Kate Eddens Matthew W. Kreuter Health Communication Research Laboratory Washington University in St. Louis Keeping clients healthy: Integrating proactive health screening and referral into systems

Eliminating health disparities by increasing the reach and effectiveness of cancer information in low-income and minority populations.

- Integrating cancer communication into practice - System-level interventions - Real-world settings

Food Stamps - Public Housing - Low-income Energy Assistance

Why this approach? Three key points Basic needs supersede cancer prevention

Why this approach? Three key points Basic needs supersede cancer prevention Systems addressing basic needs reach millions

Why this approach? Three key points Basic needs supersede cancer prevention Systems addressing basic needs reach millions Integration of health could be a Win-Win-Win

1. Our study results 2. Activities nationally 3. Questions & discussion Todays presentation

Study 1: Is it feasible? Kate Eddens, Matthew Kreuter, Kay Archer, Debbie Fagin

Pilot study November, 2007 – February, 2008 Aim 1: Estimate cancer control needs of callers Aim 2: Determine feasibility of cancer referrals

- Mammography - Pap testing - Colonoscopy - HPV vaccine - Smoking - Smoke-free home policies

Disparities associated with all of them Effective tests or interventions for all Programs available that provide them for free Why these six?

Mammograms Pap smears Colonoscopies HPV vaccination Smoking cessation Smoke free home policy

Need at least one85% Need two or more54% Need three or more30% Current cancer control needs of callers Eddens K, Kreuter MW, Archer K. J of Social Services Research (under review).

No health insurance callers (n=297) vs. Missouri vs. U.S.

Current cigarette smoker callers (n=297) vs. Missouri vs. U.S.

Has a smoke-free home policy callers (n=297) vs. Missouri vs. U.S.

Ever had a colonoscopy (ages 50) callers (n=107) vs. Missouri vs. U.S.

Pilot study November, 2007 – February, 2008 Aim 1: Estimate cancer control needs of callers Aim 2: Determine feasibility of cancer referrals

Telephone follow-up 2 weeks later - - What did they think of the mailed referrals? - - Did they make a call and/or schedule an appointment?

Reactions to mailed referrals (n=39) Outcome % Recall getting referral 92% Recall getting mailing 54% Read all of mailing 41% Liked mailing a lot 62% Very easy to understand 67% Called referral agency 26% Made an appointment 13%

Willingness to participate Among callers in pilot study 58% agreed to answer cancer risk questions 91% agreed to participate in randomized trial 81% could be contacted at 2-week follow-up

Appropriateness of health questions Among callers in pilot study Should be asking about health? (56%) Health questions too private? (5%) Comfortable with mailed health info? (81%) Health referrals make more appealing? (100%)

How is call length affected? Time to administer survey & provide referrals Mean = 4:54 minutes Enroll into study Mean = 2:52 minutes

Conclusions High level of need among callers Proactive health referrals are feasible via Mailed reminder referrals seem promising

What do we still need to learn? Is it scalable? How strong a referral is needed? Does it work equally well for all callers?

Study 2: National prevalence study Jason Purnell, Kate Eddens, Matthew Kreuter 2-1-1s of Missouri, King County, Houston, North Carolina Cancer Prevention and Control Research Network

Administered in four systems

callers (n = 1,413) BRFSS (n = 415,194) callers vs. U.S. population

- Need at least one72% - Need two or more42% - Need three or more17% Cancer needs of callers (n=1,413)

No health insurance callers vs. U.S. (p <.001)

Current smokers callers vs. U.S. (p <.001)

Smoke-free home policy callers vs. U.S. (p <.001)

Ever had colonoscopy (50+) callers vs. U.S. (p <.001)

Up-to-date mammogram (women 40+) callers vs. U.S. (p <.001)

Up-to-date Pap test (women 18+) callers vs. U.S. (p <.001)

HPV vaccination (women 18-26) callers vs. U.S.

Study 3: Statewide intervention study Matthew Kreuter, Kate Eddens, Nikki Caito Kassandra Alcaraz, Jason Purnell, Anjanette Wells, Debbie Fagin, Nikisha Bridges, Tiffany Aziz

- Mammography - Pap testing - Colonoscopy - HPV vaccine - Smoking - Smoke-free home policies

Mammograms Pap smears Colonoscopies HPV vaccination Smoking cessation Smoke free home policy

Telephone follow-up 1 and 4 months later - - Did they contact referrals? - - Did they obtain needed services?

Telephone follow-up 1 and 4 months later - - Did they contact referrals? - - Did they obtain needed services?

Telephone follow-up 1 and 4 months later - - Did they contact referrals? - - Did they obtain needed services?

Telephone follow-up 1 and 4 months later - - Did they contact referrals? - - Did they obtain needed services?

Coach Help callers act on referrals by: Making appointments Providing reminders Arranging transportation Answering questions Addressing barriers Explaining systems

- 31 enrolled in pilot - 29 contacted in 3 weeks (94%) contacts per person (range 1-6) - 35% success rate (11 of 31) Enrollment and contact

- 21 smokers (10 called Quitline) - 6 needed Pap test (1 obtained, 1 in progress) - 5 needed mammogram (1 in progress) - 3 needed smoke free home (2 called hotline) - 3 needed HPV vaccination (0 obtained) - 2 needed colonoscopy (0 obtained) Needs and resolution

1. Which approach works best? 2. Whats the impact on quality indicators? 3. What factors influence effectiveness? Key questions

1. Problem resolution 2. Unmet basic needs 3. Sense of coherence - comprehensibility - manageability - meaningfulness Factors that could affect outcomes

What will we learn? Need for cancer prevention in callers Effectiveness of referrals for health Added benefit of mailed referrals vs. coaches Effects when original problem is solved by Effects by level of basic needs, SOC

Activities nationally

2-1-1 and Research Collaboration Presentations to major organizations National Cancer Institute U.S. Centers for Disease Control and Prevention American Society of Preventive Oncology The International Communication Association Substance Abuse and Mental Health Association

2-1-1 and Research Collaboration Health Screening and I&R webinar Invited webinar to AIRS members 104 attendees

2-1-1 Health and Human Services Research Consortium Pairing systems and researchers Combining, refining, and analyzing data Providing evaluation and funding assistance Laying ground rules for collaboration Setting a research agenda

2-1-1 Research Consortium Who is participating now? United Way systems Health care systems National Cancer Institute (CECCR) Centers for Disease Control (CPCRN) University-based researchers

2-1-1 Research Consortium Special Journal Supplement Full issue dedicated to research with Published in wide-reaching scientific journal Expected to be published in 2011 Funded by the National Cancer Institute

Special Journal Supplement Why should I care? Raise awareness of Present opportunities for collaboration Show the value and reach of Lend credibility to 2-1-1

Special Journal Supplement Table of Contents Introductions Brief empirical reports Summary and commentary

Table of Contents Introductions Introduction to the Supplement I: Rationale for embracing research partnerships

Table of Contents Introductions Introduction to the Supplement II: A grand vision for research collaboration

Table of Contents Introductions The case for collaboration between systems and health researchers

Table of Contents Brief empirical reports Cancer risks of callers in Missouri, North Carolina, Texas and Washington

Table of Contents Brief empirical reports Findings from cost-benefit studies of systems: A review

Table of Contents Brief empirical reports Media strategies to increase use of during the mortgage crisis

Table of Contents Brief empirical reports Unmet health needs in Texas during disaster and recovery, Katrina-Rita, 2005

Table of Contents Brief empirical reports Other brief reports to be solicited from systems nationally

Table of Contents Summary and commentary Guiding principles for collaborative research with 2-1-1

Table of Contents Summary and commentary A research agenda and future directions for collaborative research with 2-1-1

Table of Contents Summary and commentary Commentary on the Special Supplement

Special Journal Supplement Call for Papers Surveillance Special initiatives H1N1 / SARS / Other health initiatives Disaster Aging and disability

Ongoing interaction with 2-1-1s AIRS meetings Survey of system leaders

How would you rate your evaluation process for standard services? (n=22) percent

How would you rate your evaluation process for special initiatives? (n=23) percent

Have you ever worked with researchers? (n=23) percent

How would you rate your experience working with researchers? (n=22) percent

What is your greatest concern about working with researchers? (n=23) percent

What would be the greatest benefit of working with researchers? (n=23) percent

Contact information: Kate Eddens Matthew Kreuter