Using written narratives in public health practice: A creative writing perspective

Narratives have become an increasingly common health communication tool in recent years. Vivid, engaging writing can help audiences identify with storytellers and understand health messages, but few public health practitioners are trained to create such stories. A transdisciplinary perspective, informed by both creative writing advice and evidence-based public health practices, can help public health professionals use stories more effectively in their work. This article provides techniques for creating written narratives that communicate health information for chronic disease prevention. We guide public health professionals through the process of soliciting, writing, and revising such stories, and we discuss challenges and potential solutions

African American Adults’ Experiences with the Health Care System: In Their Own Words

African Americans suffer a disproportionate burden of death and illness from a number of different chronic diseases. Inequalities in health care practices and poor patient and provider communication between African American patients and health care professionals contribute to these disparities. We describe findings from focus groups with 79 urban African Americans in which the participants discussed their interactions with the healthcare system as well as beliefs and opinions of the healthcare system and professionals. Analysis revealed five major themes: (1) historical and contextual foundations; (2) interpersonal experiences with physicians and other health care workers; (3) discrimination; (4) trust, opinions and attitudes, and (5) improving health care experiences. These findings indicate that perceptions of discrimination and racism were prevalent among African Americans in this study, and that the expectation of a negative interaction is a barrier to seeking care. Authors discuss prevention and public health implications of these findings and make recommendations for health care practitioners

Obtaining Record Linkage Consent: Results from a Wording Experiment in Germany

Many sample surveys ask respondents for consent to link their survey information with administrative sources. There is significant variation in how linkage requests are administered and little experimental evidence to suggest which approaches are useful for achieving high consent rates. A common approach is to emphasize the positive benefits of linkage to respondents. However, some evidence suggests that emphasizing the negative consequences of not consenting to linkage is a more effective strategy. To further examine this issue, we conducted a gain-loss framing experiment in which we emphasized the benefit (gain) of linking or the negative consequence (loss) of not linking one’s data as it related to the usefulness of their survey responses. In addition, we explored a sunk-prospective costs rationale by varying the emphasis on response usefulness for responses that the respondent had already provided prior to the linkage request (sunk costs) and responses that would be provided after the linkage request (prospective costs). We found a significant interaction between gain-loss framing and the sunk-prospective costs rationale: respondents in the gain-framing condition consented to linkage at a higher rate than those in the loss-framing condition when response usefulness was emphasized for responses to subsequent survey items. Conversely, the opposite pattern was observed when response usefulness was emphasized for responses that had already been provided: loss-framing resulted in a higher consent rate than the gain-framing, but this result did not reach statistical significance

Chapter 7: Statistical Identification of Fraudulent Interviews in Surveys: Improving Interviewer Controls Appendix 7

Table A7A.1 Number of identical response pattern

Tailored versus generic knowledge brokering to integrate mood management into smoking cessation interventions in primary care settings : Protocol for a cluster randomized controlled trial

Background: Both tobacco smoking and depression are major public health problems associated with high morbidity and mortality. In addition, individuals with depression are almost twice as likely to smoke and less likely to achieve smoking cessation. In the Smoking Treatment for Ontario Patients program, an established smoking cessation program in Ontario, Canada, 38% of smokers in primary care settings have current or past depression with 6-month quit rates that are significantly lower than those without depression (33% versus 40%, P<.001). Integrating self-help mood management (eg, relaxation exercises and mood monitoring) with smoking cessation treatment increases long-term quit rates by 12%-20%. However, integration in real-world settings has not been reported. It is unclear which knowledge translation strategy would be more effective for motivating clinicians to provide resources on mood management to eligible patients. Objective: The objectives of this study are to investigate the following comparisons among depressed smokers enrolled in a smoking cessation program: 1) the effectiveness of generalized, exclusively email-based prompts versus a personalized knowledge broker in implementing mood management interventions; 2) the effectiveness of the two knowledge translation strategies on smoking quit rates; and 3) the incremental costs of the two knowledge translation strategies on the implementation of mood management interventions. Methods: The study design is a cluster randomized controlled trial of Family Health Teams participating in the Smoking Treatment for Ontario Patients program. Family Health Teams will be randomly allocated 1:1 to receive either generalized messages (related to depression and smoking) exclusively via email (group A) or be assigned a knowledge broker who provides personalized support through phone- and email-based check-ins (group B). The primary outcome, measured at the site level, is the proportion of eligible baseline visits that result in the provision of the mood management intervention to eligible patients. Results: Recruitment for the primary outcome of this study will be completed in 2018/2019. Results will be reported in 2019/2020. Conclusions: This study will address the knowledge gap in the implementation strategies (ie, email-based prompts versus a knowledge broker) of mood management interventions for smokers with depression in primary care settings. Trial Registration: ClinicalTrials.gov NCT03130998; https://clinicaltrials.gov/ct2/show/NCT03130998 (Archived on WebCite at www.webcitation.org/6ylyS6RTe)

Make It Your Own Clinical Trials Posters: A Regional Collaboration with the National Cancer Institute

University of Kansas Medical Center - Midwest Cancer Institute Poster SessionIntroduction: National health organizations usually offer a limited variety of publication resources to the regional organizations that they serve. These resources may not always reflect the needs of the populations served in those diverse areas. Private industry has addressed the varied needs of their customers by offering products that can be customized by the consumer. The Cancer Prevention & Control Research Network (CPCRN) site at Washington University in St. Louis, in collaboration with Midwest Cancer Alliance and the National Cancer Institute (NCI) developed and tested a web-based tool for customizing clinical trial recruitment posters in Midwest Cancer Alliance member cancer centers, NCI's Community Cancer Center Program in Nebraska, and select NCI-designated cancer centers in the heartland region. Methods: CPCRN, Midwest Cancer Alliance, and NCI worked closely with the cancer centers to select, edit and audience test the images and messages that would populate the Make It Your Own (MIYO) system. CPCRN built a secure website and cancer center staff members were trained on the MIYO Clinical Trials Poster website by the Midwest Cancer Alliance, CPCRN and the Heartland Region Cancer Information Service. Each cancer center created a unique user name and password to access the site. Organizations were able to select images, clinical trial messages, and add their own organization's logo in order to build a poster that best reflects the population served. Once created, the poster was provided in a print ready file that could be produced on a local printer, at a hospital print shop, or through a commercial print shop. To determine if this new system of offering cancer publications is a feasible method to create and distribute publications, a program evaluation was conducted using the on-line survey tool Survey Monkey. Project outcomes measured satisfaction, ease of use, number of unique poster element combinations, and number of posters generated and printed. Results: Fifteen cancer centers were trained on the MIYO website; ten completed the post-use survey. Participants indicated that the ease to create a poster, with an average rating of 8.8 (10=very easy, 1=very difficult). Eighty percent indicated that the system offered images that represented the population served. All agreed or strongly agreed that the system was user friendly and that they would recommend the system to others, and 90 % would use MIYO again. A total of ten unique poster element combinations were selected by eleven organizations. Five organizations indicated they printed the posters within 4-8 weeks of introduction to the MIYO system, all on local printers. Discussion: MIYO is a demonstration of the varied needs of local organizations and the opportunity to meet their needs through use of a web-based customizable resource and distribution system. National and academic institutions have the opportunity to test health education resources through collaboration with local and regional health care providers. This collaboration between academia and private organizations gives rise to unique solutions for creation and dissemination of evidence-based resources

Development of targeted messages to promote smoking cessation among construction trade workers

Blue-collar workers, particularly those in the construction trades, are more likely to smoke and have less success in quitting when compared with white-collar workers. Little is known about health communication strategies that might influence this priority population. This article describes our formative work to develop targeted messages to increase participation in an existing smoking cessation program among construction workers. Using an iterative and sequential mixed-methods approach, we explored the culture, health attitudes and smoking behaviors of unionized construction workers. We used focus group and survey data to inform message development, and applied audience segmentation methods to identify potential subgroups. Among 144 current smokers, 65% reported wanting to quit smoking in the next 6 months and only 15% had heard of a union-sponsored smoking cessation program, despite widespread advertising. We tested 12 message concepts and 26 images with the target audience to evaluate perceived relevance and effectiveness. Participants responded most favorably to messages and images that emphasized family and work, although responses varied by audience segments based on age and parental status. This study is an important step towards integrating the culture of a high-risk group into targeted messages to increase participation in smoking cessation activities

Low housing quality, unmet social needs, stress and depression among low-income smokers

Smokers are at greater risk of multiple health conditions that are exacerbated by environmental hazards associated with low housing quality. However, little is known about the prevalence of low housing quality among low-income smokers. Using correlations and logistic regression, we examined associations among eight housing quality indicators - pests, water leaks, mold, lead paint, and working smoke detectors, appliances, heating, and air conditioning - and between housing quality and social needs, depressive symptoms, perceived stress, sleep problems, and self-rated health in a community-based sample of 786 low-income smokers from 6 states. Most participants were female (68%), and White (45%) or African-American (43%). One in four (27%) completed less than high school education, and 41% reported annual pre-tax household income of less than $10,000. Housing quality problems were common. Most participants (64%) reported at least one problem in their home, and 41% reported two or more problems, most commonly pest infestations (40%), water leaks (22%), lack of air conditioning (22%) and mold (18%). Lack of heat and air conditioning were correlated, as were water leaks and mold. Using logistic regression analyses controlling for participant demographic characteristics, we found that reporting more housing quality problems was associated with greater odds of worse mental and physical health outcomes. Multiple health threats, including housing quality, depressive symptoms, stress, poor sleep, and financial strain may be mutually reinforcing and compound the health consequence of smoking. Future research should seek to replicate these findings in other samples, and examine associations longitudinally to better understand causality