The Condom Pledge was designed using six criteria that have been shown to optimize the impact of public health campaigns.
Audience segmentation involves identifying a high-risk subgroup in a population to allow for tailored targeting and increased uptake of a program. Of the 2.3 million people infected each year with HIV, The Condom Pledge focuses on youth as they have grown to account for more than 40% of new infections. Selecting youth is also consistent with the idea of a global intervention in that no population in the future will be excluded from participation. Furthermore, by intervening early, we can have the best chance of reaching people before they become infected or before their infections progress.
Ethical tenability helps ensure the global acceptability of a program and thereby contributes to its longevity and impact. While public health organizations have widely come to favor HIV treatment over HIV prevention, the ethics community has sought to restore our focus on the latter. The case rests on multiple studies, including one in The Lancet demonstrating condom promotion, among other prevention efforts, to be at least 25 times more cost effective than programs for highly active antiretroviral therapy. Given our resource-limited world, two of the leading ethicists at Harvard School of Public Health have accordingly affirmed that “the moral argument for emphasizing treatment over prevention is not convincing…[and] provides stronger support for a renewed emphasis on prevention.” With this in mind, The Condom Pledge opts for condom promotion as its core intervention strategy.
Programs based on behavioral change theories are more effective than those that are not, as shown through a lifetime of work by University of Pennsylvania PIK Professor Karen Glanz. With regard to condom promotion in particular, the social ecological model is especially illuminating; it demonstrates that while past efforts have sought to increase condom education in schools and condom access in communities, little is being done to rework condom norms at the level of society. Of course, that will have to change if we hope to strengthen HIV prevention in places such as Kenya, where religious decrees have held condoms to be immoral, or Indonesia, where government agencies have even pushed for condom bans. As normalizing a health behavior like condom use often requires either public policy changes or social role modeling, The Condom Pledge homes in on the latter given its ability to transcend national borders.
While behavioral change theory should specify the program mechanism, psychological appeal should underlie the program message. But what could be socially role modeled that would be psychologically appealing? William James, the father of psychology, wrote in 1890 that “in the acquisition of a new habit…[one should] take a public pledge, if the case allows.” Coupled with the success of behavioral contracts utilized across exercise programs, medical regimens, and psychotherapies, this century-old suggestion inspired the development of a condom pledge—a public pledge to always use a condom during sex. Surprisingly, while “abstinence pledge” garners more than 800 hits on Google Scholar, the idea of a “condom pledge” has yet to receive a single mention in a research publication!
Active engagement, which requires both participation and promotion, is critical for the successful uptake and dissemination of a public health program. Fortunately, these requirements easily resonate with the taking and social role modeling of a condom pledge. In particular, The Condom Pledge envisions that youth can first craft individualized signs that read, “I took the condom pledge,” so as to satisfy the participatory requirement. Then having them publicize their signs through social networks will, in turn, satisfy the promotive one.
The final step is to select appropriate media and non-media channels to both reach the target audience and conduct the intervention. As for the media channel, Facebook is the obvious choice given the ease of access to youth networks through which public pledges can be shared. In fact, within a year of its launch, The Condom Pledge Facebook page engaged 30,000 youth across more than 60 countries. As for the non-media channel, The Condom Pledge invests in organizational partnerships, each of which help tap into additional networks that can supplement the diffusion of innovation. By uniting more than a dozen partners in concerted action, The Condom Pledge inspires the use of its campaign in communities around the world.
The Hexagon for Effective Program Design was developed by Jason Parad as a model to guide effective program design. Source: Parad, J. (2014, May). Toward Integrating The Condom Pledge into HIV/STD Control Program Activities. Capstone Presentations. Lecture conducted from the University of Pennsylvania, Philadelphia, PA.
The Social Ecological Pathway for Condom Promotion is adapted from the Social Ecological Model to demonstrate the factors involved in activating condom use behavior. Source: Parad, J. (2014, May). Toward Integrating The Condom Pledge into HIV/STD Control Program Activities. Capstone Presentations. Lecture conducted from the University of Pennsylvania, Philadelphia, PA.
Following the Hexagon for Effective Program Design led to the creation of The Condom Pledge: "Youth around the world will promote condoms by social role modeling a public pledge that can be taken by all using social media." Source: Parad, J. (2014, May). Toward Integrating The Condom Pledge into HIV/STD Control Program Activities. Capstone Presentations. Lecture conducted from the University of Pennsylvania, Philadelphia, PA.