Keri Jupka

Communicating with the public about emerging health threats: lessons from the Pre-Event Message Development Project.

OBJECTIVES We sought to better understand the challenges of communicating with the public about emerging health threats, particularly threats involving toxic chemicals, biological agents, and radioactive materials. METHODS At the request of the Centers for Disease Control and Prevention, we formed an interdisciplinary consortium of investigative teams from 4 schools of public health. Over 2 years, the investigative teams conducted 79 focus group interviews with 884 participants and individual cognitive response interviews with 129 respondents, for a total sample of 1013 individuals. The investigative teams systematically compared their results with other published research in public health, risk communication, and emergency preparedness. RESULTS We found limited public understanding of emerging biological, chemical, and radioactive materials threats and of the differences between them; demand for concrete, accurate, and consistent information about actions needed for protection of self and family; active information seeking from media, local authorities, and selected national sources; and areas in which current emergency messaging can be improved. CONCLUSIONS The public will respond to a threat situation by seeking protective information and taking self-protective action, underlining the critical role of effective communication in public health emergencies.

Changing the conversation about prostate cancer among African Americans: results of formative research.

Objectives. To understand obstacles to and opportunities for improving prostate cancer communication to and within African American communities. Design. Researchers conducted interviews with 19 community leaders and five focus groups with healthy men and survivors. The team also conducted process evaluations of two outreach projects in which survivors spoke to African American men about prostate cancer and screening. Results. Three levels of obstacles to prostate cancer screening and treatment were identified. Individual-level obstacles included limited knowledge about the condition, about prevention and treatment, and fear of cancer. Socio-cultural barriers included distrust of the medical system, lack of a provider for routine and preventive care, reluctance to talk about cancer, and aversion to aspects of screening. Institutional deficits included the scarcity of educational efforts targeting prostate cancer. Outreach project evaluations suggested that survivors can be effective in building prostate cancer knowledge, promoting positive attitudes toward screening, and fostering conversations about prostate cancer. Educational efforts included little information about screening risks and decision-making however. Conclusions. The findings suggest that most potent interventions may combine survivor-led education with mass media and institution-based outreach. Such comprehensive programs could shift social norms that inhibit conversation and foster fear, leading in turn to more informed decisions and better treatment outcomes.

Advancing Organizational Health Literacy in Health Care Organizations Serving High-Needs Populations: A Case Study

Health care organizations, well positioned to address health literacy, are beginning to shift their systems and policies to support health literacy efforts. Organizations can identify barriers, emphasize and leverage their strengths, and initiate activities that promote health literacy–related practices. The current project employed an open-ended approach to conduct a needs assessment of rural federally qualified health center clinics. Using customized assessment tools, the collaborators were then able to determine priorities for changing organizational structures and policies in order to support continued health literacy efforts. Six domains of organizational health literacy were measured with three methods: environmental assessments, patient interviews, and key informant interviews with staff and providers. Subsequent strategic planning was conducted by collaborators from the academic and clinic teams and resulted in a focused, context-appropriate action plan. The needs assessment revealed several gaps in organizational health literacy practices, such as low awareness of health literacy within the organization and variation in perceived values of protocols, interstaff communication, and patient communication. Facilitators included high employee morale and patient satisfaction. The resulting targeted action plan considered the organizations culture as revealed in the interviews, informing a collaborative process well suited to improving organizational structures and systems to support health literacy best practices. The customized needs assessment contributed to an ongoing collaborative process to implement organizational changes that aided in addressing health literacy needs.

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.

Applying cognitive response testing in message development and pre-testing

Pre-testing messages with audience members is a critical step in the creation of effective health information. Quantitative methods for message testing have limited effectiveness, as they cannot reveal complications with language and comprehension. Cognitive response testing (CRT), a form of qualitative research, allows the interviewer to probe for deeper understanding of comprehension and language by asking participants to paraphrase items, discuss thoughts or emotions that come to mind and offer suggestions for improvement. This study explores the usefulness of CRT in message development and testing, adding to the literature regarding qualitative methods in public health. CRT was employed to evaluate health messages on two topics-bioterrorism and influenza vaccination. This technique effectively identified message terminology and concepts that respondents found unfamiliar or confusing, providing the framework needed for message revision. Commonly misunderstood words were replaced and confusing concepts were explained in the revised messages, making pre-tested messages more likely to be appropriate for the intended audience. These findings are consistent with previous research that establishes the usefulness of CRT in the evaluation and development of health-related messages and surveys.

Addressing the Challenge of Informed Decision Making in Prostate Cancer Community Outreach to African American Men

African American men are disproportionately affected by prostate cancer. This project adopted a community-based participatory approach to design and pilot test an educational outreach strategy that promotes informed decision making about screening among African American men in community settings in St. Louis, Missouri. Interviews with local subject matter experts informed the design of the strategy. The revised curriculum was pilot tested in 2009 with 63 men who completed pre- and posttest surveys that measured knowledge, norms, beliefs, decision self-efficacy, and screening intention. The intervention resulted in statistically significant improvement in prostate cancer knowledge, decreased perceived risks and barriers, and increased screening decision self-efficacy. The educational outreach strategy offered in community settings was effective in improving knowledge, beliefs, and decision self-efficacy related to prostate cancer screening. This project sought to devise a screening outreach strategy that struck a balance between the imperatives of informed decision-making goals and the pragmatics of community settings. The findings suggest the need for further research to assess the effectiveness of community-based outreach efforts in enhancing engagement of men in decision making related to screening, diagnostics, and treatment.

Applying Projective Techniques to Formative Research in Health Communication Development

This article describes a new approach to formative research in which projective techniques commonly used in psychological assessment were adapted for use in focus groups to help design colorectal-cancer screening materials for African American men and women. Participants (N = 20) were divided into six “design teams.” Each team was given a selection of design supplies and asked to create and discuss a visual layout for screening materials. Participants chose design elements that reflected visual preferences that they felt would connect meaningfully with other African Americans. The dynamics within the design teams were different than in traditional focus groups, with participants having more control over the groups direction. Using projective techniques helped draw out unique information from participants by allowing them to “project” their opinions onto objects. This approach may be a valuable tool for health-promotion and health-communication practitioners seeking insight on the implicit values of a priority population.

Becoming a health literate organization: Formative research results from healthcare organizations providing care for undeserved communities:

Background Integrating health literacy into primary care institutional policy and practice is critical to effective, patient centered health care. While attributes of health literate organizations have been proposed, approaches for strengthening them in healthcare systems with limited resources have not been fully detailed. Methods We conducted key informant interviews with individuals from 11 low resourced health care organizations serving uninsured, underinsured, and government-insured patients across Missouri. The qualitative inquiry explored concepts of impetus to transform, leadership commitment, engaging staff, alignment to organization wide goals, and integration of health literacy with current practices. Findings Several health care organizations reported carrying out health literacy related activities including implementing patient portals, selecting easy to read patient materials, offering community education and outreach programs, and improving discharge and medication distribution processes. The need for change presented itself through data or anecdotal staff experience. For any change to be undertaken, administrators and medical directors had to be supportive; most often a champion facilitated these changes in the organization. Staff and providers were often resistant to change and worried they would be saddled with additional work. Lack of time and funding were the most common barriers reported for integration and sustainability. To overcome these barriers, managers supported changes by working one on one with staff, seeking external funding, utilizing existing resources, planning for stepwise implementation, including members from all staff levels and clear communication. Conclusion Even though barriers exist, resource scarce clinical settings can successfully plan, implement, and sustain organizational changes to support health literacy.

Search strategy effectiveness and relevance of YouTube videos

Precision and recall are two widely accepted measures to Information Retrieval (IR) system performance. Different search strategies can yield different precisions and recalls for the same IR system, search engine or website. Therefore, precision and recall can also be used to measure search strategy effectiveness. YouTube® is a popular social media website which hosts the largest number of user-generated videos on the web. The YouTube® search engine only provides text words search function and search results are retrieved through the system matching these search terms to video descriptions, tags, comments, etc. Therefore, precision and recall can also be used to measure search strategy effectiveness. This paper aims to test if a search strategy using multiple search terms is effective by analyzing the relevance of the retrieved YouTube® videos on Smokeless Tobacco Products (STP) and YouTube® provided video usage statistics and community engagement statistics. 17 search terms were used to retrieve YouTube® videos on STP which were recorded in a master file. All duplicate videos from the retrieved results were excluded. Unique videos were then selected based on pre-defined inclusion and exclusion criteria set by the research team. A sample of 440 unique videos was randomly selected for data analysis. SPSS 19.0 was used for data analysis. Descriptive analysis, precisions and recalls, logistic regression, and odds ratio test results are reported. The study found that only a few search terms out of the total 17 terms are more effective in terms of relevance of the retrieved videos. Also, YouTube® provided video usage statistics and community engagement statistics did not have significant association with the relevance of the retrieved videos. Recommendations for potential solutions on designing more effective search strategies are provided.

Comparing State Legislative Aides’ Perspectives on Tobacco Policymaking in States With Strong and Weak Policies A Qualitative Study

Purpose: The study compared perceptions of state legislative aides about tobacco policymaking in states with strong and weak tobacco control policies. Approach: Qualitative in-depth interviews carried out in 2009. Setting: The US states were ranked on a combination of tobacco prevention funding, taxes, and presence of smoke-free policies. States at the top and bottom of the rankings were chosen. Participants: Interviews were conducted with 10 legislative aides in 5 states with strong tobacco control policies and 10 aides in 7 states with weak policies. Method: Twenty semistructured interviews were conducted, coded, and analyzed using a consensus coding process. Results: Tobacco control was a lower priority in states with weak policies, and respondents from these states listed more barriers to tobacco control policymaking than those from states with strong policies. Successful arguments for tobacco control emphasized operational applications, for example, enhanced revenue from tobacco taxes or safety of children and employees. Conclusion: Our findings support propositions posited in the Advocacy Coalition Framework. They point to the preeminence of contextual factors, notably political leanings and economic climate on success of policy change efforts. Lessons learned from participants from states with strong policy nonetheless show promise for success in states with weak policy.