Findings highlight the need for products and processes that communicate the details of evidence-based health communication campaigns and related data while supporting campaign adaptation and integration into broader work conducted by CBOs focused on LGBTQ+ communities (figure 1).
Theme 1: show us your work
1 a: CBO staff and leaders desire details about how the campaign was developed, including community engagement and underlying values, for example, social justice or system change CBO staff and leaders described working with members of the community who are consistently experiencing barriers in access to healthcare because they live at ‘the intersections of race and identity and socioeconomic demographics’ (Interview 22). To this end, campaigns developed without consideration of factors beyond the individual level were seen as insufficient, given the immediate concerns faced by the communities served. Participants described the importance of explicitly acknowledging the multiple ways in which discriminatory systems drive health behaviours and inequities and ensuring communication is delivered in ways that avoid shaming:
The campaign messaging] comes across as like judgmental and we’re gonna hold you accountable for your bad habits or lack of care for your health without recognizing actually there’s a whole bunch of things going on socially, in society, in terms of the systems around that keep people out. Interview 22
Keeping with the systems frame, campaigns focused on targeting individual behavioural change were described as needing to be framed within this broader context of harmful systems, and participants described feeling more open to messaging campaigns when the greater context was also explicitly considered by researchers.
I think that for a lot of the people that I work with that would be interested in tobacco prevention, they might see that this is targeting individual behavior and they might instantly have that same reaction that I had, well, what about all of the – what about the historical trauma, and what about the military culture, and all those really huge things that tie into this? And so, I think making it clear that this fits into that puzzle would be important. Interview 2
Participants emphasised the need for campaign developers to integrate an understanding that specific populations may face more immediate, pressing concerns than the campaign’s focal behaviour.
My recommendation in talking to somebody like me, whose first reaction would be like, no, we don’t have time for that… is [to say] I understand that there are immediate life pressing concerns. And integrating this is a way to negate long-term life- threatening concerns. You’d have to loop it back around. Because a [client] of mine dying of cancer 30 years from now from smoking is less a concern than the legislature meeting currently, like they’re actually in session right now debating whether or not a kid getting hormones is child abuse. Interview 17
Participants also emphasised a positive, inclusive orientation to health, given the stressors and discrimination faced by the LGBTQ+ communities their organisations serve. Some participants described examining campaign materials for inclusivity regarding race, ethnicity, sexual orientation and gender identity, body sizes and other attributes.
Something that feels its intent is to shock or low-key traumatize the viewer is not something that we’re gonna be willing to share on our social media. I think having information that feels welcoming and it’s giving options to people is wonderful and doesn’t do so in a way that is shaming whatsoever. Interview 15
Regarding campaign development, participants described needing details about a given campaign’s underlying values and philosophy, for example, taking a transformational perspective. They also wanted to know whether community members were involved in the process and if materials reflected a community need.
I think it is important to know why we’re part of campaigns and why it works…I think that that is really helpful talking points for our staff at least because then if they’re working on the campaign or utilizing the tool kit… they have more of a picture behind why this is important or why you found that this works. – Interview 12
1b: CBO staff and leaders desire details about the campaign’s expected mechanisms of change and impact
Participants also emphasised the importance of deeply understanding the target change and expected impacts. This was particularly critical for a social media-based campaign as some participants expressed concern that it would just be sent out without additional follow-up and thus have no impact. For others, the emphasis was on tracking the success of implementation with a clear view of the goal.
It’s hard for me to measure if what “it” is is working if I don’t know what it is that’s supposed to be working… Knowing what the aim is, as a consumer of that information, is really helpful in planning and then implementing a strategy or a campaign at our organization with our patients. Interview 5
In addition, given the limited number of staff and/or funding available for the development and implementation of campaigns, participants—particularly leaders of small- and medium-sized CBOs—described wanting to have a sense of what would be required of them beforehand to know if it would be worth allocating limited resources.
Theme 2: support us in our work
2a: CBO staff and leaders want to see campaigns designed for flexibility and adaptation, particularly given the variation in size and resources of CBOs
CBO staff and leaders described the influence of organisational context and clients’ social context on their use of campaign materials. Thus, campaigns with built-in flexibility were noted to better support CBOs in addressing their community members’ needs. At the organisational level, participants emphasised the utility of approaches that account for the range of resources available to CBOs based on the organisation’s size. Needed flexibility included going beyond stock images or nods to inclusion and instead depicting mixed groups that accurately reflect how young adults engage one another. Similarly, participants emphasised the need to capture current moments and trends, such as social media trends or local events, to make the content seem more timely and relevant.
The ability of the campaign…to read the room of the current social mores, the social moment that we’re in, also current, being able to respond to current news is really important. Interview 14
The operationalisation of this flexibility varied greatly by organisation size. For organisations with large budgets, many described having in-house communications teams that would customise materials to reflect their brand and meet audience needs. For organisations with limited budgets, staff or other resources, the availability of ready-made materials was described as a priority, with tools that required minimal staff input to adapt and were easy to share as being most helpful.
I think we would just want you to give [the materials] to us in complete form. …We would never use anything that would come to us and say… This is an editable flier or an editable brochure. We don’t want to do that, and we never would. Interview 21
Some participants were interested in engaging campaign developer teams during the implementation process. They described wanting opportunities to learn more about the campaign through direct and ongoing interaction.
That’s how we were able to do what we needed to do with the American Lung Association was through our relationship with the technical assistants that were helping us roll that out. Interview 5
The CBO size was identified as a central factor driving their requests for products and approaches, suggesting how the need for flexibility takes quite different shapes for small and large organisations. Leaders of smaller CBOs described heavy reliance on volunteers and board members to fill some of the resource gaps, so dissemination of products and processes that required minimal additional effort were described as most useful. Exemplar products included language and graphics that need minimal resources to customise. CBO staff and leaders of smaller organisations also described valuing the possibility of co-branding materials as part of efforts to expand their reach. Some leaders from larger organisations described having in-house research, marketing, communications and graphics departments. For these organisations, support that could be offered at different stages of development was highlighted, for example, being provided with visuals and messaging that they could then tailor themselves, targeted technical assistance at a particular point, or, for an organisation with the capacity to develop the product themselves, support with getting that final product ‘out into the world’.
2b: CBO staff and leaders seek practical guidance and tools from developers to support adaptation and implementation of campaigns
A desire was expressed for tools that would facilitate the process of adapting original materials to better suit the needs of the communities they are working with. A central focus surrounding requests for guidance was the diverse and intersecting identities of LGBTQ+ community members served by the CBOs. Some participants described the usefulness of including detailed instructions on the process of customising campaign materials:
If there were instructions on how to customize it and really lay it out, if I can see your process for developing that communication, then it’s easier for me to wrap my mind around how to shape it for my population. Because otherwise, it feels like I’m going back through the steps of figuring out how you created it, and then recreating it. Interview 2
Survey and interview guides were also mentioned as being beneficial to support CBOs in assessing community response to a campaign to support adaptation. Participants wanted to access and use data collection tools to gather local data without the burden of creating data collection instruments. This was seen as the only way to achieve systematic adaptation goals for organisations without staff with this expertise.
2c: CBO staff and leaders seek granular data to serve their clients and communities more effectively
Several participants described needing granular data about the groups within the LGBTQ+ community they serve. This was positioned as a contrast to typically available data, with broad groupings that limit the CBOs’ ability to understand the nuances of health issues and behavioural patterns among groups of interest. For example, state-level tobacco use data were discussed as having limited utility because LGBTQ+ populations were all grouped, without the ability to examine data for a particular sexual orientation or gender identity or for rural versus urban residents of the state. Similarly, participants noted that researchers tend to have invested in deep study of the populations of interest and can share summary information to support CBOs’ broader work.
Bisexual outcomes is something that we would want to see. Especially knowing that bisexual populations are more adversely affected by tobacco use than others. Just making sure that [they’re] not just lumped in as a datapoint, I think, would be really important. Interview 11
Exemplar dissemination products/processes nominated
As summarised in figure 2, participants suggested a range of products and processes that allow CBO leaders and staff to understand the nuances of campaigns and access rich support for adaptation and implementation.
Figure 2Exemplar nominated dissemination products and processes.
Many participants suggested products such as fact sheets and briefs to describe the campaign’s development, mechanisms and impact. They noted the need for both summary and detailed information so that CBO staff and leaders could access varied levels of detail. They also spoke of the importance of products facilitating local data access and synthesis. These products were expected to reduce work for organisational staff and make the research’s central aspects (eg, literature reviews, findings) more accessible. Additionally, numerous products and processes were nominated to support adaptation, including customisable surveys and focus-group interview guides, webinars, storytelling activities and technical assistance. In this vein, participants also highlighted the importance of direct interactions between campaign developers and CBO staff. Other adaptation-focused nominations were directly tied to products intended for distribution via social media. These included social media templates that support minor adjustments, for example, adding a logo; social media elements that can be integrated into a range of platforms and allow for intense adaptation; a range of text choices and images that communicate core messages; and brief videos.
