The uptake and effect of a mailed multi-modal colon cancer screening intervention: A pilot controlled trial

Abstract Background We sought to determine whether a multi-modal intervention, which included mailing a patient reminder with a colon cancer decision aid to patients and system changes allowing direct access to scheduling screening tests through standing orders, would be an effective and efficient means of promoting colon cancer screening in primary care practice. Methods We conducted a controlled trial comparing the proportion of intervention patients who received colon cancer screening with wait list controls at one practice site. The intervention was a mailed package that included a letter from their primary care physician, a colon cancer screening decision aid, and instructions for obtaining each screening test without an office visit so that patients could access screening tests directly. Major outcomes were screening test completion and cost per additional patient screened. Results In the intervention group, 15% (20/137) were screened versus 4% (4/100) in the control group (difference 11%; (95%; CI 3%;18% p = 0.01). The cost per additional patient screened was estimated to be $94. Conclusion A multi-modal intervention, which included mailing a patient reminder with a colon cancer decision aid to patients and system changes allowing patients direct access to schedule screening tests, increased colon cancer screening test completion in a subset of patients within a single academic practice. Although the uptake of the decision aid was low, the cost was also modest, suggesting that this method could be a viable approach to colon cancer screening

Heterogeneity within the Asian American community

BACKGROUND: Educational interventions are grounded on scientific data and assumptions about the community to be served. While the Pan Asian community is composed of multiple, ethnic subgroups, it is often treated as a single group for which one health promotion program will be applicable for all of its cultural subgroups. Compounding this stereotypical view of the Pan Asian community, there is sparse data about the cultural subgroups' similarities and dissimilarities. The Asian Grocery Store based cancer education program evaluation data provided an opportunity to compare data collected under identical circumstances from members of six Asian American cultural groups. METHODS: A convenience sample of 1,202 Asian American women evaluated the cultural alignment of a cancer education program, completing baseline and follow-up surveys that included questions about their breast cancer knowledge, attitudes, and screening behaviors. Participants took part in a brief education program that facilitated adherence to recommended screening guidelines. RESULTS: Unique recruitment methods were needed to attract participants from each ethnic group. Impressions gained from the aggregate data revealed different insights than the disaggregate data. Statistically significant variations existed among the subgroups' breast cancer knowledge, attitudes, and screening behaviors that could contribute to health disparities among the subgroups and within the aggregate Pan Asian community. CONCLUSION: Health promotion efforts of providers, educators, and policy makers can be enhanced if cultural differences are identified and taken into account when developing strategies to reduce health disparities and promote health equity

Health communication: a discussion of North American and European views on sustainable health in the digital age

Following the United Nations’ Sustainable Development Goals, the UN’s third goal is meant to “ensure health lives and promote well-being for all at all ages” (UN 2017). Thus health is closely linked to sustainability. While progress has been made over the past decades, which have seen an increase in life expectancy and a success in combatting several diseases (e.g., children’s diseases such as measles or adult diseases such as HIV and malaria), new health issues have emerged and need to be addressed. In this context, communication is of uttermost relevance. Broadly speaking, health communication refers to “any type of human communication whose content is concerned with health” (Rogers, J Health Commun 1:15–23, 1996) and can be directed at both individuals and organizations with the goal of preventing illness and fostering health (Thompson et al., The Routledge handbook of health communication, 2nd edn. Routledge, New York, 2011). As a multifaceted and multidisciplinary approach, health communication draws from and combines influences from different theoretical backgrounds and disciplines, such as education, sociology, (mass) communication, anthropology, psychology, and social sciences (WHO, Health and sustainable development. Key health trends. Available via WHO. http://www.who.int/mediacentre/events/HSD_Plaq_02.2_Gb_def1.pdf. Accessed 20 Dec 2017, 2003; Institute of Medicine, Health literacy: a prescription to end confusion. Available via The National Academies of Sciences Engineering Medicine. http://www.nap.edu/openbook.php?record_id=10883. Accessed 11 Apr 2016, 2003; Bernhardt, Am J Public Health 94:2051–2053, 2004). Health communication – regardless of the form it takes (e.g., policies, patient-provider interactions, community projects, public service announcements, or advertising) – is concerned with “influencing, engaging and supporting individuals, communities, health professionals, special groups, policy makers and the public to champion, introduce, adopt, or sustain a behavior, practice or policy that will ultimately improve health outcomes” (Schiavo, Health communication: from theory to practice. Wiley, San Francisco, 2007). As such, it needs to be perceived as “a part of everyday life” (du Pré, Communicating about health: current issues and perspectives. Mayfield Publishing Company, Mountain View, 2000). Since health communication occurs in the health communication environment (Schiavo, Health communication: from theory to practice, 2nd edn. Jossey-Bass, San Francisco, 2014), which is composed of four main domains, namely: (1) health audience; (2) recommended health behavior, service, or product; (3) social environment; and (4) political environment, it takes place on various levels (societal, institutional, and individual) which need to be studied in order to provide a comprehensible and complete picture of the subject area. The present contribution seeks to highlight the contribution of the different disciplines to effective health communication, outline changes in the health communication environment, as well as carve out future challenges that are brought about by changes in demographics, disease treatment, and communication patterns. A special focus will be put on gender-specific and digital health communication. In conclusion, limitations and directions for future research are addressed