kate eddens matthew w. kreuter health communication research laboratory washington university in st....

Kate Eddens

Matthew W. Kreuter

Health Communication Research Laboratory

Washington University in St. Louis

Keeping clients healthy: Integrating proactive health screening and referral into 2-1-1 systems

Eliminating health disparities by increasing the reach and effectiveness of cancer information in low-income and minority populations.

- Integrating cancer communication into practice

- System-level interventions

- Real-world settings

- 2-1-1

- Food Stamps

- Public Housing

- Low-income Energy Assistance

Why this approach?Three key points

• Basic needs supersede cancer prevention

Why this approach?Three key points

• Basic needs supersede cancer prevention

• Systems addressing basic needs reach millions

Why this approach?Three key points

• Basic needs supersede cancer prevention

• Systems addressing basic needs reach millions

• Integration of health could be a Win-Win-Win

1. Our study results

2. Activities nationally

3. Questions & discussion

Today’s presentation

Study 1: Is it feasible?

Kate Eddens, Matthew Kreuter, Kay Archer, Debbie Fagin

Pilot studyNovember, 2007 – February, 2008

• Aim 1: Estimate cancer control needs of callers

• Aim 2: Determine feasibility of cancer referrals

- Mammography

- Pap testing

- Colonoscopy

- HPV vaccine

- Smoking

- Smoke-free home policies

Disparities associated with all of them

Effective tests or interventions for all

Programs available that provide them for free

Why these six?

Mammograms

Pap smears

Colonoscopies

HPV vaccination

Smoking cessation

Smoke free home policy

Need at least one 85%

Need two or more 54%

Need three or more 30%

Current cancer control needs of 2-1-1 callers

Eddens K, Kreuter MW, Archer K. J of Social Services Research (under review).

26

1315

0

10

20

30

40

2-1-1 callers Missouri U.S.

percent

No health insurance2-1-1 callers (n=297) vs. Missouri vs. U.S.

33

2320

0

10

20

30

40

2-1-1 callers Missouri U.S.

percent

Current cigarette smoker2-1-1 callers (n=297) vs. Missouri vs. U.S.

52

64

72

0

10

20

30

40

50

60

70

80

2-1-1 callers Missouri U.S.

percent

Has a smoke-free home policy2-1-1 callers (n=297) vs. Missouri vs. U.S.

5058 57

0

10

20

30

40

50

60

70

80

2-1-1 callers Missouri U.S.

percent

Ever had a colonoscopy (ages ≥ 50)2-1-1 callers (n=107) vs. Missouri vs. U.S.

Pilot studyNovember, 2007 – February, 2008

• Aim 1: Estimate cancer control needs of callers

• Aim 2: Determine feasibility of cancer referrals

Telephone follow-up 2 weeks later- What did they think of the mailed referrals?- Did they make a call and/or schedule an appointment?

Reactions to mailed referrals (n=39)

Outcome %

Recall getting referral 92%Recall getting mailing 54%Read all of mailing 41%Liked mailing a lot 62%Very easy to understand 67%Called referral agency 26%Made an appointment 13%

Willingness to participateAmong 2-1-1 callers in pilot study

• 58% agreed to answer cancer risk questions

• 91% agreed to participate in randomized trial

• 81% could be contacted at 2-week follow-up

Appropriateness of health questionsAmong 2-1-1 callers in pilot study

• Should 2-1-1 be asking about health? (56%)

• Health questions too private? (5%)

• Comfortable with mailed health info? (81%)

• Health referrals make 2-1-1 more appealing? (100%)

How is call length affected?

Time to administer survey & provide referrals

• Mean = 4:54 minutes

Enroll into study

• Mean = 2:52 minutes

Conclusions

• High level of need among 2-1-1 callers

• Proactive health referrals are feasible via 2-1-1

• Mailed reminder referrals seem promising

What do we still need to learn?

• Is it scalable?

• How strong a referral is needed?

• Does it work equally well for all callers?

Study 2: National prevalence study

Jason Purnell, Kate Eddens, Matthew Kreuter2-1-1s of Missouri, King County, Houston, North Carolina

Cancer Prevention and Control Research Network

Administered in four 2-1-1 systems

- 2-1-1 callers (n = 1,413)

- 2008 BRFSS (n = 415,194)

2-1-1 callers vs. U.S. population

- Need at least one 72%

- Need two or more 42%

- Need three or more 17%

Cancer needs of 2-1-1 callers (n=1,413)

No health insurance2-1-1 callers vs. U.S. (p < .001)

Current smokers2-1-1 callers vs. U.S. (p < .001)

Smoke-free home policy2-1-1 callers vs. U.S. (p < .001)

Ever had colonoscopy (50+)2-1-1 callers vs. U.S. (p < .001)

Up-to-date mammogram (women 40+)2-1-1 callers vs. U.S. (p < .001)

Up-to-date Pap test (women 18+)2-1-1 callers vs. U.S. (p < .001)

HPV vaccination (women 18-26)2-1-1 callers vs. U.S.

Study 3: Statewide intervention study

Matthew Kreuter, Kate Eddens, Nikki CaitoKassandra Alcaraz, Jason Purnell, Anjanette Wells,

Debbie Fagin, Nikisha Bridges, Tiffany Aziz

- Mammography

- Pap testing

- Colonoscopy

- HPV vaccine

- Smoking

- Smoke-free home policies

Mammograms

Pap smears

Colonoscopies

HPV vaccination

Smoking cessation

Smoke free home policy

Telephone follow-up 1 and 4 months later- Did they contact referrals?- Did they obtain needed services?

Telephone follow-up 1 and 4 months later- Did they contact referrals?- Did they obtain needed services?

Telephone follow-up 1 and 4 months later- Did they contact referrals?- Did they obtain needed services?

Telephone follow-up 1 and 4 months later- Did they contact referrals?- Did they obtain needed services?

Coach

Help callers act on referrals by:

• Making appointments

• Providing reminders

• Arranging transportation

• Answering questions

• Addressing barriers

• Explaining systems

- 31 enrolled in pilot

- 29 contacted in 3 weeks (94%)

- 2.7 contacts per person (range 1-6)

- 35% success rate (11 of 31)

Enrollment and contact

- 21 smokers (10 called Quitline)

- 6 needed Pap test (1 obtained, 1 in progress)

- 5 needed mammogram (1 in progress)

- 3 needed smoke free home (2 called hotline)

- 3 needed HPV vaccination (0 obtained)

- 2 needed colonoscopy (0 obtained)

Needs and resolution

1. Which approach works best?

2. What’s the impact on 2-1-1 quality indicators?

3. What factors influence effectiveness?

Key questions

1. Problem resolution

2. Unmet basic needs

3. Sense of coherence

- comprehensibility- manageability- meaningfulness

Factors that could affect outcomes

What will we learn?

• Need for cancer prevention in 2-1-1 callers

• Effectiveness of 2-1-1 referrals for health

• Added benefit of mailed referrals vs. coaches

• Effects when original problem is solved by 2-1-1

• Effects by level of basic needs, SOC

Activities nationallyActivities nationally

2-1-1 and Research CollaborationPresentations to major organizations

• National Cancer Institute

• U.S. Centers for Disease Control and Prevention

• American Society of Preventive Oncology

• The International Communication Association

• Substance Abuse and Mental Health Association

2-1-1 and Research CollaborationHealth Screening and I&R webinar

• Invited webinar to AIRS members

• 104 attendees

2-1-1 Health and Human Services Research Consortium

• Pairing 2-1-1 systems and researchers

• Combining, refining, and analyzing data

• Providing evaluation and funding assistance

• Laying ground rules for collaboration

• Setting a research agenda

2-1-1 Research ConsortiumWho is participating now?

• United Way

• 2-1-1 systems

• Health care systems

• National Cancer Institute (CECCR)

• Centers for Disease Control (CPCRN)

• University-based researchers

2-1-1 Research Consortium Special Journal Supplement

• Full issue dedicated to research with 2-1-1

• Published in wide-reaching scientific journal

• Expected to be published in 2011

• Funded by the National Cancer Institute

Special Journal Supplement Why should I care?

• Raise awareness of 2-1-1

• Present opportunities for collaboration

• Show the value and reach of 2-1-1

• Lend credibility to 2-1-1

Special Journal Supplement Table of Contents

• Introductions

• Brief empirical reports

• Summary and commentary

Table of Contents Introductions

Introduction to the Supplement I: Rationale for 2-1-1 embracing research partnerships

Table of Contents Introductions

Introduction to the Supplement II: A grand vision for 2-1-1 research collaboration

Table of Contents Introductions

The case for collaboration between 2-1-1 systems and health researchers

Table of Contents Brief empirical reports

Cancer risks of 2-1-1 callers in Missouri, North Carolina, Texas and Washington

Table of Contents Brief empirical reports

Findings from cost-benefit studies of 2-1-1 systems: A review

Table of Contents Brief empirical reports

Media strategies to increase use of 2-1-1 during the mortgage crisis

Table of Contents Brief empirical reports

Unmet health needs in Texas during disaster and recovery, Katrina-Rita, 2005

Table of Contents Brief empirical reports

Other brief reports to be solicited from 2-1-1 systems nationally

Table of Contents Summary and commentary

Guiding principles for collaborative research with 2-1-1

Table of Contents Summary and commentary

A research agenda and future directions for collaborative research with 2-1-1

Table of Contents Summary and commentary

Commentary on the Special Supplement

Special Journal Supplement Call for Papers

• Surveillance

• Special initiatives

• H1N1 / SARS / Other health initiatives

• Disaster

• Aging and disability

Ongoing interaction with 2-1-1sAIRS meetings

• Survey of system leaders

How would you rate your evaluation process for standard services? (n=22)

percent

How would you rate your evaluation process for special initiatives? (n=23)

percent

Have you ever worked with researchers? (n=23)

percent

How would you rate your experience working with researchers? (n=22)

percent

What is your greatest concern about working with researchers? (n=23)

percent

What would be the greatest benefit of working with researchers? (n=23)

percent

Contact information:

Kate Eddens (keddens@wustl.edu)

Matthew Kreuter (mkreuter@wustl.edu)