S

Heath Education and Literacy Project (HELP)

Community Service. Research. Education.

Club Mission

HELP is a community service project dedicated to providing health education and increasing health literacy through lessons at local adult education centers.

Additionally, our project seeks to teach medical students how to become advocates for public health and health literacy, as well as proficient counselors on health issues affecting the most vulnerable segments of the population.

The Health Education Literacy Project seeks to foster a spirit of learning by integrating a research component to assess the success of our interventions.

The final goal is to reduce health disparities in underserved communities through education and the publication of scholarly work.

Why HELP?

Educational inequities and health disparities exist.

HELP exists because there are people in the greater NYC area (and country) who lack health education AND have low health literacy.

We are working to improve the health knowledge and health literacy of the learners that we serve.

We also hope to improve student’s understanding of their risk for particular health conditions, and hope to motivate students to seek health services, if necessary.

Health Literacy

“Degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.” (HHS, 2000; IOM, 2004)

• Stronger predictor of health than age, income, employment, education, and race (JAMA, 1999)

• >1/3 of US adults have low health literacy (2003 NAAL; Kutner 2006)

• Minorities and low SES at increased risk for low health literacy

Health Knowledge

Health knowledge refers to one’s knowledge of specific health topics.

Individuals with low health literacy often lack knowledge or have misinformation about health topics.

Literacy impacts knowledge.

Who We Are

Group of over 50 medical students at NYU

Mostly MS2’s (and now MS1’s), with MS2’s and MS4’s leading our research initiative

Program began in 2009

Has expanded from 12 medical students

What We Do

Designed user-friendly, low literacy lesson plans

Teach lessons at an adult education site in Central Harlem: Nutrition Hypertension Diabetes

Conduct pre- and post- semester surveys

Analyze results at the end of each semester for scholarly purposes, and to assess our effectiveness as teachers

RML Outreach Express Award

Primary Goals: Incorporate technology into instruction Promote access and use of MedlinePlus and

MedlinePlus en Espanol Revise curriculum to include sources for more

information Improve medical student understanding of patient

education and health literacy concepts and resources

Purchases

Two Pocket Projectors

9 iPad 2 – 32 GB with WiFi

Productivity Apps (Keynote and GoodNotes

Help Curriculum

6 Lessons per Class: Diabetes (2x – English and

Spanish) HTN (2x – English and Spanish) Nutrition (2x – English and

Spanish)

RML Grant iPads and portable projectors

New, updated curriculum 15 person collaboration

Hypertension Curriculum• ESL, GED classesCommunity Recruitment

• Demographic information• Current Health Literacy level

• Current hypertension knowledge

Session 1 - Preliminary Questionnaire

• Lesson on reading nutrition facts labelSession 2 - Nutrition

• Scheduling visits to health care providers• Finding a local healthcare facility

Session 3 - Access and Availability of Health

Resources

• Risk factors• Blood pressure scale

Session 4 - Hypertension Education

• Complications of hypertension• Risks for other diseases

Session 5 - Importance of Hypertension Awareness

• Regular monitoring of blood pressure• Dietary modifications, exercise

Session 6 - Lifestyle modifications

Session 7 - Cumulative Review

• Post-intervention level of health literacy• Post-intervention level of hypertension knowledge

Session 8 - Post-Intervention Assessment

Help Curriculum

Sample Lesson #1: PPT Presentation Group Activity Small Group Review

Sample Lesson #2: IRAT/GRAT- Based on information from Lesson #1 Group Activity- Apply knowledge in clinical settings

Outcomes

Spring 2013 – Four classes (six sessions each) taught Two for diabetes and two for hypertension About 15 participants per class – 60 participants overall

Participants enjoyed learning how to use the iPads

Participants liked the interactive modules

Medical students liked having the flexibility and interactivity provided by the technology

Challenges

Hurricane Sandy in Fall 2012

Teaching location closed

Student leaders

New leaders every year

Community contacts New community contacts not as invested

Future Plans

Work with health literacy faculty advisor to re-establish program

Recruit and train new student leaders

Find new community contacts

Thanks!

HELP President 2010-2011: Lauren Antler

Co-Presidents 2011-2012: Alex Dillon and Sue Boddu

Co-Presidents 2012-2013: Kathryn Iwata and Julie Kokinos

AND

NN/LM Middle Atlantic Region

This project has been funded in whole or in part with Federal funds from the National Library of Medicine, National Institutes of Health, Department of Health and Human Services, under Contract No. HHS-N-276-2011-00003-C with the University of Pittsburgh, Health Sciences Library System.

A Clinical Information Tool for Community Health Centersfunded by the National Library of Medicine, National Institutes of Health, Department of Health and Human Services, under Contract No. HHS-N-276-2011-00003-C with the University of Pittsburgh, Health Sciences Library System

Charles B. Wessel, John LaDue & Julia DahmHealth Sciences Library System - University of Pittsburgh

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Used with permission National Association of Community Health Centers.  2013.  "Community Health Centers at a Glance" Fact Sheet #S0313.  Available at:  http://www.nachc.org/client/documents/Infographic--CHCs.pdf 18

PROJECT OVERVIEW clinical information tool for community health centers

Develop, evaluate and validate a search tool that maximizes the use of freely available relevant Internet clinical resources

Target audience for the tool Primary care health professionals practicing in

community health care settings Lack access to a medical library Expensive licensed information tools and resources

are cost prohibitive

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PROJECT TEAM–clinical information tool for community health centers

Tool Developme

nt Team

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John LaDueKnowledge Integration

Librarianjol25@pitt.edu

Julia DahmTechnology Services Librarianjdahm@pitt.edu

Charlie WesselHead of Research and Reference Initiativescbw@pitt.edu

PROJECT PHASES clinical information tool for community health centers

2012-2013 Feasibility Study

2013-2014 Demonstration and Evaluation Study

2014-2015 Validation Study

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FEASIBILITY STUDY 2012-2013 clinical information tool for community health centers

• NLM• CDC• NHS• WebMD• AHRQ• Cochrane• ARUP• QuestDiagnostics

• AACC• Skyscape

Identified Quality Free Resources • Drug

Information• Patient Education

• Free Medical Resources

• Free PubMed Articles

• Lab Tests• Medical Calculators

• USPTSF Recommendations

Arranged Free Resources

• IBM InfoSphere Data Explorer (formerly Vivisimo Velocity)

• LibGuides

Federated Search Tool

and Web Platform

• Knowledge Integration Librarian [LaDue]

Engineered Search

Strings for Resources

•Content expert (Wessel)

• ADHD• COPD• Bipolar disorder• Osteomyletis• Type 1 diabetes• Diabetes mellitus• Hip replacement• Coronary artery bypass• Influenza• Atrial fibrillation• Migraines• Thyroid nodules• Thyroid cancer• Chemoprevention breast cancer

• Autism• Back pain• Atorvastatin• Evening primrose• Black cohash• menopause• Coumadin• Urinalysis• Anion gap• etc

Analyzed Resource

Performance in Tool

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THE TOOL –FEASIBILITY STUDY 2012-2013 clinical information tool for community health centers

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THE TOOL –FEASIBILITY STUDY 2012-2013 clinical information tool for community health centers

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RESULTS - FEASIBILITY STUDY 2012—2013 clinical information tool for community health centers

Proof of Concept• Technically feasible• Quality “free” clinical resources• Can Integrate “free” resources• Maximize use of NLM resources • Prototype Web site

Barriers• Free clinical resources contain both

consumer/patient & professional content

• Duplication of content• Registration required to access one

selected resource• Viability of access to free content• Querying whole site

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PROJECT PHASES clinical information tool for community health centers

2012-2013 Feasibility Study

2013-2014 Demonstration and Evaluation Study

2014-2015 Validation Study

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DEMONSTRATION & EVALUATION STUDY 2013-2014 clinical information tool for community health centers

Name Tool

• Open Access Clinical: a clinical information tool for community health centers

Adjust Tool

• move tool to content management system

• add auto-complete

• make 508 compliant

Evaluation

• Develop Usability Test Interview

• Recruitment scripts

• IRB approval

• Study participant recruitment partner-Southwest Pennsylvania AHEC, Inc

Interviews

•

Julia Dahm, technology services librarian

• March 2014

• Transcribe recorded interviews

Study Data

• Code

• Analyze

• Interpret

• Results

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THE TOOL –DEMONSTRATION & EVALUATION STUDY 2013-2014 clinical information tool for community health centers

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THE TOOL –DEMONSTRATION & EVALUATION STUDY 2013-2014 clinical information tool for community health centers

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STUDY PARTICIPANTS – 5 CLINICAL EXPERTS –DEMONSTRATION & EVALUATION STUDY 2013-2014 clinical information tool for community health centers

People

Equipment

Locations

Manufacturing

Sales

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USABILITY INTERVIEW TASKS DEMONSTRATION & EVALUATION

STUDY 2013-2014 clinical information tool for community health centers

Task 1: Find the recommended adult dosing for valtrex for herpes zosterAre you able to find the information? Is the content what you expected?

Task 2: Find an article on the management or evaluation of solitary pulmonary nodules

Are you able to find the information? Is the content what you expected?

Task 3: Find information on when to do PSA screening in asymptomatic menAre you able to find the information? Is the content what you expected?

Task 4: You have a patient that was just diagnosed with asthma. Can you find some information on how to use an inhaler for her to read?

Are you able to find the information? Is the content what you expected?

Task 5: Look for information on a clinical topic you are familiar with or locate information on clinical question you

recently looked up.Are you able to find the information? Is the content what you

expected?

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USABILITY INTERVIEW TASKS DEMONSTRATION & EVALUATION STUDY 2013-2014 clinical information tool for community health centers

Unsuccessful TasksDrug Task

Patient Education TaskSuccessful Tasks

Diagnosis TaskDisease Task

Their Clinical Task

Found information to answer most of the clinical usability tasks.

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STUDY PARTICIPANTS –CLINICAL EXPERTS’ SUGGESTIONS –DEMONSTRATION & EVALUATION STUDY 2013-2014 clinical information tool for community health centers

Brand the site

Radiology tests and interpretation

Herbs and dietary supplement

Drug interaction checker

Patient education in foreign languages

ICD-10 look-up tool

Rank results in tiers to speed up the display of Vivisimo search results 33

SUMMATION OF TOOL COMPONENTS – DEMONSTRATION & EVALUATION STUDY 2013-2014 clinical information tool for community health centers

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SUMMATION OF TOOL COMPONENTS–DEMONSTRATION & EVALUATION STUDY 2013-2014 clinical information tool for community health centers

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TEAM QUESTIONS–DEMONSTRATION & EVALUATION STUDY 2013-2014 clinical information tool for community health centers

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1. What was bad or did not work with the site?

2. Are there solutions (fixes) to address #2?

3. If yes what are the solutions?

4. If no, why are there no solutions? 

5. Can we move to the next evaluation phase as proposed?

CONCLUSIONS - DEMONSTRATION & EVALUATION STUDY 2013-2014 clinical information tool for community health centers

Open Access Clinical:

Provides free clinical resources of high quality

Can answer primary care providers clinical questions

Will highlight and maximize the use of National of Library of Medicine resources in a clinical setting

Can be deployed and tested using “real” primary care clinical questions through a validation study.   37

2012-2013 Feasibility Study

2013-2014 Demonstration and Evaluation Study

2014-2015 Validation Study

PROJECT PHASES clinical information tool for community health centers

Site Upgrades

Stay Tuned!

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