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Flu: What You Can Do – Caring For People At Home Statewide Educational Campaign Allison Hackbarth, MPH Health Education Unit Manager and Epidemiologist.

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Presentation on theme: "Flu: What You Can Do – Caring For People At Home Statewide Educational Campaign Allison Hackbarth, MPH Health Education Unit Manager and Epidemiologist."— Presentation transcript:

1 Flu: What You Can Do – Caring For People At Home Statewide Educational Campaign Allison Hackbarth, MPH Health Education Unit Manager and Epidemiologist Massachusetts Department of Public Health Division of Epidemiology and Immunization October 15, 2008

2 Summarize the impact of seasonal flu and a flu pandemic Describe current pandemic planning educational initiatives at DPH and how the current campaign relates to them List the goals and objectives of the campaign Summarize the development and implementation of the campaign Summarize evaluation data (pre- and post-testing) Identify how businesses can potentially incorporate using campaign materials to educate their employees Learning Objectives

3 Impact of Seasonal Influenza Approximately 36,000 influenza-associated deaths during each influenza season in the US (1990 – 1999) –19,000 deaths from 1976 – 1990, increasing in part due to the larger population of older person –Note that there is higher mortality in seasons in which influenza A virsus predominate Average of 226,000 influenza-related excess hospitalizations Millions more affected The term flu is used very generically, leading to a perception that its not serious

4 In Massachusetts – Season peaks in January - February and can last into April or May –~800 residents die from complications of flu –2,600 - 5,000 excess hospitalizations –300,000 – 1.3 M residents get the flu –Puts a surge on the healthcare system Impact of Seasonal Influenza

5 Pandemic Flu Flu virus is constantly changing Drift: Minor change due to constant mutation –A reason why flu vaccine must be updated each year Shift: Major change with new virus causing human infection –Pandemic potential Pandemic: A sudden, widespread outbreak caused by a new strain of an influenza virus

6 Pandemic Flu Because the virus is new, virtually no one is immune - all exposed could get sick Pandemic influenza may occur at any time of year, but conditions most favor rapid spread during regular flu season Occurred in 1918, 1957, 1968 Spread rapidly throughout the world Result in an unusually high number of cases and deaths Duration of 1-2 years; may have second wave

7 Impact of an Influenza Pandemic In Massachusetts – 2 million clinically ill – 80,000 hospitalizations – 20,000 deaths High volume of outpatient visits and hospitalizations Existing facilities will be overwhelmed Vaccine and antivirals will be in short supply Up to 40% absenteeism in all sectors

8 Why is a pandemic different from other disasters? Every community will experience the pandemic as a local event There will be little help available from the federal or state govt. No community or hospital will be able to respond alone The entire community will need to work together to respond effectively –e.g., when schools close, the parents must keep the children at home for the strategy of social distancing to be fully effective Impact of an Influenza Pandemic

9 Vaccine, antivirals, antibiotics will be in short supply Existing facilities will be overwhelmed Impact of an Influenza Pandemic

10 MBTA cuts back service Delivery of goods curtailed Impact of an Influenza Pandemic

11 Prisons and jails on 24-hour lock-down Day care centers for children and the elderly are closed Impact of an Influenza Pandemic

12 The ultimate toll that a pandemic takes on the community (and its mitigation) will be a direct reflection of: community and individual awareness the level of community and individual preparedness the use of community containment measures community resiliency With many people ill and heavy demand on the health care system, it is important that people are prepared to care for family with cases of the flu at home Impact of an Influenza Pandemic


14 Pandemic Planning Activities Continuity of Society –State agency and provider COOPs and COGs –Supply chain –Community containment –Provider payment –Indemnification Surveillance and Reporting –Sentinel / influenza-like illness

15 Policy Direction –Command and control –MEMA –Emergency Service Functions (ESFs) Healthcare Providers –MA System for Advanced Registration (MSAR) –MA Reserve Corps (MRCs) –Indemnification Pandemic Planning Activities

16 Healthcare Surge –Flu surge and gap analysis –Materials and equipment (SNS) –ISCU development –Altered standard of care / liability –Care at Home Pandemic Planning Activities

17 Fall 2005: Public Engagement Project – input at the community level, ongoing Winter 2006: Harvard School of PH study Spring 2006: – Be Prepared for Pandemic Flu education & training program for local health departments – MDPH Flu Forums – education for schools, businesses, faith-based organizations, colleges & universities Pandemic Planning Educational Initiatives at MDPH

18 Pandemic Planning Educational Initiatives at MDPH (cont.) Fall 2006: Flu Facts statewide educational campaign 4 main messages for the general public 1) Wash your hands 2) Cover your mouth when you cough or sneeze 3) Get a yearly flu vaccine 4) Make a family emergency plan Use of the media (TV and transit) to distribute info

19 Flu Facts Campaign

20 Pandemic Planning Educational Initiatives at MDPH (cont.) Fall 2007: Flu: What You Can Do statewide educational campaign Expansion of the Flu Facts campaign As there are less cases in avian flu cases in Asia/Europe, less attention here but a pandemic is real Focus on flu care at home during both yearly seasonal flu and a flu pandemic A reinforcement of the message that caring for a someone with the flu during a pandemic will be very similar to what the general public already does during each regular flu season

21 Public and Private Partnership Content development and review: Boston, Amherst and Needham Health Departments Harvard School of Public Health Harvard Vanguard Medical Associates - Atrius Health Home Health Care Alliance of Massachusetts Massachusetts Chapter - American Academy of Pediatrics U-Mass Memorial Health Care, Dept. of Pediatrics

22 Public and Private Partnership Financial support from: Blue Cross Blue Shield of MA Harvard School of Public Health Harvard Vanguard Medical Associates - Atrius Health Massachusetts Medical Society

23 Target Audience and Goals of the Flu: What You Can Do Campaign Target Audience: The general public Two Main Goals: 1) To build community preparedness and resiliency that will become very important during a pandemic 2) To reduce the potential surge of patients seeking care at hospital emergency rooms and alternative care sites during a pandemic Note that these goals will not be achieved in the short-term and the campaign will need to be carried out over multiple years.

24 Learning Objectives of the Campaign To increase the knowledge regarding the similarities and differences between seasonal and pandemic flu To provide information and tools to care for persons with influenza at home To provide information and tools to simplify communication with health care providers and help determine when an office visit or emergency medical help is indicated A reinforcement of the message that caring for a someone with the flu during a pandemic will be very similar to what the general public already does during each regular flu season

25 Development of the Campaign Formative Research Focus groups held with the public to learn about: –Their understanding about flu care issues –Understanding of a pandemic –Types of information they need –Preferences for receiving flu care information

26 Key Findings: People have experience treating the flu, but need more info Want specific instructions and details on: – Symptoms, illness duration – Prevention, treatment and preparation – When to call a doctor or get medical care Fear regarding a pandemic Information should be comprehensive and provide: – Resources to help other family members prepare for and understand flu care at home – Simple, consistent messages in easy-to-read formats Development of the Campaign

27 Two Main Educational Materials: Booklet and DVD Contain information on the following 1) Reduce the Risk, Reduce the Spread: – How flu is spread, vaccines and other medications, and methods to reduce risk and spread 2) What to Look for, What to Do: – Flu symptoms and home treatment, when to seek medical advice or care 3) Prepare Yourself, Prepare Your Home: – Supply list, information summary for the doctor, summary of personal contact information Development of the Campaign


29 Flu: What You Can Do DVD DVD is 22-minutes, same topics as booklet, but less detailed info

30 Flu: What You Can Do Website

31 Implementation of the Campaign Fall 2007 (Passive Education): Statewide mailing of letter (from MDPH Commissioner), booklet and DVD samples to local boards of health, community health centers, school nurses and some healthcare providers DVD also sent to local cable access stations Order form as the mechanism to obtain more copies Available for download on MDPH website Booklet available in Spanish, Portuguese, Chinese, Vietnamese and Haitian Creole DVD available in Spanish (more languages dependent on funding)

32 Fall 2007 (Active Education): Goal was/is to recruit locally-based educators to help DPH implement the campaign around the state Locally-based educators trained on the content through train-the- trainer sessions, taught by a group of MDPH staff Educators then turn around and educate in their communities Through distribution of materials, giving educational presentations (at such places as senior centers, libraries, schools, etc.), or bringing info to already established events Implementation of the Campaign

33 Community education strategy development: Who is your target audience? How can they be reached? Are there any unique issues to address for your audience? How will you promotion, plan and identify community partners? Are there any barriers such as language and being homebound? Implementation of the Campaign

34 Active Education Step 1: Training of DPH staff to implement T-T-T sessions Step 2: Preparing local educators through the T-T-T sessions Step 3: Outreach and education to the general public MDPH Staff Local Board of Health Staff School Nurses CHC Staff MRC Volunteers Health Plan Staff VNA Nurses Library Seminar Church Group High School Health Class Mothers Group PTA Meeting Senior Center Health Plan Ed Classes

35 Response To-Date Overwhelming positive response Large demand for booklet; distribution to-date of more than 330,000 booklets Highest demand from schools (elementary, middle & high schools) Distribution of more than 1,000 DVDs Implementation of 23 train-the-trainer sessions across the state resulting in the preparation of 275 participants to become part of the education team.

36 Current Flu Season: 2008 - 2009 Development of a lower literacy educational item Provide another round of 14 train-the-trainer sessions Expand the campaign to reach even more residents, including greater numbers of people who do not read English, and those who may need special assistance during an emergency Increasing partnerships with community members that represent diverse populations Challenge of sustaining campaign with decreasing federal funds

37 Evaluation Data Pre- and post-testing of knowledge, behaviors in the home, and perceptions of various aspects of seasonal and pandemic flu Group of 100 participants –50% read the booklet; 50% viewed the video Age range of 18 – 60+ Household income: 82% reporting under $50,000 Education level: –67% had completed high school, trade school or some college –17% had completed college –16% had completed graduate level work 81% own a thermometer

38 Evaluation Data (cont.) Knowledge: Of the 32 measures, small - large improvement on 26 (81%) A few examples: Knowledge already quite high for understanding flu symptoms and spread –Largest change was understanding that diarrhea and vomiting are often not a symptom Large change regarding differences between seasonal vs pandemic flu Large change regarding understanding that rubbing alcohol should not be applied to the skin No change for contacting a doctor when someone is having trouble breathing and other emergency situations

39 Evaluation Data (cont.) Confidence: Largest changes in confidence: –Taking care of someone at home for both seasonal and pandemic flu –Treating dehydration –When to call a doctor Already high confidence with taking a temperature

40 Evaluation Data (cont.) Intention to change behaviors in the home: Nearly all state that they currently wash their hands and cover their mouths while coughing/sneezing (98%) Many got the flu vaccine last season (64%) Greatest intention to make changes in the home are with: Checking cleaning supplies Stocking up on appropriate foods and fluids Cleaning/disinfecting surfaces and objects Stocking up on medicines

41 Involvement of Businesses Can business get involved? Certainly How? Putting a link to the campaign website on your own website Ordering and distributing materials to employees - Note that quantities are limited but the files can be provided if you want or can produce quantities on your own Conducting education within your business through your occupational health department or other means (MDPH can provide a T-T-T session) Become part of the partnership by financially supporting the campaign

42 T-T-T sessions coming up –October 22: Weston, 6 – 8 pm –October 29: Fall River, 1 - 3 pm –November 5: Marthas Vineyard, 5 – 7 pm –November 12: Easthampton, 6 – 8 pm To register, go to the Local Public Health Institute website at: Involvement of Businesses (cont.)

43 Harvard Vanguard Medical Associates Became a partner in the campaign last fall Purchased and distributed booklets & videos (for all their sites) Put booklets in waiting rooms, registration counters, etc Played video in waiting rooms Infection Control Manager attended one of the DPH T-T-T sessions

44 Recruited and organized an in-house T-T-T session for 15 staff (mostly nurses but 1 physician assistant) These staff then educated patients during visits, education series and through their patient newsletter Support of Infection Control Director (Dr. Ben Kruskal) and other Senior Leadership Harvard Vanguard Medical Associates (cont.)

45 Seasonal Influenza Preparedness Pandemic Influenza Preparedness

46 Campaign Website and Contact Information Campaign website: On the right side of the page under Featured Links, click on Flu: What You Can Do Allison Hackbarth, MPH Health Education Unit Manager and Epidemiologist Massachusetts Department of Public Health Division of Epidemiology and Immunization Work: (617) 983.6800 Email:

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