Guide to Reaching and Engaging

Participate in health fairs or other large community events

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Participate in health fairs or other large community events.

Be creative and interactive when participating in health fairs and community events. Provide incentives for people who take information, fill out a questionnaire or complete an application. Incentives can include entry into a raffle or small gifts (e.g., a toothbrush, a tiny eraser). Plan a children’s activity (parents usually follow their children to the table). Have unusual, attention-getting table displays, or have your staff wear costumes or eye-catching attire, such as T-shirts saying, “Want to protect your family from the FLU? Talk to me.”

  • Post fliers around town.

Post everywhere possible, especially in places where community members congregate. Going door-to-door may be labor intensive, but it is effective. Use your community connections (such as scouts, college students, and outreach workers) to help you distribute fliers throughout their blocks or neighborhoods. Do this twice if possible.

  • Enlist the help of community agencies and businesses.

Encourage community agencies and businesses to incorporate flu or other health information into their daily routine. For example, ask them to hand out fliers to every client, place them in every intake packet, or include them in every purchase.

  • Make pharmacists your allies.

Pharmacists often know who has unmet health care needs. Encourage them to post fliers and information on their counters or distribute them to those they serve. Ask the pharmacy if you can set up an information table in their stores.

  • Attend school or after-school activity information or registration events.

  • Provide trainings in “temp” or day-labor agencies.

  • Co-host a casual information session with a community partner.

Hold an after-hours or weekend coffee at someone’s house, a local church or community center. Provide food and ask one of your community partners if they will host with you and invite their friends.

  • Partner with students.

Ask high school or college students to help you reach their peers or to distribute fliers in target neighborhoods.

(Resources to help plan your outreach campaign can be found on page 39.)

Section Three:

Engaging Your Community:

Faith-Based Organizations

Section Three: Engaging Your Community: Faith-Based Organizations

We often think of churches, mosques, temples and synagogues as places where our communities find spiritual resources and leaders. They are also trusted cultural and activity centers for many hard-to-reach populations. Members and leaders of faith-based organizations are important links to the community for all kinds of health outreach. Health departments and community organizations may be working with them or may have worked with them in the past. Your city or town may have a directory of its faith-based organizations or lists of all churches by denomination, location, times of worship, populations served and contact numbers. Many communities developed such lists in the midst of a local emergency, such as an ice storm, a power outage, or the H1N1 outbreak in 2009.

If you have access to one of these lists, now is the time to bring it up to date. If not, it is well worth the effort to create a complete database of faith-based organizations in your community. This information will be a great resource in the future.

As you reach out to these diverse groups, keep the following tips in mind.
  • Find a primary contact. The church leader (pastor, imam, priest, etc.) may be too busy for you, so begin somewhere else. Is there a nurse, doctor or other health professional who attends the place of worship and can be your ally?

  • Seek to hold a meeting in their place of worship. Does the institution have a health committee or ministry that can assist with education and vaccination at their place of worship or in the surrounding community as part of their community volunteer work? If so, offer to hold an educational program (see Section Eight: Flu Education).

  • Reach underserved populations through key programs. Does the institution sponsor a meal program, food pantry, clothing drive, or drop-in space? These are excellent opportunities to reach underserved and underinsured populations.

  • Participate in existing events. You don’t have to plan an event if you are able to attend one that is already scheduled. What events are planned for the future? Ask if you can have a table or hand out informational material at upcoming fairs or social events.

  • Spend time getting to know the institution. Find out:

    • What is the institutional structure?

    • Do they have elders or lay ministers?

  • Learn how they communicate with members outside of religious services. Ask:

    • Do they have a newsletter?

    • Do they have a website where they post announcements?

    • Do they use an e-mail list?

    • What languages do they use?

  • When planning a flu clinic with a faith-based institution, it can help to:

    • Ask if the pastor or leader can participate in or advocate for the flu vaccination.

    • Train church volunteers in the basics of flu and turn them into flu ambassadors—give them their flu shots first, and they will help publicize the clinic.
    • Find out if the event will be open to the general public, or only to members of that religious community.

    • Determine what language capacity you will need.

    • Ask when people are most likely to attend.

    • Get full endorsement from the institution. Put its name front and center.

Faith-Based Organizations

Faith-based institutions may be Buddhist, Christian, Hindu, Jewish, Muslim or Humanist, and among these, there are many denominations and differences in faith and practice. While diverse in beliefs, they are linked by their ability to connect with and lead communities. Members may gather daily or weekly, for worship or other events.

Partnership in Peabody

At a church in Peabody, Massachusetts that serves a largely Brazilian population, community members were concerned that undocumented members would not participate in something sponsored by the government. For this reason, the health department was not mentioned in promotional materials. Instead, the church’s name was prominent.

Building bridges to reach Guatemalan Mayans

Third time’s the charm

At the St. Paul’s AME Church in Cambridge, initial participation in H1N1 flu vaccination was very low. Public health nurses returned two weeks later to offer a flu educational session and vaccines, and participation went up. At a third event, held at the church’s Christian Life Center, the pastor got his flu shot and spoke about it from the pulpit the following Sunday. Each time, community acceptance and response increased.

he New Bedford Health Department reached a significant new population of Mayans through the priest at their church. Mayans in New Bedford have been targets of raids and deportations at their workplaces, and they are understandably distrustful of government.

The priest was not receptive at first, but now has become a partner with the health department.

A bridge was built through flu vaccination, but now stands ready for other health interventions.

Be persistent!

Don’t be discouraged by low turnout at the first effort. Plan another event and stay in touch. It takes time to earn trust and become a community partner. The partnerships you develop during this time will be of value for other community outreach and engagement work in the future. When flu shot season is past, be sure to schedule a meeting with your partner(s) to thank them and talk about what worked and what did not work. Use the feedback from that meeting to start planning for improvements in future health initiatives.

Church members lining up for flu vaccine. Photo courtesy of Peabody Public Health Department

(Resources to help you engage faith-based organizations can be found on page 42.)

Section Four:

Engaging Your Community:


Section Four: Engaging Your Community: Schools

No flu outreach to underserved populations is complete without considering the schools in the community. School buildings today are not just open to students but also bring together adults, children and workers for a wide range of community programs and activities. Schools are used after hours for recreation, adult education programs and parenting classes. Several approaches to schools in your community can help with promoting and improving flu vaccination.

Your target group may not be the children. By working with the schools, you are able to reach out to communities of people who use school facilities, whether or not they have children in those schools.

Develop a list of all schools and day care centers in your area with contact information, ages served and lists of the programs offered. Include private and parochial schools, which often provide scholarships or supported tuition to children from diverse communities. The school superintendent and school principals are important allies. In the spring and fall of 2009, H1N1 caused such high absenteeism that many classrooms and school activities ceased. Because of this, school personnel today understand the vital importance of educating children and families about flu prevention. Start planning well before the beginning of the school year. Back-to-school letters can include simple “four ways to prevent flu” messages. Bring teachers, school health educators, and school nurses on board to sponsor a Flu Education Week or Month.

You can’t educate a child who isn’t healthy, and you can’t keep a child healthy who isn’t educated.”

- Dr. Jocelyn Elders,

U.S. Surgeon General,

1993 - 1994

Ten minutes of interrupted classroom time is a small trade-off to keep a child from being out of school for a week.”

- Dr. Jeffrey Young, Superintendent, Cambridge Public Schools, Cambridge, Massachusetts

Photo courtesy of Manet Community Health Department

Tulsa, Oklahoma: children grades 1-5 participate in a

Don’t Bug Me contest to create flu posters.


Simple pledge: “How I am Going to Prevent Flu This Year”

Check off each of the following:

  • Cover my coughs and sneezes

  • Wash my hands for 20 seconds with soap and water before eating and after going to the bathroom.

  • Stay away from people who have a fever and sore throat.

  • Stay home if I am sick.

  • Get a flu shot or nasal spray.

  • Tell my family and friends about the flu.

ncreased awareness of flu vaccines

Awareness of the importance of flu vaccines continues to grow in local schools. As a result of the H1N1 flu virus outbreak in the 2009-2010 flu season, most cities and towns in Massachusetts held some kind of school-based or school-located immunization effort.

When contacting a school or day care center, you may want to ask the following:

  • Who is responsible for health education? (Ask to speak with that person.)

  • Does the school have a nurse? Does he or she give flu vaccine?

  • What languages do the children and parents served by this school speak? What cultures do they represent?

  • Is there a parent advisory council or parent-teacher organization?

  • How does the school communicate with parents?

    • Do they send children home with fliers or handouts (i.e., “backpack express”)?

    • Do they send out regular mailings?

    • Do they have an emergency parental communication system that could be used?

Ideas for a flu education week or month:

  • Plan early—get school allies on board before the school year begins.
  • Ensure that flu is part of age- and grade-appropriate health education curriculum.

  • Sponsor a flu education poster competition among the students and display the winners in school hallways.

  • Encourage children to sign a pledge: “How I am going to prevent flu this year.” (See below.)

  • Develop classroom skits about flu (see the Whack the Flu materials in Toolbox).

  • Send reminders home with specific information about when and where to get a flu shot.

(Resources for working with schools can be found on page 42.)

Section Five:

Engaging Your Community:


Section Five: Engaging Your Community: Workplaces

Because flu causes thousands of hours of lost work time, workplaces have an economic interest in keeping workers healthy and protected from flu.

Large workplaces can be encouraged to sponsor their own flu clinics and to send reminders about flu vaccination to all of their employees. When workers have health insurance, the flu shot is often covered and may not require a co-payment. Company bulletin boards can post information about nearby flu clinics and reminders about flu prevention. Local health departments and community-based organizations can encourage flu vaccination at workplaces by providing flu education materials, posters and letters for employees and by providing information about convenient nearby sites for vaccination. Some large workplaces may have an occupational health department or nurse, but this is rare when it comes to low-wage and non-English speaking workers.

Workers at minimum and low-wage jobs often must work two or more jobs to support their families. This means they have very little time to devote to finding and getting a flu shot. Convenient and timely access to the vaccine is extremely important to them. If they have to wait, or travel too far, it just won’t happen.

To reach culturally and linguistically isolated members of the workforce, you need to find and map their work locations within your community. This will help you plan public clinics that are easily accessible to them.

Ask yourself:

  • What are the low-wage jobs in your area?

  • What are the service industries in your area, such as restaurants, hotels, shopping malls, contracting and landscaping businesses?

  • Is there an outdoor location in your community where workers gather informally to seek contract work for a day or a few hours?

  • Where in your community do workers break for lunch or coffee? Is there a popular after-work hang out spot?

  • Are the workers represented by a union or another workers’ organization?

  • What languages do the workers speak and read?


  • Getting a flu shot:

    • Prevents missed workdays and lost sick time.

    • Protects the other workers near you.

    • Protects your family—don’t bring home the flu!

    • At public clinics, you don’t have to have insurance, and no one will ask about your immigration status.

    • Information about you is confidential and protected by law.

Photo courtesy of Manet Community Health Center

If there are eight guys in a group, I will go right up to the biggest one first, and then the rest of them will roll up their sleeves.”

- Kitty Mahoney, PHN, Framingham Health Department

Photo courtesy of Cambridge Public Health Department

Examples of successful practices

Flu shots at the bakery

In Framingham, Massachusetts, the public health department set up vaccination supplies and a public health nurse in a neighborhood bakery frequented by Brazilian workers who congregate there while waiting for work.

Flu shots on the job

In Belmont, Massachusetts, the health department worked with the largest restaurants, where service workers were vaccinated before and after the lunchtime shift. Restaurant managers were happy to cooperate, and few workers refused the opportunity.

In Gloucester, Massachusetts, the health department reached out to the three largest fish processing plants to offer onsite vaccination to workers. This activity was so successful that it is now done every year, offering multiple opportunities for health promotion activities.

Flu shots while you shop

The cities of Cambridge, Somerville and Chelsea teamed up with mall management at the CambridgeSide Galleria Mall to offer three flu clinics in 2010. Food court and retail sales workers were highly represented among those vaccinated. For many, it was their first flu shot ever, and because 10 percent of them had risk factors for pneumonia such as smoking, asthma, or other chronic disease, the clinic provided the pneumonia vaccine at the same time as the flu shot.

(Resources on workplaces can be found on page 43.)

Section Six:

Engaging Your Community:

Homeless Populations

Section Six: Engaging Your Community: Homeless Populations

Homeless people are a unique group. Many of them are 65 or older and suffer chronic diseases such as asthma, diabetes and heart disease that put them at high risk for flu and its complications. They are also likely to be transient, with irregular access to medical and preventive health services. Their overcrowded living facilities and exposure to extreme weather conditions lower their immunity, further predisposing them to flu. This is why homeless shelters and drop-in programs are excellent venues in which to educate and vaccinate people in our community.

Homeless clients may be wary or fearful, so it is essential to partner with those at the facility who have already established relationships with clients. Providing education or vaccination to staff, volunteers and visitors is an excellent first step. Engaging shelter staff to help plan your flu outreach initiative is critical. You may also want to identify natural leaders among the homeless to help support your effort, or vaccinate clients and staff together.

Lunchtime flu shots

In Western Massachusetts, the Amherst and Northampton Survival Centers provide lunchtime flu shots to homeless persons. Since clients already gather for their daily meal, and to receive staples such as clothing and toiletries, they have been more receptive to education and vaccination at the Centers.

A healthy New Year’s resolution

A South Carolina health department collaborated with the First Baptist Church to conduct a vaccination effort during the annual New Year’s Day gathering for the homeless. Church volunteers provided guests with hot meals and winter coats and health department staff walked around the church, talking to people and encouraging them to receive the vaccine. More than 20 percent of attendees were vaccinated.

Flu shots at Thanksgiving Dinner for the homeless. Photo courtesy of City of Framingham Health Department

Consider also extending your outreach to food pantries, welfare offices, libraries and other spots where homeless persons congregate. You may find one-to-one outreach most successful, especially if you are accompanied by trusted staff. Verbal presentation is likely to be more effective than written material.

Incentives including food, socks, toiletries or gift cards will be especially appreciated and might increase your success.

Remember to include in your training sessions preventive housekeeping and hygiene practices that may prevent an flu outbreak: management of staff absences due to flu outbreaks and strategies for isolation and care of clients suffering from flu.

(Resources for working with homeless populations can be found on page 43.)

Section Seven:

Engaging Your Community:

Community Organizations

and Ethnic Groups

Section Seven: Engaging Your Community: Community

Organizations and Ethnic Groups

Local community-based organizations, in particular those that serve particular ethnic populations, are ideal partners for flu prevention campaigns. Settlement houses, community action agencies, civic and business organizations and athletic clubs have already developed trusting relationships with their constituents, and know those who are most vulnerable and hard to reach. They can help communicate important health information about the need for vaccination and healthy practices in an effective and motivating manner.

Many towns have interagency coalitions that meet regularly. Ask for a list of their members, and see if you can participate in a meeting, preferably well before the start of flu season. Follow up by contacting the leaders of these groups, and request their help in keeping their community healthy. Offer to host a coffee hour, or ask to be invited to a meeting to educate staff or board members about flu prevention. Encourage them to partner with you to:

  • Spread the word about what individuals can do to stay healthy during flu season.

  • Set a healthy example by getting vaccinated and staying home if they are sick.

  • Include information about flu in their regular newsletter or website.

  • Identify people who are homeless, shut in, uninsured or underinsured, non-English speaking, unconnected to mainstream media, migrant workers, immigrants, or refugees.
  • Offer space in their premises that can allow you to engage clients in conversation about flu prevention.

  • Translate your information into culturally and linguistically appropriate materials that can be understood by members of their community.

  • Ensure that messages are simple and clear to low-literacy audiences.

  • Organize rides to vaccination clinics and set up vaccination appointments.

  • Host an information session on flu vaccination for people in their community.

  • Follow up with community members to help ensure that they receive all necessary vaccinations and see their doctor for treatment.

Door-to-Door health education

Cambridge Literacy

Ambassadors, who have established close connections to six ethnic groups to encourage parents to read to their children, reviewed flu education materials and hung flu info “door hangers” in their neighborhoods.

They got so excited about this work that they planned a special flu outreach event at a public housing development with residents from more than 20 nationalities. They now think of themselves as health educators as well as literacy advocates, and are eager to help with other health issues in the future.

Young Health Advocates

The Family Van, a health outreach program in an urban Boston neighborhood, worked with the Roxbury and Chelsea Boys & Girls Clubs to encourage youth to become flu educators. They taught the kids about flu, and they in turn worked to educate their peers and their parents about the importance of getting the flu shot. The kids also designed posters, put them up through the club and designed an outreach plan for their neighborhoods. These young health advocates helped implement seven flu education and vaccination events.

Photo courtesy of Manet Community Health Center

Many community organizations already have outreach educators trained to provide health information and connect residents to health services. Ask if they can add information about flu to their menu of services. Perhaps they might be willing to focus-test your materials or offer suggestions about what messages will work best for your target group. MDPH’s Refugee and Immigrant Health Program (RIHP) has a significant outreach component staffed by trained bilingual, bicultural individuals who provide the primary link between their respective communities and the health care delivery system. The program provides health education, outreach, clinical interpreting, treatment monitoring and follow-up for refugees from Southeast Asia, the former Soviet Union, Haiti, Cuba, Somalia, Iraq and Bosnia. RIHP staff work to control tuberculosis and hepatitis B, to increase understanding of and compliance with medical recommendations, and to provide basic information to the local health care groups. For help on how to contact individuals assigned to your area, check the Resources listed on page 42.

It’s easiest to participate in events that are already scheduled. Find out if the organization hosts a regular men’s or women’s group, a teen or senior program, or an annual fair. Ask if you can have a table or a portion of their meeting to discuss the importance of flu prevention.

In Massachusetts, there are many community-based organizations that serve the needs of specific ethnic and language groups. Staff there know the people, the norms and customs, and the informal and formal leaders who are important in that community. They will likely be comfortable in the language and dialect of your target group, and they may understand the specific issues facing them, such as:

  • Are there recent immigrants? How did they stay healthy in their country of origin?

  • Which generation has the most influence?

  • Can children carry a message for their parents?

  • What is their attitude toward government or medical services?

  • Are they more likely to respond to a message from a male or female health worker?

For a list of programs that serve distinct ethnic and linguistic communities, see Toolbox, Section 11.

(Resources on Community and Advocacy organizations can be found on page 43.)

Section Eight:

Flu Education:

Beliefs and Perceptions

Section Eight: Flu Education: Beliefs and Perceptions

Your community’s awareness of flu and flu vaccination depends on many factors: socio-cultural, level of education and past experience. Populations with the greatest health disparities may also have had discriminatory experiences in the past with health providers and health authorities. They have learned to be skeptical. They need information, but they also need to trust the source—you. Developing the trust of your population is the key. The biggest mistake you can make in your approach is to assume you know what people think or how they feel about flu.

Sometimes a particularly vocal community member will tell you “all of my people believe (this or that).” It might be true that many people have a particular belief, but never base your educational program on the word of one or two outspoken people. Here, as with any other community outreach, it helps to do homework ahead of time, and start by asking questions instead of giving answers.

Before you begin doing flu education

Find out what a particular group thinks about vaccines, and specifically about flu vaccines, by starting your meeting or educational session with these questions:

  • Do they get shots? Do their children get shots? If they do, why? If not, why?

  • What have they heard about flu vaccines?

  • Who do they trust for reliable health information?

  • What practices do they follow to prevent diseases?

  • What are their feelings about “official” sources of health information such as their provider, the health department, and the government?

Disparities in vaccination rates

In 2009, only half of eligible Massachusetts’ residents got a flu vaccine. African Americans had the lowest vaccination rates.

During the 2009–2010 flu season, African Americans and Hispanics in the U.S. were almost twice as likely to be hospitalized with flu as whites.

Photo courtesy of Tapestry Health

As you hear the answers to these questions, write them down on a board or flipchart and acknowledge them—don’t argue with them, and don’t judge them. Statements such as “many people think this” and “I have heard that before from others” and “we’ll talk about this one” are helpful to support people being open about sharing these beliefs. This will give the group permission to talk honestly about their attitudes toward flu.

When you have the list, go through each statement. Ask how many agree with the statement, and then ask for responses to it. Then, provide simple, clear answers to each concern. Your goal is to inform and win trust by being a partner with the group. It usually takes several exposures to new information for people to adopt a new health behavior, so it won’t happen all at once. Your efforts will combine with those of their providers, with community leaders, and with public information campaigns.

  • Don’t argue with strongly held beliefs. Mistrust of the government or authorities is usually based on real-life experiences of discrimination, cultural and linguistic barriers.

  • Don’t overpromise results—sometimes people still get flu after having a flu shot!

  • Be open about possible side effects and pain from flu shots.

  • Be clear, and keep it simple.

  • Congratulate others in the group who have had a flu shot—elicit their experiences.

  • Be a good example! Let them know that you have had a flu shot.

(A basic flu education outline and PowerPoint presentation are located in the Toolbox, Section 11. Flu education resources can be found on page 44.)

Dealing with Myths and Misinformation

Strongly held beliefs about health and illness may create barriers to our goals of preventing disease. Health beliefs are rooted in culture and the history of a community, and they are sometimes hard to change. While correcting misinformation, we need to respect the diversity of experiences and backgrounds that inform different health beliefs.

Listen. Respect. Educate.

These answers contain more details than the average audience will need, but will give you the background that you need to tailor your own answers.

  1. The vaccine makes you sick or gives you the flu.

The vaccine in the flu shot is made from inactivated viruses that cannot cause the flu. Does everybody know what I mean by inactive? These inactive viruses make your body develop its own protection (antibodies) from flu. A few people may get some aches and low-grade fever one to two days after a flu shot, but this is not the same as having the flu. You might still get the flu right after a flu shot because it takes up to two weeks for the vaccine to work. You are not protected if you have just been exposed to someone with the flu in the last few days. The vaccine in the nasal spray is made from a live virus that has been modified so that it cannot cause disease. In all of the testing, it has been shown to be very safe for healthy people ages 2 to 49 with no history of asthma or wheezing.

  1. I am healthy, and I never get the flu, so I don’t need a vaccine.

We recommend flu vaccine every year for everyone because, by being vaccinated, you protect those who aren’t so healthy. If you get the flu, you can pass it on to babies, seniors, and people who have chronic health conditions such as heart disease, lung disease, diabetes or asthma. Those people may end up in the hospital or even die from flu. Many of us don’t get the flu shot only to protect ourselves, but to protect our families, friends and co-workers.

  1. The flu vaccine is experimental. You don’t know what is in it. I have heard that it can give you bad blood.

The flu vaccine is not experimental. While the vaccine is a new formula each year, it is closely related to flu vaccine that has been given for decades. Hundreds of millions of doses of flu vaccine are given every year, and public health authorities keep track of all new side effects. It is one of the most frequently given vaccines in history. Serious problems with flu vaccine are fewer than one in a million.

  1. We already get too many shots. There are too many vaccines, and they are weakening people’s immune systems.

Vaccines do not weaken the immune system. They actually strengthen the body’s immune system to fight particular diseases. It’s true that today, children get more vaccines—against 14 different diseases—than they did in past years. Vaccines come from disabled germs that imitate disease-causing germs. They trick your body into making a defense (antibodies) that protect you against the disease for which you were vaccinated.

  1. Flu vaccine isn’t safe for babies, pregnant women, or sick people.

Flu vaccine is especially important to these more vulnerable people, because their immune systems are not as strong as others’. Over the years, flu vaccine has been given to millions of pregnant women, babies over six months, and people with chronic illness, and it has helped to keep them from getting flu. Babies under six months cannot get flu vaccine because their immune systems are still developing.

nswers to 13 myths about flu vaccination


  1. Stomach flu is another kind of flu.

Stomach flu is not a kind of flu. The term “stomach flu” is used to describe illness with nausea and vomiting. It is usually caused by contaminated food, or germs passed from one person to another. It lasts a few days at most. The flu we are talking about here, also called influenza, is not a stomach illness, and usually does not cause diarrhea or vomiting. The symptoms of flu are fever, cough, sore throat, fatigue, aches and pains.

  1. The flu is not as big a risk as you say. Remember “swine flu”? Just a big government hype, where drug companies made a lot of money and nobody was really at risk.

A mild flu for one person may be deadly for another. It is difficult to predict which flu will cause serious problems, and who will have the worst problems. H1N1 (swine flu) was not as serious for many as was originally expected, and for many the vaccine arrived too late. Still, in the United States, 61 million people got sick and over 12,000 died between April 2009 and August 2010, according to a CDC estimate. In Massachusetts, non-whites were much more likely to be hospitalized or die than whites were. Pregnant women and children under five were hardest hit. The worst flu, which could happen again, was in 1918, when 50 to 100 million people died, worldwide. Many of those who died in 1918-1919 were healthy young adults.

  1. It is better to get the flu, and fight it off naturally.

(See the answer to #2.) This may be your choice, but you might not want to take that risk for your grandmother or your newborn niece.

  1. We don’t trust authorities. When everyone is urging you to get something like this, it is right to be suspicious. They want too much personal information and I don’t know what they are using it for.

Past experiences of discrimination by medical and government policies and abuses such as the Tuskegee research have made many people mistrustful of medical and public health personnel. We hope to earn your respect by working with your community and with trusted leaders, not by imposing what we think is best on a community. A lot of effort goes into making vaccines safe. Information about you and your vaccination is kept private and is protected by law.

  1. I already had the flu, so I don’t need the vaccine.

Without testing you, we can’t be sure that what you had was the flu. It could have been a cold or an infection that felt like the flu. If it was a stomach illness, it was not the flu. Because the virus that causes flu changes every year, you need a new flu shot each fall.

  1. People get the flu from: going out with wet hair; not eating healthy foods; not eating hot food in cold months; not dressing warmly in the winter; not wearing underwear.

How we eat and take care of ourselves can be very important in resisting infections. It makes sense to follow our traditional beliefs about how to stay healthy. But flu is caused by a virus, and you may get flu if you are exposed to someone who has it. The best ways to protect yourself from flu are to wash hands frequently, especially after contact with anyone who is sick; avoid direct exposure to people who are sick; and get a flu shot!

  1. Flu isn’t important in comparison to social, financial, or other issues or diseases, especially where I’m from.

A lot of issues can impact your health, such as those you mention, and some of them are really hard to do much about. If you have a chance to get a flu shot, it is a free or low cost way to protect yourself easily. Being protected against flu won’t solve those other problems, but it will give you one less thing to worry about for you, your family and community.

  1. Flu vaccines are expensive and hard to locate, and usually the clinics are scheduled at inconvenient times.

Flu vaccine is free to people who are uninsured. Many health insurance plans cover flu vaccine without a co-payment, so you can ask your primary care provider (PCP) about it. If you don’t have a PCP or you don’t have health insurance, most local public health departments provide it for free. Please let us know what are good times and places for a flu clinic in your area, and we will work with you or your organizations to plan these. Pharmacies are a convenient location where flu vaccine is available for a fee. A list of Massachusetts’ flu clinics can be found at
nswers to 13 myths about flu vaccination (Continued)

Section Nine:

Publicize and Disseminate

Your Message

Section Nine: Publicize and Disseminate Your Message

Planning an effective health communication campaign takes careful thought and knowledge of the community you intend to serve. Your efforts to understand the community will lead to valuable clues about what kinds of messages and resources are most likely to motivate community members to seek out a flu vaccination or engage in other preventive health behaviors. Building on this knowledge will enable a successful health promotion effort—one that promotes flu education and vaccination in a way that fulfills the needs and desires of the target audience and reinforces their core beliefs.

DO NOT WAIT until flu season to think about how you will publicize your flu outreach and vaccination efforts—this should be part of your initial planning efforts. If possible, invite your agency’s media or communications person (or someone else in your community with marketing expertise) to your first planning meeting, so you can craft a publicity campaign that will successfully engage your target community.

Look for existing ways by which information is disseminated to your specific target group. If you are targeting children and families, is there a school or church bulletin that everyone reads? Is it electronic or paper? Does the local school or day care center communicate regularly with families? If so, ask them if you can include information about flu.

Does your town send out regular print or electronic communications to citizens? Does the Council on Aging have a monthly bulletin? Do seniors in your community read the local newspaper?

Always include consumers from the target group in planning and designing your campaign. Ask them:

  • What attracts their particular group?

  • What are the ways they get their information? From their physician, peers, newspaper or radio?

  • Where do they spend their time?

Your outreach strategy should maximize social media, such as texting, Twitter, YouTube and Facebook, which are increasingly a major source of information for both younger and older people. The CDC social-media website has many flu-focused podcasts, widgets and videos in multiple languages.


Latinos and African Americans under 25 are the ones most at risk of being hospitalized from H1N1, one of the three kinds of flu in this year’s vaccine. Peak flu season usually occurs in January—or later!

Call your health center today for a flu vaccination appointment. Your friends and your family will thank you.

Keep your friends healthy by sharing this message via Facebook or Twitter.
From “Seriously?” a flu message developed by the Massachusetts League of Community Health Centers for Facebook and Twitter, in English and Spanish

Did you know?

In the last five years, the number of seniors actively using the Internet has increased by more than 55 percent. Many seniors find social networking exciting, and are connecting with family and friends by joining Facebook, LinkedIn, and Twitter. Use these to get your flu message out!

Here are some other ideas that have proven effective in Massachusetts:
  • Focus your efforts. Choose one message for one population in order to get the most “bang for your buck.”

  • Rely on word of mouth. Word of mouth is your best marketing strategy. Tell one or two well-respected people and ask them to spread the word!

  • Lead with new information. If there’s something new to say, emphasize that! For example, previous flu vaccination efforts targeted seniors. Now, some of the most successful campaigns are designed to target families (see the Cambridge posters below) or young people.

Test your materials, if possible. Even an informal group from the community can offer critical feedback about the messages, images and language that will be most acceptable to your community. If recruiting a group is not feasible, ask your local partners to help identify a group that already meets (such as parents, community health workers, or civic organizations) and offer refreshments or other incentives in exchange for their valuable input.

Consider whether you can:

  • Create a display window in a prominent area (such as a well-traveled street, a popular gathering area, a bus depot, or a library).

  • Advertise on local billboards.

  • Advertise in small everyday items, such as store receipts, food tray liners at fast-food restaurants, and paper placemats at local restaurants.

  • Put fliers or inserts in supermarket shopping bags (especially at ethnic supermarkets likely to be patronized by your target community) or in take-out food containers, such as pizza boxes.

  • Identify local celebrity spokespeople who are willing to be photographed for your promotion materials.

  • Use photos of your community members getting vaccinated.

  • Use children’s or local artwork in your promotional materials. This greatly increases community buy-in!
  • Whenever possible, use photos and images of local people in your materials.

Courtesy of Cambridge Public Health Department

Make use of local and statewide communications avenues. For example:

  • Use the “backpack express.” Ask local schools to send fliers home in their younger children’s backpacks. Be sure to accommodate different language needs in your community.

  • Use your town or school system’s emergency communication system. This allows your city or school district to call every resident or family to let them know about your flu clinic or event.

  • Promote use of information and referral services. 2-1-1 (or 1-877-211-MASS) is the abbreviated dialing code for free access to Massachusetts health and human services, information and referral. Let your constituents know who they can call to find information about the availability of flu vaccine and the location of flu clinics near them.

  • Use the help of community partners and members to distribute materials from door to door. College and high school health classes or volunteers are great resources for this activity.

Courtesy of Cambridge Public Health Department

Train community-based peer educators

Health education research shows that peer educators—individuals who are bicultural or bilingual and indigenous to the community—are your best allies to deliver health outreach messages. Work with your community partners to identify appropriate members of your target community, such as teens, seniors, parents and care providers. Train them on simple flu prevention strategies and encourage them to talk to their friends and neighbors, distribute fliers door-to-door or help staff a table at a health fair.

Plan Early!

Most newsletter deadlines are at least one month before publication, so be sure to get your information to them in plenty of time.

Use your local media, such as newspapers, newsletters, radio and cable television. You will find a list of ethnic media throughout the Commonwealth in the Toolbox. There are many ways to use these media, including:

  • A feature story using a local leader or celebrity.

  • A press release before an event.

  • A photo and story after an event.

  • A simple listing in the calendar section.

  • An insert about your event in a local paper or newsletter.

  • A radio call-in show.

  • A TV public service announcement.

Refer to the resources in the Toolbox for detailed information about how to write a press release and links to comprehensive resources for engaging your local media and getting coverage for your activities.

Make use of the many flu education resources (news articles, public service announcements, videos and sample letters to the editor) that have been developed by the CDC and the Commonwealth of Massachusetts, as well as those for national health events such as National Immunization Awareness Month.

(Resources for publicizing your message are found on page 45.)

Section Ten:

Language and Translation

Section Ten: Language and Translation

We’ve been vaccinated—have you?

The city of Lawrence targeted its sizeable young Spanish-speaking population with this message in Spanish: “We’ve been vaccinated against the flu–have you?”

One in five Massachusetts families speaks a language other than English at home. There are more than 62 languages spoken in Massachusetts. With new arrivals and populations suddenly appearing, often in response to world events, local health departments are often the first to be aware of a new community group needing attention. Sections Eight and Nine have given information about what to say and how to get the word out. Equally important are what language to use and whether written or spoken is the best medium. Language differences represent some of the most difficult barriers to building equity in access to health information. This is where community partnerships can really pay off. Health departments and community outreach workers working together to get the message across are more effective than either of them working alone.

You may get information from your local school district, which keeps records of what languages are spoken at home by their students. Many languages also have regional variations or differences. The term “Creole” may refer to a language derived from French, Portuguese, Dutch, or one of several African or Pacific Island languages. Usage of common terms varies, depending on the region or country the person is from. It is not sufficient to rely upon a dictionary or glossary of terms. Community partners who know the language used in their neighborhoods, shops and households are the most valuable resource.

Unless you are a fluent speaker and reader of the language, you have no way of knowing what translated material says or sounds like. It is tempting to rely on a volunteer community member, but bear in mind that accurate translation is a very complex process. All translated materials, even those listed in the Toolbox in the back of this Guide, should be tried out with a small group of representative community members before using them. Once you have a completed translation, be sure to ask someone to read and translate the piece back into English so that you can make sure that the message is correct. See the Toolbox for tools to do this evaluation.

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