1. Project Title: Tips and Suggestions for Addressing Issues of Health Literacy in a Medical Setting
Organization: Harvard School of Public Health
Background: Low health literacy can impair a person's ability to function in a health care environment and may contribute to poor health outcomes. The Harvard School of Public Health has a website devoted to health literacy, and this project focused on developing 'Voices of Experience' - a section designed for health care providers who are interested in improving their patient communication skills. Population: Busy healthcare professionals who are interested in health literacy, but are unable to invest much time in searching for resources.
Methodology: A literature review on health literacy in the context of doctor-patient communication was conducted, and practitioners in various specialties were interviewed about their experiences with different strategies to address health literacy.
Results: The literature revealed five major "lessons learned," as well as techniques to help providers put these communication lessons into action. Strategies of current practitioners, obtained by interviews, were also summarized for the Web.
Recommendations: The targeted section of HSPH's website became a compilation of best-practice tips, suggestions, and recommendations that providers could easily access and use in their own practice to improve communication with patients.
2. Project Title: Smallpox, Risk Communication, and the Media
Organization: ABC News: Medical Unit
Background: Smallpox has reemerged in recent years and, along with other forms of bioterrorism, has been an active area of research for the past decade. Due to the media's ability to effectively disseminate information about emergencies or threats, ABC Network News has launched an effort to follow the smallpox story as well as develop contacts with city and state health department officials to prepare for communication in the case of an outbreak. The purpose of this project was to explore how public health departments and the Medical Unit could work together to provide quality information to the public.
Population: Medical Unit personnel / Public Relations Personnel at local and state Public Health Departments
Methodology: A literature review was conducted that focused primarily on the history and treatment of smallpox, biowarfare, and the role and responsibility of the media in communicating health and medical news, including risks to the public. Other methods included contacting the 13 largest city and state health departments, assessing their availability to provide information on short notice, and gauging their willingness to put the ABC News Medical Unit in touch with health department experts.
Results: Relationship building with health departments revolved around public relations officers, as they all self-identified as the middlemen for communication regarding smallpox issues. A "briefing report" about smallpox was created to compile information on the disease into one resource. Recommendations: Communication would be enhanced if media professionals were better educated about health issues. More time should be dedicated to relationship building with public health officials through phone and email contact. Anticipation and preparation of health phenomena by the media is also necessary.
3. Project Title: Culturally Sensitive Cancer Prevention: Resource Guide Recommendations for a Latino Audience
Organization: Dana Farber/Harvard Cancer Center
Background: Although cancer incidence is generally lower among Latinos when compared with non-Latino whites, Latinos are less likely to survive most cancer, as it is typically discovered at an advanced stage. This is in part due to lower rates of cancer screening within this population. This project was part of the US56 Partnership Grant between Dana-Farber/Harvard Cancer Center, UMass Boston, and Boston University, and focused on developing culturally-specific recommendations for a cancer prevention resource guide, which would be distributed to the target population at an East Boston church.
Population: Low-income Latinos in a faith-based setting
Methodology: A literature review, which addressed cultural beliefs and perceptions related to cancer-screening practices and recommendations for cancer prevention print materials and resource guides, was conducted. Three focus groups, one with Latino pastors from the greater Boston area, and two with Latino congregants from the target audience, were implemented to asses similar constructs. Results: There was a strong interest in a cancer prevention guide for the whole family with information on multiple cancers that affect men and women. Preferred design elements included bright colors and happy family-oriented images. The focus groups revealed a tension in Latino culture between the medical system and faith in God, a lack of medical coverage, and a fear of detection by legal authorities as barriers to cancer screening.
Recommendations: The guide should have a clearly defined goal, include information about multiple cancers, be whole-family oriented, and be universal enough to appeal to a broad Latino audience.
4. Project Title: "Aminah's Decision": Improving LTBI Treatment Adherence among Somali Bantu Refugee Women in Massachusetts
Organization: Refugee and Immigrant Health Program, Massachusetts Department of Public Health
Background: While Massachusetts' tuberculosis (TB) case rates have remained stagnant over the past decade, adherence in Somali Bantu refugees is inconsistent - mainly due to their lack of understanding of latent TB infection (LTBI) and its proper treatment. This project was developed with the Refugee and Immigrant Health Program (RIHP) of the Massachusetts Department of Public Health in order to increase awareness of LTBI and its treatment options, and improve LTBI treatment adherence.
Population: Somali Bantu refugees in Massachusetts
Methodology: A broad literature review and a pilot intervention were conducted. A total of 23 women participated in the intervention, which consisted of three small-group viewings of the ten-minute audio drama, "Aminah's Decision," followed by a one-hour discussion about the video. Prior to the viewing, the women took a pre-intervention survey to establish a baseline of LBTI knowledge and awareness. A satisfaction survey was administered immediately following the intervention to assess initial reactions and behavioral intentions. Participants completed a third survey one month after the intervention to assess changes in knowledge, message recall, and behavior.
Results: Knowledge surrounding LTBI and its treatment improved among most women. Participants demonstrated lasting recall of messages, although a small group of women reported new misconceptions regarding LBTI treatment in the post-intervention survey.
Recommendations: Future interventions should ensure behavioral objectives are appropriate to the target population, reduce the number of messages and maximize their repetition, reinforce messages after the intervention, and expand the intervention to include trusted information sources.
5. Project Title: Improving School-Parent Communication about Sexual Health in Gloucester, Massachusetts
Organization: Gloucester, MA School System
Background: After a significant spike in Gloucester teen pregnancies and the negative media surrounding an assertion that high school girls made a pact to become pregnant, there has been a heightened need for improved school-parent communication about sexual health issues. The goal of this project was to help Gloucester school administrators better communicate with parents about sexual health and other sensitive health issues.
Population: Gloucester Public High School parents and staff
Methodology: A literature review, applied theory, school staff interviews, and a parent focus group lead to the identification of key barriers to school-parent communication about sexual health.
Results: The key barriers to successful school-parent communication included: (1) lack of a welcoming environment for parent participation, (2) lack of encouragement to obtain parent feedback, and (3) lack of understanding parents' motivations for attending school-sponsored health workshops.
Recommendations: Recommendations were made in the following three areas: (1) school-parent communication, including a phone messaging system for health announcements and a parent-targeted student health newsletter; (2) internal school communication, including monthly health meetings for staff and a monthly health "e-blast;" and (3) sexual health messaging, including acknowledgment of parent values, encouragement of parent feedback, and detailed information on sexual health events at the school.
6. Project Title: Factors that Influence Bicycle Helmet Use among Parents, Children and Young Adults
Organization: Massachusetts Department of Public Health
Background: Bicycling is the leading cause of recreational sports injuries treated in emergency rooms in the United States. Many of these injuries can be prevented by wearing a helmet. Studies indicate that helmets are associated with a reduction of head injuries by 69%. While bicycle helmets are effective for all ages, many cyclists, particularly adolescents and adults aged 30 to 39, do not wear them. Massachusetts law requires that a bicycle helmet be worn by children age 16 years and under. The purpose of this project was to determine the factors that influence helmet use among parents, children, and young adults, and develop recommendations for the Massachusetts Department of Public Health on increasing helmet use among these populations.
Population: Bicyclists in Arlington and Cambridge, Massachusetts
Methodology: A literature review and observational survey of bike path users assessed helmet use behavior. A written survey, conducted with parents and young adults in Arlington and Cambridge, assessed knowledge, attitudes, and other factors associated with helmet use.
Results: Children were more likely to wear a helmet when riding with a parent or companion who is wearing a helmet and are less likely to wear a helmet when riding with a group of other children. Helmets were perceived as unattractive, uncomfortable and socially "not cool" by many children and young adult riders in Arlington and Cambridge. Additionally, 60% of parents were unaware of the Massachusetts (MA) law which requires children to wear a helmet when bicycling.
Recommendations: Recommendations included the following: 1) instituting bicycle helmet giveaways in physicians' offices and at schools, 2) increasing awareness of the MA bicycle helmet law for children, 3) promoting police enforcement of state helmet laws, 4) addressing bicycle safety on college campuses through educational materials, and 5) increasing media messages portraying helmet use as cool.
7. Project Title: SADD "For Parents" Project: Promoting the Parent-Teen Relationship through the Web
Organization: Students Against Destructive Decisions (SADD)
Background: Previous research has shown that parental support is a significant factor in teens' ability to make good decisions about their health. Students Against Destructive Decisions (SADD), an organization dedicated to promoting healthy decisions and substance-free lifestyles among teens, adopted a "For Parents" project in an effort to get a national audience of parents to initiate conversations with their teens about healthy decisions. The purpose of this project was to create a "For Parents" website, which was to be added to the existing SADD website.
Population: Parents of teens throughout the United States
Methodology: An extensive literature review explored different aspects of the parent-teen relationship, as well as issues relating to online health information, including accuracy, readability, and access. To develop content for the "For Parents" website, an online search process was conducted to gather resources on parent-teen communication and substance abuse. The findings were then synthesized and rewritten using Health Literacy and Web-based communication principles. The website content was evaluated by soliciting feedback via two online parenting communities.
Results: The literature review provided strong justification for targeting parents in order to influence adolescent behavior, but revealed that parents face significant perceived barriers to discussing healthy decision-making with their teens. The "For Parents" site was thus conceived and designed as a communication channel not only to educate parents, but also to indirectly elicit behavior changes in their teens. In evaluating the website content, six parents responded to requests for content feedback via two online parenting communities. The feedback indicated that parents are concerned about teen substance abuse issues and that they welcome resources such as the "For Parents" website to enhance parent-teen communication.
Recommendations: Recommendations for building the "For Parents" website included the following: (1) suggested content (six online modules, such as "Teen Rites of Passage" and "Motivating Teens"), (2) website design criteria (including easy motivation, appealing visuals), and (3) website features (such as an interactive community, "News Update" button, and exit evaluation).