Kate%20Eddens

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Keeping clients healthy Integrating proactive
health screening and referral into 2-1-1 systems

• Kate Eddens
• Matthew W. Kreuter
• Health Communication Research Laboratory
• Washington University in St. Louis

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Eliminating health disparities by increasing the
reach and effectiveness of cancer information in
low-income and minority populations.
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- Integrating cancer communication into
practice - System-level interventions -
Real-world settings
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- 2-1-1- Food Stamps- Public Housing-
Low-income Energy Assistance
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Why this approach?Three key points
Basic needs supersede cancer prevention
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Why this approach?Three key points
Basic needs supersede cancer prevention Systems addressing basic needs reach millions
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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
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1. Our study results2. Activities
nationally 3. Questions discussion
Todays presentation
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Study 1 Is it feasible?Kate Eddens, Matthew
Kreuter, Kay Archer, Debbie Fagin
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Pilot studyNovember, 2007 February, 2008
Aim 1 Estimate cancer control needs of callers Aim 2 Determine feasibility of cancer referrals
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- Mammography - Pap testing -
Colonoscopy - HPV vaccine - Smoking
- Smoke-free home policies
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Disparities associated with all of
themEffective tests or interventions for
allPrograms available that provide them for free
Why these six?
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Mammograms Pap smears Colonoscopies HPV
vaccination Smoking cessation Smoke free home
policy
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Need at least one 85Need two or
more 54 Need three or more 30
Current cancer control needs of 2-1-1 callers
Eddens K, Kreuter MW, Archer K. J of Social
Services Research (under review).
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No health insurance 2-1-1 callers (n297) vs.
Missouri vs. U.S.
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Current cigarette smoker 2-1-1 callers (n297)
vs. Missouri vs. U.S.
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Has a smoke-free home policy 2-1-1 callers
(n297) vs. Missouri vs. U.S.
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Ever had a colonoscopy (ages 50) 2-1-1 callers
(n107) vs. Missouri vs. U.S.
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Pilot studyNovember, 2007 February, 2008
Aim 1 Estimate cancer control needs of callers Aim 2 Determine feasibility of cancer referrals
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• Telephone follow-up 2 weeks later
• What did they think of the mailed referrals?
• Did they make a call and/or schedule an
  appointment?

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Reactions to mailed referrals (n39)
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
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Willingness to participateAmong 2-1-1 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

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Appropriateness of health questionsAmong 2-1-1
callers in pilot study
Should 2-1-1 be asking about health? (56) Health questions too private? (5) Comfortable with mailed health info? (81) Health referrals make 2-1-1 more appealing? (100)

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How is call length affected?

• Time to administer survey provide referrals
• Mean 454 minutes
• Enroll into study
• Mean 252 minutes

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Conclusions
High level of need among 2-1-1 callers Proactive health referrals are feasible via 2-1-1 Mailed reminder referrals seem promising

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

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Study 2 National prevalence studyJason
Purnell, Kate Eddens, Matthew Kreuter2-1-1s of
Missouri, King County, Houston, North
CarolinaCancer Prevention and Control Research
Network
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Administered in four 2-1-1 systems
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- 2-1-1 callers (n 1,413)- 2008 BRFSS (n
415,194)
2-1-1 callers vs. U.S. population
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- Need at least one 72- Need two or
more 42- Need three or more 17
Cancer needs of 2-1-1 callers (n1,413)
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No health insurance 2-1-1 callers vs. U.S. (p lt
.001)
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Current smokers 2-1-1 callers vs. U.S. (p lt .001)
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Smoke-free home policy 2-1-1 callers vs. U.S. (p
lt .001)
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Ever had colonoscopy (50) 2-1-1 callers vs. U.S.
(p lt .001)
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Up-to-date mammogram (women 40) 2-1-1 callers
vs. U.S. (p lt .001)
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Up-to-date Pap test (women 18) 2-1-1 callers vs.
U.S. (p lt .001)
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HPV vaccination (women 18-26) 2-1-1 callers vs.
U.S.
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Study 3 Statewide intervention studyMatthew
Kreuter, Kate Eddens, Nikki CaitoKassandra
Alcaraz, Jason Purnell, Anjanette Wells,Debbie
Fagin, Nikisha Bridges, Tiffany Aziz
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- Mammography - Pap testing -
Colonoscopy - HPV vaccine - Smoking
- Smoke-free home policies
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Mammograms Pap smears Colonoscopies HPV
vaccination Smoking cessation Smoke free home
policy
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• Telephone follow-up 1 and 4 months later
• Did they contact referrals?
• Did they obtain needed services?

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

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

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

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Coach

• Help callers act on referrals by
• Making appointments
• Providing reminders
• Arranging transportation

• Answering questions
• Addressing barriers
• Explaining systems

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- 31 enrolled in pilot- 29 contacted in 3
weeks (94) - 2.7 contacts per person
(range 1-6)- 35 success rate (11 of 31)
Enrollment and contact
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- 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
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1. Which approach works best?2. Whats
the impact on 2-1-1 quality indicators? 3.
What factors influence effectiveness?
Key questions
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1. Problem resolution2. Unmet basic
needs 3. Sense of coherence -
comprehensibility - manageability -
meaningfulness
Factors that could affect outcomes
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What will we learn?
Need for cancer prevention in 2-1-1 callers Effectiveness of 2-1-1 referrals for health Added benefit of mailed referrals vs. coaches Effects when original problem is solved by 2-1-1 Effects by level of basic needs, SOC

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Activities nationally
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2-1-1 and Research CollaborationPresentations 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
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2-1-1 and Research CollaborationHealth Screening
and IR webinar
Invited webinar to AIRS members 104 attendees
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2-1-1 Health and Human Services Research
Consortium
Pairing 2-1-1 systems and researchers Combining, refining, and analyzing data Providing evaluation and funding assistance Laying ground rules for collaboration Setting a research agenda
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2-1-1 Research ConsortiumWho is participating
now?
United Way 2-1-1 systems Health care systems National Cancer Institute (CECCR) Centers for Disease Control (CPCRN) University-based researchers
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2-1-1 Research Consortium Special Journal
Supplement
Full issue dedicated to research with 2-1-1 Published in wide-reaching scientific journal Expected to be published in 2011 Funded by the National Cancer Institute
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Special Journal Supplement Why should I care?
Raise awareness of 2-1-1 Present opportunities for collaboration Show the value and reach of 2-1-1 Lend credibility to 2-1-1
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Special Journal Supplement Table of Contents
Introductions Brief empirical reports Summary and commentary
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Table of Contents Introductions
Introduction to the Supplement I Rationale for 2-1-1 embracing research partnerships
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Table of Contents Introductions
Introduction to the Supplement II A grand vision for 2-1-1 research collaboration
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Table of Contents Introductions
The case for collaboration between 2-1-1 systems and health researchers
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Table of Contents Brief empirical reports
Cancer risks of 2-1-1 callers in Missouri, North Carolina, Texas and Washington
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Table of Contents Brief empirical reports
Findings from cost-benefit studies of 2-1-1 systems A review
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Table of Contents Brief empirical reports
Media strategies to increase use of 2-1-1 during the mortgage crisis
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Table of Contents Brief empirical reports
Unmet health needs in Texas during disaster and recovery, Katrina-Rita, 2005
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Table of Contents Brief empirical reports
Other brief reports to be solicited from 2-1-1 systems nationally
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Table of Contents Summary and commentary
Guiding principles for collaborative research with 2-1-1
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Table of Contents Summary and commentary
A research agenda and future directions for collaborative research with 2-1-1
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Table of Contents Summary and commentary
Commentary on the Special Supplement
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Special Journal Supplement Call for Papers
Surveillance Special initiatives H1N1 / SARS / Other health initiatives Disaster Aging and disability
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Ongoing interaction with 2-1-1sAIRS meetings
Survey of system leaders
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How would you rate your evaluation process for
standard services? (n22)
percent
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How would you rate your evaluation process for
special initiatives? (n23)
percent
90
Have you ever worked with researchers? (n23)
percent
91
How would you rate your experience working with
researchers? (n22)
percent
92
What is your greatest concern about working with
researchers? (n23)
percent
93
What would be the greatest benefit of working
with researchers? (n23)
percent
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Contact information
Kate Eddens (keddens_at_wustl.edu) Matthew Kreuter (mkreuter_at_wustl.edu)