Allison Erickson
MPH 588
Marketing Pubic Health
Lea Pounds
Audience Selection for Alzheimer’s Disease Campaign
Introduction
With its discovery more than 100 years ago, Alzheimer’s disease research has only began
to progress over the last 30 years (Alzheimer’s Association, 2013). There are, however, great
unknowns yet to be discovered in the realm of scientific research around how, why, and when
individuals develop the fatal disease. Research has shown that as one ages, the risk of developing
Alzheimer’s increases. However, Alzheimer’s researchers, the medical community, and public
health professionals continue to seek answers of ways to prevent the disease. Some of the
hypothesized and known risk factors for developing Alzheimer’s, according to the Alzheimer’s
Association (2013), include family history, mild cognitive impairment (MCI), education levels,
traumatic brain injury (TBI), and cardiovascular disease. Because there is no cure for
Alzheimer’s, the public health and medical communities are continuing to reduce the prevalence
of these known risk factors with hopes of seeing the prevalence of Alzheimer’s decrease through
the middle of the century.
As aforementioned, the risk of developing Alzheimer’s disease increases as one ages. The
Alzheimer’s Association (2013) estimates that 5.2 million Americans are suffering from the
disease, but of that population, five million are ages 65 and older. Alzheimer’s tends to affect
more women than men, with about two-thirds of the Alzheimer’s population being women. In
addition, African-American and Hispanic older adults are proportionately more likely to have
Alzheimer’s (Alzheimer’s Association, 2013). “Data indicate that in the United States, older
African-Americans are probably about twice as likely to have Alzheimer’s and other dementias
ad older whites…” (Alzheimer’s Association, 2013, p. 16). Health professionals also hypothesize
that the populations of African-American and Hispanic adults are at heightened risk for the
disease due to having an increased prevalence of cardiovascular disease.
1
Seeking to reduce the risk factors of Alzheimer’s requires health professionals to develop
campaigns specifically addressing one or more of the risk factors. Alzheimer’s research has
shown that vascular health not only affects the body from the neck down, but greatly impacts the
functioning of the cognitive and brain system. “Growing evidence suggests that the health of the
brain is closely linked to the overall health of the heart and blood vessels. The brain is nourished
by one of the body’s richest networks of blood vessels” (Alzheimer’s Association, 2013, p. 12).
Knowing this important connection gives public health and medical professionals an opportunity
to improve the cardiovascular system knowing that the brain’s health will also be positively
impacted. According to Olives, Myerson, Mokdad, Murray, and Lin (2013), “Hypertension is an
important and modifiable risk factor for cardiovascular disease and mortality” (p. 1).
Hypertension is currently responsible for one in six deaths, while one in three American adults
are living with the condition. Having hypertension is when an individual regularly shows a
systolic blood pressure (SBP) of 140 mm Hg (Olives et al., 2013). When examining the
prevalence of hypertension in the United States, data indicate that African-American men and
women have significantly higher risks of uncontrolled hypertension when comparing to white
men and women (Olives et al., 2013). Finally, the presence of hypertension is strong in the
southeastern states of the United States.
Identifying the Population of Interest
For the purpose of the social marketing campaign at hand, the goal is to improve healthy
living behaviors and habits that directly affect hypertension with the long-term goal of reducing
Alzheimer’s prevalence by 2020. Objectives of the campaign include increased knowledge and
awareness around how hypertension is a risk factor for Alzheimer’s, change behaviors in
healthier eating to reduce sodium intake, and increase medication adherence and compliance
2
among patients with the assistance of physicians and pharmacists. With the data and information
stated, the primary target audience for the campaign will be African-American females over age
35 that have been diagnosed with borderline hypertension or have hypertension in the
southeastern region of the United States, specifically South Carolina. According to the South
Carolina Department of Health (SCDH) (2013), the prevalence of hypertension is 36.6 percent.
Additionally, the Center for Disease Control and Prevention’s (CDC) (2010) Interactive Atlas of
Heart Disease and Stroke shows that African-American females, over age 35 in South Carolina
have a high prevalence of hypertension mortality across multiple counties.
This population was chosen primarily due to the observations that more women than men
are affected by Alzheimer’s disease and that African-American’s have higher risks for
developing the disease. Additionally, according to the Alzheimer’s Association (2013), “Sixtyfive percent of African-American Medicare beneficiaries have hypertension, compared to fiveone percent of white beneficiaries” (p. 2). The Alzheimer’s Association (2013) also indicates
that, compared to white Americans, African-Americans have a higher rate of vascular dementias.
Therefore, with the supporting research and data, this primary audience would aid in providing
substantial and positive results in reducing the prevalence of Alzheimer’s in the long-term.
Finally, for all South Carolinians within this specified population, the objectives specifically
referring to an increase in how hypertension is a risk factor of Alzheimer’s disease will apply to
the whole population.
Segmenting to Multiple Audiences
With population of interest identified, the next step is to segment this population into
groups or variables. According to Resnick and Siegel (2013), “The goal of audience
3
segmentation is to identify subgroups whose members are similar to each other and distinct from
members of other groups along dimensions that are meaningful in the context of the behavior to
be changed” (p. 134). The first segmentation of this audience would be to segment AfricanAmerican females over age 35 who are borderline hypertensive who are not taking medications
in South Carolina. Using this information, the goal is that these women will be more likely to
change healthy eating behaviors around sodium intake to reduce the likelihood of being placed
on anti-hypertensive medication. In this case, these women would be “non-doers” of medication,
but “doers” for attempting to reverse the borderline hypertension through healthier eating
behaviors. This audience will require educational opportunity for knowing how to reduce sodium
intake to the recommended 1,500 to 2,300 milligrams per day as recommended by the CDC
(2011).
The next audience would be African-American females over age 35 that are currently
being treated for hypertension through medication. Adding to that, this segmented audience will
be determined by those that are compliant and adhere to the medication. Creating this disclaimer
will allow the focus to be on healthier eating and sodium reduction, rather than sodium reduction
and medication adherence and compliance. Here, the developer is determining the audience
around “doers” of taking medications as prescribed and filling them correctly, but this is a
population that could begin practicing new healthy eating behaviors to, in hopes, reduce the need
for medication. Similarly to the previous segmented audience, this audience will require the
knowledge and demonstration of how to reduce sodium intake.
Continuing, the next segmented audience will consist of African-American females over
age 35 in South Carolina who report not taking hypertension medications as prescribed. KrouselWood, Muntner, Islam, Morisky, and Webber (2009) indicate, “Low patient adherence to
4
antihypertensive medication is the most significant modifiable patient-related barrier to
achieving controlled blood pressure” (p. 753). Using that as supporting evidence, this population
will require education around why medication adherence is important for overall health
improvement. In fact, the Alzheimer’s Association (2013) reports, “Effective therapies for
primary and secondary prevention of vascular disease already exist – including cholesterollowering drugs and anti-hypertensive medications. Now, observational studies indicate that these
drugs may also protect against cognitive impairment and Alzheimer’s disease” (p. 1). All of this
information will aid in producing positive results in medication adherence and compliance
among this audience. In the next section, discussion around what audiences will assist these three
audiences in successful reduction of hypertension will be discussed.
Selection of Secondary Audiences
In order for the segmented audiences to be successful in reducing the prevalence of
hypertension, the secondary audience of focus will be healthcare practitioners and physicians in
South Carolina. To be more specific, the two different physician groups will include general
practitioners, or physician assistants, and Obstetrics and Gynecology (OBGYN) physicians. Not
every woman visits an OBGYN for regular visits, but using both populations of physicians will
create a wider range of opportunity for discussion. These discussions will aid in meeting the
objectives of increasing patient-doctor conversations around medication adherence and
compliance, as well as the discussion around Alzheimer’s development. This secondary audience
is important because, “Ineffective communication between the primary care physician and the
patient with a chronic disease such as CVD further compromises the patient’s understanding of
his or her disease, its potential complications, and the importance of medication adherence”
(Brown & Bussell, 2011, p. 313). The physician-patient relationship greatly impacts the
5
adherence to prescribed medications and suggestions for behavior changes. Therefore, this
secondary audience can either hurt or help the desired outcome of the campaign.
The final secondary audience will be pharmacists. Utilizing geographical information
from patient history and where the majority of hypertensive medications are filled, pharmacists
within the most used pharmacies in South Carolina will be encouraged to take a moment to share
with the patient how the medication will be taken. Taking that further, for the purpose of the
campaign, pharmacists will be encouraged to not ask if the customer knows how to take the
medication, but instead share the information as the customer is picking the medication up.
Today, home delivery for medications is becoming increasingly more popular. Therefore, for
women meeting the criteria of the primary population, if medication for hypertension is sent via
mail, there will be a follow-up call from a pharmacist to talk about how and when to take the
medications.
Conclusion
Alzheimer’s disease affects more than 5.2 million Americans, the majority being adults
over age 65. With no cure for the disease, health professionals are continuing to seek
preventative techniques to reduce the foreseen chance that Alzheimer’s disease will continue to
rise significantly over the next 25 years. One such risk factor of Alzheimer’s is hypertension and
other cardiovascular conditions. The campaign at hand seeks to improve and reduce hypertension
prevalence in South Carolinian African-American females age 35 or older. Making an impact on
this condition among this population will show a positive impact on the prevalence of
Alzheimer’s disease in the next 10 to 25 years.
6
References
Alzheimer’s Association. (2013). African-Americans and Alzheimer’s disease: The silent
epidemic. Retrieved from:
http://www.alz.org/national/documents/report_africanamericanssilentepidemic.pdf
Alzheimer’s Association. (2013). 2013 Alzheimer’s disease: Facts and figures. Retrieved from:
http://www.alz.org/downloads/facts_figures_2013.pdf
Brown, M.T. & Bussell, J.K. (2011). Medication adherence: WHO cares? Mayo Clinic Proceedings.
86(4), p. 304-314.
Centers for Disease Control and Prevention. (2011). Americans consume too much sodium (salt).
Retrieved from: www.cdc.gov/features/dssodium/
Centers for Disease Control and Prevention. (2010). Interactive atlas of heart disease and stroke.
Retrieved from: http://nccd.cdc.gov/DHDSPAtlas/viewer.aspx?state=GA
Krousel-Wood, M.A., Munter, P., Islam, T., Morisky, D.E., & Webber, L.S. (2009). Barriers to and
determinants of medication adherence in hypertension management: Perspective of the cohort
study of medication adherence among older adults. Medical Clinics of North America. 93(3), p.
753-769.
Olives, C., Myerson, R., Mokdad, A.H., Murray, C.J.L, & Lim, S.S. (2013). Prevalence,
awareness, treatment, and control of hypertension in United States counties, 2001-2009.
PLOS One. 8(4), p. 1-8.
South Carolina Department of Health. (2013). State of the heart: Heart disease in South
Carolina. Retrieved from: http://www.scdhec.gov/administration/library/ML-002149.pdf
7