the first one so that the campaign or program is constantly learning and improving on the basis of past experiences, successes, and failures (Valente and Schuster, 2002).

One example of a social marketing approach is the ABC Immunization Calendar program developed by the Health Communication Research Laboratory at St. Louis University in Missouri. In response to the fact that less than half of children ages 2 and younger are fully immunized in most major U.S. cities, the ABC Immunization Calendar program was developed to raise immunization rates among children from families in lower socioeconomic groups—the targeted audience (Zell et al., 1994). Based on evidence that more patient-oriented approaches by providers have been recommended and that computer-generated educational materials that are tailored to individuals are more likely to be read, remembered, saved, and discussed and to lead to changes in behavior, especially among poor and underserved populations, the program provides computer-made immunization promotion calendars tailored to each child (National Vaccine Advisory Committee, 1992; Skinner et al., 1994; Brug et al., 1996; Bull et al., 1999). The calendar includes the child’s name, picture, height, and weight as well as room to track his or her growth, family birth dates, helpful hints, interesting facts about the child’s living environment (e.g., use of car seats, limiting exposure to smokers, and the presence of smoke detectors in the house), the most recent and next immunization appointment, and appointments for future well-baby checkups.

The calendars were developed on the basis of interviews and focus group meetings with mothers of young children from communities of lower socioeconomic status who strongly supported the inclusion of a color photo of their child on the calendar. Because many families could not afford to have professional pictures taken of their child, the calendar fulfilled this need and was seen as a valuable and prized addition to the home. The calendars were printed on brightly colored paper and laminated for durability. Mothers would receive calendars for each of the months leading up to their children’s next immunization appointment. When the child was vaccinated, new calendars were generated for the next appointment. As a result, the calendars provided an incentive for the family to keep appointments, come to the clinic, and have the child immunized.

To monitor the program’s effectiveness, mothers who were given calendars, as well as the providers at participating health clinics, were asked about the perceived value and utility of the calendars, enrollment in the program, adherence to the immunization schedule in terms of keeping appointments, and overall immunization behavior. In the clinics and communities where the ABC Immunization Calendar program has been implemented, great strides have been made in increasing the number of immunized children. Multiple strategies at the state, clinic, and family or



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