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Western Governors University C229 Community Health and Population-Focused Nursing Field Experience Jennifer Frisbee December 20, 2020

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Social Media Campaign A. See attached B. The nursing diagnosis I choose to discuss for my county, Buncombe County, North Carolina is Disaster Preparedness: Increased risk of COVID-19 among adults in Buncombe County, North Carolina related to lack of knowledge of preventative measures such as masks, social distancing, handwashing, and avoiding gatherings as evidenced by a 23% increase (75 new cases a day) in one week. B1. Buncombe County has a population of 261,191. According to the North Carolina Department of Health and Human Services, as of December 14th, the total number of COVID-19 cases is 7,029 and of those, 134 cases have resulted in death. (North Carolina Department of Health and Human Services) From November 30th to December 7th Buncombe county reported an average of 75 new cases a day and the number of COVID-19 positive patients increased 23%. (Buncombe County, 2020) Based on this information, the evidence implies that citizens of Buncombe County are not following county mandates such as wearing masks, social distancing, and avoiding gatherings. This health concern is linked to a health disparity: low socioeconomic status. 12.3% of the population is living at the poverty level and according to Homeward Bound of Western North Carolina, there are 541 homeless citizens. (Homeward Bound of Western North Carolina, 2020) This population may not have adequate access to hygiene and sanitation facilities or connection to services or healthcare. (Centers for Disease Control, 2020) Although there are congregate living facilities in my community, this puts the homeless at a higher risk for contracting COVID-19. These shelters are close quarters and often citizens are gathered which

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allows for a higher risk of transmission and outbreaks within the shelters. This population usually has no access to primary care services, has underlying health conditions, and lack transportation services. B1A. The primary community resources and primary prevention resources currently in place in Buncombe County to address this health concern are those that follow the Center for Disease Control recommendations. These include washing your hands for at least 20 seconds with soap and water, wearing masks, staying 6ft apart while with others, avoid gatherings, especially indoors, and covering your cough and sneezes. (Centers for Disease Control, 2020) The Buncombe County Task Force convened to ensure compliance with the latest State Executive Orders. The Key factors they assessed were signage requirements, mask compliance, capacity limitations, greeters at stores with over 15,000 sqft, and compliance with 6-foot physical distancing. (Buncombe County, 2020) They observed 40 businesses throughout the county and found that other than some signage violations, most businesses were complying. During my windshield survey and site assessments, I found that most businesses; grocery stores, retail stores, and gyms did have store greeters that had masks and hand sanitizer available. If customers did not have masks, the greeter would give them one and ask them to put it on. Businesses that I noticed had the least compliance were gas stations. From my observations, about 50% of patrons wore masks and the other 50% did not have any face coverings when going into the store. Many of the clerks behind the counter at these gas stations did not wear masks either, plexiglass was hung between the clerk and the customer, but no masks.

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B1B. I believe that the underlying cause of this health concern is citizens becoming lax on wearing masks, avoiding social gatherings, and staying at home. In a piece that was released by John Hopkins Medical, Lisa Maragakis, MD discussed why communities are seeing an increase in COVID-19. She states “human behavior is the major factor. State and local governments, as well as individual people, differ in their response to the pandemic. Some follow COVID-19 precautions, such as physical distancing, handwashing, and mask-wearing. Others are not as prescriptive in requiring these measures or in restricting certain high-risk activities. (John Hopkins Medical, 2020) My community, like most, is tired and ready for COVID-19 to be over. They miss hugging, shaking hands, seeing family and I believe at some point the community just got tired and quit following county mandated prevention measures. The thought of going through holidays without seeing family seemed obscured to some. Before the Thanksgiving Holiday, North Carolina Governor, Roy Cooper released an executive order stating that citizens should keep gatherings to 10 people or less and while in a household other than your own, masks are recommended. The governor addressed why mask wearing and social distancing was important in preventing the spread of COVID-19. When speaking to others in the community, most of them were not compliant with the order or did not understand why they needed to wear mask around their own family. Many people can have COVID-19 and not have any symptoms, although these cases are asymptomatic, they are still able to transmit the virus to others. I feel for some this concept is hard to grasp and so if they are not showing signs and symptoms of COVID-19, they are choosing to carry on like normal, not realizing that this virus that did not affect them much could be detrimental to others. B2.

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In a study shared by the Centers for Disease Control, the authors discussed how community and close contact exposures continue to drive the COVID-19 pandemic. (Fisher, et al. 2020) They studied case-patients, those who were COVID-19 positive, and control patients, negative for COVD-19. The study discusses the likelihood of contracting COVID-19 at businesses that offer on-site eating and drinking. They discuss that is it often hard to maintain mask-wearing and social distancing at places where you are eating and drinking, and states that exposures in restaurants have been linked to transmission because of air circulation, direction, ventilation, and intensity of airflow. This study showed that among adults, those with positive COVID-19 results were approximately twice as likely to have reported dining at a restaurant than were those with negative results. They suggest that efforts to reduce possible exposures where mask use and social distancing are difficult to maintain should be considered to protect customers, employees, and communities. (Fisher, et al. 2020) In another article, COVID-19 case numbers in Taiwan were compared to those in Singapore. Taiwan reported 348 cases and Singapore reported 1,114. Both Countries reported using preventative measures, but Taiwan recommended the use of masks early in the pandemic. Singapore did not recommend masks until April 3rd. (Chiang, et al., 2020) According to the CDC, COVID-19 most commonly spreads during close contact. (CDC, 2020) Transmission occurs through respiratory droplets, when people talk, sneeze, or cough those droplets can travel through the air and infect a close contact. CDC recommends handwashing with soap and water for at least 20 seconds, or with hand sanitizer that contains at least 60% alcohol. They recommend avoiding close contact, remaining at least 6ft away from others, wear masks, and disinfect surfaces. (CDC, 2020) B2A.

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Buncombe County, North Carolina has a population of 261,191. According to the North Carolina Department of Health and Human Services, as of December 14th, the total number of COVID-19 cases is 7,029 and of those, 134 cases have resulted in death. From November 30th to December 7th Buncombe county reported an average of 75 new cases a day and the number of COVID-19 positive patients increased 23%. (North Carolina Department of Health and Human Services) As a state, North Carolina has 466,104 cases and 6,174 have resulted in deaths. In the last 7 days, North Carolina has had 42,481 new cases reported. (CDC, 2020) As a nation, as of December 19th, there are 17,391,270 confirmed cases. 403,359 of those have been new cases reported in the last 7 days and there has been a total of 312,636 total deaths. (CDC, 2020) These statistics prove that the pandemic is worsening and something needs to happen to stop the numbers from rising. I believe that increased knowledge of preventative measures and compliance with these measures is the answer.

C1. The objective of my social media campaign is to reduce the number of COVID-19 positive cases in Buncombe County, North Carolina by 20% in 3 months. I plan to do this by providing information and resources regarding the effectiveness of preventative measures such as handwashing, wearing masks, and socially distancing. C2. The population-focused social marketing interventions I would use are Facebook and YouTube. Both platforms are free, adults of all ages use them, and they are easily accessible. These platforms can get information across in different ways. Facebook would improve my health message by providing information to my community regarding the effects of using

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preventative measures to decrease the number of COVID-19 cases. I would share informative fliers that are easy to read and understand, I would also provide links to the CDC’s website for information on how to protect yourself and others, and direct links to Buncombe County, North Carolina for updated information specific to our county. YouTube would improve my health message by providing videos on the importance of using the CDC preventative measures recommendations. On this platform, I would share animated videos that were fun, but informative. In these videos, I would develop different simulation scenarios regarding social distancing, mask-wearing, and hand washing. I would provide examples of how being compliant with each method has a positive effect on transmitting the spread of COVID-19. On this platform, I would also share videos of citizens in my community who have been affected by COVID-19. I believe that personal stories can have a positive impact on issues that we care about. C3. The social media platform I would use is YouTube. YouTube is a video-sharing platform and can provide information to people locally and across the globe. On this site, users can like, share, and save videos. This platform is appropriate for communicating with adults of all ages and those with varying levels of education. C3A. Using video-sharing sites to disseminate tailored health education and health communication messages helps provide an engaging experience for consumers to view and create health and safety information. With people watching over 100 million clips a day, these online video sources can be a powerful mechanism. (CDC, 2019) I chose this platform because I am a visual learner and for people like me it is often hard to sit down and read the information

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regarding preventative healthcare. Through videos, information can get across to different types of learners, and through fun, interactive videos, the information is often easier to absorb. C4. I believe that adults will benefit from my health message through this social media platform because they will be able to visually see how COVID-19 is spread and how socially distancing, handwashing, and wearing face masks would help to prevent the spread. I would use reliable sources such as the CDC and WHO when providing information. YouTube makes it easy for people to learn, they can listen to the videos provided at any time and can also share informative videos with their family and friends. Employers can use these videos to educate their employees. Primary Care Practices can have discussions with their patients and share the videos with them as well. The overall benefit would be increasing the knowledge of the community to decrease the number of COVID-19 positive cases. D. The best practices for implementing social media tools for health marketing is to have a clear and organized approach when relaying information to your targeted population. When choosing a social media platform, it is important to choose one that is user-friendly for all ages, and all levels of learners. It is important to make sure that messages are science-based, and that the information you are providing is easy for people to share so that they too can be health advocates. According to the Centers for Disease Control, there are three key attributes of social media channels that are believed to make them highly effective as health communication tools: 

Personalization- content tailored to individual needs



Presentation- timely and relevant content accessible in multiple formats and contexts

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

Participation- partners and the public who contribute content in meaningful ways. (CDC, 2019)

E. Stakeholders that would be involved in my project would be the Center for Disease Control to provide me with the most up-to-date information regarding transmission prevention. I would also involve a frontline physician and nurse to help demonstrate care practices and speak on personal experience when creating videos since they are directly affected by the result of citizens being non-compliant with preventative measures. Another stakeholder would be a Public Health official to better understand mandates, laws, and how well things are being enforced. Public Health officials would also analyze what community health needs are. Lastly, I would have 4 members of the community on the team to bring different perspectives on mask-wearing, social distancing, and other preventative measures. E2. A potential public partnership I could form to aid in the implementation of my plan would be Buncombe County Health and Human Services. They would be able to provide up-todate information on COVID-19 cases and populations that are most affected by COVID-19 and apply their knowledge of health screens, contact tracing, and quarantine/isolation guidelines. A potential private partnership I could form to aid in the implementation of my plan is Mission Health Hospital. This partnership could provide the funding’s that are needed to build my campaign, the knowledge of the physicians, nurses, respiratory therapists, pharmacists, and others who are on the frontline of COVID-19, and educators that could assist in the making of the videos and how to best get information across to the general public. E3.

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I would start implementing my social media campaign on December 27, 2020. During week 1 I would hold a meeting with key stakeholders, private and public partners to create a plan, secure necessary resources, and develop a budget. Week 2 January 3rd-9th The team and I would start recruiting volunteers and hiring staff members to execute the social media campaign. The week of January 10th we would talk to local businesses and county board members to discuss how to present the YouTube video campaign. We would work with businesses, who are willing, to plan a release of the campaign on their websites, Facebook pages, YouTube channels, etc. The next two weeks January 17th-31st would start the training process. We would collect information from stakeholders, decide how we want to execute the videos, and start making the videos. February 1st, the start of week 6, we would go live with the YouTube campaign. We would begin releasing our animated videos of how COVID-19 is transmitted, how masks and social distancing can help prevent the spread, educating on proper handwashing techniques, and sharing real-life stories of how locals have been affected by COVID-19. Week 6-10 we would continue to engage with the community, work with more businesses to get our campaign on their platforms, and continue gathering information to make more educational videos. February 28th, the end of the second month, we would start reaching out to the community, business owners, and local health department to evaluate the effectiveness of our campaign on mask-wearing, social distancing, and COVID-19 positive cases. We would take the information gathered and apply it to our campaign process for improvements. At the end of the campaign, we would meet again with stakeholders, county officials, and the health department to look at statistics to see if we reached our goal of increasing the adult population's knowledge on preventive measures and decreasing our COVID-19 positive cases by 20%. E4.

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To evaluate the effectiveness of the social media campaign, I would analyze data collected by the health department regarding COVID-19 case numbers. I would use charts and graphs to demonstrate case numbers before starting the campaign, during the campaign, and at the end of the 3months. Based on that information, I would be able to determine if the campaign did its job in decreasing the amount of COVID-19 positive cases. E5. The most expensive part of the campaign would be direct costs such as the money you would pay out to your staff members for their work and time, programs that assist in making animated videos, building charts and graphs, and manufacturing supplies such as fliers to supply to local businesses promoting our video campaign. Another big expense would include renting out space for planning, building videos, and analyzing data. This expense is an example of an indirect cost. Smaller indirect costs would be general office supplies needed to plan and build our campaign. F. Social media marketing supports the community health nurse’s efforts to promote healthier populations by supplying the nurse with several resources to spread the word on healthy habits, ways to keep yourself and your family healthy, and the most up-to-date information regarding specific health information. Social media and its many platforms give the community health nurse the ability to provide education to all populations and allows the information to spread rapidly through the community by posts, likes, and sharing capabilities. In this situation, it allows the nurse to provide CDC recommendations on how to prevent the spread of COVID-19 and provides the community with visual representations and examples of the steps they should take to protect themselves and others.

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F1. In my current position, I sometimes work in labor and delivery triage. We see every patient that comes to the hospital that’s pregnant no matter the gestation or situation. Here I assess, treat, and either admit or discharge patients. Part of the discharge process includes providing education. I can apply my social media campaign to my future nursing practice by making this campaign a part of the discharge education process. Since we are currently living through a pandemic, I feel it is important to provide the community with the most up-to-date information regarding it. I can include my Youtube videos as part of the education depending on their current situation and health-risk needs assessment. To measure effectiveness, I can pull statistics of the number of pregnant patients who are COVID-19 positive before implementing the campaign and compare that number to the number of positive pregnant patients after the implementation.

References Buncombe County, North Carolina. Coronavirus (COVID-19) Cases Weekly Community Update. (2020, December 11). Retrieved from https://www.buncombecounty.org/countycenter/news-detail.aspx?id=18543

Centers for Disease Control. COVID Data Tracker. (2020, December 19). Retrieved from https://covid.cdc.gov/covid-data-tracker/

Centers for Disease Control. People Experiencing Homelessness. (2020, August 6). Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/community/homelessshelters/unsheltered-homelessness.html

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Centers For Disease Control. Social Media Tools, Guidelines & Best Practices. (2019, December 27). Retrieved from https://www.cdc.gov/socialmedia/tools/guidelines/

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