Blog
2012
2011
Research about sustainability is becoming a hot topic. The Brown School of Social Work at Washington University hosts a sustainability research conference beginning today, February 9. This is a topic that has never achieved much attention on the agendas of researchers or funders, but that condition may be shifting. This conference features Ross Brownson, Enola Proctor, and Doug Luke from Wash U, and adds researchers such as Jill Marsteller, Kurt Stange, and Phyllis Panzano who will discuss cases of sustained programs and the factors that led to their continuation. Program officers from CDC, NIMH, NIDA, and NCI will take part, too. Perhaps a large part of the lack of funded projects that explicitly study sustainability is that the timelines required to study long-term effects are, well, long. This will be a prime obstacle in creating a research agenda about sustainability, but it may also force consideration of alternative study designs.
Jim
Dearing
Director/PI, CCRC
KPCO
Training in Dissemination and Implementation Research
Recently, the NIH sent out a call for applications to attend the second annual Training Institute in Dissemination and Implementation Research in Health (http://conferences.thehillgroup.com/OBSSRinstitutes/TIDIRH2012/index.html). This is a week-long intensive training in dissemination and implementation (D&I) science taught by leading experts in the field. As an alumnus of the first annual TIDIRH in 2011, I would highly recommend this institute experience for any new scientist working in D&I. The expert faculty have been at the front lines of D&I research for many years, and the institute venue provides for both didactic and personal training from these experts. During the 5 days of the institute, you will have access to the faculty breakfast, lunch, and dinner in small conversational groups during the meals. During last year's institute, the faculty were flexible and modified the didactic portion on the fly to accommodate our needs and wishes for the training experience.
This year's training will be held in San Jose, California in early July. Having been to California infrequently, I cannot hazard a guess as to the weather at that time of year, however, you will probably willingly stay indoors to take advantage of all the institute has to offer. At the end of the institute, you will be sent home with an arsenal of tools and information to help you not only further your own career in D&I but to spread the word to others as well.
Good luck and best wishes!
Alanna
Kulchak Rahm
Staff Researcher, CCRC
KPCO
Research, Theory and Reality
For the past five years, I have spent my time studying the intersection of health and communication. I have used theory as the lens with which to examine patient-provider interaction, medical adherence, breaking bad news, grief and end-of-life issues. I have read hundreds of journal articles based on studies done on a variety of populations with all different types of diseases: cancers, diabetes, Parkinson's, Alzheimer's, hypertension and more. Interactions are examined from the point of view of the patient, the family, the caregiver, the organization or the healthcare professionals. Populations range from multiple age groups, from young children to seniors. In my own studies, I have interviewed people whose loved one was dying, children who had lost a loved one, and women with breast cancer currently on Tamoxifen regimens.
Beginning on September 26, 2011, my research paradigm changed when I went for my annual mammogram. The mammogram went as usual and I thought nothing about it as I focused on my semester of preparing for my dissertation prospectus defense and teaching a couple of Communication classes.
The first frisson of alarm occurred when my doctor called me the day after my mammogram; getting a call that soon after a test is never a good sign. She told me they had spotted something and that I needed a follow-up mammogram. Still calm, I made another appointment two weeks later.
This appointment was almost the same as the first except the radiologist explained that this was a much higher magnification in order to look at the calcifications. She also said I would be getting the results today. After the test, she directed me to dress and take my things to a room down the hall. It was all the way at the end of the hall and once I stood in the doorway and looked in the room, it hit me. This room, with its two chairs carefully angled at 45 degrees towards each other, its blank walls, and its two end tables with brochures on them, this was a bad news room!
The doctor came in and told me the news, in this case, the bad news. I would need a biopsy to see just how bad. A nurse came and walked me to an isolated part of the reception area. She explained what the procedure involved. I made an appointment for the procedure and left. Once in my car, I spoke to my primary care physician and she recommended a breast surgeon. I spent the next three days of my fall break switching the testing over to the new doctor, having blood drawn, running back and forth between appointments, picking up x-rays and filling prescriptions.
In the middle of my very busy school schedule, I stepped aboard the breast cancer diagnosis train. In the space of about three weeks, I had two mammograms. Filled several prescriptions. Underwent two MRIs. Taught six classes. Went to one out of town conference. Interviewed at the National Cancer Institute as a finalist for their Cancer Prevention Fellowship (yes, I know. Ironic.). Underwent one needle biopsy and finally, one lumpectomy.
I'm not going to dissemble; this process was difficult. And I am one of the lucky ones. I do not have breast cancer. I have atypical lobular dysplasia meaning that on a cellular spectrum with normal cells on one end and cancer cells on the other, I have some abnormal cells. The upshot of this is that my likelihood of getting breast cancer is twice that of another woman and that my medical oncologist wants me to start a five year regimen of Tamoxifen in order to reduce my chances of getting cancer by 50%. It also means that I have had or will have the opportunity to experience patient-provider interactions, breaking bad news, and medical adherence on a very personal level.
Reflecting on this experience reminds me that the patient populations in those studies are based on the real-life experiences of human beings, not just dry statistics laid out into neat tables and figures on a page.
Now more than ever, I see the importance of what we as researchers do. We have the power to find better information for people going through the trajectory of a disease, whether it's during the diagnosis testing or at the end when the disease has run its course. What we do can make a difference. What we do matters.
Paula Baldwin
2011 CCRC Doctoral Fellow
George Mason University
A recent New York Times article discussed one debate in the medical community about the word "cancer." The article addressed those who are diagnosed with Stage 0 cancer, where cells are found to be abnormal, but do not pose an immediate threat of spreading or becoming more threatening.
Susana's blog from December 22 addressed patient uncertainties surrounding cancer communication in prevention, screening, and treatment. When discussing results with a patient, even using the words "abnormal cells" can strike fear and anxiety in a patient. While clinicians need to communicate clearly to the patient what their diagnosis means to help reduce uncertainty, should Stage 0 cancer still be called cancer? If not cancer, what should it be called?
Michelle
Henton
Senior Research Assistant, CCRC
KPCO
Managing Uncertainty in Cancer Communication
Uncertainty is ever present in communication surrounding cancer prevention, screening, and treatment.
News media continuously disseminate information and research findings regarding cancer causes and prevention. This constant cycle of new and sometimes conflicting information can be confusing and contribute to a chronic state of uncertainty about cancer prevention recommendations. In fact, the National Cancer Institute's 2007 Health Information National Trends Survey found that almost 75% of respondents were confused and uncertain about which cancer prevention recommendations to follow and 50% were uncertain about the causes of cancer.
Additionally, the U.S. Preventive Services Task Force (USPSTF) recently changed its screening recommendations for breast and prostate cancer, likely confusing many people in the process and leaving many uncertain about how to proceed. For example, the recent breast cancer screening recommendations were not universally adopted across all cancer organizations, which likely contributed to confusion and uncertainty in the public. An earlier post by Minal Patel on October 14 also discussed the importance of communication to address rapidly changing health behavior recommendations.
In the context of cancer care, patients and their family members frequently face uncertainties related to prognosis and treatment effectiveness.
How can health communication and health care professionals best address public and patient uncertainties? I sat in on a course this past fall that discussed theoretical approaches to understanding uncertainty in a variety of contexts, including health and illness, which provided some guidance.
The literature provides various definitions of uncertainty. According to Brashers (2001), "uncertainty exists when details of situations are ambiguous, complex, unpredictable, or probabilistic; when information is unavailable or inconsistent; and when people feel insecure in their own state of knowledge or the state of knowledge in general." Theoretical discussions of uncertainty have historically suggested that people typically attempt to reduce uncertainty because uncertainty leads to negative emotions, such as anxiety, and that in order to reduce uncertainty people seek information. However, the current state of research on uncertainty has shifted from an emphasis on uncertainty reduction to uncertainty management. In addition, people can feel uncertain even when they have a lot of information about a topic. In fact, when people have too much information, they may end up feeling overwhelmed and helpless rather than empowered.
It is also likely that as some uncertainties are reduced, others will surface. Therefore, addressing uncertainty is not always a matter of reducing it, but is frequently a matter of managing it. It can also involve managing resulting negative emotions, such as anxiety and fear, as well as allowing the opportunity for hope and preventing fatalism.
Managing uncertainty in patients and the public
Managing uncertainty is clearly important in each phase of the cancer continuum, including prevention, screening, diagnosis, treatment, survivorship, and end of life.
A monograph produced by Epstein and Street in 2007 for the National Cancer Institute (NCI) emphasized the important role of patient-centered communication between clinicians and cancer patients in helping to manage the many uncertainties faced by cancer patients and their families. Patient-centered communication considers patients' needs, perspectives, and individual experiences; provides opportunities to patients to participate in their care; allows clinicians and patients to come to a shared understanding of the problem; and enhances the patient-clinician relationship.
To successfully manage uncertainty, communication between clinicians and patients should acknowledge uncertainty while maintaining hope, recognize that uncertainty often cannot be eliminated, and help the patient effectively cope with uncertainty by providing information, emotional support, and cognitive strategies for dealing with the anxiety associated with uncertainty. Epstein and Street suggest that patient outcomes may be best when clinicians directly address uncertainties with patients rather than acting as if they do not exist.
Many of the same strategies suggested for managing uncertainty in patient-clinician interactions would likely benefit others communicating cancer information, such as community health educators and health journalists. A frequent criticism of news coverage of health is that it tends not to discuss research findings in the context of previous relevant studies, so that people can make informed decisions based on the information available. A commonly suggested way to improve news media coverage of cancer is to increase the degree of uncertainty it conveys. If the degree of uncertainty is increased in individual news stories, then the variation in messages across time will appear to be reduced. In other words, greater uncertainty within stories about research findings will soften the "yo-yo" approach to cancer coverage and prevent the confusing reversals that play out in media coverage of cancer causes and prevention behaviors. Contrary to what one might suspect, including expressions of uncertainty such as hedging in cancer news stories has been found to have a positive effect on perceptions of the credibility of journalists and scientists.
Finally, it is important to remember that education level and health literacy level also play important roles in the process of understanding, making decisions, and acting on health information.
References:
Brashers, B. E. (2001). Communication and uncertainty management.
Journal of Communication, 51, 477-497.
Susana
Peinado
2011 CCRC Doctoral Fellow
University of California, Santa Barbara
A Call to Action
There has been a lot of discussion about Dr. Don Berwick's speech he recently gave at the annual conference at the Institute for Healthcare Improvement. As the former administrator for the Centers for Medicare and Medicaid Services, Dr. Berwick sought to improve the current Medicare/Medicaid system by increasing the quality of health care and to also cut costs (read the New York Times article here). However, in his short 17 months as administrator, he was not able to accomplish this. What he did accomplish, though, was bringing about a new way of thinking about the health care system and the potential it has to be improved.
In his speech, Dr. Berwick discussed his ideas on how to change the health care system in this country. He addressed some of the following points: putting the patient, especially those who are disadvantage, first; doing things at scale; and mobilizing on a local level. Most importantly, he gave those in the health care field a much needed call to action.
I thought of Dr. Berwick's call to action after reading Patrick Dillon's blog from December 14. Patrick discussed how several of his students were unaware that health disparities exist, and they are not alone. Dr. Berwick's point about putting the patient first reminds us to treat people from all walks of life and at every stage of life. Additionally, Dr. Berwick discusses how rationing health care hinders improvement. He notes, "It boggles my mind that the same people who cry 'foul' about rationing an instant later argue to reduce health care benefits for the needy, to defund crucial programs of care and prevention, and to shift thousands of dollars of annual costs to people-elders, the poor, the disabled-who are least able to bear them." There must be an awareness brought to the disparity in treatment between the young and the old, the rich and the poor; but beyond creating awareness, there must action. As he stated, "The good news: the possibility of change has never been greater-not in my lifetime. The bad news: if it's going to be the right change, the burden is yours."
I feel like those who are in public health, especially the 2011 CCRC Doctoral Fellows, have a lot to offer. From Rui Shi and Rannie Teodoro's work with social media; to Kisha Coa and Minal Patel's research with behavior change and disease management; to Rachel Faulkenberry's work with health literacy; to Adam Richards's expertise in communication and Paula Baldwin's contribution to the field of palliative care; there is a lot of potential for change in our health care system. And as long as we have people like Patrick Dillon teaching future generations that disparities exist, perhaps in time, Dr. Berwick's vision will come to fruition.
Michelle
Henton
Senior Research Assistant, CCRC
KPCO
Guide for Holiday Cooking - or the different ways
Network Analysis can help your life
Click to
enlarge
There is no better time to bring you a guide on how flavors should
be combined in your kitchen than the Holiday Season. Network
analysis - an excellent tool for dissemination and implementation
research, organizational science, and more is now debuting in
gastronomy - giving you an explanation for why certain flavors pair
well with each other. As a special holiday post, please also accept
our best wishes to you and your loved ones for this Holiday
Season.
http://www.nature.com/srep/2011/111215/srep00196/full/srep00196.html
Best wishes,
Borsika
Rabin for the the CCRC team
During the past semester, I have had the distinct pleasure of teaching an upper-level undergraduate course in health communication. A few weeks ago we completed a unit on communication and health disparities. As part of this unit, I invited Dr. Brian Rivers (an Assistant Research Faculty Member in the Department of Health Outcomes & Behavior at Moffitt Cancer Center) to perform a guest lecture during our class session. For nearly an hour, Dr. Rivers presented information related to health disparities across a wide range of health measures, including access to health insurance; rates of infant mortality; life expectancy; end-of-life care; and the prevalence of specific diseases such as diabetes, hypertension, and HIV/AIDs. He also spoke about his own work related to prostate cancer screening and health disparities (see http://www.insidemoffitt.com/Doctor-Rivers-Prostate-Cancer-Health-Disparities-Video.htm).
As the presentation came to a close, Dr. Rivers clicked to his final slide, smoothed his nave blue tie, and stepped to the front of the lectern. He clasped his hands together and took a deep breath. "More than anything, I hope this presentation has allowed you to understand that although the overall health of our nation has improved over the past several decades, inequities in health and health care continue to persist among racial and ethnic minorities. I also hope it inspires you consider how you might work to address these inequalities in your own unique ways."
As was the custom following guest lectures in our class, I asked the students to respond to the presentation. As I moved to the front of the class, I noticed one student eagerly waving her hand in the hand. "Go ahead," I said, gesturing toward her.
"These readings were difficult to get through this week. I had
no idea that there were such extreme differences in health
experiences of people here in the United States. It's even more
troubling that when I mentioned it to my family and friends, they
seemed just as surprised as I was."
As she finished, another student's hand shot into the air. "I
agree. I mean it seems like you never hear about this kind of
stuff," he said, shaking his head. "How are we supposed to do
anything health disparities if people don't even know they
exist?"
****
The students in my class were not alone in being unaware of the pervasive health disparities in the United States. The landmark Institute of Medicine (2003) report, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care suggested that efforts were needed to increase awareness about racial and ethnic health disparities. A recent study by Benz, Espinosa, Welsh, and Fontes (2011) suggests that awareness of health disparities is still lacking. The study reported that only 59 percent of Americans in 2010 were aware of racial and ethnic health disparities. This is alarming when one considers that increasing awareness is "a necessary first step toward changing behavior and compelling action" aimed at eliminating health disparities (p. 1860).
Consistent with the reasoning that increased awareness of health disparities may promote increased action, I was amazed how learning about heath disparities galvanized many of the students in my health communication course. Nearly half of the students decided to examine a health disparity for their final course project (one has discussed continuing the projects for an Honor's Thesis). Other students have started working with various student organizations to begin planning an on-campus event to raise awareness about health disparities. Finally, several students have simply committed to telling their friends and family about this important issue.
The recognition of the magnitude of health inequities in the United States has made addressing these disparities a significant public health priority among researchers, health care providers, policymakers, and government agencies (Thomas, Quinn, Butler, Fryer, & Garza, 2011). Despite these efforts, an unequal burden of illness, death, and lack of access to quality health services continues to fall on racial and ethnic minorities. Increasing awareness is not sufficient on its own to address all of the complex factors that contribute to health disparities (Benz et al., 2011). It does, however, represent an important first step toward achieving health equity. Moving forward, I hope we can all commit to continue spreading the word about health disparities.
For more information:
- Benz, J., Espinosa, O., Welsh, V., & Fontes, A.. (2011).
Awareness Of Racial And Ethnic Health Disparities Has Improved Only
Modestly Over A Decade. Health Affairs, 30(10), 1860-1867.
- Centers for Disease Control and Prevention. (2011). CDC
health disparities & inequalities report. Retrieved from: http://www.cdc.gov/mmwr/pdf/other/su6001.pdf
- Institute of Medicine (2003). Unequal treatment: Confronting
racial and ethnic disparities in healthcare. Washington D. C.: The
National Academic Press.
- Thomas, S. B., Quinn, S. C., Butler, J., Fryer, C. S., &
Garza, M. A. (2011). Toward a fourth generation of disparities
research to achieve health equity. Annual Review of Public Health,
32(1), 399-416.
Patrick
Dillon
2011 CCRC Doctoral Fellow
University of South Florida
Given my growing interest in long-term cancer survivors, I was excited to see the announcement for the 2012 Biennial Cancer Survivorship Research Conference "Cancer Survivorship Research: Translating Science to Care". The large number of cancer survivors in the U.S. (approximately 11.7 million) is reflective of the strides that have been made in the "war against cancer," due to factors such as early detection and effective treatment. In one sense, effective treatment of cancer marks an endpoint, but in another it represents a new beginning for survivors. We are now faced with the challenge of meeting the unique needs of cancer survivors. Cancer survivors have ongoing needs due to the long-term physical and psychological effects of cancer diagnosis and treatment, as well as other issues related to successful reintegration into society (e.g., workplace discrimination).
I am currently involved in a project exploring the promotion of lifestyle behavior change (e.g., dietary changes) in the care of cancer survivors. Although we are still in the early stages of the project, it is already evident that there is a lack of clarity regarding who is "responsible" for cancer survivors once they have completed active treatment. As Richard Wood discusses in his Nov. 23 blog, mandated cancer survivorship care plans will play an essential role in ensuring coordination of survivor care. I believe that the research discussed during the Cancer Survivorship Research Conference will inform efforts to develop cancer survivorship care plans that best address the needs of cancer survivors. I look forward to attending this conference to learn about both the scientific and programmatic work being conducted to enhance the care of cancer survivors.
Kisha Coa
2011 CCRC Doctoral Fellow
Johns Hopkins Bloomberg School of Public Health
I currently take a Health Informatics course and I've been noticing some interesting trends in health information seeking behaviors within non-traditional contexts of new media and technology; particularly, social media and mobile phone use.
Social media is such a hot topic right now and the healthcare industry is still findings its place to fit in. Social media has shaped the way patients, physicians, care providers, and other medical professionals engage with health information and resources. The simple absorption of information is replaced by engagement with information. We can see from the literature that information-seeking behavior trends head towards personalization and tailored information (e.g., PatientsLikeMe, DiabetesMine, i[2]y), where everyday individuals are empowered with the tools to research, generate and share their own content. Sarasohn-Kahn (2008) describes this as Health 2.0, social software to promote collaboration between patients and other health stakeholders to create and consume information related to health. As Ginossar (2008) found, patients are not limited to seeking personal information, but they also offer information to others and demonstrate "information reply" helping behaviors more often than family members. Hawn (2009) also confirms the idea of a participatory health care system with Hello Health utilizing technology to benefit both the patient and the physician.
I wonder how much the attainment of personalized and tailored information affects information-seeking expectations as a whole in our everyday lives. A search for cancer information, for example, can yield "relevant" results within Google. However, this idea of "relevant" disease information really means "relevant information to me." I also think that this means new things for information competency. That is, finding information is no longer an issue; rather, sorting through information and determining personal relevance requires much higher-level skill and competency. Sorting through data means having at least some pre-existing knowledge or idea of what is relevant or not relevant to a health condition.
Additionally, mobile technology certainly perpetuates a phenomenon of ubiquitous computing. Personalization and tailored patterns also include preferred modes of delivery and media. Consumers desire information at their fingertips and mobile phones are especially powerful means of obtaining such information.
Undoubtedly, technology has influenced time expectations. "Waiting" to fill prescriptions, to book an appointment, or to communicate with one's physician are considered inconvenient and poor service. However, what sacrifices are individuals making by obtaining information and resources in the "now"? Is efficiency and convenience taking place of quality and efficacy? Hawn (2009) describes social media as "changing the locus of control to the patient," (p. 368) but are patients adequately informed or qualified to take the control? What things need to be done for them to be informed or qualified to take control?
References
Ginossar, T. (2008). Online participation: a content analysis of
differences in utilization of two online cancer communities by men
and women, patients and family members. Health
Communication, 23(1), 1-12.
Hawn, C. (2009). Take two aspirin and tweet me in the morning: How
Twitter, Facebook, and other social media are reshaping health
care. Health Affairs, 28(2), 361-368.
Sarasohn-Kahn, J. (April 2008). The Wisdom of Patients: Health Care
Meets Online Social Media. Oakland, CA: California Health Care
Foundation.
(http://www.chcf.org/publications/2008/04/the-wisdom-of-patients-health-care-meets-online-social-media)
Rannie
Teodoro
2011 CCRC Doctoral Fellow
Rutgers, The State University of New Jersey
Missouri is unofficially referred to as the Show-Me State. As a native of the nation's 24th state, I was glad to go home to attend the annual Centers of Excellence in Cancer Communication (CECCR) meeting on the campus of Washington University in St. Louis, Missouri on October 10-12. As a (relatively) new Senior Research Assistant at KPCO, I was ready to learn more about each CECCR and to meet many of the people I only knew through e-mails. After two days of posters, presentations, and panels, Washington University and the other four CECCRs really showed me the amazing work that is being done in the field of cancer communication, and made me excited to be a part of it.
The first night was the poster presentation. I was immediately impressed by the quantity of posters that were submitted, not to mention the quality. On the final day of the meeting, the winners of the top three posters were announced. Rui Shi, a 2011 CCRC Doctoral Fellow and a PhD student at the University of Pennsylvania, took top prize. I was thrilled for her accomplishment.
The annual CECCR meeting consisted of members of the five centers: The Cancer Research Network-Cancer Communication Research Center (which Kaiser Permanente Colorado is a member), University of Michigan, University of Wisconsin, University of Pennsylvania, and Washington University. On the first full day, each CECCR presented the work being conducted at their location. While I was familiar with some of the studies the other CECCRs were doing, it was great to get a more in-depth analysis of the variety of work being done; from smoking cessation and media messages, to evaluating psychosocial factors in elderly cancer patients and using online support with CHESS, to studying referral systems and publishing newspapers with targeted and tailored health messages. Since some of the studies involve more than one CECCR site, I also saw the importance of collaboration. Each CECCR brings something different to the research table, which definitely strengthens a study.
In addition to the CECCR presentations, there were also three panels. Each panel comprised of individuals from different agencies and institutions who discussed topics which directly related to cancer communication, namely policy, cost of care, and challenges. One intriguing panel presentation was from Dr. Christine Berg from the National Cancer Institute. She discussed one study, the National Lung Screening Trial (NLST), which compared lung cancer deaths of those who were screened with chest X-rays with those screened with a low-dose helical CT. In sum, they found that current or former heavy smokers screened with the low-dose helical CT scan resulted in 20 percent fewer deaths from lung cancer than those screened with a chest X-ray. This is an important study and a valuable finding for the future of cancer detection. However, as it was noted throughout the meeting, smoking prevention and cessation are key to decreasing lung cancer rates.
Overall, the CECCR meeting was a great success. Though there are some challenges ahead, I'm optimistic about the contributions the great minds within the CECCR have on the future of cancer communication research. I'm looking forward to meeting with everyone again next year in Wisconsin.
Michelle
Henton
Senior Research Assistant, CCRC
KPCO
In the last decade, and especially after 2005 with the Institute of Medicine report From Cancer Patient to Cancer Survivor: Lost in Transition, a greater consensus has formed around the need for cancer survivorship care plans. (See the related IOM Fact Sheet.) This year the American College of Surgeons Commission on Cancer (CoC) decided to integrate survivorship care plans into their accreditation program standards. The CoC accreditation process will phase in requirements for survivorship care plans starting in 2015. These requirements are as follows:
(a) A survivorship care plan is prepared by the principal provider(s) who coordinated the oncology treatment for the patient with input from the patient's other providers.
(b) The survivorship care plan is given to the patient on completion of treatment.
(c) The written or electronic survivorship care plan contains a record of care received, important disease characteristics, and a follow-up care plan incorporating available and recognized evidence-based standards of care, when available. The minimum care plan standards are included in the Fact Sheet: Cancer Survivorship Care Planning, from the IOM.
Compliance with the new CoC survivorship care plan standards requires programs to fulfill two criteria:
1. The cancer committee has developed a process to disseminate a comprehensive care summary and follow-up plan to patients with cancer who are completing treatment.
2. Each year, the process is implemented, monitored, evaluated, and presented to the cancer committee.
From now to 2015 (and beyond) we have an opportunity to measure uptake as accredited cancer centers move from a current best practice to a future mandate. How exactly will this occur? Who are the agents of change? What are the barriers and facilitators? Perhaps by studying dissemination of survivorship care planning, we can learn something useful about transforming the standard of cancer care for the future.
The CoC standards point to care planning templates available from several sources such as the American Society of Clinical Oncology, National Coalition for Cancer Survivorship, and the Lance Armstrong Foundation (Livestrong). How will these templates differ? Will we see differences as drastic as those seen in the standards for mammography screening from the U.S. Preventive Services Task Force and the American Cancer Society? Livestrong has already taken initiative in defining what their survivorship care planning template(s) will consist of. In September 2011, a hundred leaders, stakeholders, and experts met with Livestrong to determine what elements are essential in survivorship care. (See both Livestrong Blog and Dr. Len's Cancer Blog for further details.) Other organizations such as UT MD Anderson Cancer Center have constructed long-term clinical practice algorithms around survivorship. Will these algorithms, or others like them, diffuse through organizations across the country as the 2015 CoC requirements for survivorship care planning draw closer? Will organizations create their own algorithms and templates?
There is currently quite a lot of flexibility for implementation of survivorship care plans both across and within healthcare organizations. This flexibility presents many opportunities for study. What will survivorship care plans look like? Will there be one standard template in an organization, or will there be multiple templates? Will the specifics of implementation be left up to each individual oncologist? Will survivorship care plans be updated? How often? Will they be utilized? Will the care plans be effective?
As we learn more about the needs of cancer survivors, we will continue to adapt our clinical standards and practices to better serve this emerging population. Our healthcare system can greatly benefit by learning how to best go about such a complex and dynamic process of change.
Richard
Wood
2011 CCRC Doctoral Fellow
Texas A&M Health Science Center (TAMHSC) School of Rural Public
Health
Advertising Campaign and Organizational Identification in Health Care Organizations
Today, managed care, which developed from the need to reduce medical costs, has spawned new concerns about the quality of care Americans will receive from health care organizations. The challenge to provide patients with excellent and affordable health care is a challenge worthy of health care professionals' best efforts.
Facing the challenge, health care organizations may have difficulties in maintaining a clearly defined identity as other service organizations in terms of its complexity and unique physician-organizational relationship. In addition, given the recent struggles of policy makers in the United States to reform the U.S. health care system to balance issues of quality, access, and cost, understanding and managing organizational identity well has ever-increasing practical relevance. This relevance is especially clear given that any restructuring of health care will certainly have unanticipated consequences for the day-to-day provision and management of care. In this case, health care managers are increasingly aware that organizational identification influence key outcomes at work, including effort, cooperation, organizational support, and citizenship behaviors.
Existing research concludes that external communication aiming to build perceived external prestige for the organization helps to foster organizational identification. As an important form of external communication in organizations, advertising campaign is increasingly being used both externally and internally to influence health care consumers and stakeholders today. Besides sending messages externally to the public, advertising is also utilized by health care organizations as a self-enhancing tool to enhance their own values.
I've been working on a research project with my advisor for the past academic year on the possible effects of advertising campaigns on employees' organization identification in health care organizations. Through interview-based qualitative method, my project looked at employees' perceptions of advertising campaigns in a health care organization locally in Albany, and how their perceptions suggest that advertising campaigns can help to promote their identification with the organization. Analysis on the interview data found that the advertising campaigns in the health care organization does affect employees' sense of identification with it. Interestingly, some findings in the employees' evaluation of the campaigns are beyond my expectation. I was delighted to see that both health care professionals and non health care professional identify not only with the whole organization, but also with multiple targets such as their professional medical specialty as well as their work unit in the hospital.
However, due to strategy of recruitment, all of the interviewees in my sample are directly employed by the organization. As the problem of competing identifications to multiple identities becomes a challenge for health care organizations to promote employees' organization identification, future research may examine whether forms of external communication may affect health care providers' organization identification while they are having multiple identities, such as professional and organizational identities.
Sunny
Zhao
2011 CCRC Doctoral Fellow
Department of Communication, University at Albany, State
University of New York
Practical theory in health communication
Gestalt psychologist Kurt Lewin is famously known to have said, "There is nothing so practical as a good theory." Theoretical approaches to the study of health communication are crucial to the accumulation of empirical research and the ability to make useful recommendations to health practitioners and consumers. On the one hand, a theory allows researchers to make meaning of their results by providing a systematic framework with which to interpret, connect, and make meaning of findings across studies. On the other hand, variable analytic research-research that assesses relationships between variables in the absence of theory-often leads to a long list of findings that sometimes coalesce, sometimes contradict, and sometimes simply do not relate. For an amusing satirical article about the futility of variable analytic research, consider reading Michael Pacanowsky's review of studies about why people "pass the salt" (citation below, written under the pseudonym of Murdoch Pencil).
I was reminded of theory's importance after reading Rui's blog post from October 25 in which she mentioned how her recent paper's findings contradicted what one might intuitively expect. Not only that, but her results also (importantly) opposed what many previous studies have found about the beneficial effects of subsequent communications after exposure to a health advertisement. Theory can ultimately reconcile these findings and account for the conditions under which communication can help or hinder health campaign effects. Without a theory to make sense of contradictory research, recommendations that researchers make to health practitioners will ebb and flow without a consistent direction, subject to the most recent study's findings that do not clearly inform or sensibly add to what is already known.
Health communication researchers are in the business of investigating important issues that have implications to many people's well-being. These are practical problems that necessitate good theories.
Pencil, M. (1976). Salt passage research: The state of the art. Journal of Communication, 26, 31-36. doi:10.1111/j.1460-2466.1976.tb01932.x
Adam
Richards
Department of Communication at the University of Maryland
2011 CCRC Doctoral Fellow
Implementation and Dissemination at the American Public Health Association Annual Meeting
While implementation and dissemination did not play a starring role at this year's APHA meeting, one session that called for more "practice-based evidence" reviewed a variety of approaches relevant to cancer prevention within community and organizational settings. Each presenter on the panel highlighted the role practice-based evidence plays in complementing traditional research-based evidence. Jennifer Leeman described a valuable online database available via the Center for Training and Research Translation. The website--www.center-trt.org-- offers trainings and intervention translation resources to improve nutrition and physical activity programming reach, effectiveness, adoption, and sustainability. The center aims to overcome the challenge of the practical "how" that is often lacking in descriptions of interventions in peer-reviewed literature. Staff at the center work with intervention developers to create standards templates that detail core intervention elements, steps for implementation, required resources, underlying theory, evidence of effectiveness, and potential health impact using the REAIM framework along with links to intervention materials and trainings.
In addition to this valuable online resource, Brenda Henry from the Robert Wood Johnson Foundation discussed the need to develop practical guidance on the process of local intervention adaptation. She talked about a color-coded adaptation guide her team has developed to help practitioners tease out components of programs that are thought to be necessary for effectiveness and those that are optional or less important for intervention impact. She also used a fun analogy to allrecipes.com that really stuck with me, as a food-lover. She described how great it would be if we had a resource out there that listed interventions just like we list recipes online: contributors could post their intervention just like recipes for a dish with step by step instructions and ingredients (or required materials, staff etc.), other folks could add comments describing how they adapted the intervention to fit the needs of their population/program/setting just as people comment on the extra vegetables they add or spices they substitute in a recipe. Meanwhile, all participants could rate the interventions and their adaptations once they try them out. I'd love to see how researchers and practitioners could come together to produce a user-generated resource like this or even how the Center for Training and Research Translation might be able to integrate some of these ideas into their existing site!
Rebekka
Lee
Harvard School of Public Health
2011 CCRC Doctoral Fellow
October 25, 2011
Promote health using social media?
Information in the age of Internet no longer flows one way from media to audience. Instead audiences create media as well as comment on it. Social media like Facebook have been around for seven years; various news websites have started to allow for comments to virtually every news story; Amazon not only allows potential buyers to read prior buyers' reviews of the product, but also recommend to them books that they may be interested in based on what "people like you" have bought.
It is important to understand the social impact online recommendation system because whatever media product it accompanies - a piece of news, a music video, a commercial, or an anti-smoking public service announcement - the information carried by the recommendation system synchronizes with the media product and thus becomes a part of the message sent to the audience.
I got the feeling when attending to various health related conferences that everyone in our field is excited about social media and the interactivity that internet allows. Health campaigners as well as intervention practitioners constantly talked about the social buzz they created with Facebook fan page, twitter, blogs, and YouTube with the assumption that the "buzz", especially the positive buzz is a good thing. However plausible this assumption sounds intuitively, there is very little empirical evidence. In fact, our recent study (presented as a poster at the Annual CECCR Grantee Meeting two weeks ago) found quite the opposite: not only negative comments but also positive comments significantly decreased smokers' perceived effectiveness of high-quality anti-smoking ads.
Health practitioners need to raise some caution when adopting social media to promote health. Interactivity is a double edged sword. Sometimes it helps to send the message to more people, but sometimes it twists the message during the diffusion process and creates unintentional effects that backfire.
Rui Shi
Annenberg School of Communication at the University of
Pennsylvania
2011 CCRC Doctoral Fellow
October 18, 2011
The Importance of Mixed Methods in Cancer Communication Research
Increasingly acceptable in many scientific disciplines, mixed methods research presents many opportunities for the field of cancer communication to gain a richer and more complex understanding of the topic of inquiry. Among its many benefits, integrating quantitative and qualitative methodologies enables researchers to balance the weaknesses of one methodology with the strengths of another and vice versa.
The National Institutes of Health's Office of Behavioral and Social Science Research recently commissioned a group of leaders in the field of mixed methods research to develop best practices. Their report, Best Practices for Mixed Methods Research in the Health Sciences, issued in August 2011, serves as an important resource for budding mixed methods researchers. The creation of formal guidelines is an encouraging step towards acceptance of this emergent research paradigm that holds great potential to yield useful, applicable and more nuanced research findings. The NIH press release and a link to the report can be found at: http://www.nih.gov/news/health/aug2011/od-23a.htm
Currently immersed in dissertation work, I'm learning firsthand the benefits of engaging my topic from both qualitative and quantitative perspectives. The quantitative portion of my research enables me to test whether hypotheses that I've developed are statistically significant, but really, there's more to the big picture. Since my work focuses on leukemia and lymphoma survivors, it seems equally important to capture their experiences and psychosocial needs as they articulate them, not just as I theorize and hypothesize. By using mixed methods, I've learned the value of not only testing my own hypotheses using statistics, but also delving into interviews with cancer survivors to see if they echo my findings, offer suggestions as to why certain findings weren't statistically significant, or offer entirely new suggestions that can guide future research. All in all, I'm encouraged and excited about the possibilities that abound with the increasing use and acceptance of mixed methods research in cancer communication.
Whitney
Jones
University of Colorado Denver School of Health and Behavioral
Sciences
2011 CCRC Doctoral Fellow
October 14, 2011
Recent headlines have been inundated with a new recommendation by the U.S. Preventive Task Force suggesting that healthy men should not undergo prostate cancer screening. I also recently learned from a special nutrition issue of Time Magazine that when you take all the fat out of milk, you're left with too high a concentration of natural sugars, which interacts like candy with your hormones, especially insulin (directly quoted).
Recommendations for engaging in healthy behaviors are constantly evolving with the advancement of science and new knowledge. As researchers, we are trained in contributing to these advancements and building the evidence-base. As a regular consumer of information who may typically drink a glass of fat free milk, new, and almost conflicting health recommendations can be daunting for individuals trying to maintain healthy lifestyles. The many avenues in society through which information is disseminated further complicate the task of disentangling these messages.
Evolving health recommendations based on new examinations of the evidence increase the importance of communication between health practitioners and consumers. This need not be exclusive to clinicians, but also may encompass strengthening the capacity of community health workers and health educators. If the end goal entails assurance that people sustain healthy behaviors, two-way communication with the opportunity to build trust and rapport with someone, may be a better resource for people in the face of rapid mixed messaging.
Minal
Patel
University of Michigan School of Public Health
2011 CCRC Doctoral Fellow
October 5, 2011
When a patient enters a hospital or medical clinic, are there simple, clear signs telling them where to go? Are they able to navigate and fill out required forms? Can they read and understand medical records, educational materials, and treatment instructions?
I am currently taking a health literacy class that is increasing my awareness of the complexity of the written and spoken health environment. I find that I am beginning to delve deeper into understanding the challenges and potential opportunities that a patient may encounter during interactions within medical centers and when interpreting health information from a number of sources.
People are often expected to have a range of skills in addition to reading, including the ability to manipulate and understand concepts such as numbers and risk, in order to fully navigate the healthcare system. Unfortunately, research has found that the complexity of many health materials, including resources for cancer patients, surpasses the health literacy skills of many Americans and leaves them unable to fully interpret the information at hand. This disparity has led to poor outcomes and low perceptions of coordinated care for cancer patients with low health literacy.
It requires somewhat of a perspective shift to fully understand the challenges of the written health environment. As researchers and doctors become established in the health world, certain terms and phrases may become commonplace and familiar. However, to patients, written or spoken communication containing numbers, complex terms, and long sentences may create an overwhelming amount of information to process. When grappling with the concept of risk in life or death treatment options, this information overload may be even more distressing.
As I am learning, it requires some practice to step back and disentangle the different aspects of language and identify the ways in which words, numbers, and charts can be expressed in more approachable terms. The exercise is also a reflexive one as it requires not just examining the literacy skills of patients, but turning the mirror around and examining the communication skills (written or spoken) of the person expressing the information. Understanding the assumptions we bring in expressing and researching health communication materials can serve to benefit both our own knowledge and that of patients and community members. As promising research in this field grows, I am eager to see how future studies continue to make health literacy a key component of cancer research and education.
Rachel
Faulkenberry
Harvard University
2011 CCRC Doctoral Fellow
September 26, 2011
Public understanding of science and public belief in the credibility of scientists take a hit every once in a while. Cases of misconduct in cancer research are very unusual but when they do occur, they can make for the sorts of stories that journalists and their editors find impossible to ignore. Such is the case with the recent scandal at Duke University (The Economist, September 10, 2011, page 91-92) concerning an approach for predicting which chemotherapies are most effective for individual lung, breast, or ovarian cancer patients. Despite the fact that large majorities of cancer researchers do credible work, this is the sort of startling case that can give the whole profession a black eye.
Jim
Dearing
Director/PI, CCRC
KPCO
August 30, 2011
When does the study of innovation implementation happen?
I know of lots of studies of implementation that focus on a time frame past the time of adoption. That means that dissemination of an innovation occurs, some potential adopters in fact adopt, and then some of those in fact implement. And we then may study that time frame of implementation.
Most work in implementation science that I currently see, however, is something different. It is the study of implementation prior to the attempt to disseminate an innovation. This is the study of what study site implementers do with an innovation, for the objective of understanding quality of implementation, degree of fidelity, and robustness of an innovation as implemented at multiple sites. Very often, this is not implementation as a result of a voluntary adoption decision, but rather implementation as a result of a site opting in to being part of a study so that external validity of the innovation can be assessed. It's an important, prior step along the path toward understanding if an innovation should then be broadly disseminated so that subsequent diffusion outcome variables such as adoption and implementation and sustainability can be studied under real-world conditions.
I expect that those researchers who use the term mean both "stage 1" implementation and "stage 2" implementation both when they refer to implementation science. But rarely do they clarify this processual distinction.
Jim
Dearing
Director/PI, CCRC
KPCO
August 23, 2011
Will the current interest in dissemination, diffusion, and implementation research and practice last?
Previously, federal agency interest in these topics have ebbed and flowed (mostly ebbed). But the current high salience is broadly represented across federal agencies, and is developing legs in graduate training programs at prestigious institutions. Both trends suggest longetivity. Case in point: The just-concluded Global Implementation Conference in Washington DC was by all accounts wildly successful in attendance. In this first year for the meeting, nearly 800 registrants participated.
Jim
Dearing
Director/PI, CCRC
KPCO
August 17, 2011
The expansion and apparent resiliency of university-level degree programs and certificates in the study and practice of dissemination, diffusion, and implementation is striking. Check out the offerings from the University of California San Francisco in its IDS (Implementation and Dissemination Science) Programs. Great training programs and classes, with top-notch faculty who have long practical experience in issues such as AIDS prevention and strong academic credentials as continual contributors to DD&I literature.
Jim
Dearing
Director/PI, CCRC
KPCO
August 2, 2011
Many of us concerned with increasing the rate of uptake of evidence-based interventions are great believers of early engagement of target users in the development of new interventions. This notion is conceptualized in the public health arena by the term community-based participatory research (CBPR). A provocative piece on CBPR and its role in translational research is presented in the Editorial of the August 2011 issue of the American Journal of Public Health. Distinction between using CBPR as an instrumental strategy to enhance localization and as an all-inclusive worldview is discussed in reference to a recent study by Katz et al. The editorial also provides a great discussion on how we conceptualize and operationalize fidelity in the context of complex interventions.
To read the Editorial: Trickett, EJ. Community-Based Participatory Research as Worldview or Instrumental Strategy: Is It Lost in Translation(al) Research? Am J Public Health; 2011;101(8): 1353-1355
Borsika
Rabin
Staff Researcher/Research Coordinator
KPCO
July 26, 2011
As a graduate student about to finish up my PhD, career options have been top of mind recently. Most doctoral candidates spend the bulk of their time working within a university setting. It is where we learn to research and find our mentors. Because of the all-consuming nature of graduate studies, it can be difficult to think outside of the ivory tower.
The myriad of career directions available to health communication researchers was made clearer this week as I spent several days observing the inner workings of Kaiser Permanente, the largest managed care organization in the United States. I was lucky enough to participate in the first ever Kaiser Permanente Cancer Communication Doctoral Fellows program hosted by the Cancer Communication Research Center in Denver, Colorado.
The fellows spent two mornings shadowing Kaiser Permanente employees who contributed to the organization in a variety of ways. While several of the participating doctoral students were matched with care providers who engaged in patient interaction, I spent my mornings following people primarily responsible for administrative functions and got to see first hand the complexities involved in managing and building communication networks across the organization. Afternoons were reserved for feedback sessions and guest speakers.
Any experience that broadens my vision is welcome and appreciated and the opportunity to see how research can be applied in practice is beneficial to all students, regardless of their discipline or area of academic interest. Several high profile publications have published articles lately on the glut of PhDs flooding the academic job market at a time when tenure track positions are becoming increasingly difficult to come by.
It is heartening to see that the research skills built through countless hours of graduate training can be used to address pressing issues within large organizations. Advancing knowledge in the abstract is an admirable goal, but applying new knowledge to improve practice also has enormous value. I appreciate the opportunity to learn how researchers can contribute outside of the academic world.
Kathleen
Stansberry
University of Oregon
2011 CCRC Doctoral Fellow
July 19, 2011
"Killing Peer Review"
Check out the
link for an interesting idea of exchanging the
current journal and editor based peer review process to a more open
community-based review of pre-publication articles by scholars and
experts. What do you think - would this approach produce an
appropriate degree of quality and selection?
Borsika
Rabin
Staff Researcher/Research Coordinator
KPCO
July 17, 2011
Great four-day meeting with our 2011 Summer Doctoral Fellows. Very exciting to see in what good hands the future of cancer communication research resides! And a double thanks to our KPCO faculty from across the organization who gave up their time and attention to help these students understand some of the complexities and opportunities in an organization like this one.
Jim
Dearing
Director/PI, CCRC
KPCO
July 11, 2011
Assessing "readiness" is something that we often seek to do in social change research and in social change practice. Often, though, the readiness assessed only concerns the end-user social system that will be targeted for change or that will be invited into some sort of participative change process. For example, communities may be assessed for their degree of readiness in organizing to prevent homelessness. Those scores might then be used to determine which communities are "ready" to engage in change.
Unfortunately, there are two other component parts that are critical for successful social change: The innovation that will be introduced to the targeted social system, and those organizational stakeholders who sponsor and who will be responsible for delivering the innovation to the targeted end-user social system. Rarely do we assess the readiness of innovations themselves, or the readiness of the resource or intermediary delivery system that will get the innovation to the end-user social system. But there is no reason this cannot be done!
We've done some work along these lines of parsing out types of readiness assessments. If you're interested, let me know. If you've also done some work like this, let me know!
Jim
Dearing
Director/PI, CCRC
KPCO
July 8, 2011
Proctor & Gamble Corporation spends $300 million dollars per year on marketing research. $300 million. Per year. Not to market its products; just to conduct applied research about its products. Now given, that's worldwide and P&G is a huge organization with a huge product line. And they are very profitable. Shouldn't that suggest to us researchers and our program officers that formative evaluation about dissemination messages and audience segments deserves attention and funding?
Jim
Dearing
Director/PI, CCRC
KPCO
June 23, 2011
Thinking of planning a research study concerning cancer communication? A good place to start is HINTS, the Health Information National Trends Survey, which has been fielded three times over the last several years (most recently in 2007-2008 with almost 7,700 respondents) and has been developed into a highly usable resource by the National Cancer Institute. Questions and answers on topics such as cancer screening behaviors, risk perceptions, information exposure and seeking about cancer, patient-provider interactions, patient numeracy, and a variety of cancer related behaviors concerning smoking, skin protection, and nutrition and physical activity are included. You'll have some hunches supported and, if you're like me, challenged, by scrolling through the pages of HINTS topics.
Jim
Dearing
Director/PI, CCRC
KPCO
June 22, 2011
Dr. Mehmet Oz is a celebrity physician who relates well to millions of people; six time best-selling author. But being a cancer patient is a little different than being a physician. Read his insightful article on news stands now, the cover article in Time magazine (June 27 issue).
Jim
Dearing
Director/PI, CCRC
KPCO
June 21, 2011
Want to get involved in the future of cancer communication research in the U.S.? You can. We are involved with a loose federation of cancer communication researchers to redefine and move forward this research program. We welcome you to visit discussions in our monthly meetings of our Dissemination Research Interest Group, our Discovery Core, or our Dissemination Core. Contact Michelle Henton at Crn-Ccrc@kp.org for joining one or more of these calls.
Jim
Dearing
Director/PI, CCRC
KPCO
June 20, 2011
Sometimes in cancer communication research it's hard to get the patient experience, including the experience of loved ones. Sometimes it's impossible, when we're too distant from understanding what our patients and family members are really going through. Aleksandar Hemon, writing in the June 13 & 20th double issue of The New Yorker, does a beautiful crystalline job with life's most difficult task of retelling his family's ordeal with their baby daughter and her cancer. If you think you're getting the patient perspective in your data-collection, think again. Read Hemon's "The Aquarium: A Tale of Two Daughters."
Jim
Dearing
Director/PI, CCRC
KPCO
June 17, 2011
Have you seen the Article of the Future?
We are all well aware of the advantages of publishing in online scientific journals like the ones affiliated with BioMed Central. There is no length limit and additional materials can be posted on the website, the peer-review process is transparent and timely and open access is often granted to readers.
Elsevier is taking the web-based platform offered opportunities to the next level by developing new prototypes that include all well-known components of scientific publications but with a substantially increased interactivity, functionality, and visual appeal. Currently they are showcasing 15 prototypes of the article of the future in different topic areas and readers are welcome to comment on these examples.
If interested, you can get more information at: http://www.articleofthefuture.com/about
Borsika
Rabin
Staff Researcher/Research Coordinator
KPCO
June 7, 2011
What does it mean to "scale-up" an innovation? Researchers use the term differently. Some apply the term to mean moving from a small effort to a larger effort, such as transitioning from a pilot version of a nurse navigator intervention in which 30 breast cancer survivors are proactively helped by a nurse, to full-scale intervention in which all of the same clinic's 300 breast cancer patients are now offered proactive nurse guidance. That's frequently called "going to scale". Other researchers use the same term when they describe a process of spread or diffusion, as in one clinic's nurse navigator intervention being communicated to (disseminated to) other clinics which then adopt the intervention. Is that process of replication (even with adaptations along the way) also one of scaling? Many times, "scaling-up" is used to mean a marshalling of resources (i.e., "ramping up") in anticipation of deployment and demand, as a corporation does in working its distribution chain for a new product launch. The question is complicated by the issue of generalizability. If we scale a pilot to a full intervention in one clinic, we almost certainly increase the variability of the people who experience the program. They may all still be cancer patients, but now we have older patients, younger patients, sicker patients, the newly diagnosed, Hispanics and Asians, a broader representation of people now interacting with the intervention. Some economists reserve the term "scale-up" to only mean extension of an intervention to greater numbers of similar people. In this way, variability does not increase (theoretically, to the economic mind) and the only variable at work is scale. That perspective is, in many cases, a good description of the diffusion of innovations, though in practice innovations very often spread to people & places where they were never purposively intended to go.
Jim
Dearing
Director/PI, CCRC
KPCO
June 6, 2011
We talk a lot about "getting inside the heads" of those people we want to change some behavior, and of not just "pushing" information at them but generating "pull" from them. But this is hard to do as any good marketing researcher knows. It's hard in part because it requires us -- highly educated academics who long have been told that we know a lot of impressive things -- to listen. And that's less about listening to what people think than it is listening to how people feel. That's what the art of consumer research is about. It's learning how to elicit and then recognize affect, how people feel. The very best job I've ever seen of listening and interpreting feelings was done by a consumer marketing research group led by Russell W. Belk at the University of Utah. Belk and his doctoral students studied how people feel about things, and not just any things, but those things -- those possessions -- that they value most of all. How did they do this? They outfitted an RV as a research vehicle and drove across the U.S. visiting flea markets and antique malls. They conducted interviews with everyday collectors about those things that they were hunting for. You know, that specific cobalt blue Roseville vase that they'd never found but gotten oh so close. People care deeply about certain things. Most things, we don't care much about. If you want to understand how to create pull from people you want to help or affect, read Belk's work (Possessions and the extended self, Journal of Consumer Research 15, 1988, pp. 139-168; The sacred and the profane in consumer behavior: Theodicy on the Odyssey, Journal of Consumer Research 16, 1989, pp 1-38). Absolutely terrific research.
Jim
Dearing
Director/PI, CCRC
KPCO
May 31, 2011
Why can good, direct training of low-level healthcare and public health workers have such dramatic effects? I think it's because workers don't often get acknowledgement or attention for the importance of their work, so on those rare occasions when they're singled out and asked to help in improvement initatives, they take the responsibility very seriously. Two recent studies show how important low-level health workers can be when trained: (1) hospital birth attendants, selected purposively for being influential among their peers in 19 Argentina and Uruguay hospitals, produced dramatic improvements in use of evidence-based birthing practices (see Althabe et al, 2008, New England Journal of Medicine 358(18): 1929-1940). The behavioral intervention with the birth attendants was multifaceted but it centered on selecting the "right" attendants, simple training, and simple reminders. A second study just reported by the New York Times (May 9, 2011) is equally impressive. In this study (2) midwives from 18 Zambian clinics were taught a basic course in newborn care and encouraged to talk with their colleagues too. This pilot cost $20,244 and saved 97 lives. $208 per infant! Now that's worth the investment.
Jim
Dearing
Director/PI, CCRC
KPCO
May 27, 2011
What do new drug therapies for high-risk HIV-negative people, decision support tools for breast cancer survivors, counseling protocols on tobacco quitlines, flexible scheduling for achieving better work-family balance, classroom pedagogies in the sciences, community disease prevention programs, well child care, performance improvement strategies in healthcare organizations, substance abuse screening, and insecticide-embedded mosquito nets all have in common? Each of these topical areas has new evidence-based programs, protocols, and practices that warrant strategic dissemination to trigger diffusion! And we work in every one of these areas to help make that happen. Get involved with us to learn & apply these lessons to your topical area.
Jim
Dearing
Director/PI, CCRC
KPCO
May 26, 2011
Conferences, especially those that are slightly outside your normal range of conference attendance, can be good opportunities to meet the people who will really value your perspective because it is slightly different from theirs yet consonant enough to interest them. Several upcoming meetings that may fall into this category for you are: (1) the CDC's national conference on health communication, marketing and media August 9-11 in Atlanta; (2) the first global implementation conference August 15-16 in Washington DC; and (3) the first of three Seattle Implementation Research Conferences at the University of Washington October 14-15. Weatherwise, you'd have to choose the latter....
Jim
Dearing
Director/PI, CCRC
KPCO
May 24, 2011
A number of people ask me about our Cancer Communication
Research Center. What's it like, how big is the office and
the staff, don't they like living in Denver. Most are
impressed that we have so many communication and cancer researchers
in one place.
And of course we are nothing of the sort. We are a virtual
center. While we do have researchers and staff in our Denver
office, they work on many other sorts of work too (like pediatric
research and occupational research) and most of the researchers
working on CCRC projects are based across the country, in different
healthcare organizations (like Kathy Mazor at Meyers Primary Care
in Massachusetts) and in universities (such as Tom Gallagher at the
University of Washington or Rick Street at Texas A&M).
This has a number of implications but one of them is that there's a
lot of points of entry into this research center, and if you want
to get involved, you can.
When I was a grad student, I knew that universities hired researchers (oh yeah, we taught and advised, too) and that many of those researchers worked collaboratively in "invisible colleges" with peer faculty elsewhere, coming together annually at their professional association conferences. I had no clue that healthcare organizations had their own research units. Well, our research center spans across researchers in both sorts of units or departments. And by becoming involved with us you can make connections with researchers in both of those sorts of departments. Help us get to know who you are and what you know!
Jim
Dearing
Director/PI, CCRC
KPCO
May 23, 2011
When we are trained in grad school about intervention design the
emphasis (at least as I remember it!) is on fashioning the
strongest effect possible.
We start with a particular behavior change theory, move from
constructs to variables, operationalize the variables by adopting
or adapting or god forbid creating our own measures so that we'll
have something to get us through the hurdles of a doctoral program
and submit for publication. We write it all up for a
class. Stand up and describe what we wrote before our
professor and classmates. And then, this creeping feeling
comes on that perhaps we've forgotten something, that there's
something missing, something that in our rush to turn in our paper
and make it through another semester we put on the back burner
and...
Oh yeah! The intervention. The thing that's supposed to
induce the behavior change in the way that we so carefully
justified in our class paper!
On paper we can do a lot with an intervention. There can be
interactive online training. Efficacy building
exercises. Support groups in peer networks. One on one
counseling. Diaries. Performances. Reminders and
checklists and placards. PSAs and paid advertising and social
modeling. And of course full participatory involvement with
our intended beneficiaries and their service providers so that
whatever gets designed is going to generate not just attention
but-- dare I say it--demand.
Anything's possible on paper. But the real-world intervention
game has different rules than the game of learning about research
through specifying mock interventions in classrooms or even real
interventions in academe.
In practice settings--communities or organizations where services
are provided for people at risk of something undesirable--the real
game is figuring out what's not only effective but also efficient
and, when those objectives collide as they often do, what's
efficient while also achieving an acceptable degree of positive
effect. In communities and organizations where there's never
enough money nor enough staff nor enough time and where there are
always competing demands just as worthy as the objectives of your
intervention, it's a cost-benefit question. Always.
My friend Chris Dede, in the Graduate School of Education at
Harvard, describes this challenge eloquently as "the trap of
perfection". We keep trying to define, test, and publish the
gold standard of interventions. Then we complain why no one
in the worlds of practice has picked up and run with our truly
excellent programs, products, and protocols. In the realm of
public health and health services research, the National Cancer
Institute scholar and methodologist Russ Glasgow has long argued
the same thing. Excellence is not the objective; "good
enough" interventions which come in at low cost is the place out on
the horizon where we should set our sights. That way, us
students and teachers and writers have a shot at helping real
people in real communities and organizations.
Jim
Dearing
Director/PI, CCRC
KPCO
