Winning
Proposals
2002-2003 Secretary's Award for Innovations
in
Health Promotion and Disease Prevention
Fulfilling
the PROMISE of Health Communication: Implementing a Visual
Intervention Among Homeless and Low-income Patients
Vijay
Bhandari and Cesar Castro
University of California San Francisco, School of Medicine
Abstract
A
number of barriers are known to preclude effective communication
between patients and the health care system. Foremost among
these is poor health literacy, a measure of patients' ability
to read, comprehend, and act on medical instructions. Other
communication barriers include limited English proficiency,
cultural differences between patient and provider, depression,
anxiety, organic brain syndromes, and substance abuse.
Poor
patient-provider communication adversely affects patient
satisfaction, patient adherence to provider recommendations,
and even health status. Of particular concern are the nation's
half million homeless, who suffer disproportionate rates
of communication barriers. Innovative approaches to improve
treatment adherence among populations with communication
barriers, and in particular homeless patients, are needed.
We
will implement a Pictorial Reminder Of Medication Instructions
and Side Effects (PROMISE) system at a student-run free
clinic serving low income and homeless, ethnically diverse
patients. PROMISE cards exploit the benefits of digital
photographs of the prescribed medication and illustrations
that explain how to take this medication or what side effects
may result from the medication. Our computer-generated PROMISE
cards will be printed in the three most prevalent languages
of our clientele (English, Spanish, and Chinese). The objectives
of the PROMISE cards are: 1) to facilitate oral communication
between patient and provider. 2) to improve patient-provider
concordance with the treatment regimen. 3) to improve patient
satisfaction with the provider's communication skills. 4)
to improve patient adherence to the prescribed treatment
regimen. Pilot testing indicates that our simple, inexpensive,
language-concordant intervention will be well received by
our patients and support the goals of Healthy People 2010
in using innovative strategies to improve health communication.
Bridge
Over Troubled Waters: Project Bridge
Ashish
Sahasrabudhe and Michael A. Gentile
Harvard University, School of Dental Medicine
Abstract
Volunteer-supported
community dental clinics are often short of supplies and
staff, impeding their ability to run efficiently. Bridge
Over Troubled Waters (BOTW), an established organization
that provides outreach, counseling and primary health and
dental care services to runaway teens in Boston, has a dental
clinic that similarly suffers from these insufficient resources.
To aid in the need for dental care among Boston's runaway
teens, a pilot student-run collaboration called Project
Bridge was started three years ago between Harvard School
of Dental Medicine (HSDM) and BOTW. Project Bridge began
as a monthly program where fourth year dental students,
assisted by dental student junior to them, volunteered in
BOTW's dental clinic under faculty supervision. A year after
the program's initiation, Project Bridge has become a vehicle
for students to exercise their creative capacity in a broad
range of fields, including the submission of grant proposals
and writing letters for commercial contributions and donations,
creation of comprehensive education programs designed to
teach both BOTW's staff members and teens comprehensive
oral health care, and collection of data on dental needs
in a runaway youth population, as well as data on the effectiveness
of these educational programs. Specifically, educational
programs include preventative oral health care, general
dental education and anti-smoking information. In addition,
student efforts have resulted in outside financial support
to fund this initiative. This support has helped to satisfy
the dental needs of runaway teens in Boston and has served
to increase the students' ability to creatively think of
solutions to help solve dental needs in the community.
Shifting
the Lens: A Focus on Stress and Coping Among African American
Adolescents in East Baltimore
Anita Chandra and Ameena Batada
Johns Hopkins University, Bloomberg School of Public
Health
Abstract
There
is limited information on mental health issues in the African
American community, particularly among African American
adolescents. This is particularly troubling given the problem
of unmet need with respect to mental health care in this
population. Moreover, the youth perspective is missing from
the limited work on adolescent mental health, including
research on stress. Understanding the relationship between
stress and mental health problems for African American teens
greatly improves our ability to meet their unique needs.
The goal of Shifting the Lens: A Focus on Stress and Coping
among African American Adolescents in East Baltimore is
to increase understanding of stress and coping issues for
African American urban youth and to inform youth service
providers on ways to more appropriately serve this population.
Shifting
the Lens consists of two phases. Phase One: Data Collection
involves a series of quantitative and qualitative methods
in order to describe how teens, their primary caregivers,
and youth service providers discuss adolescent stress and
where the opportunity for improvement in mental health services
exists for this population. Phase Two of Shifting the Lens,
the Communication Project, involves local youth in the translation
of the findings from Phase One into community action. Teens
design, produce, disseminate, and evaluate a video to convey
information about stress and coping to the greater community.
Shifting
the Lens is one of the first initiatives to explore stress
and coping among African American teens living in an urban
setting from the youth perspective. Adolescents are the
leaders in framing the issues that affect them through a
unique health communication project, a video intended to
raise awareness about stress and coping among teens in East
Baltimore. The findings of the project will address the
disparities in mental health service use for African American
youth by highlighting ways to improve mental health care
for this population.
Heart to Heart: Putting Heart Health
First
A Collaboration to Promote Heart Health Among People and
Their Pets
S. Michelle Goree and Sara K.
Matteson
Auburn University, Medical College of Georgia, School
of Medicine, School of Veterinary Medicine
Abstract
The
present project outlines the implementation of a public
health screening clinic collaboratively conducted by medical
and veterinary students as a means of simultaneously promoting
heart health among people and their pets. It is designed
according to two important premises: that taking care of
another living thing often promotes self-care, and that
the interdependence of human and animal welfare can provide
a basis for motivating people to aspire to and achieve greater
heart health. By screening for human hypertension and canine
heartworm disease (Dirofilaria immitis) at such a clinic,
students are able to identify those in a community who are
at risk for heart disease. Then, using an interdisciplinary
educational pamphlet and poster designed to emphasize the
similarities between controlling high blood pressure in
humans and preventing dirofilariasis in animals, physicians
and veterinarians in training are able to counsel individuals
regarding appropriate treatment and behavior change. Proposed
intervention methods also serve as opportunities for medical
and veterinary students to gain valuable experience in patient
education and motivation. Opportunities for professional
students to practice patient/client counseling have been
identified as areas demanding increased emphasis within
medical curricula. "Heart to Heart" provides aspiring
physicians and veterinarians a unique practical setting
in which to practice negotiating compliance barriers and
to compel patients and clients to comply with prescribed
treatments.
University
of Iowa Mobile Clinic
Nicholas
Mohr, Amanda Jones, Kelly Herbert, Dominic Cirillo, Andrea
Rebman, and Jennifer Loucks
The University of Iowa, College of Medicine, College
of Pharmacy, College of Public Health, College of Nursing,
College of Dentistry Abstract
The University of Iowa Mobile Clinic is a student-run community-centered
health care treatment and education initiative designed
to provide screening, treatment, and prevention services
to targeted communities in Johnson County, Iowa that are
not well served by the current medical infrastructure. We
have approximately 200 student volunteers drawn from programs
in medicine, pharmacy, nursing, social work, dentistry,
and public health. Currently, we are serving people in four
local communities who have inadequate access to health services
due to their remote location, unique cultural composition,
or extreme poverty. We focus on the detection and management
of chronic conditions that would otherwise cause significant
morbidity and mortality.
Since
September 2002 the University of Iowa Mobile Clinic has
been serving targeted communities in partnership with community
leaders, other local aid agencies, the University of Iowa
Hospitals and Clinics, and the Carver College of Medicine-the
only allopathic medical school in the state of Iowa. We
regularly hold clinics at two low-income housing centers,
a homeless shelter, and a rural school district with a significant
Hispanic immigrant population to provide basic assessments,
education, counseling, and referral services. Our efforts
are closely aligned with the goals of Healthy People 2010
in extending access to quality health care for targeted
populations poorly served in rural areas. Our objective
is to use a focused public health approach to detect and
manage chronic illnesses that cause much of the morbidity
and mortality in our patient populations. We are striving
to provide long-term, comprehensive health care in a culturally
sensitive manner that can facilitate measurable improvement
in the health status of the populations we serve.
Students
In The Community (SITC): A Collaborative Effort to Provide
Quality Health Care to the Homeless.
Brian Johnson, Marie Bach, Lauren
Hafner, Hanako Tani, and Denice Hotz
University of Washington, School of Medicine, School
of Pharmacy, School of Public Health, School of Nursing,
School of Social Work Abstract
Homeless
populations face high risks of health problems and encounter
multiple barriers to care. As the number of homeless in
our cities continues to rise, there is an increased need
to insure accessible and quality health care to these populations.
Health science students from the University of Washington
recognized gaps in providing affordable healthcare and preventive
services to the homeless and transitional housing populations
of Seattle. To address these issues, students from a number
of disciplines established SITC: Students in the Community.
This interdisciplinary group includes over fifty medical,
public health, nursing, pharmacy, and social work students.
The goal of SITC is to develop and maintain a free, student-run
clinic to provide health promotion, prevention, screening,
medical referral, social support and health education to
the underserved communities in Seattle. The clinic will
fulfill a need in the community for accessible, affordable
healthcare and preventive services, while meeting needs
within the University of Washington health sciences community.
It will enhance students' exposure to underserved populations
and expand their opportunities for interdisciplinary learning.
To implement these goals, SITC has paired with the Aloha
Inn, an organization providing transitional housing for
homeless men and women in Seattle. The availability of health
education and promotion, as well as medical and social referrals,
will help residents to address and plan for their health
needs in this transitional time. Ultimately, this pairing
of the student-run clinic and the Aloha Inn both has been
designed to meet, and will be guided by, the needs of the
residents at the Aloha Inn. It will be run jointly by those
residents and health science students of the University
of Washington.
