During her 19 years working in HIV (human immunodeficiency virus) prevention, Karen Hartfield has seen her field transformed more than once by sweeping changes. She has also seen a less dramatic development, the steadily increasing rigor with which public health communications professionals have designed and evaluated their efforts at reaching at-risk populations. This progress does not always generate headlines, but it may hold an important key to reducing the spread of the disease.
Karen describes HIV infection in the Seattle area as a "stable epidemic," meaning that HIV incidence has remained steady over the past few years. This leads to an ever-increasing population of infected individuals who, as Karen explains it, have "been hearing the same message for 25 years." The challenge for communications professionals in tailoring HIV prevention activities is to ensure that they target people who are willing to make changes in their behaviors, speak to these people effectively, and promote behavioral changes that actually do reduce infection rates.
The art and science of behavior change has always been part of Karen's interest in public health, ever since she discovered the field through a summer job in college with a child injury prevention program. This work led her to a position at Planned Parenthood, and then eventually to a MPH degree with a focus on women's health. Graduating in 1986, she found her family planning expertise to be applicable to the growing AIDS (acquired immune deficiency syndrome) crisis, and joined Public Health Seattle & King County to work on HIV prevention.
Karen's current work involves both developing internally-created media campaigns for the department and helping to allocate the funding provided by city and county governments to community groups for more localized prevention efforts. Both aspects of her job involve deciding how to mobilize scarce resources in the most productive way possible, and require her to determine the effectiveness of an array of different programs and campaigns. She describes this as a relatively new way of thinking for people who have devoted their careers to helping others. "We tend to feel that what we do is beyond reproach," she says, "and if people say 'I like that,' we judge a campaign as a success." But increasingly, "we have to ask 'What does successful mean?'"
For Karen, the steps to a successful campaign include setting concrete, realistic goals, working with advertisers and designers to create professional products, and, most importantly, consulting with the people the campaign needs to reach through focus groups and surveys. She calls audience research the gold standard for her area of health communications, and says, "You need to understand the audience before you can start developing a message."
These kinds of strategies direct not only her work in the field, but also her teaching as a faculty member in the University of Washington's School of Public Health and Community Medicine, where she teaches courses in health communication and also coordinates practicum opportunities for MPH students in the Community-Oriented Public Health Practice Program. She also values her own opportunity to move between the practice and academic worlds, and to use all the resources of passion and intellect to help solve seemingly intractable problems. Her work is rewarding, she says, because every strategic adjustment and every new campaign contribute to a change in society a change that can have a real impact on a life and death issue.