Promotores and Community Health Workers: from the Frontlines to the Forefront

Aug 30

In the past couple of years, Promotores and Community Health Workers have been receiving significant attention from public health Federal agencies, especially those interested in reaching and making an impact among vulnerable, low income, and underserved members of the Latino/Hispanic population. More specifically, Federal agencies are turning to these individuals for their unique ability to serve as “bridges” between community members and health care services.  “Promotores de Salud”, or loosely translated “Promoters of Health,” are similar to community health workers in that they conduct outreach for advocacy organizations, health clinics, and medical organizations. However, many Promotores are not permanently employed; they are individuals and leaders within their community and they volunteer their time to help out due to their love and concern for their communities. Unlike other outreach vehicles, Promotores do not have to be deployed to “hard to reach” areas because they already live, work, and are actively engaged in those areas.

Galpón Sur

Last year, the Department of Health and Human Services (HHS) announced the creation of an HHS Promotores de Salud/Community Health Workers Initiative that aims to 1) recognize the important contributions of Promotores, and 2) promote the increased engagement of

Promotores to support health education and prevention efforts and access to health insurance programs. The Initiative is guided by a Federal Work Group representing HHS agencies and coordinated by the HHS Office of Minority Health. A Project Steering Committee of 15 Promotores from various parts of the U.S. regularly provides information to the Federal Work Group.  While the Initiative has not yet showed specific outcomes, I personally applaud this first step.

I have had the privilege of working closely with Promotores and community health workers on behalf of my Government clients for the past few years. These individuals are dedicated to their community; they are persistent, resourceful, savvy, compassionate, and noble. They have an admirable gift for service and above all, they will protect their community with “uñas y dientes” (tooth and nail).  As the demand for their services increases and more Government and public relations agencies (on behalf of their clients) reach out to them, it will be increasingly important to understand the best ways to approach them to create a genuine and sustainable relationship. The following are my recommended tips for creating such a relationship:

  1. Understand their work first, then identify if this is the right initiative for your campaign.
  2. There is not a national Promotores and CHWs program. These exist mainly at the local level. What works in Los Angeles may not work in New York.
  3. They know how to communicate information to the audience you want to reach. Don’t tell them what to do and/or how to communicate your information; they have the expertise you don’t have. It should be a collaboration.
  4. Spanish is their preferred language. Try to assign a Spanish-speaking staff member to manage the outreach.
  5. Pay them for their time, especially if you require a long term commitment and evaluation of the activities.

All (credible) News is Local

Aug 24

Call it the Ron Burgundy effect. Pew Research Center for the People & the Press put out its most recent ratings of believability of news organizations and it’s bad. The average positive believability across 13 news organizations went from 62% in 2010 to today’s low of 56%. To give you some kind of perspective, 10 years ago the average rating for the news organizations tested was 71%.  What they did is ask 1001 people to rate 13 news organizations from 1 – 4 and “a rating of 4 means someone believes ‘all or most’ of what the news organization says; a rating of 1 means someone believes ‘almost nothing’ of what they say.”  So consequently, a score of 3 or 4 is “positive” for believability and a score of 1 or 2 is “negative” for believability.

So how does Ron Burgundy fit into this? Local TV (along with 60 Minutes) is on top when it comes to believability – they got a 65% positive rating and 35% negative rating – and they’ve maintained that top status for a long time. In case you’re not a fan, Ron Burgundy – played by comedian Will Farrell in the movie Anchorman: The Legend of Ron Burgundy – is a 1970’s anchorman for a fictional  local San Diego TV station. While the movie facetiously portrays the 70’s as the heyday of the anchorman as local celebrity (with all the braggadocio a burgundy blazer can inspire) , Pew’s research suggest most people still look to their local anchors and reporters as the most credible sources of information in their communities.

In 2011, Pew did a similar study this time comparing the low state of believability of news organizations with other sources of information. They found that though the credibility of news organizations have been on the decline for years, others fared worse: “while the public holds news organizations in low regard, they are more trusted as a source of information than are federal, state and local governments, the Obama administration and business corporations.”

All this is to say, when developing a media strategy, think local… as in local TV news. If you want to get your message out and have it believed, then you’ll need to depend on local TV newsgathers to help you. While they have lost some of their sway and influence (and wide ties) of the 70’s, they often are the best we’ve got in a jaded and skeptical world to inspire at least a modicum of trust.

By the way, Will Ferrell is already working on Ron Burgundy’s return in Anchorman 2.

Can Counting Bikes Change Behavior?

Aug 23

I recently read an article about a bike counter that was installed on a bridge in Portland, OR. The idea is that it counts how many cyclists cross the bridge and then keeps a visible tally for all who pass by, on bikes or otherwise.  From midnight to 3pm, Portland’s Hawthorne Bridge had a cyclist count of nearly 3,500. Pretty impressive.  In addition, the counter tracks several other factors including time of day and the weather.  Information like this can help city planners keep roads safe for all and provide better access for cyclists.

But more than just counting bikes, I wonder if seeing just how many of their fellow peers are pushing pedals will help motivate others to take up cycling as a more regular mode of transportation?  Surely knowing thousands of others are taking up biking will inspire action in others to do the same.

Nowadays this tactic of using positive peer pressure to change your perception of what your neighbors are doing is used widely and can be greatly influential.  From a note in your electric bill comparing your energy efficiency to that of your neighbors to seeing their recycling bin by the curb, harnessing the power positive peer pressure can have an immense impact and help positively change behaviors.

What do you think? Would driving by a sign promoting just how many of your fellow citizens were biking make you more aware of cycling as an option? What behaviors have you changed due to a little positive peer pressure?

Can Counting Bikes Change Behavior

Check Your App and Call Me in the Morning

Aug 21

Health-related smartphone apps have been on the market for years, and have evolved from one-dimensional offerings such as basic calorie counters, to multi-dimensional applications that enable users to track their weight loss and share their progress with their social networks. Perhaps this can be attributed to what the Pew Internet & American Life Project refers to as the “apps culture.”

So what’s next?

According to tech blog Mashable, the sports, fitness, and wellness mobile app market is projected to nearly quadruple in size from 2010 to 2016, and more than 40,000 health apps exist and are expected to bring in $1.3 billion in 2012. WellDoc – a medical app developer profiled in a recent New York Times article – has taken what’s seen by many medical professionals as the next step in medical app development. In 2010, the company received FDA clearance to market their DiabetesManager® System to healthcare providers and their adult patients with Type 2 diabetes. According to the New York Times, DiabetesManager can be used through an app or mobile phone, and collects biometric information such as a patient’s blood sugar levels and medication regimen. This is where many health-related apps stop. DiabetesManager goes a step further and runs the data patients enter through a proprietary analytics system, which identifies trends and delivers educational and behavioral coaching based on the data. A few insurance companies have already agreed to pay the bill for patients whose doctors ask them to use the system.

One of the most important questions for marketers is — who’s using these apps?

In a recent survey conducted in conjunction with Nielsen, Pew points out that having apps and using apps are not synonymous. Of adults in the U.S. who have apps on their mobile phones, approximately two-thirds use the software. That means only 24% of adults in the U.S. are active apps users.  And seniors – an audience segment that could benefit immensely from health-related apps – have particularly low app usage. App users tend to be younger, more educated, and more affluent than other mobile phone users.

So while app usage may be on the rise, the data suggest it’s rising among a small subset of Americans. Also, when you compare Pew’s data with data that suggest most chronically ill Americans tend to be low-income, things get even more complicated. If app users tend to be more affluent, are the chronically ill really benefitting from the “apps culture”?

I don’t know the answer, but I hope the social marketing community rises to the challenge. If developers really believe their apps have the ability to enhance our wellbeing, the new wave of health related apps need to reach the people who need them most.

Back to School Season Brings Challenges Yet Hope

Aug 14

As the beaches empty, the traffic congestion returns to normal, and shopping discounts for clothes and school supplies all signal the end to summer and the start of a new school year, one may wonder what the new school term will bring for many students across the country besides new friends and homeroom classes. With many school administrators, teachers, students, parents, policymakers, and the American public still deeming the education system in a state of crisis, we know this will undoubtedly be a part of the many issues up for debate this election season with varying opinions and lots of progress still to make.

It should come as no surprise that America’s primary and secondary schools are widely seen as failing. There are steep gaps in achievement between middle-class and poor students, and even in the midst of high unemployment rates, business owners are struggling to find graduates with sufficient skills in reading, math, and science to fill today’s jobs. High school graduation rates, while improving, are still far too low with more than 25 percent of students failing to graduate from high school in four years. For African-American and Hispanic students, it’s only about 40 percent. In addition, test scores are not up to par, and show us that students across America are performing at levels far below their peers overseas. In fact, a recent report from the Council on Foreign Relations (CFR) states that our education system is so failed that it puts our National Security at risk.

There is no doubt that America’s students deserve better. If we examine this issue in our own backyard, and look closely at the children in the District of Columbia school system, we know they have recently been confronted with many obstacles in their quest for a promising education.  There have been allegations of widespread cheating, embezzlement of educational funds intended for youth programs, dismissal of hundreds of poor performing teachers, and claims of excessive reliance on testing but not teaching and learning skills.

However, despite these many challenges for D.C. schools, there is hope on the horizon—which those in the D.C. school system would certainly welcome since reportedly fewer than 60% of D.C. high school students graduated on time in 2011. Beginning this school year there is anticipation and excitement for many students and parents in D.C., with the opening of a new public charter middle and high school that will enroll hundreds of students in grades 5 to 8 into its program.

BASIS DC is the name of the new charter school program that will seek to offer students the same internationally competitive liberal arts academic curricula that earned BASIS Tucson—the flagship program with six schools in Arizona—national acclaim and ranked among the top ten high school programs in the nation by Newsweek, U.S. News & World Report, and The Washington Post.

This program focuses on changing the behaviors and setting clear roles for students, teachers, and parents by making everyone accountable and active contributors in the learning process. This to me would seem to be a vital formula for success for a student since we know the responsibility cannot fall on the teacher alone, and that it takes the whole community or “village” to play an active role in a student’s educational journey. The program teaches students as early as 5th grade about organizational and study skills to provide them with the proper foundation to continue their matriculation through the college level; and  hires teachers who can help to influence a student’s behavior by conveying  that learning is exciting, rewarding, and worthwhile. In addition, parents must support and be involved in their children’s educational development and this program focuses on striking the correct balance by encouraging parents to be their children’s “cheerleaders” while still allowing their children enough autonomy to build the skills and personal responsibility they will need to succeed in college and beyond.

As a native Washingtonian and someone who has been taught the value of a quality education and reaped the benefits, it would be great to see along with the start of a new school year renewed hope for parents, teachers, and students that new programs are advocating and encouraging innovation in education in D.C. And, that educational models that focus on changing attitudes and behaviors of the entire school community can be replicated to fit the diverse needs of students in various geographic locations who all have the common goal of making a good education a right not a privilege. While I know this program alone won’t solve the national crisis, it could be the step in the right direction to show that everyone plays a role and is accountable in the future educational growth and development of a child’s learning, and help to restore faith and optimism in school systems one program at a time.

Section 508 Compliance: Stifle Your Groan and Remember Why

Aug 09

If you have worked on a government project since 1998, you have probably heard someone say “508 compliance.” If you’re experience is similar to mine, that utterance was probably followed by a groan.

A picture of a blind man listening to a screen reader

It’s true, sometimes taking the extra time to make a material compliant with Section 508 guidelines can feel like an undue burden—especially when you’ve very likely already labored over the development of that material in so many other ways.  But I think this feeling comes only when we allow ourselves to forget why the government requires us make things 508 compliant in the first place.

For those not familiar with Section 508 Compliance—and for those who have heard the term but never an explanation—let me give you a quick background. In 1998, Congress amended the U.S. Rehabilitation Act to require Federal agencies to make their electronic and information technology accessible to people with disabilities. This means that federal agencies cannot buy, develop, maintain, or use electronic or information technology that is inaccessible to people with disabilities.  So basically, Section 508 requires that we, as professionals who create materials on behalf of government clients, make sure that these materials can be accessed and understood by people who have visual, hearing, cognitive, and/or motor disabilities.

I’m certain no one reading this blog is so callous as to begrudge a disabled person access to information. But I’d be willing to bet that few non-disabled readers truly understand what it might be like to try to access information when you have a disability. Be honest. Have you ever tried to access a website without the use of a mouse? Have you ever listened to a PDF reader “read” a document? So, let’s do a little experiment so that we can all gain some small amount of empathy.

Imagine for moment that you have a motor disability that prevents you from using a mouse.  Go ahead. Put your mouse aside. Now, using only your keyboard, I want you to navigate from this web page to your favorite website and click on a link that is about half way down that page. I’ll give you a hint: you need to use the tab key to move from link to link. When you’re done, don’t forget to come back and finish reading. Okay. Ready, set, go!

A picture of a baby in a car seat typing on a keyboard

Welcome back! How’d it go? For those of you who are lucky enough to have a favorite website that is Section 508 compliant, you probably noticed that it took quite a while to get to the link you wanted. But at least you could get there. For those who have a favorite website that isn’t fully compliant, you might not have been able to get to your link at all.  And this is just one possible issue that might be encountered by someone living with a disability when trying to access information.

So the next time you hear someone say, “We need to make sure this is 508 compliant,” stifle that groan and remember:

  • More than 1 million Americans are legally blind, nearly 3 million are color blind, and more than 11 million have visual conditions that are not corrected by glasses.
  • About 28 million Americans are deaf or hearing impaired.
  • Almost 33% of adults have at least one basic actions difficulty or complex activity limitation.
  • Almost 14 million people over age 5 have difficulty concentrating, remembering, or making decisions.

And know that of these millions of people living with disabilities, it is very likely that someone will greatly appreciate the work you did to make your information accessible.

Leveling the Playing Field?

Jul 31

2012 USA Olympic Team, Opening Ceremony

http://bit.ly/N7xvI4

As millions of us tuned into the Olympic’s Opening Ceremony we saw for the first time, the United States sending more women than men. During the games, 269 women will wear the red, white, and blue; while only 261 men are part of the U.S. delegation. Athletes like Shawn Johnson, Kerri Walsh Jennings, and Gabby Douglas are just as much of household names as Ryan Lochte, Justin Gatlin, and Anthony Davis. Is this a result of Title IX?

Forty years ago, young girls were only able to dream of playing collegiate and professional sports with the same opportunities as their male counterparts. In 1972, President Nixon signed into law what we know today as Title IX, making it illegal to discriminate against participation, education, or financial assistance based on sex. Its impact extends off the sports fields as well, into the classroom and education programs.

The effects of this are evident wherever you look – from the iconic image of Brandi Chastain ripping off her shirt after scoring the winning goal in the 1999 World Cup, to ESPN broadcasting the NCAA women’s basketball selection show in primetime, women’s sports have come a long way from Billie Jean King battling Bobby Riggs in the Battle of the Sexes.

Brandi Chastain ripping off her shirt after scoring the winning goal in the 1999 World Cup

http://bit.ly/OeW9dq

A 2006 study revealed the number of women in college sports has increased more than 450% since Title IX was passed. But have we gone too far? Have women’s successes lead to us ignoring men?

Around the country, men’s collegiate sports programs are being cut an alarming rate. Princeton and Syracuse cut the wrestling programs, Boston University does not have official football team, and Colgate‘s baseball team has been defunded as well. Nearby, the University of Maryland recently cut its men’s track teams (indoor and outdoor track, cross-country) while my alma matter James Madison University dropped a host of sports in 2007 including men’s  archery, indoor and outdoor track, cross-country, gymnastics, swimming, and wrestling. UCLA cut its men’s swimming and diving program, which produced 16 Olympic Gold Medalists, and dropped its men’s gymnastics team after it comprised half of the gold medal winning 1984 Olympic squad, the last U.S. men’s team to win gold. The list goes on.

Wrestling has seen the brunt of the cuts as 355 college teams (22,000 roster positions) have been eliminated in the past decade. Cross country, indoor track, golf, tennis, rowing, outdoor track and swimming have been the other’s most affected – all Olympic sports. This potentially doesn’t bode well for our future on the world’s biggest athletic stage.

Men playing Olympic sports, across the country are losing the opportunity to go to college on an athletic scholarship because of “having to level the playing field.” According to Title IX, the number of athletic scholarships has to be equal for men and women so what’s happening to all the high school wrestlers and track runners who cannot afford college without assistance? If these athletes cannot play college sports, what happens to their future Olympic dreams?

Are we doing exactly what we promised not to do with Title IX? While attempting to encourage women and provide them with ample opportunities, have we deemphasized our support for everyone else? Were we short-sighted in our thinking? What implications will this have for future Olympics, future American athletics, and our overall global positioning?

Can I Quote You on That?

Jul 27

A recent article in the Texas Observer brought up the question that I hear a lot in my media trainings: will reporters share their story pre-publication with me? If you’re talking to  the Texas Observer, the answer is an emphatic “no.” If you’re talking to The Washington Post, the answer is “maybe” – an answer that so galls the Texas Observer that they wrote about it.

Some background:  reporters see themselves almost akin to umpires; they call ‘em as they see ‘em. Good journalists take the responsibility seriously and work hard to get it right – the first time. They also work very hard to get people to speak openly and freely.  Most reporters worry that  if they let a source – the people they are interviewing – review an article before it’s published, the source will see what others are saying and decide he or she needs to be more circumspect. Hence the open and free conversation the reporter was seeking becomes restrained and cautious and the source might demand unwarranted changes that will affect the tone and tenor of the story.  Fact checking is different. Facts are either right or wrong, how a person comes across in a quote is up for a lot of interpretation. That is why most reporters pride themselves on being good interpreters: of politics, of science, of business, and learn to stand by what they heard.

Back to the current discussion: so a Post reporter visited the University of Texas and interviewed a bunch of administrators about their testing policy. He then wrote his story and sent it to the people there and told them, “everything here is negotiable” – before The Post published it – on the front page no less. According to public emails acquired by the Texas Observer, the school did change the original copy to softened their criticism of the current tests being used.

The Texas Observer saw this as an abrogation of a reporter’s duty to get it right the first time and to “call ‘em as he sees ‘em.” Surprisingly, The Post wrote their own article about the Texas Observer piece and headlined it with: “Should a reporter’s source get a preview of the story?” The Post stands by the article saying it still had comments in it that criticized testing. But the article admits that even though The Post allows reporters to “fact check” stories particularly in complex science stories, “it is not our policy (The Post’s) to routinely read stories or parts of stories to sources or to share copy with outsiders…”

One of our clients recently worked with The Wall Street Journal on a complicated science story and was amazed at how much they got to see of the article before the story was published. This, however, is an exception to the rule. In general, don’t expect reporters to share their article with you before they go to print. Most reporters won’t do it, and those who will do it, will be excoriated by their colleagues.

The Post advanced the story after I posted this. Their ombudsman, Patrick Pexton, didn’t like what happened and was appalled with the quote from the reporter (now that’s a switch) indicating, “everything’s negotiable” to his source.  He said it was “time for some backbone,” and that “because of the changes in technology (i.e. the Internet) and relentless financial pressures, the press is weaker that it has been in many years. We look over our shoulders too much, we bow to the wises of officialdom too often, we yield too readily to ideologues.”

He seems to see it as “old school” vs. “new school” journalism. If that’s the case, my clients might be reviewing a lot more copy in the future. This gives a new dimension to the cliche, “can I quote you on that?”

The First Social Media Olympic Games … Or Not?

Jul 26

The First Social Media Olympic Games … Or Not?

As the opening ceremonies begin tomorrow, so too will the idea that athletes are no longer just idolized sports stars, they are creating content that is being shared around the world.  Some 10,000 competing athletes from 200 countries will be using Facebook, Twitter, YouTube, Flickr, among other social media to share information, photos, and commentary about events as they happen.

An Olympic Story…from a Public Health Point of View

Jul 19

With about one week remaining until the Opening Ceremony of the 2012 Olympics, media outlets across the world have been and will continue to cover the trials, athletes, uniforms, performers, and much more. But, from a public health and social marketing perspective, there’s another type of story that we need to ensure gets out there – a story about staying healthy when traveling to London. Massive gatherings, particularly ones of THIS size, call for major health preparedness plans to be in place. During the Olympic Games, visitors to London are estimated to increase by approximately 325,000 each day! With the immense influx of visitors, local residents, spectators, officials, and athletes, need to take the proper precautions while attending the Games, but also when they’re returning home. Flu pandemics in the past have caused massive public health issues, such as the 1918 Spanish Flu outbreak after WWI that killed up to 40 million people or the Swine Flu outbreak during 2009-2010, which according to the Centers for Disease Control and Prevention (CDC), affected between 43 and 89 million people in the United States. To make matters worse, according to a recent Maplecroft study, the UK is already at “extreme risk” for an influenza pandemic because of its popularity as a key travel center, the highly populated and densely packed cities, and a very mobile population. Check out their map below to see what other countries are at risk.

Map of the world showing each country's risk for an influenza outbreak

Luckily, public health agencies and organizations throughout the world and in London in particular are on it! According to the Health Protection Agency (HPA), they are “working closely with partners in the run up to the London 2012 Olympic and Paralympic Games to ensure the health of those attending and participating is protected.” So, if you’re going to the Olympics and want to stay healthy, here are a few tips from HPA and CDC:

  • Make sure you (and anyone traveling with you) are up-to-date on their vaccinations, particularly the measles vaccine.
  • Watch what you bring home! If you’re not vaccinated when traveling abroad and contract measles, you could bring it back to the States.
  • Wash your hands thoroughly with soap and warm water.
  • If you become sick with a stomach bug or flu-like illness, don’t spread it! And, just to be safe, stay home.
  • To prevent heatstroke, wear sun block and a hat.
  • Drink a lot of water, but make sure it’s safe by ensuring the cap is sealed (with bottled water) or obtaining it from an “authorized water point.”

If you’re heading to the 2012 Olympics, remember those simple tips and, most importantly, have fun and go team USA!