Jennifer R. Banas

Teachers' Attitudes toward Technology: Considerations for Designing Preservice and Practicing Teacher Instruction.

To best design technological pedagogical content knowledge (TPCK) related instruction for preservice teachers or for practicing teachers, community college librarians must have an accurate assessment of their audiences attitudes towards technology. A summary, analysis, and excerpts from 225 student responses to a course reflection regarding attitude toward technology are shared. The course, Learning with Technology, was a required course in an online master in education degree program. Students were practicing teachers or certified education professionals. Results indicated the majority, 52%, had positive feelings about and were integrating technology into instruction, 28% had positive feelings but cited obstacles to integration, 13% were fully integrating technology, and 7% were not integrating technology at all. Common obstacles to technology integration included knowledge/skills, confidence, access, and time. Based on the findings, implications of and suggestions for the design of TPCK related instruction are shared.

eSalud: Designing and Implementing Culturally Competent eHealth Research With Latino Patient Populations

eHealth is characterized by technology-enabled processes, systems, and applications that expedite accurate, real-time health information, feedback, and skill development to advance patient-centered care. When designed and applied in a culturally competent manner, eHealth tools can be particularly beneficial for traditionally marginalized ethnic minority groups, such as Latinos, a group that has been identified as being at the forefront of emerging technology use in the United States. In this analytic overview, we describe current eHealth research that has been conducted with Latino patient populations. In addition, we highlight cultural and linguistic factors that should be considered during the design and implementation of eHealth interventions with this population. With increasing disparities in preventive care information, behaviors, and services, as well as health care access in general, culturally competent eHealth tools hold great promise to help narrow this gap and empower communities.

Developing a Peer-to-Peer mHealth Application to Connect Hispanic Cancer Patients

Cancer and its treatment can significantly impact health-related quality of life (HRQOL) (J Pain Symptom Manag 9 (3):186–192, 1994; Soc Sci Med 46:1569–1584, 1998), particularly for Hispanics (Healthcare Financ Rev 29 (4):23–40, 2008; Psycho-Oncology 21 (2):115–124, 2012). Moreover, providers of cancer support for this population may encounter unique challenges. Grounded in social capital theory, this study identified Spanish-speaking, Hispanic breast cancer survivor support needs and preferences for a mHealth intervention. A user-centered, community-engaged research design was employed, consisting of focus groups made up of constituents from a local Hispanic-serving, cancer support organization. Focus group audio-recordings, translated into English, were coded using a grounded theory analytic approach. First, lead researchers read the complete transcripts to obtain a general sense of the discussion. Next, coding rules were established (e.g., code at the most granular level; double and triple code if necessary, code exhaustively) and initial codebook was created through open-coding. Three new coders were trained to establish requisite kappa statistic levels (≥.70) for inter-rater reliability. With training and discussion, kappa estimates reached .81–.88. Focus group (n = 31) results revealed a mHealth intervention targeting Hispanic cancer patients should not only offer information and support on disease/treatment effects but also respond to the individual’s HRQOL, particularly emotional and social challenges. Specifically, participants expressed a strong desire for Spanish content and to connect with others who had gone through a similar experience. Overall, participants indicated they would have access to and would use such an intervention. Findings indicate positive support for a mHealth tool, which is culturally tailored to Spanish speakers, is available in Spanish, and connects cancer patients with survivors.

The Adolescent Health Care Broker—Adolescents Interpreting for Family Members and Themselves in Health Care

Parents with limited English proficiency might rely on their adolescent children to interpret health information. We call this adolescent healthcare brokering. Using a mixed-methods, transformative research approach rooted in grounded theory, we sought to answer these questions: (a) “What is happening? What are people doing?” and (b) “What do these stories indicate? What might they suggest about social justice?” High school students from a community in which 53.4% speak another language at home were invited to participate in a survey and focus groups. Of 238 survey participants, 57.5% (n = 137) indicated they assisted with healthcare tasks. When doing so, 81.7% (n = 112) translated. Common tasks were reading prescriptions and talking to doctors. While some participants cited negative emotions associated with brokering, the net emotion was positive. Focus groups (n = 11) revealed that tasks varied broadly in complexity and type, emotional experiences were dichotomous, and access to interpreting services and other supports was inconsistent. This research adopts an advocacy lens and uses a mixed-methods, transformative research approach rooted in grounded theory to describe and call attention to a social justice phenomenon we call adolescent healthcare brokering. We define adolescent healthcare brokering as young people acting as linguistic interpreters in healthcare situations for themselves and for family members with limited English proficiency (LEP). In such situations, language acts as a barrier to health literacy and access to healthcare [17]. Despite this known barrier, there is a gap in the research regarding how to successfully address this situation (McKee, Paasche-Orlow, Journal of health communication 17(3):7–12, 2012).

Adolescent Healthcare Brokering: Prevalence, Experience, Impact, and Opportunities

BACKGROUND Limited health literacy disproportionately affects those with limited English proficiency (LEP). Parents with LEP might rely on their adolescent children to interpret health information. We call this adolescent healthcare brokering. This study uncovers the prevalence of brokering, kinds of tasks, emotional and academic impact, and desired support. METHODS We invited 165 students from health classes (in a community in which 29.8% are foreign-born and 53.4% speak another language at home) to complete a survey. We used IBM SPSS to calculate descriptive statistics. RESULTS Of the 159 who received parental consent and assented, 54.1% (N = 86) assist with healthcare tasks. When brokering, 80.2% (N = 69) translate. Most common tasks were talking to a doctor, reading prescriptions, and searching on the Internet. Participants were most confident reading prescriptions and talking to a doctor and least confident finding healthcare services. Among brokers, 29.1% (N = 24) missed school; 33.7% did not complete homework. They most wanted to learn about filling out insurance forms and talking to doctors. CONCLUSIONS Despite assurances that children are not permitted to interpret, adolescents are acting as healthcare brokers. The impact can be academic and emotional. Findings indicate a need for further research and support for adolescents who want to learn about healthcare tasks.

Institutional Alliances to Reduce Cancer Disparities in Chicago

A partnership formed between Northeastern Illinois University (NEIU) and the Robert H. Lurie Comprehensive Cancer Center of Northwestern University sought to address well-documented cancer health disparities in Chicago by developing a collaborative research, training, and educational infrastructure between a minority-serving institution and a National Cancer Institute designated comprehensive cancer center. With a critical examination of partnership documentation and outputs, we describe the partnership’s community-engaged approaches, challenges, and lessons learned. Northeastern Illinois University and the Lurie Cancer Center engaged in a yearlong partnership-building phase, identified interdisciplinary research teams, formed a governance structure, and identified collective aims. Partnership outcomes included funded inter-institutional research projects, new curriculum, and an annual research trainee program. Significant challenges faced included uncertain fiscal climate, widespread turnover, and dissimilar institutional demands. Lessons learned from this minority serving institution and comprehensive cancer center partnership may be useful for bridging distinct academic communities in the pursuit of ameliorating health disparities.

Abstract A08: Designing eHealth applications to support Hispanic cancer survivors

Background: Formative work was conducted with a Hispanic cancer survivor community toward the development of a tailored, literacy-friendly eHealth symptom management application. Ultimately, data will be used to create a symptom monitoring and support system. Theoretical Framework: Cancer is the leading cause of death for Hispanics. Given the heterogeneity of sub-groups, designing appropriate health communications is challenging. Leveraging this population9s increasing use of information and communication technology (ICT), there is potential to provide Hispanic cancer survivors with appropriately tailored eHealth communications. Tailoring is a message design technique that incorporates formally assessed individual characteristics into message design, thus making the message personally relevant.1,2 Tailoring eliminates unessential information; what remains is more personally relevant. When information is relevant, it is more likely to be thoughtfully processed, and thus, more successful in guiding a person to make a suggested behavior change.1 Using a reliable and valid behavior model when designing health communications increases the likelihood for success. This study employed Fishbein9s Integrative Model of Behavioral Prediction. This model has demonstrated to be effective in predicting intention, identifying key variables for intervention, and discriminating audience characteristics.3 Research Questions: Our research questions were as follows: (1) What are survivors9 most common symptoms/side effects post treatment; (2) What strategies do they use to manage symptoms/side effects; (3) How do they use ICT for information or symptom support? (4) What suggestions do they have for the design of eHealth symptom support? Methods: We conducted 3 mixed cancer patient focus groups (n=30). Trained Spanish-speaking facilitators lead the sessions using a moderator9s guide grounded in the research questions. Recorded sessions were translated by a transcription service. Investigators and research assistants systematically examined transcriptions to generate a list of themes. Results: Five key themes emerged: (1) Participants placed high importance on quality patient/medical professional communication; (2) When obtaining information or support, participants preferred to engage with a real person; (3) Participants are open to using various ICT, but recognize not all have access; (4) Depression and stress were the most common side effects; (5) The primary coping mechanism was social support; (6) Participants indicated a desire to connect with other cancer survivors. Discussion: The ability to intervene with Hispanic cancer survivors in a culturally and personally relevant, literacy-friendly manner through an accessible symptom management eHealth application has great potential to address health disparities and contribute to improved health related quality of life with this population. It is critical such applications address the desire for personal communication and high quality relationships with a health professional. This application should also provide an opportunity to connect with similar others. Conclusion: The ability to help Hispanic cancer survivors manage symptoms via a tailored, literacy-friendly manner eHealth application has potential to reduce health disparities among this population and to improve their health-related quality of life. Continued research will support the design of such eHealth applications. (1) Kreuter M, Farrell D, Olevitch L, Brennan L. Tailoring Health Messages: Customizing Communication with Computer Technology. New Jersey: Lawrence Erlbaum Associates; 2000. (2) Victorson D, Mendoza-Temple L, Takagishi C, Brendler C, Shevrin D, Cella D. Tailoring Supportive Care Interventions to Men Diagnosed with Prostate Cancer. Psychooncology. 2009; 18:S1-S58. (3) Fishbein M. The Role of Theory in Developing Effecive Health Communications. Journal of Communication 56, s1-s17. 2006. Citation Format: Jennifer R. Banas, David Victorson, Sandra Gutierrez, Evelyn Cordero, Lucia Flores. Designing eHealth applications to support Hispanic cancer survivors. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr A08. doi:10.1158/1538-7755.DISP13-A08