Examining Education, Media, and Dialogue under Occupation

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go to link For example, recommendations for breast cancer screening may vary, depending on age and family history. They are different from recommendations for cardiovascular disease, such as blood pressure and cholesterol screening. The navigation of the health system and the organization of medical care place an unfair burden on low-SES groups. Such issues as language, culture, and social status may interfere with having a more positive experience with the system Cooper and Roter, Issues in treatment require adherence to complex drug regimens and compliance with recommendations.

Acting on obtained health information is subject to opportunity structure, particularly the built environment. For example, it is difficult to act on prevention information on obesity, when one does not have decent grocery stores in the neighborhood, an availability of fruits and vegetables at reasonable prices, and safe neighborhoods to engage in physical activity. Lack of this insurance may deter people from acting on screening recommendations.

Any effort to bridge this inequality requires efforts to offer information on possible resources that allow people to act. There are differences in what people learn from the mass media and differences in the advantages that accrue from public health communication campaigns. The success and failure of campaigns has been of considerable interest to scholars and practitioners, given the mixed record of major public health education efforts over the past several decades Hornik, ; Snyder and Hamilton, Yet, one type of failure or unintended effect is often observed: The HINTS study, cited above, illustrates the argument about learning from the general information environment about cancer risk factors.

Members of higher-SES groups often know more than those from lower-SES groups, even on such widely publicized risk factors such as smoking and its link to cancer Figures G-9 and G Conditions that may deter information gaps include inducing or increasing relevance for that information, extensive coverage in mass media, wide diffusion of information leading to saturation on that topic e.

On the other hand, carefully designed public health communication campaigns have successfully reduced smoking among adults and teens, increased seat belt use, reduced Sudden Infant Death Syndrome, and increased mammogram use Hornik, ; Rimer, Yet another type of knowledge gap may also deter mobilization for social action. There is a lack of awareness among both providers and patients on the existence of disparities or the extent to which disparities pose a significant problem in health care. Kaiser Family Foundation, , In short, learning from and acting on health communications is a complex, challenging process.

It is little wonder that students of public health and medicine are now discussing how to improve health literacy , the capacity of people to obtain health information and make informed decisions about their health Nielsen-Bolhman et al. Much discussion on health literacy is based on its potential; more systematic and empirical evidence of its effectiveness still remains to be found. In addition, the fact that almost 48 million Americans older than 5 years speak a language other than English at home may warrant a closer look at not only health literacy, but also the importance of providing services and information in different languages.

In summary, the recent developments in a information delivery services, b the generation of information as a result of biomedical research, and c the interest in health information among different publics offer tremendous potential in changing public health through the provision of information, thereby contributing to a reduction if not elimination of health disparities. Yet, in line with existing disparities in health, inequalities in communication can act as significant deterrents to bridging disparities, unless concerted efforts are made to reduce them.

In the so-called information age, a fair and equitable distribution of relevant information may be considered a critical need. In addition, although the target audience is not clear, one objective explicitly identifies the establishment of an informatics infrastructure to disseminate scientific information regarding health disparities. Such an infrastructure is more likely to be used by trained, professional public health stakeholders than ordinary citizens. NIH is uniquely qualified to disseminate research-based information to health professionals and community stakeholders involved in public health.

What are the barriers in disseminating evidence-based information on health disparities to different stakeholders? What kind of infrastructure exists to facilitate knowledge dissemination to groups working with medically underserved groups? How can there be more coordination and collaboration among both federal and nonfederal partners on public outreach and communications to reduce, if not eliminate, health disparities? This section will attempt to address some of these questions. It was recently commented that findings from clinical research take as long as 17 years before they find their way into practice Balas et al.

There is no reason to suspect that dissemination of information on prevention should be any faster, though news media routinely cover major developments published in medical journals. There are many reasons why translation of evidence-based information to the clinic, as well as to the community, is slow or even absent:.

Public communication to a general audience or research dissemination to health professionals, community groups, or policy and decision makers can be effective, if preceded by systematic and strategic planning, careful execution, and rigorous evaluation. The elements of such strategic communications are outlined in Table G-2 , a planning matrix that could guide outreach efforts. The matrix to be discussed here is only meant to be a practical, heuristic tool that could be used once the marketing research has been done and a decision has been made on the product, service, or information to be disseminated.

We will next discuss each element of the matrix briefly. In theory, NIH , or one of its Institutes and Centers ICs , is the primary sponsor for the public information or outreach effort on health disparities. Other agencies of the U. Several federal agencies have overlapping roles in health promotion and sometimes partner with each other. Such a partnership is strongly encouraged, so that each agency can bring its unique strengths and expertise to the table. This closeness enables NIH to tap into the most up-to-date science on health disparities and translate the science for the consumption of different stakeholders to bridge those disparities.

Lessons learned from such experiences could come in handy to develop and study outreach programs to eliminate health disparities. Any information outreach must start with a close identification, definition, and characterization of the target audience, and the same principle applies to the information outreach objectives of NCMHD. Some questions to guide the selection and profiling of the audience include:. It is important that the product or information selected for outreach meets the needs of the audience and addresses a particular problem or threat that they face.

For physicians, it could be a recommendation on treatment, such as when an intervention is warranted to reduce cholesterol. It could be a consensus statement on screening guidelines, to address uncertainty or lack of consensus.

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Summary. This book is an in-depth examination of education and media under occupation. The contributors to this volume engage dialogue to. This book is an in-depth examination of education and media under occupation. The contributors to this volume engage dialogue to explore these domains and.

In all cases, information outreach efforts are assumed to follow formative research that, in addition to messages and channels, identifies and profiles the audience. Audience characterization is also commonly termed audience segmentation, an effort to define groups that share certain characteristics. A number of variables are used to segment the audience:.

A number of statistical techniques such as factor analyses Trenkner et al. The idea behind segmentation is that homogeneity within segments will allow campaign sponsors to design messages that are compatible with the cultural, structural, and attitudinal status of the segments, thereby enhancing the probability of campaign success. Segmentation is also useful in channel selection, and, in fact, many commercial providers of audience measurement and market research services offer information on different audience segments that a given channel could potentially reach.

Despite the apparently successful track record of segmentation strategies, certain caveats are warranted and worthy of future investigations:. The first assumption here is that the sponsors have already made a decision about what product, service, or idea should be disseminated. The message specifically refers to what is being disseminated and how it is being disseminated. A product or a service could be a set of treatment recommendations on hypertension in a minority group or vaccination against influenza in the elderly.

It could be a synthesis of knowledge about a treatment of a particular disease or disorder, or it could be a national campaign to reach minorities on AIDS education. How should an agency go about deciding what areas, topics, diseases, or products are likely to be subjects of outreach? A set of criteria may be developed to decide on the a target audience, b documented level of disparities that trigger action, and c selection of the subject or product for outreach e.

If a product or service is a broad public information campaign—say, a campaign on obesity that is aimed at African Americans who suffer disproportionately from its consequences—there is first a need to understand the behavioral and environmental determinants that may reduce the barriers to physical activity. Both individual-level and structural-level factors are likely to mediate the effect of public communication efforts on different groups of people. Within communication science, a body of work on message theories and their impact on public health has begun to emerge to better inform the work of public health practitioners.

The assumption behind message-effects theories is that certain features of messages—their format, structure, and construction—interact with individual attributes of the audience, thus influencing information processing and leading to changes in audience knowledge, attitudes, and behaviors. Several types of message formats have been studied: Theories of fear appeals posit that audiences, when exposed to information, make a calculated appraisal of the threat of the topic or the issue to the self; evaluate the efficacy of the recommended action, if it is accompanied with action; and may react accordingly Witte and Allen, Sensation seeking is a personality type where the individual seeks adventure and novelty to reduce boredom Donohew et al.

Sensation seekers are likely to seek out intense experiences or stimulations and often are spontaneous in their actions while ignoring the consequences. Several studies have found an association between sensation seeking and risky behaviors, such as drug and alcohol use, sex with multiple partners, and even unprotected sex. Health campaigns have successfully used messages with high-sensation value to change attitudes and behaviors about illicit drug use and risky sex among teenagers Donohew et al.

One of the more intriguing message effects is exemplification. Exemplification is the extent to which selected events or cases in a news story are illustrated as representative of a general class of events typifying those events Zillmann, The contention of proponents of this message effect is that recipients of campaign messages often ignore quantitative information, such as the risk of contracting an infection or sexually transmitted disease from unsafe sex, for example, but will be more attentive to exemplars that discuss the very same issue.

Exemplars are successful when they are concrete, vivid, simple, consequential, and emotional. Evidence shows that people learn about health—or any knowledge topic, for that matter—through purposeful campaigns and through incidental exposure to media messages, such as when watching a sitcom on a television.

This ability of stories to engender deeper involvement and learning has been used to study the message effects of narratives. Narrative messages are stories with persuasive health content Slater, Narratives work though positive or negative reinforcement of behaviors through modeling Bandura, The positive effects of narratives have been touted with examples from teaching health and social issues in Latin America and Africa Rogers, On the negative side, some have argued that exposure to televised violence can have negative effects of aggressive behavior among children and distorted worldviews among adults Gerbner et al.

Intuitively, it should make sense that stories are powerful and have both positive and negative effects. The empirical evidence on narratives so far has been less than rigorously gathered and requires more study. Framing is yet another message effect that has been studied and has two meanings, based on its intellectual origins. Drawing from the psychology of communication, framing refers to the construction of messages that highlights either the benefit in performing a health behavior gain-framed or the costs of not performing a behavior loss-framed Salovey et al. It has been argued that loss-framed messages are more persuasive when the audience member is facing uncertainty or risk such as infection, and gain-framed messages are more persuasive when outcomes are certain, such as treatment.

For example, the recent debate over mammography was framed in the news media as either leading to false positives, thereby resulting in unnecessary treatment and distress, or as a prevention tool that has saved lives through early detection. Studies have shown that such debates in the media have differential effects on the audience, depending on their SES. This brief overview of message effects offers some interesting possibilities in reaching different target audiences in bridging disparities. Yet, an alternative structural view suggests that audiences attend and react to mediated content based on their structural location in the environment and the social roles they play McLeod et al.

Structural determinants such as social class, occupational structure, race and ethnicity, and gender mediate the impact of messages through such factors as collective experiences, group membership, access, preferences, appeals, attention, and processing and capacity to act on the information. We have, however, little scientific knowledge of how such structural determinants interact with personality variables to mediate different message effects.

Even less is known about how these determinants are mediated in different racial and ethnic groups. Lastly, more work is needed on the influence of message effects on health among groups suffering with differential disease burdens. Such partnerships will obviate duplication among different governmental and nongovernmental organizations, facilitate coordination, and rationalize outreach expenditures.

A number of community groups that work with minority audiences and that are sensitive to the culture of the minority community may lend credibility to the program. In fact, several such examples in public communication exist. EPCs have been designed to perform systematic reviews of scientific literature on clinical, behavioral, organizational, and financing issues related to treatment and then produce reports. Professional organizations such as the National Medical Association could serve the twin purposes of providing forums for disseminating evidence-based medicine and also bringing the necessary credibility to the campaigns within the target audience community.

NIH and various ICs are funding several networks that already have an infrastructure to educate and conduct research. Such networks could be good vehicles to translate knowledge speedily. In summary, a partnership approach could go a long way in stretching the limited budget for outreach, bringing credibility to the programs, and broadening reach. A strategy may structure the actions one might take to achieve broad communication goals. A tactic is the specification of execution of the strategy—that is, an operationalization of it. It lays out the specific actions the sponsor might take to achieve the campaign or outreach goal.

For example, to draw from Table G-2 , the goal of promoting the most current understanding of cervical cancer screening guidelines may involve the strategy to target health care providers that provide the usual source of care for the medically underserved. It could involve such tactics as training, providing continuing medical education credits, and following up with frequent meetings.

A national campaign to promote physical activity among Hispanic audiences may involve a broader strategy of reaching Hispanic children and specific tactics of promoting organized community physical activity programs. Although the distinction between strategy and tactics often seems academic, the exercise of identification and delineation will help clarify this distinction. Channels are the means through which health information is disseminated to target audiences, which may include citizens, providers, or community leaders.

Optimal channel selection is a critical and essential factor in the dissemination of health information to different publics, as it will make the difference between reaching the right target audience and missing them completely. Channel selection is done by careful formative research, either through custom research done by individual sponsors or by subscription to commercial providers of information such as Nielsen Media Research.

There are a variety of channels, including interpersonal, organizational, and mass media channels. Campaign sponsors may use one channel at a time or multiple channels that complement one another. Using a variety of channels that complement and supplement each other is usually more effective Hornik, ; IOM, For example, the National Youth Anti-Drug Media Campaign is an integrated social marketing effort that uses advertising, mass media, and the Internet with outreach efforts to different partners, including Hollywood and racial ethnic organizations.

The decision to select one or more channels depends on factors such as reach, control over the message, intensity, and costs. Mass media can provide a wide reach with a lower cost per person, but it is also difficult to exert control over how the message is disseminated and to collect immediate feedback from the audience. On the other hand, one might be able to exert greater control over the message and obtain immediate feedback when using interpersonal or organizational channels, but these offer limited reach and may be more expensive.

Given the complexity and intractability of the problem of health disparities, it is desirable to use both mass media as well as interpersonal and organizational channels. Channel selection is based on the principle that the information provided through those channels draws distinct groups of people who are interested in that information and who share some common characteristics. Often, the audience characteristics that are considered in channel selection include:. In contrast to reaching general audiences, research dissemination to provider organizations may be done through professional and civic organizations such as medical societies, nursing organizations, and national civic organizations.

These organizations are optimal vehicles for the release of state-of-the-art information on prevention, screening, diagnoses, and treatment through their professional meetings, newsletters, and workshops. A significant challenge is reaching nonprofessional audiences and community groups; this warrants creativity in the form of using existing structures or in funding the creation of new ones.

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Despite the opportunities and the availability of organizations, researchers lack a systematic body of evidence on the appropriate dissemination vehicles for groups suffering from a disproportionate burden of disease and ill health. We have little idea of the effectiveness, receptivity, resources, barriers, and capacity of these community groups to carry out dissemination and the conditions under which they could be effective.

NCMHD may do well to promote research in this important area. This element is included to compel clarity in specifying communication goals. The development of programs and measurement of their success in achieving those objectives, however, requires greater specificity and operationalization. For example, one specific goal under the objective of incorporation of science-based information into the medical curriculum could be the treatment guidelines for diabetes among African Americans.

Yet another example is incorporating cultural competence into medical school curricula. The objective of maintaining a dialogue with ethnic groups also requires greater specificity to assess the impact. One possible goal could be a periodic survey of specific groups to do needs assessment surveys to understand the barriers in obtaining access to, and the use of, health information. Such specificity will help to clarify exactly what objectives are being pursued and will aid in developing appropriate products, target audiences, and message strategies.

It will also help to identify the necessary incentives that will facilitate the adoption of the innovation. Specification of a timeline will provide an idea of requirements in staffing, resources, and budget.

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A timeline will minimize the danger of setting unrealistic goals, a common feature of public health education. Moreover, specifying the timeline for translation could narrow the long period between research discovery and delivery. It is essential that there be mechanisms in place to track the success of the outreach programs and products. Tracking and evaluation offers several advantages:. It is important that the evaluation distinguish between hard and soft outcomes.

Soft measures include, for example, how many brochures have been distributed to provider groups on treatment. Another soft measure is how many linkages have been created with community organizations. The soft outcomes are intermediate process measures, outcomes of process evaluation that could be helpful in serving as markers of outreach efforts. Yet more important is the development of hard measures that actually assess change in the provider practice or health behaviors as a result of the outreach efforts. This will also provide the necessary feedback loop discussed earlier so that NIH can ascertain and incorporate the needs of different publics into programming.

The current NCMHD objectives for public information and outreach appropriately identify challenges in identifying target audiences that may help in bridging the deep chasm between research discovery and delivery, when it comes to health disparities. As NCMHD refines its strategic plan in subsequent years, some additional considerations will be necessary for success.

There is currently no comprehensive system in place for communication and outreach surveillance that will help NCMHD systematically assess the needs of academic, professional, and community groups working with the underserved groups and use that information in program planning.

Similarly, we know little about the information needs, media use, and information-seeking patterns of citizens suffering from disproportionate disease burdens. It is unclear what systems are in place to do such surveillance and how they are being fed back in program planning. On community groups and citizens, some questions that a surveillance program may address include the following:. These are only some examples of questions that are worth exploring in future research on dissemination, and they have strong implications for practice. It is strongly recommended that NCMHD develop a surveillance system that will track the health information needs, sources, and information-seeking patterns of different audience subgroups, as well address the needs of providers and institutions working with medically underserved groups.

Currently, a number of NIH ICs are supporting research on public health communication and provider-patient communication and developing an infrastructure to promote dissemination. There is a significant gap in our understanding of public information when it comes to minority and low-SES audiences, as well as the appropriate models of dissemination to transfer the latest medical knowledge to academia and providers dealing with health disparities groups. In short, there is a need to develop and accelerate work on the science of health communication and research dissemination, with a particular focus on minorities and low-SES groups.

A strong program of research on communication and dissemination could address the following issues:. These questions are only suggestive and are not meant to be exhaustive. They do give an idea of the need for a more evidence-based and scientific approach to public information outreach on health disparities. With the development of a strategic plan, NCMHD made a sound start by clearly identifying the objectives for research, research infrastructure, and public information and community outreach.

The objectives for public information and community outreach suggest two broad strategies to reduce health disparities: This essay provided some broad outlines that can enable NCMHD to achieve its objectives by taking the following steps:. The unprecedented advances in engineering and biomedical sciences offer a tremendous opportunity to prevent and treat diseases that have long plagued humans.

These advances, coupled with the communications revolution in telecommunications and informatics, offer the potential to intervene along the different stages of the disease control continuum—from prevention to survivorship and end of life—thereby reducing mortality and morbidity due to disease.

Yet the persistent inequities in health and the corresponding inequality in communications among different social groups could disrupt the revolution, resulting in the rich getting richer and the poor poorer, in terms of health and information.

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A national action plan involving careful, systematic, scientific, strategic, and deliberate efforts to address the twin disparities in communication and health could potentially help to fulfill the promise of the revolution to all instead of a few. The author is grateful to the assistance and suggestions from a number of people in writing the manuscript. Using LexisNexis, almost publications under the U.

News category were searched. Ethnic NewsWatch provided information on coverage of health issues in almost English- and Spanish-language ethnic newspapers, magazines, and journals. The search terms were also entered into Google to assess the number of Internet web pages that mention the four major health issues. In the absence of a denominator, it is difficult to argue that media attention to health news is increasing in relation to other topics. It is equally conceivable that the increase may also be related to more channels of information. What the numbers do suggest is a change in the information environment where more information on health is available on organized communication channels such as the news media.

I want to thank Dr. The conceptual distinction between them has been muddy, and these terms have often been used interchangeably. Kerner and colleagues in his office have been engaged in the conceptual explication of diffusion and dissemination as well in promoting the science of dissemination in cancer control. Turn recording back on. National Center for Biotechnology Information , U.

Harvard University An amazing feature of the waning years of the 20th century and the beginning of the 21st century is the stunning transformation in both the generation and delivery of information of all kinds—a development that few of us have yet come to grips with. Provide the latest research-based information to health care providers to enhance the care provided to individuals within populations experiencing health disparities.

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Facilitate the incorporation of science-based information into the curricula of medical and allied health professions schools and into continuing education activities of health professionals. Maintain ongoing communication linkages and dialogues with minority, ethnic, and other special populations, including the underserved, who experience health disparities. Develop computer databases and Internet resources to disseminate current information about scientific research and discoveries and other activities regarding health disparities.

Develop targeted public health education programs focused on particular disease areas in order to reach those individuals within minority, ethnic, and other special populations who experience health disparities within these disease areas. Communication Inequality Two more principles of communication are worth noting.

SES, Race, and Ethnicity and Their Relation to Inequalities in the Comprehension of and Action on Health Information A significant dimension of health inequality is the ability of the individual or the capacity of a community group to process and act on health information. Health Disparities and Research Dissemination: Some Issues for Consideration It was recently commented that findings from clinical research take as long as 17 years before they find their way into practice Balas et al.

There are many reasons why translation of evidence-based information to the clinic, as well as to the community, is slow or even absent: The academic setting and reward system encourage publications in peer-reviewed journals, and few incentives, if any, encourage work on dissemination Jacobson et al. Health care systems are unlikely to adopt innovations unless there are incentives in place that will support dissemination, as it will incur costs in production, personnel, and technical support.

Individual scholars need incentives to promote dissemination as well as study dissemination. The entire incentive structure around the adoption of evidenced-based information in practice must be closely examined. By nature, most academic research is abstract and not in a format immediately usable by practitioners.

The importance of knowledge brokers who can move in both knowledge-generating research and practice community settings has often been cited as useful in a speedier dissemination of laboratory research into practice, as is evident in the case of AIDS treatment in sub-Saharan Africa Philpott et al.

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Cancer PLANET is a website that a provides information on behavioral interventions in cancer control, b rates different behavioral interventions in cancer on their effectiveness, and c provides links to grantees who developed those interventions. Within academic medical centers and federal and state agencies, research dissemination often is an afterthought—and not a very systematic one at that. For example, as was observed in another context, it is a matter of some irony that considerable time, money, and intellectual capital is exerted in ensuring rigor in day-to-day health research, but somehow the same intensity is lacking when translating that research into the community Viswanath, What are the ideal systems and processes to ensure speedy translation of rapid medical advances to the bedside and the community?

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What roles do different organizations, federal and state agencies, scientific associations, and commercial and civil sectors play in the speedy delivery of services? More important, how do we ensure that the benefits of translation accrue equally to all groups that need the most appropriate and up-to-date treatments?

Addressing these questions requires partnerships between researchers, academic medical centers, and federal funding agencies. The science of dissemination in general, and our knowledge about dissemination to reduce health disparities in particular, is still underdeveloped Kerner et al. At the federal level, agencies such as NIH can contribute to the science of dissemination by working with NIH study sections to be sensitive to the challenges of studying dissemination. The challenges include review criteria that value innovativeness, the risk-aversive nature of the reviewers, and discomfort with research designs that are not conventional randomized controlled trials, among others Glasgow et al.

NCMHD could play a crucial role in promoting more systematic inquiries into studying research dissemination to professionals dealing with health disparities. Systems and people vary in their capacity to learn and use information related to both well-established and emerging innovations. These communication inequalities at the system level are one of the least investigated areas in public health communication research.

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We have not yet successfully designed systems and processes to cater to the so-called hard-to-reach groups. Some have advocated and argued for a push-pull approach in accelerating knowledge transfer Kerner, On the push side, we need information on the existing capacity among academic medical centers to disseminate appropriate information to the clinicians, community groups, and the people.

Some questions to ask on the push side include: The pull side is a major challenge in translation. There is a differential capacity among different community and social groups and publics in accessing, processing, and using health-related information. Such differential capacity coincides rather inconveniently with profound inequities in disease prevalence, treatment, and mortality along racial, ethnic, and social class lines. We know little about the kind of community groups and networks that could be helpful in accelerating knowledge transfer.

For example, several community groups engage in health promotion programs on a voluntary basis. The health promotion efforts may or may not be evidence-based, and often the groups reinvent the wheel by creating programs from scratch. At the same time, several groups in the community may conceivably lack the resources to use Cancer PLANET and other such resources, as they survive on volunteer time and efforts. We need more information on how academic medical centers, in collaboration with other groups, can enhance community capacity to use existing resources such as Cancer PLANET.

Here is one place where academic medical centers can build linkages with community groups and networks by offering information, training, and modest resources. Moreover, what kind of systems and services are available to different ethnic groups and non-English speakers? The cultural and ethnic fabric of the nation is changing rapidly, with increasing migration into the United States from other countries.

About 47 million people in the United States speak a language other than English. Any effort to promote dissemination and adoption of evidence-based practice cannot ignore the needs of different ethnic and linguistic groups. The organization of the health care systems that tend to the medically underserved also remains to be explored. What are the training and resources needs of such organizations?

What constraints do the practitioners working in these organizations face in adopting the latest innovations and how can we build this into intervention development? How do they keep up with the latest advances in biomedical science, and how do they translate it to treat population groups suffering from a disproportionate disease burden? Currently, the state of the science allows us to identify interventions that are effective in reaching groups that bear the brunt of the most preventable diseases.

The translation of the interventions to more real-world settings, however, faces at least two challenges: Interventions and trials work well in controlled settings, given the careful oversight, nurturing, and funding provided by the scientists and the funding agencies. A successful transfer of knowledge requires that we understand how real-world conditions influence the integration of new treatments and technologies from the lab to the clinic and the field. The uncertainty resulting from new variables and the larger scale can dilute the effectiveness and adoption of innovation unless scalability is taken into account.

Similarly, how do we ensure successful ownership and incorporation of clinical innovations and preventive practices from the research centers by practitioners and groups in the community? Successful integration demands resources that either exist somewhere or need to be raised. Unless we take the issues of sustainability more seriously, we will be stuck in the vicious cycle of bench-to-peer-review-journals and back to the bench.

If so, whatever information reaches the bedside and the community is more due to adventitious circumstances than to deliberate efforts. The institutional and social context in adopting evidence-based information for prevention and treatment must be closely examined to ensure successful adoption. Some suggest that health disparities could be reduced by promoting environmental change systems as opposed to the individual and building community capacity at the local level Lavis et al.

Although it is correct that building community capacity to adopt evidence-based information is critical, it is also worth noting that the focus in examining the adoption of innovations should not be exclusive to either the system or the individual, but at the intersection of individual and the system. Patients, for example, draw support from their providers, family and friends, and mass media. In addition, they are also likely to be members of social groups, community networks, and faith-based and secular organizations. Similarly, clinicians are influenced by their organizational structures, incentive and payment systems, and the legal and regulatory environment.

Understanding these diverse sources of influence on individual behaviors and practices—whether a clinician or a community group or an individual—is critical in enabling knowledge transfer. The adoption of evidence-based information by groups and practitioners representing underserved groups faces the additional challenge of mistrust due to previous experiences, a lack of awareness about medical innovations such as clinical trials, and a disconnection with the established medical system.

It is unlikely to change unless there is more sustained interaction between those promoting evidence-based information and the consumers that use the information—an interaction that may repair trust and confidence. NCMHD should actively engage existing community groups, organizations, and social movements to accelerate the transfer of research knowledge. One effective way is to build relationships with community groups, including voluntary associations, civic organizations, faith-based organizations, and community practices, among others Farquhar et al.

Outreach efforts could be made by careful needs assessment and active programs to satisfy those needs. Sustained efforts could potentially be fruitful over the long term and may also result in reaching groups that are traditionally difficult to reach. Sponsors In theory, NIH , or one of its Institutes and Centers ICs , is the primary sponsor for the public information or outreach effort on health disparities.

The Audience Any information outreach must start with a close identification, definition, and characterization of the target audience, and the same principle applies to the information outreach objectives of NCMHD. Some questions to guide the selection and profiling of the audience include: What is the degree of understanding about the needs of the audience and the extent to which the product being disseminated meets those needs? What kind of advanced information through formative research informs audience selection and characterization?

Psychographics such as personal values, lifestyles, preferences, orientations, and religiosity Albrecht and Bryant, ; Slater and Flora, ;. Beliefs such as a sense of perceived risk Lemon et al. Personality traits such as innovativeness Rogers, or sensation seeking Stephenson et al. Health behaviors and health status Boslaugh et al. Product use or consumption, for example, the number of drinks consumed or contraceptive usage El-Zanaty, ; Lintonen and Konu, ; and. Second, it sometimes also takes a static view of membership in the segments as if people do not change. Both are questionable and empirically untenable.

People often enjoy a web of affiliations by often simultaneously belonging to several groups and playing multiple roles. They concomitantly draw from and contribute to the collective experiences of those groups and affiliations. Their views, status, values, and preferences may change with changes in either group norms or group affiliations. Another pitfall in this assumption of homogeneity could be when one variable may or may not be appropriate for segmentation.

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It is now widely agreed, for example, that Hispanics are extremely heterogeneous in SES and political and cultural beliefs, despite their common language. In fact, one recent analysis showed that Spanish-speaking Hispanics are considerably different from English-speaking Hispanics in their SES, media use, and media credibility Clayman et al. Lastly, segmentation strategies are based on the premise that individuals can change given the appropriate messages through appropriate channels when sometimes the systems and the social context in which health behaviors occur may warrant more attention.

The Message The first assumption here is that the sponsors have already made a decision about what product, service, or idea should be disseminated. Strategy and Tactics A strategy may structure the actions one might take to achieve broad communication goals. Channels Channels are the means through which health information is disseminated to target audiences, which may include citizens, providers, or community leaders.

Often, the audience characteristics that are considered in channel selection include: Demographics such as age, gender, income, and residence. For example, local newspapers are optimal for reaching a variety of people and are usually consumed by adults who are enjoy strong social ties to the local media Viswanath et al. Magazines and radio provide ideal vehicles for careful segmentation given the specialized content they offer. There are varieties of magazines that cater to different age and gender groups. Race or ethnicity , while often included in demographics, are unique factors given the nature of the media that reaches different racial and ethnic groups and the heterogeneity among different racial and ethnic groups.

American society is becoming increasingly diverse with more than Hispanics constitute about 13 percent of the population and African Americans another 13 percent. Asian Americans account for about 4 percent of the U. Census Bureau projects that between and , the U. That is, factors that usually drive the establishment and maintenance of ethnic media, such as audience size, general consumption expenditures, and SES, are already in place.

In fact, there is already a tremendous diversity in American mass media catering to different ethnic and racial groups: These media play a variety of roles such as community boosters, transmitting culture, assimilation into the mainstream of American culture, and watching out for the community Viswanath and Lee, in press. The ethnic media offers an ideal and optimal set of vehicles in addition to the mainstream channels in providing health information to audiences of diverse racial and ethnic backgrounds. Yet, we know little about how widely these vehicles are being used to provide health information and how successful those efforts have been—both areas worthy of future investigation.

Lifestyle and orientation refer to factors that go beyond demographics to interests and orientations. These may include media catering to audiences with subject interests including travel, news, recreation, sports, sexuality, health, movies, and shopping, among many others. Tracking and evaluation offers several advantages: Mid-course correction of current outreach efforts,. Without these tools and technologies, individuals and institutions have poorer chances to address 21st-century issues and challenges.

Therefore, higher education institutes worldwide are redesigning their educational systems, teaching methods and learning practices. To our knowledge, neither studies nor validated frameworks currently exist to establish an integrative approach to ICT needs assessment. The purpose of this study is to examine the role of ICT in enhancing community outreach, academic and research collaboration, and education and support services IT-CARES in an academic setting. The survey was developed using the Delphi methodology, which is an iterative, multistage process designed to combine opinion into group consensus.

Questionnaire development was initiated by asking key stakeholders in community outreach, academic, research, education, and service support settings to provide feedback on current ICT issues and future recommendations for relevant ICT tools that would be beneficial in their jobs, and to capture current ICT issues. The questions were modified to meet the needs identified by the stakeholders within the college. From their feedback, a structured questionnaire was created to address existing and future directions for resources, intranet, training, hardware, social media, support, and usability, and existing use of technologies.

The initial survey was then sent back to the same key stakeholders to provide feedback and further develop the questionnaire. After recommendations were made and consensus was reached, the questionnaire was further refined to address relevant ICT questions. Participants were asked to rate the level of importance of each ICT question on the following five-point Likert scale: Participants were also asked to answer descriptive questions about their role in the college and the nature of their work to better gauge their perspective of ICT needs.

The questionnaire consisted of eight sections. These sections were developed on the basis of prior literature 17 , 18 and were modified to meet the study needs. The survey was uploaded to SurveyMonkey, an Internet-based survey provider, and the link was distributed to COPH faculty, staff, and students via e-mail. Inclusion criteria specified that participants were to be part of the COPH and 19 years of age or older. The survey was sent to a total number of participants, including 70 faculty, 89 staff, and students.

An e-mail message was sent to faculty, staff, and students identified from university rosters. The survey was available online for two weeks. At the beginning of the second week, one reminder to complete the survey was sent to the participants. The participants voluntarily completed the survey and submitted it anonymously. The responses were confidential and were used to determine the needs of ICT in the academic, educational, community outreach, research, and support areas.

The survey was hosted on SurveyMonkey from November 19, , to December 3, The data were gathered and analyzed during December Descriptive analysis using univariate statistics was performed to determine frequency distributions for the categorical variables and to report the means and frequency distributions for continuous variables when appropriate. Chi-square tests or Fisher's exact tests were conducted to examine the differences in responses by age and role in the COPH at significance level of.

When the comparisons were performed, responses for moderate and high importance, low and no importance, agree and strongly agree, and disagree and strongly disagree were grouped under one category each. Among the COPH roles, staff and other roles were considered in the same group. The survey was made available on Survey Monkey and an e-mail message was sent to participants, including faculty, staff, and students.

The results show that the majority of the participants above 50 years of age The majority of faculty members There seemed to be a high concern for keeping track of active projects online and learning what tools are currently available to develop research proposals and track progress.

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No significant association was found when comparing responses between age groups or by the participant's role in the COPH. The participants were asked about the necessary functions of the intranet to support the internal needs of the college. The majority attributed moderate For the ability to view collaborative research opportunities, The ability to disseminate student research activities was seen as highly important by The dissemination of student research interests was attributed high importance by This finding was expected because the item referred specifically to dissemination of student research activities.

One respondent suggested that the intranet could disseminate faculty research interests, and another suggested dissemination of staff research activities and interests. Community events as part of the intranet were also mentioned. ICT could be the means to achieve that through development of the institutional intranet. More information was deemed necessary about distance learning tools.

Participants also suggested that training should be available for different web design and statistical software packages. One respondent identified the need for training of faculty and staff on instructional design, especially for the online courses. The majority of the participants attributed high importance to dealing with problems such as personal computer speed None of the participants attributed low importance to any of these four items, and only two participants deemed it not at all important to deal with computer backup procedures. One respondent identified iPads and iPhones as crucial hardware.

Live streaming was also a concern related to hardware, as was functioning hardware on classroom computers. Participants also identified ICT support needs for workstation computers, in electronic testing environments, and for general support and timely maintenance to enable faculty to do their jobs more effectively. Online discussions were attributed high importance by Dissemination of research activities was also deemed highly important by The importance attributed to dissemination of research activities was significantly associated with role in the COPH: Finally, community engagement and outreach activities by students and faculty through the use of social media was considered to be of high importance by The majority of participants reported that they use the COPH website frequently However, there is little agreement on the complexity, consistency, functionality, and ease of use of the website.

No differences were found among the age groups. Internet and Blackboard access challenges were also reported Among the respondents who reported Internet access challenges, Among the participants who reported Blackboard access challenges, Browser compatibility problems were identified by Challenges with live video streaming were identified by Virtual private network issues were reported by I have missed emails or have trouble finding [them] because of the way this web product groups email history.

The results indicate that ICT strategies in the setting examined should take into account the dissemination of research capabilities of the college, and the available learning tools to develop proposals and track progress. Collaboration on research and grant writing should be also taken into consideration. Student participants attributed great importance to disseminating their research activities through the intranet, which was also supported by faculty and staff to a lesser extent and should be taken into account.

The least importance was assigned to learning how to create web pages, create YouTube videos, and use Skype. Reasons for these findings could be a lack of understanding of the potential uses of these tools in the academic and research setting. Participants of older age groups, however, more often attributed moderate to high importance to Skype training, which may be the result of a generational gap in familiarity with the use of such communication technologies.

Interaction with the Blackboard system was given high importance among the participants, which may signify that more training on how to operate the system is needed before users become confident with it. Tools involving graphic design and digital audio and video were not given as much importance as other tools, which may signify that they are currently underused.

This finding may signal a missed opportunity because such tools can be effectively used to support public health messages, in the development of social marketing campaigns, or in behavioral change theories and models, for example. ICT problems reported to be of high importance were personal computer speed, Internet access, printer issues, and computer backup procedures.

Classroom and conference room technology maintenance and support is of high importance for the participants and should be prioritized by ICT personnel.