Katherine S. Eddens

Use of cancer control referrals by 2-1-1 callers: a randomized trial.

BACKGROUND Callers to 2-1-1 have greater need for and lesser use of cancer control services than other Americans. Integrating cancer risk assessment and referrals to preventive services into 2-1-1 systems is both feasible and acceptable to callers. PURPOSE To determine whether callers will act on these referrals. METHODS In a randomized trial, 2-1-1 callers (n=1200) received standard service and those with at least one cancer risk factor or need for screening were assigned to receive verbal referrals only, verbal referrals + a tailored reminder mailed to their home, or verbal referrals + a telephone health coach/navigator. All data were collected from June 2010 to March 2012 and analyzed in March and April 2012. RESULTS At 1-month follow-up, callers in the navigator condition were more likely to report having contacted a cancer control referral than those receiving tailored reminders or verbal referrals only (34% vs 24% vs 18%, respectively; n=772, p<0.0001). Compared to verbal referrals only, navigators were particularly effective in getting 2-1-1 callers to contact providers for mammograms (OR=2.10, 95% CI=1.04, 4.22); Paps (OR=2.98, 95% CI=1.18, 7.54); and smoking cessation (OR=2.07, 95% CI=1.14, 3.74). CONCLUSIONS Given the extensive reach of 2-1-1s and the elevated risk profile of their callers, even modest response rates could have meaningful impact on population health if proactive health referrals were implemented nationally.

Disparities by Race and Ethnicity in Cancer Survivor Stories Available on the Web

Background The rapid growth of eHealth could have the unintended effect of deepening health disparities between population subgroups. Most concerns to date have focused on population differences in access to technology, but differences may also exist in the appropriateness of online health content for diverse populations. Objective This paper reports findings from the first descriptive study of online cancer survivor stories by race and ethnicity of the survivor. Methods Using the five highest-rated Internet search engines and a set of search terms that a layperson would use to find cancer survivor stories online, we identified 3738 distinct sites. Of these, 106 met study criteria and contained 7995 total stories, including 1670 with an accompanying photo or video image of the survivor. Characteristics of both websites and survivor stories were coded. Results All racial minority groups combined accounted for 9.8% of online cancer survivor stories, despite making up at least 16.3% of prevalent cancer cases. Also notably underrepresented were stories from people of Hispanic ethnicity (4.1%), men (35.7%), survivors of colon cancer (3.5%), and older adults. Conclusions Because racial/ethnic minority cancer survivors are underrepresented in survivor stories available online, it is unlikely that this eHealth resource in its current form will help eliminate the disproportionate burden of cancer experienced by these groups.

Proactive screening for health needs in United Way’s 2-1-1 information and referral service

ABSTRACT Cancer disproportionately affects the underserved. United Way 2-1-1 is an information and referral system that links underserved populations to community services. This study explores the feasibility of integrating proactive screening and referral to health services into 2-1-1. A cancer risk assessment was administered to callers (n = 297), measuring their need for 6 cancer control services. A subset of respondents was randomized to receive generic or tailored referrals to needed services. Nearly all participants (85%) needed at least one of the services. Those who received tailored referrals were more likely to make appointments. Future research will explore approaches to address and eliminate health disparities through 2-1-1.

What can health communication science offer for ACA implementation? Five evidence-informed strategies for expanding Medicaid enrollment.

CONTEXT Implementing the Affordable Care Act (ACA) in 2014 will require effective enrollment and outreach efforts to previously uninsured individuals now eligible for coverage. METHODS From 1996 to 2013, the Health Communication Research Laboratory conducted more than 40 original studies with more than 30,000 participants to learn how to improve the reach to and effectiveness of health information for low-income and racial/ethnic minority populations. We synthesized the findings from this body of research and used them to inform current challenges in implementing the ACA. FINDINGS We found empirical support for 5 recommendations regarding partnerships, outreach, messages and messengers, life priorities of low-income individuals and families, and the information environment. We translated these into 12 action steps. CONCLUSIONS Health communication science can inform the development and execution of strategies to increase the publics understanding of the ACA and to support the enrollment of eligible individuals into Medicaid or the Health Insurance Marketplace.

Advancing Collaborative Research with 2-1-1 to Reduce Health Disparities Challenges, Opportunities, and Recommendations

The 2-1-1 system is a Federal Communications Commission nationally designated 3-digit telephone information and referral (IR track utilization of health services; and provide evidence-based information, referral, and behavioral interventions to vulnerable segments of the population. The papers in this supplement to the American Journal of Preventive Medicine 1–17 bring together an emerging body of research conducted in the context of the 2-1-1 system and highlight the exciting opportunities for collaborations between researchers and these systems. This foundation is drawn on to outline a path for moving forward to systematically and strategically realize this potential. In particular, there is a need to (1) utilize theoretical and conceptual frameworks to better place 2-1-1 in the larger public health context and show linkages between/among other public health organizations. Next, tackling differences among data systems across 2-1-1 systems arguably

A 2-1-1 Research Collaboration Participant Accrual and Service Quality Indicators

BACKGROUND In times of crises, 2-1-1 serves as a lifeline in many ways. These crises often cause a spike in call volume that can challenge 2-1-1s ability to meet its service quality standards. For researchers gathering data through 2-1-1s, a sudden increase in call volume might reduce accrual as 2-1-1 has less time to administer study protocols. Research activities imbedded in 2-1-1 systems may affect directly 2-1-1 service quality indicators. PURPOSE Using data from a 2-1-1 research collaboration, this paper examines the impact of crises on call volume to 2-1-1, how call volume affects research participant accrual through 2-1-1, and how research recruitment efforts affect 2-1-1 service quality indicators. METHODS t-tests were used to examine the effect of call volume on research participant accrual. Linear and logistic regressions were used to examine the effect of research participant accrual on 2-1-1 service quality indicators. Data were collected June 2010-December 2011; data were analyzed in 2012. RESULTS Findings from this collaboration suggest that crises causing spikes in call volume adversely affect 2-1-1 service quality indicators as well as accrual of research participants. Administering a brief (2-3 minute) health risk assessment did not affect service quality negatively, but administering a longer (15-18 minute) survey had a modest adverse effect on these indicators. CONCLUSIONS In 2-1-1 research collaborations, both partners need to understand the dynamic relationship among call volume, research accrual, and service quality and adjust expectations accordingly. If research goals include administering a longer survey, increased staffing of 2-1-1 call centers may be needed to avoid compromising service quality.

Guiding principles for collaborative research with 2-1-1.

ollaborations between 2-1-1 systems and aca- demic researchers should be based on a mutual dedication to helping populations in need, and will be most successful when they provide needed help to 2-1-1 callers, improve the 2-1-1 systems service to callers, and generate useful knowledge that is beneficial to both partners. Can a single collaboration do all that? It can, especially if it is designed that way. The researchers and 2-1-1 leaders involved with the projects reported in the papers in this supplement to the American Journal of Preventive Medicine 1-17 and elsewhere have faced some of the common challenges of research collaboration and emerged with successful research-service partnerships. This paper draws on their experiences as well as lessons from team science and participatory research to propose a set of guiding principles for conducting collaborative research with 2-1-1 systems. For decades, researchers have strived to build mutually beneficial partnerships with community organizations. This work has generated valuable new knowledge as well as recommendations and best practices for establishing and sustaining such partnerships. 18 -20 Developing re- search partnerships that integrate multiple disciplines, such as 2-1-1 and academic collaborations, requires that several processes be followed in the development phase. Hall et al., 21 in a model of transdisciplinary team-based research, identify some of these crucial processes as gen- erating a shared mission and goals, developing a critical awareness of the strengths and limitations that each part- ner brings to the team, defining the problem and creating a concrete representation of where each team member can contribute to the solution, and creating a psycholog- ically safe environment where partners are comfortable to share ideas and opinions openly in a mutually respect- ful discussion. When this environment is established, issues and challenges that arise during a partnership can be addressed in a constructive and productive manner, contributing to the success of the collaboration. Among partnerships applying these recommenda- tions, perhaps the most similar and relevant to the 2-1-1- academic collaborations described in this supplement is the Cancer Information Service Research Consortium (CISRC). The CISRC partnership joined the National Cancer Institutes Cancer Information Service (CIS)— like 2-1-1, a telephone information and referral system— and scientific investigators dedicated to cancer control research. The CISRC produced a laboratory for research advancing the field of health communication, which re- sulted in improvement in the reach, quality, and effec- tiveness of CIS service to its clients, as well as the publi- cation of five monographs compiling CISRC-based

Mobile Technology, Cancer Prevention, and Health Status Among Diverse, Low-Income Adults

Purpose. Characterize mobile technology ownership, use, and relationship to self-reported cancer prevention behaviors and health status in a diverse, low-income sample of callers to 2-1-1. Design. Secondary analyses of cross-sectional survey data from a larger trial collected from June 2010 to December 2012. Setting. United Way Missouri 2-1-1 serves 99 of 114 counties and received 166,000 calls in 2011. Subjects. The respondents (baseline, n = 1898; 4 month, n = 1242) were predominantly female, non-Hispanic Black, younger than 50 years, with high-school education or less and annual income <

An Interactive, Mobile-Based Tool for Personal Social Network Data Collection and Visualization Among a Geographically Isolated and Socioeconomically Disadvantaged Population: Early-Stage Feasibility Study With Qualitative User Feedback

20,000. Measures. Cell phone ownership and use and its relationship to cancer prevention services and health status were assessed via telephone-based survey, using items adapted from previous research and the Behavioral Risk Factor Surveillance System. Smartphone ownership and use were also assessed. Analysis. Descriptive statistics and bivariate and multivariate associations between cell phone ownership and prevention and health status are reported. Results. Three-fourths (74%) of study participants owned a cell phone and 23% owned a smartphone. Text messaging was the most popular use. Ownership was significantly associated with good to excellent health status and presence of smoke-free home policies in multivariate models. Conclusion. Cell phone ownership is growing and has potential to deliver health information to low-income populations. With 16 million calls annually, the national 2-1-1 system may be a promising model and platform.

Effective Dual Method Contraceptive Use and HPV Vaccination Among U.S. Adolescent and Young Adult Females

Background Personal social networks have a profound impact on our health, yet collecting personal network data for use in health communication, behavior change, or translation and dissemination interventions has proved challenging. Recent advances in social network data collection software have reduced the burden of network studies on researchers and respondents alike, yet little testing has occurred to discover whether these methods are: (1) acceptable to a variety of target populations, including those who may have limited experience with technology or limited literacy; and (2) practical in the field, specifically in areas that are geographically and technologically disconnected, such as rural Appalachian Kentucky. Objective We explored the early-stage feasibility (Acceptability, Demand, Implementation, and Practicality) of using innovative, interactive, tablet-based network data collection and visualization software (OpenEddi) in field collection of personal network data in Appalachian Kentucky. Methods A total of 168 rural Appalachian women who had previously participated in a study on the use of a self-collected vaginal swab (SCVS) for human papillomavirus testing were recruited by community-based nurse interviewers between September 2013 and August 2014. Participants completed egocentric network surveys via OpenEddi, which captured social and communication network influences on participation in, and recruitment to, the SCVS study. After study completion, we conducted a qualitative group interview with four nurse interviewers and two participants in the network study. Using this qualitative data, and quantitative data from the network study, we applied guidelines from Bowen et al to assess feasibility in four areas of early-stage development of OpenEddi: Acceptability, Demand, Implementation, and Practicality. Basic descriptive network statistics (size, edges, density) were analyzed using RStudio. Results OpenEddi was perceived as fun, novel, and superior to other data collection methods or tools. Respondents enjoyed the social network survey component, and visualizing social networks produced thoughtful responses from participants about leveraging or changing network content and structure for specific health-promoting purposes. Areas for improved literacy and functionality of the tool were identified. However, technical issues led to substantial (50%) data loss, limiting the success of its implementation from a researcher’s perspective, and hindering practicality in the field. Conclusions OpenEddi is a promising data collection tool for use in geographically isolated and socioeconomically disadvantaged populations. Future development will mitigate technical problems, improve usability and literacy, and test new methods of data collection. These changes will support goals for use of this tool in the delivery of network-based health communication and social support interventions to socioeconomically disadvantaged populations.