E-Health Training Program for Underserved Populations

1. E-Health Technologies to Address Underserved Populations: A Training Program Silvia Martinez, Ed. D., Howard University Kevin Lyons, Ph. D., Thomas Jefferson University Margaret Vescovich, MS, Holy Redeemer Home Care and Hospice Services ASHA Convention

2. eHEalth Summer Institute • Allied Health Center for Excellence in eHealth Promotion Programs for Underserved Populations (Allied Health CEEPs-UP)

3. Center For ExcellenceIN eHEALTH PROMOTION: ALLIED HEALTH CEEPs UP • Period of time: 2003-2006 • Disciplines involved: Occupational Therapy Physical Therapy Speech Language Hearing

4. Allied Health CEEPs – UPGoal • To develop a center for excellence in eHealth promotion • Partners • Center for Collaborative Research • Journey Home • American Speech-Language Hearing Association • Occupational Therapy • Physical Therapy

5. Allied Health CEEPs – UPObjectives • Conduct a yearly summer institute designed to teach allied health professionals how to develop eHealth programs tailored specifically to underserved populations • Train 60 allied health professionals how to develop eHealth websites

6. Allied Health CEEPs – UP • Teams of three individuals working in either urban, rural or Native American underserved communities • Combination of faculty and clinicians • Preference to interdisciplinary teams

7. Summer Institute: Overview • Week long, hands-on experience designed to provide the knowledge and skill to develop a web-based eHealth Promotion Program • Designed for interdisciplinary teams of clinicians and faculty • Teams bring plan for a program and refine and revise the plan during the week so that they will have the first phase of the website designed to address a significant health problem in an underserved community and a plan for its implementation

8. Summer Institute: Components • Tailoring health information to a community • Establishing an infrastructure in an underserved community • Addressing issues of computer and health literacy • Developing a website using a template and a website program

9. Summer Institute: Components • Evaluating other health related internet websites as appropriate links. • Conducting needs assessments • Developing a plan to evaluate the effectiveness of the eHealth Program • Understand the barriers to implementation

10. Projects • Creighton University-Omaha, NB • Omaha and Winnebago Ho-Chunk Indian Tribes • Interface with Tribal Community Health Education Office and Diabetes Program • Train community members to bring health information to the community • Training in computer and internet usage to increase access to allied health resources

11. Projects • Springfield Technical Community College, Springfield, MA • Develop “Healthline,” a user friendly health information website for underserved residents; • Black, non Hispanic (21%) • Hispanic (27%) • Asian (4%) • Caucasian (48%)

12. Projects • Holy Redeemer Home Care, Philadelphia, PA • Community outreach using the internet • Website for the care of the frail elderly • Research on four syndromes • Treatment protocols from Holy Redeemer • True stories of those helped by the program

13. Conclusions • If interested, go to the Center for Collaborative Research website, www.jefferson.edu/ccrgrants

14. Talking Fotonovelas for Low-Literacy Hispanics and African Americans Silvia Martinez, Ed. D., CCC-S Howard University

15. Support American Speech-Language-Hearing Association (ASHA) Multicultural Grants Project

16. Collaborators • Janice Trent, M. Ed. CCC-A – Howard University Speech and Hearing Clinic • Margarita Bautista-Vigas, M. A. CCC-S, Scottish Rite Center for Childhood Language Disorder

17. Assistants • Tara Smith, CCC-S, Doctoral Student, Howard University • Martine Ellis, CCC-S, Doctoral Student, Howard University • Johanna Losi, Master Student, Howard University

18. One of the leading health indicators is Access to Health Care (Healthy People 2000-2010) For minorities, financial, structural and personal barriers prevent access to health. The Issues

19. Barriers • Structural- A structural barrier includes the lack of service providers to meet the needs of clients. • Personal - Includes language barriers and lack of knowledge about health procedures.

20. Literacy Issues • The Center for Health Care Strategies has estimated that minorities and immigrants (50% Hispanics and 40% Blacks) have disproportionate literacy problems, which increase their health risks. • In Washington, D. C., adult education levels in the site communities are the second lowest with only 68.4% report having a High School education.

21. Literacy Issues • As reported by the National Library of Medicine (NLM), this study states that “one-third of English-speaking patients at two public hospitals were unable to read basic health materials.” • NLM also reports a Medicare finding that “34% of the English speaking and 54% of the Spanish speaking patients had inadequate or marginal health literacy”

22. Literacy Issues • The Institute for Healthcare Advancement summarized from research that written health materials • usually appear at the 10th grade level or higher (above average abilities), • that they include too much information and no explanation of uncommon words, • and that treatments are accompanied by complex instructions

23. Increase the knowledge of African Americans and Hispanic populations about speech and language pathology, and audiology issues and services. Meet the needs of health providers by developing materials to complement and enhance their services. Carry out research activities to probe the effectiveness of e-health web-based materials with low literacy and limited English proficient clients. Broad Objectives

24. Specific Aims • To describe health literacy growth in low-literacy clients after using web-based materials developed. • To describe health literacy retention in low-literacy clients after using web-based materials developed.

25. Fotonovelas • Fotonovelas are similar to comic books, contain photographs and simple dialogue bubbles, which address the needs of cultures with low literacy rates and oral traditions. • Internationally and historically have been effective as educational methods in the areas of education, health, and citizenship. They also have been used for entertainment.

26. An Example

27. How to Read a Book

28. Come on honey, let’s read.

29. Isn’t he too little to read? You can read to all children, even babies.

30. Oh, but I don’t read too well. You don’t need to know how to read.You can use the pictures.

31. I’ll show you. Come here Michael and Davonte.

32. I can use the pictures to tell a story from my head.

33. Next Steps

34. Holy Redeemer Home Care -Founded in 1928 as a Catholic Health System -Missions Statement -Located in Greater Philadelphia Area -Services provided

35. JCAHO Disease Specific Certification in the care of the Frail Elderly • Holy Redeemer Home Care is first in the nation to be granted this distinction as of September, 2003. • Who are the Frail Elderly? • Recertification process

36. Why Tailor Specific Care To Specific Populations??? • Commitment to care that is patient-centered. • Get beyond “generic” home care. • Quality of care should look different with different disorders. • Model for chronic care

37. Four Common Geriatric Syndromes • Often seen in combination • Make living independently difficult, often requiring more restrictive placement • Commonly affect the Frail Elderly: 1. Depression 2. Dementia 3. Falls Risk 4. Urinary Incontinence

38. DEPRESSION -affects about 6 million Americans over age 65 -frequently co-exists with other medical conditions -only 10% of older Americans receive treatment DEMENTIA -affects about 45% of the population 85 and older -chronic and progressive dysfunction -whether temporary or chronic, dramatically impacts every part of life Four Common Geriatric Syndromes

39. FALLS RISK -about 50% of those aged 80 and older are a falls risk each year -falls, and injury from falls, is a major reason for hospital and nursing home admissions. URINARY INCONTINENCE -experienced by 50% or more of elderly persons living at home -approximately 13 million Americans are incontinent (11 million are women) -UI accounts for many NH admissions Four Common Geriatric Syndromes

40. Holy Redeemer’s responsibility to Educate the Community • Along with the distinction with certification in the care of the Frail Elderly comes the responsibility to educate the Community • This includes educating the public about the Frail Elderly, as well as specific problems relating to clients, their caregivers and families • Informing the public of LifeAssess-a program implemented by Holy Redeemer Home Care, specifically designed to care for the Frail Elderly

41. An Interdisciplinary Approach to Web-Site Development • June of 2004- Fran Moore, PT, Kathy Staples, OT, and Maggie Vescovich, SLP, participated in week-long e-Health Summer Training Institute at Jefferson University in Philadelphia, PA. • Jefferson’s goal of e-health education for allied health professionals matched our desire to creatively educate the community as to the needs of the Frail Elderly.

42. LifeAssess.org • Collaboration • Design each syndrome to include a story, facts, self-survey and resources • Focus Group • Grant-Writing • Translations of website into Russian and Spanish • Provide field staff with laptop • Continuing Education re: Four Common Geriatric Syndromes

43. LifeAssess.org • What is fastest growing group of computer users and information seekers on the World Wide Web? • Who is more likely to talk to their physician about health information they found online-those in poor health, or those in good health?

44. CONCLUSIONS • LifeAssess.org connects clients, caregivers and families to needed health resources and information through eHealth • LifeAssess.org empowers healthcare consumers to be active participants in managing their disease • LifeAssess.org will further our mission to help seniors stay safely and comfortably in their own homes for longer than they might otherwise have