced in Moscow by Medicine for You, the semiprivatized public information arm of the Ministry of Health. Three of the PSAs focused on adult immunization, emphasizing the diphtheria immunization messages noted above; the fourth PSA targeted mothers and focused on
the timely completion of the full childhood immunization schedule. The four television PSAs were distributed to project oblasts in September 1996.

All of the other media products created for local campaigns were developed in the oblasts. The oblast teams also worked with local media outlets to generate news coverage (television, radio, and print) as well as free placement for television and radio PSAs (there was no precedent for running unpaid public service advertising in these oblasts)....

Information to guide program design and assess performance came from both oblast health information systems (HIS) and rapid, inexpensive studies that could be implemented by staff from oblast health agencies. Exploratory focus group research was carried out in Novgorod and Voronezh, a quantitative communications tracking study was conducted in Novgorod, and rapid, semiquantitative consumer surveys, employing selective sampling, were implemented in Voronezh and Yekaterinburg. Vaccination coverage data generated through oblast HIS were also available for Voronezh and Novgorod...

Voronezh recorded a dramatic increase in coverage for Td2 and Td3 in the last 6 months of 1996, up from just under 20% at the end of June to just under 80% at the end of December, a time frame that includes the period of intensified diphtheria communications.
This steep rate of increase during the last 6 months
of 1996 followed a 6-month period during which coverage had leveled off. In contrast, coverage data from Novgorod show a much more moderate, straight-line increase in coverage for Td2 and Td3.

Did diphtheria communications in Voronezh have a much more significant impact on coverage rates than communications in Novgorod? The reasons for the marked increase in coverage for second and third doses of vaccine in Voronezh are not fully understood. We do know, however, that media activities in Voronezh differed from those in Novgorod in several crucial respects. Perhaps the most important difference is that oblast television in Voronezh is a more effective medium than it is in Novgorod. These are very different media markets. Local Voronezh
television does not compete for audience share with television from any nearby and more cosmopolitan urban center. The Novgorod market, in contrast, is dominated by St. Petersburg television, and partly as a result, Novgorod’s local channel offers only several hours of (less competitive) programming per day. In addition, the diphtheria communications team in Voronezh, with support from local government, secured placements for diphtheria PSAs in time slots surrounding Santa Barbara, one of the most-watched soap operas in Voronezh (and in all of Russia)....

Data from a rapid consumer survey in Voronezh also
suggest that exposure to diphtheria communications in Voronezh was greater than that in Novgorod....72% of respondents in Voronezh cited the media as a source of diphtheria information (compared with
only 33% in Novgorod); and 60% of Voronezh respondents who had seen or heard diphtheria messages said that they had influenced their decision to get vaccinated..."

Editor's note: footnote numbers were omitted from this selection