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Creative Contributory Contests to Spur Innovation in Sexual Health

2 Cases and a Guide for Implementation

Zhang, Ye MPH*†‡; Kim, Julie A. BS; Liu, Fengying MS*‡; Tso, Lai Sze PhD†‡; Tang, Weiming PhD*†‡; Wei, Chongyi DrPH§; Bayus, Barry L. PhD; Tucker, Joseph D. MD, PhD‡†

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doi: 10.1097/OLQ.0000000000000349

Conventional systems of sexual health programming are often organized “top-down,” with experts designing, implementing, and evaluating interventions with minimal input from key affected populations. In promoting HIV and other sexually transmitted disease (STD) testing in these communities, top-down approaches have not been effective.1 Major global health research funders such as the National Institutes of Health and the National Science Foundation disproportionately support incremental advances rather than transformative, high-risk research.2,3 Incorporating knowledge from key affected populations into HIV/STD testing has been difficult. Social marketing approaches often draw on key population information gathered in focus groups and in-depth interviews, but such engagement is frequently superficial.4 Key population empowerment and multisectoral community engagement have also attempted to strengthen community input toward HIV/STD control programs,5 but such programs have been challenging to implement in the absence of a strong civil society and community-based organizations.5,6 Responding to the need for greater community engagement to create HIV/STD programs, we introduce creative contributory contests (CCCs) to promote sexual health in China.

Creative Contributory Contests

Conventional approaches to designing and implementing HIV/STD testing campaigns can be enhanced through contests. Conventional approaches engage many individuals to contribute creative knowledge toward a public good. Contests have been used mostly in the private sector and championed by the Executive Office of the President of the United States as a cost-effective tool for generating creative, new ideas.7 A CCC approach to designing an HIV test promotion campaign substantially differs from conventional approaches in 3 ways (Fig. 1). First, CCCs are “bottom-up,” based on crowd input, whereas conventional campaigns are “top-down” and often rely on public health expert opinions. Second, CCCs increase community engagement from a broad range of nonexperts, including key affected populations, experience-rich leaders, and creative individuals. A key advantage of CCCs is the allowance for greater inclusion of perspectives from diverse community members. Third, because of the heterogeneity of knowledge incubating in the crowd compared with a panel of experts, CCCs possess higher potential for innovation compared with conventional approaches.8

Figure 1:
CCCs compared with conventional approaches to the development and implementation of sexual health promotion campaigns.

Implementing CCCs

Our multisectoral team, Social Entrepreneurship for Sexual Health (SESH), organized 2 CCCs, soliciting videos through “Testing Saves Lives” and images through the “Sex + Health” contest. Our video contest encouraged community-based organization (CBO) to develop 1-minute films promoting HIV testing in China. Eligible organizations included all CBOs delivering HIV testing in China, Taiwan, and Hong Kong. Two open Skype calls clarified the contest mission and goals, yielding 7 eligible entries after 8 weeks. The video contest was promoted through the Web site, e-mails, and the 2 open Skype calls. Judging criteria included generating excitement about HIV testing, reaching untested individuals, and community engagement. Incentives for participation included video promotion through local, regional, national, and international media. A multisectoral (public health, medicine, anthropology, advocacy, business) panel of judges selected 3 finalists during a public event hosted at a Chinese university.

All judges ranked each entry on a scale of 1 to 10, assigning scores twice, first prior to discussion, then following a group discussion, with minimal change in scores postdiscussion (see table, Supplemental Digital Content 1, which shows judge scores, Judges noted that positively messaged (e.g., focusing on the benefits of testing rather than spreading fear of not testing) short films were generally more effective than ones denoting negative messages (see videos, Supplemental Digital Content 2, in terms of perceived potential for increasing HIV test uptake.

Our video contest had the following advantages: (1) empowering CBOs to develop more effective social marketing of HIV testing programs (shifting the context from key populations as the problem to engagement of key populations as the solution); (2) nurturing multisectoral collaboration between CBOs, public health leaders, and film/marketing experts; and (3) using a short film medium designed to resonate with youth, including young key populations.

Our second event, the Sex + Health Image Contest, focused on engaging youth to create images to motivate discussions about sexual health. Individuals living in China, 30 years and older, were eligible to participate. We incentivized participation at individual and group levels by offering a range of prizes (see Supplemental Digital Content 3, and displaying semifinalist and finalist images at a final event in Guangzhou. The final event was an open, in-person activity at an entrepreneurship laboratory in Guangzhou alongside Web site promotion. Judging criteria included relevance to sexual health promotion and capacity to excite young people in China. The Social Entrepreneurship for Sexual Health promoted the contest by organizing a series of in-person discussion activities at 4 high schools and universities and the US Consulate in Guangzhou. In addition, 2 universities held activities organized by student volunteers and 1one university group created a student video. We used social media to update participants, with SESH's Weixin (a Chinese hybrid between Facebook and Twitter) account accruing 374 new followers within 4 weeks. Instagram and Weibo (a Chinese platform similar to Twitter) were also used in contest promotion.

The Sex + Health image contest received 96 entries for 39 days. Images were evaluated on a 1 to 10 scale by a panel of 20 judges. Each entry was scored by 2 judges, and the mean score used to determine rank order. The top 5 entries were displayed on SESH's Web site for 6 days of voting to determine the crowd favorite (images, Supplemental Digital Content 4,

Hard copies of individual semifinalist entries, a photograph gallery of in-person engagement activities, and framed prints of the finalist entries were displayed in Guangzhou, China, during World AIDS Day. Individuals who created finalist images were invited to contribute in-person on a sexual health panel, alongside an STD control center director, a young physician, a youth organization leader, and an LGBT organization director. Although the 3 finalists were announced and celebrated, wider participation from individuals and CBOs was also publically recognized. This acknowledgement of contribution is critical because most individual submissions were not awarded prizes. Sustaining participation among diverse community members is important for accruing medium and long-term effects of community engagement.


Contests are not a panacea for community engagement and have several limitations that must be considered. First, many contests focus on Internet channels, ignoring the large population of individuals who lack regular Internet access, especially marginalized groups. However, advances in mobile phone technology and expanding social media networks will slowly and partially mitigate this issue, especially among young gay populations who are often online.9 Complementing online activities with strong in-person activities is an essential component of organizing effective contests. Second, by design, contests are temporally transient and produce large numbers of “losers.” However, our decision to host a public viewing of winners and to widely acknowledge community contributions increases awareness of pressing issues among key populations with hard-to-reach groups. Finally, there are no preestablished set points for knowing when a sufficient crowd threshold has been reached to yield crowd wisdom. Further research is needed in this area.

In conclusion, our experience organizing CCCs may be useful for other groups expanding community engagement in sexual health campaigns. Table 1 shows guidelines we designed to inform the development and implementation of CCCs.10–13 Realizing their full potential as effective and innovative mechanisms in health programming requires further action in several areas. First, starting contests is relatively frictionless and will become easier as more individuals get online and CCC engagement expands among key populations. Technical (e.g., online forums) and substantive (e.g., monetary incentives or vouchers) improvements in organizing contests should further reduce barriers to participation. However, ending contests well is far more challenging. Devising a strategy for continued engagement between contests is instrumental in transforming one-off events into sustainable platforms to support social change. Second, although the Internet has been invaluable in harnessing the wisdom in crowds, our Sex + Health contest underlines the importance of in-person engagement. Especially for health programs intended to reach marginalized groups with limited Internet access, in-person activities are key for building rapport and trust with local partners and contributors.

Guidance for Organizing CCCs for Health

Community engagement is a “key social enabler” for HIV testing according to UNAIDS14 and has been associated with the scaling up of HIV testing services.15 Creative contributory contests could be useful for designing a range of sexual health campaigns beyond HIV testing, including STD testing among key populations, preexposure prophylaxis awareness and uptake, and HPV vaccination. Our HIV test video CCC was evaluated using a randomized controlled trial16 and the image contest is now undergoing more formal evaluation,17 but other evaluation research is necessary. Creative contributory contests may provide a cost-effective, structured mechanism to more transparently and explicitly involve communities in health campaigns to make them more people centered.


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Supplemental Digital Content

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