Engaging Diverse Populations in Chronic Disease Self Management Programs Quarterly Self-Management Webinar Series Oregon Health Authority September 19, 2012 Phone conference line: Participant code:

Moderator  Laura Chisholm – (formerly Saddler) Self-Management Technical Lead, Oregon Public Health Division Oversees statewide self-management program sustainability efforts

Learning Objectives –Identify effective ways to engage members of diverse populations in self-management programs through targeted marketing –Articulate culturally specific ways to encourage continued participation in programs (retention) –Share successes and challenges in engaging people in programs who experience social stigma as a result of their chronic condition(s)

Some Requests –Please mute your phone: #0, option 1 = mute/un-mute –Use the chat function for questions –Please participate!

Let’s hear from the audience! –Poll: What is your main role with self-management programs? –Poll: What populations do your programs serve now?

Presenters  John Motter – Speakers Bureau Coordinator, Cascade AIDS Project Leads HIV Basic and Positive Self Management Programs

Presenters  Catherine Potter – Eastside Program Director, Parish Health Promoter Program Coordinates trained Latino immigrant volunteers from faith communities who carry out programs, including Tomando Control de su Salud

Community characteristics Parish Health Promoter Program serves: –Low-income Latino immigrants in Portland –Focus on faith communities –Health promoters are dedicated volunteers from participating parishes –“Tomando Control” classes are 1 of several regular ongoing activities

Community characteristics – Tomando Control participants –Most participants are working adults –People hear about classes through word of mouth and through their churches –Less than half of participants “register” ahead of time –Important that class is free, food is provided –Sometimes childcare is needed

Successful recruitment – Tomando Control –Volunteers and past participants are best spokespeople –Promote class at health screening events –Explain class well –Communicate what they will gain from it –Location is key

Successful recruitment – Tomando Control –Announcements at church are our best strategy –Personal contact with class leaders before class is important –Make use of community partners in recruiting –Partner with local clinics that don’t offer classes but want patients to attend

Common Characteristics – People Living with HIV –Numerous co-morbidities (i.e. diabetes, bone density problems, Hepatitis C, etc.) –Medication adherence problems –Medication side effects –Mental Health and/or Substance Abuse (not all) –Disease discrimination and stigma

Distinct Characteristics It’s some of the distinct characteristics that create barriers in engagement. –Males who identify as gay –Socio-Economic Status (Employed vs. Disability) –Heterosexual Women –Heterosexual Men –Intravenous Drug Users (IDU)

Positive Self-Management Program –PSMP was first piloted in 1994 –7 weeks instead of 6 weeks –In studies: –Improvements in symptoms –Significantly better medication adherence –Better HIV suppression in blood after 6 months –No more side effects than non-PSMP participants

What should recruiters be aware of? –HIV+ individuals can benefit from attending CDSMP (Living Well) workshops if a PSMP workshop is not currently scheduled. –Evening workshops may be more effective in order to reach those individuals who still work –Many individuals aren’t likely to be clients of, or affiliated, with an HIV/AIDS organization –There can still a significant level of stigma associated with coming to a program sponsored by Cascade AIDS Project (CAP)

What means of recruitment are likely to be successful? –Facebook and other social marketing –Personal connections with direct phone calls –Housing and Medical Case Managers –Mailings to CAP’s “Positive Directions” list –Marketing to a specific target group (i.e., Kid’s Connection, Women of Wisdom, Oregon Bears)

What means of recruitment are likely to be unsuccessful? –Housing and Medical Case Managers –Individuals can feel pressured –Afraid of losing services for not attending (MYTH) –Mailings to CAP’s Positive Directions

Participant retention – Tomando Control –Lots of phone contact important (between each class) –Make sure people understand class well before starting –Give out books at 2 nd class –Explain incentives for workshop completion (certificate, book, gifts) at beginning

Materials – Tomando Control –Flyers serve as reminders (date, time, place) –Flyers should include photos with variety of ages –Make sure language is appropriate for group –(sample flyer)

Tomando control de su salud Siéntase mejor. Tome control. Haga las cosas que USTED DESEA hacer. Asista al taller… ‘Tomando control de su salud’ Enfermedades crónicas son la diabetes, artritis, alta presión de la sangre, asma, depresión, enfermedades del corazón, dolor crónico, ansiedad, y fibromialgia. Si usted o algún ser querido tiene una de estas enfermedades, el taller ‘Tomando control de su salud’ puede ayudarle. “Ahora siento más energía que la que he tenido en años. Me siento más tranquilo y con mayor confianza en lo que se refiere a mi salud.” Cada taller…  Es completamente gratuito  Es una vez a la semana por 2 ½ horas  Dura un total de seis semanas En el taller aprenderá a:  Planificar sus comidas, alimentarse mejor  Trabajar con su equipo de la salud  Ponerse metas semanales  Solucionar problemas eficazmente  Afrontar emociones difíciles  Organizar la toma de sus medicamentos Sabados: Agosto 11 - Septiembre 15, :00 am – 11:30am Iglesia Santa Ana 1015 SE 182nd Ave., Gresham, OR Para inscribirse o más informacion, llame:

Retention is an Issue for PSMP –Retention rates have ranged from 25% to 70% –Newer workshops have been at the higher range –Improved due to: –Better screening of participants at time of sign-up –Targeted audience workshops –Gift card incentives each week (insure that everyone has received one by final day) –Providing food and/or child care

Marketing Materials and Distribution - PSMP –Flyers –Direct phone calls –How do you distribute them? –Listservs –Direct mailings to clients –Facebook

What messages about self- management seem to resonate best? –Knowledge that at least one leader is also HIV+ –Being able to improve treatment adherence –Being able to address side effects

Corrections Population –Community characteristics –Marketing –What works? –What messages resonate best? –Participant retention –How to reach people who’ve been recently released?

Questions for the presenters?

Let’s Hear from the Audience! –Poll: What is your biggest challenge in terms of recruiting and retaining a diverse population of participants in your programs? –Discussion question: How have you overcome this challenge?

Who’s Attending Our Programs? In 2011, participants statewide were: –75% female, 25% male –1% African American –4% American Indian/Alaska Native –6% Asian/Pacific Islander –81% White –18% Latino/Hispanic ethnicity –Aged (average age 60)

Who’s Attending Our Programs? Chronic Condition Percent (number) attending LW/TC/PSMP/DMSP statewide in 2011 Arthritis/fibromyalgia48% (1,002) High blood pressure42% (890) Chronic pain38% (789) Depression41% (869) High cholesterol34% (714) Diabetes32% (667) Cancer survivors11% (225) HIV+2% (33) 2012 Living Well Data Report: DiseasesConditions/ChronicDisease/LivingWell/Documents/Reports/statedata12.pdf

Who’s Attending Your Programs? –See county reports at ChronicDisease/LivingWell/Pages/pubs.aspx#county ChronicDisease/LivingWell/Pages/pubs.aspx#county

Let’s Hear from the Audience! –Who are your programs effectively reaching? –Who are they not reaching? –How can you overcome this challenge?

Let’s Hear from the Audience! –What is your #1 take-away from the discussion today?

Presenter Contact Information John P. Motter Speakers Bureau Coordinator Catherine Potter Eastside Program Coordinator Parish Health Promoter Program

Thank you for participating! Oregon Living Well Program Oregon Public Health Division (888) or (971)