5 Links to Help You Navigate Government Social Media Guidelines

May 15

Navigating government social media guidelines can be tricky since there are so many different components to consider, so I wanted to share 5 links that help me advise my clients and comply with the guidelines.

1. Apps.gov– Apps.gov lists all the approved social media sites and tools that have Terms of Service agreements with the government.  This is a great place to start when looking to solve a communication problem with a social media tool since the site needs to have an approved TOS agreement in order for your client/agency to use it.   While you can use this site as a resource you still need to check with your clients/agency leadership as every agency has more specific guidance that may limit this list further.

2.Web2Access.org.uk–  This site has tested many of the most popular Web 2.0 sites for accessibility for those with disabilities.  You can use it to evaluate the strengths and weaknesses of a particular site in relation to 508 compliance.  They even give each site a score based on different types of disabilities.

3. Archives.gov Memo on FOIA Archiving– I get many questions about how and what to archive from government clients, but most of the advice on agency sites is vague and recommends talking with your agency’s FOIA officer or checking with archives.gov (which is still a good course of action).  However, a direct link to this archiving guidance is hard to find, so I dug it up on the archives.gov website.  The memo clearly outlines what needs to be archived in Social media and how you might go about doing that.

4. OMB Guidance on Information Collected through Social Media– As a best practice, we recommend our clients engage in social media by asking questions and involving their audience in a two-way dialogue.  However, there is always confusion about what government agencies are allowed to ask and what types of information they can collect from the public without OMB approval.  Luckily, OMB has guidance on this very issue online and available to the public in case you ever need a refresher.  As a little preview, open ended questions are OK, but surveys and polls are not without OMB clearance.  Read the memo for guidance on contests, e-mail address collection, rankings/ratings/votes and more.

5. HHS Center for New Media– Most of my clients fall under the HHS umbrella so this site is exceedingly helpful to me when I need to research a social media guidelines question.  It’s got a great section on Standards and Policies for HHS that is inclusive of everything you need to think about before embarking on a social media campaign for a HHS agency.   There are also many many resources and tools that can help you educate yourself and learn where to go for more information.

What links do you rely on to help you comply with government social media guidelines?  This is definitely not a comprehensive list, so please leave a few of your favorite resources in the comments.

Want to be smarter? Try dressing like a doctor.

May 10

As a preteen in the 80s, my demands for Guess jeans and Z Cavaricci shorts were met repeatedly with the same wise—but at the time, annoying—words from my mom: “It’s not what you wear. It’s what’s on the inside that counts.”

Even though she was doing it more in the “we’re not buying you those ridiculously expensive designer clothes” kind of way, the point was not lost on me.  We’d all like to think that what we wear doesn’t really impact how people perceive us – that people will be able to tell how smart or talented or kind we are by what we say and how we act.  But what about how we perceive ourselves?

We know that there are times when we want to “dress to impress,” whether for a job interview or to meet your boyfriend’s parents.  We know that people do pay attention to what we are wearing, whether consciously or not.  Studies have shown that women wearing masculine clothing in a job interview are more likely to be hired, and teaching assistants wearing more formal clothes are thought to be smarter.  Plus, maybe more importantly, what we wear can impact how we feel about ourselves.  I think many of us feel differently when we dress up for a special event or wear a suit to an important meeting.

But could what we wear actually influence our cognitive abilities?  Turns out the answer might be yes, and that wearing clothing that you associate with being smart can make you act smarter.  The New York Times recently reported on a study led by Northwestern University’s Kellogg School of Management (read study abstract) that showed that wearing a white coat that you believe to be a doctor’s coat—as opposed to a painter’s coat—will increase your ability to pay attention.  This is a phenomenon the authors call “enclothed cognition,” which posits that the clothing you wear systematically affects your psychological processes.  If you know the symbolic meaning of a piece of clothing (i.e., a doctor’s white coat), you may take on the traits you associate with it (i.e., being careful, rigorous) when you wear it.  It’s a play on “embodied cognition,” a growing scientific field focused on the interplay of how our physical experiences (e.g., position, posture) impact our psychological processes (e.g., make us feel more powerful).

Image from Mercy Hospital

The goal of the study was to determine if your clothes could affect how you approach and interact with the world.  Research participants who wore a white “doctor’s coat” performed better on a test of sustained attention than those wearing a white “painter’s coat,” a generic white coat, or street clothes.

The idea that what you wear could have a real impact on how you think or perform in the world is fascinating, bringing new meaning to the expression “dressing for success.”  What else could make us act smarter?  Wearing glasses?  Carrying a briefcase?

As a public health professional, the study results make me think: how can we use enclothed cognition to improve people’s health?  Is there something we can wear to help us make better/healthier choices?  Will putting on our exercise clothes really motivate us to go for that run or get to that exercise class?  And how can we facilitate access to these types of clothes for everyone, not just those who can afford them?  Beyond exercise, how can this effect be used to help us stick to our health resolutions or follow through on those behaviors that we know are better for us?

Pass First–On and Off the Court

May 08

North Carolina Tar Heels are super passionate about their college basketball team.  (Case and point: the season is over and I’m still talking about it.)  So when North Carolina point guard Kendall Marshall–the nation’s leading assist man–announced he had a fractured wrist shortly after his team’s advancement to the Sweet 16, many ardent fans–myself included–felt their championship dreams crushed, much like Marshall’s wrist.  But instead of wallowing in despair, one student decided to bring Carolina fans together and hold out hope for Marshall’s tournament return.  Turns out, it proved to be more than a gesture among friends as the idea quickly transformed into a movement.

The idea was simple: draw the number five on your right wrist, representing Marshall’s jersey number and the location of his fracture.  The creators—who have chosen to remain anonymous—coined it “PassFir5t,” citing Marshall’s pass-first basketball mentality.  They casually created a Twitter account and a Facebook page, and shared it with a few friends.

Five on Wrist

It didn’t take long for the Carolina community to catch on.  Within hours, hundreds of people had posted pictures of “5” wrists on their Facebook accounts and Twitter handles, showing silent solidarity for the injured guard.  Ten days later, there were more than 3,200 members on the PassFir5t Facebook page. Articles were written by ESPN.com, the News & Observer, and several blogs.  Even Kendall Marshall took notice.

K. Marshall Tweet

With the growing momentum, the creators began to ask themselves: what do you do with the attention of thousands of passionate people?  How can we make this about more than basketball?  Their answer: use the platform and its message to exemplify how people should live their lives—by putting others before themselves (or in Marshall’s case: pass first).   The creators wanted to inspire people to do good within their own community.   Leading by example, they set up a meeting with Basebald–a local organization dedicated to raising money for childhood cancer research–and established their first partnership.  News of the partnership spread quickly over their social media network and within 24 hours, PassFir5t and its supporters had raised $2,000 for Basebald.

The Tar Heels rallied past the University of Ohio in the Sweet 16 game before falling to the University of Kansas in the Elite Eight.  Kendall Marshall did not play in either game.  Wrists were washed, but the PassFir5t spirit lived on as the number of supporters grew and new partnerships formed with other organizations, including local chapters of Fighting Cancer Below the Belt and Uhuru Child.  As of April 12, 2012, PassFir5t had raised almost $4,000 for various charities.  The creators have stressed that PassFir5t is more than simply raising money.  It’s about sharing the message of selflessness with others and taking a more active role in the community through volunteerism or supporting local organizations.

As an early supporter of the PassFir5t movement, it’s been amazing to see how quickly an idea can spread over social media, how it evolves over time, and how one person’s passion can inspire an entire community to act.  This year, Carolina fans proved that their passion extends beyond the basketball court and into communities where their actions truly make a difference.  And that makes me proud to be a Tar Heel.

For more information about PassFir5t, visit:

Website: http://www.passfir5t.org/
Twitter: https://twitter.com/#!/PassFir5t
Facebook: https://www.facebook.com/PassFir5tCarolina

“China’s Evolving Social Health Initiative: A Metaphor for New China?”

May 01

*The views expressed on this blog are my own and do not necessarily reflect the views of my employer.*

World Health Organization (WHO) definition of health literacy: The cognitive and social skills which determine the motivation and ability of individuals to gain access to understand and use information in ways which promote and maintain good health.

As China is establishing itself as a more permanent global presence, efforts are being taken to shift how the government connects with and influences the general public on health related issues. When the People’s Republic of China was first established in 1949, the government’s concept of health education revolved mainly around increasing knowledge of the general public through heavy-handed, top down campaigns that provided little information. Recently, there has been a gradual shift toward measures that support the WHO’s definition of health literacy with campaign efforts using positive language to proactively maintain healthy habits.

The responsibility of health education in The People’s Republic of China has typically fallen to the Ministry of Health (MOH)’s Patriotic Health Campaign Committee (PHCC). This committee, established in 1950, heads the Patriotic Health Campaign, which works on a national and provincial level to inform the general public on actions to take to improve health.

In the past, the PHCC has presented health issues as enemies to be destroyed. Little information was provided and issues were oversimplified in an attempt to eradicate problems as quickly as possible, rather than educating the public to encourage healthier decisions. Dialogue about healthcare was typically one-way, with education curriculums developed at the national level and then taught throughout cities across the country regardless of local characteristics and needs.

In the 1950s and 1960s, to help control the schistosomiasis endemic, the PHCC identified snails as being responsible for the transmission of the disease. The government conducted a mass campaign to eliminate snails through poisonous drugs, an approach that had limited success eradicating the problem. This complemented Mao Zedongs’s war against “the four devils”—flies, mosquitoes, mice, and sparrows—that encouraged Chinese peasants to kill these pests to improve general health. Mao era propaganda targeted specific environmental factors as being the fastest and easiest way to “understand” and therefore eliminate a much more complex problem.

"The Four Pests" (image.baidu.com)

As recently as 2004, the Communist Party mobilized a campaign to remove civet cats, badgers, raccoon dogs, rats, and cockroaches in order to combat the SARS virus. Rather than informing the public of what SARS is and how it can be avoided, the government took a simplistic approach to the issue by identifying an enemy to defeat in order to solve the problem.  Both SARS and schistosomiasis are influenced by a number of environmental factors.  Furthermore, the mass killing of species can greatly influence the environment and cause new issues.  For these reasons, such tactics oversimplified the issues and did nothing to increase the education of the general public about these diseases. http://news.bbc.co.uk/2/hi/asia-pacific/3371659.stm

Another example of the Chinese government’s heavy-handed approach to an overly-simplified problem concerns the country’s on-going anti-smoking campaign. The MOH has a history of adopting a strong anti-smoking stance and in 2003 ratified the WHO’s Framework Convention on Tobacco Control. While there has been international support for this effort through the Bill and Melinda Gates Foundation, the MOH approach has intentionally presented a limited scope of information in their marketing tactics to intensify their discouraging of specific behaviors.  The campaign’s visual assets do not provide any information about why smoking is dangerous or the benefits of quitting other than associating smoking with death. Scare tactics such as these have been known to produce results, but do nothing to help increase the general public’s understanding of the underlying issues.

Chinese anti-smoking OOH (image.baidu.com)

Despite these current examples of propaganda-supported social marketing, the MOH and Chinese government have been showing increasing acceptance of other social marketing efforts. In the case of the schistosomiasis control-program mentioned before, recently China has been exploring a more informative approach by administering “a health education program aimed at changing behaviors of people living in the epidemic area. Three preventive healthy behaviors were proposed for the residents:  avoid contact with contaminated water; comply with treatment for prevention and infection; and properly dispose of excreta.  Knowledge about the dangers of unhealthy behaviors is provided and disseminated.” [Wang 272 http://www.bvsde.paho.org/bvsacd/cd26/promocion/v15n3/269.pdf]  This approach better informs the public of the exact means through which schistosomiasis is spread.  Possessing a more complete knowledge of this danger is an important element to developing the motivation to combat it.  Rather than strict control, a more well-rounded behavioral reform is the focus.  Good habits are encouraged and two of the three directives are encouraging healthy behavior rather than admonishing poor behavior.

Schistosomiasis OOH (mgcdc.cn)

As the government decentralizes and the power of local governments increases, there should be more opportunities to explore social marketing practices that encourage healthy behaviors. While challenges remain, it will be exciting to see what strategies are adopted to reach the various audiences of such a vast population. It is encouraging that there is already a shift away from overly-negative, overly-simplified messages and tactics toward more informational, audience-focused efforts. Additionally, the involvement of such organizations as the Gates Foundation and WHO in health education efforts indicates that the government is becoming more tolerant and flexible in how it reaches the general public.

The Changing Patient Pharma Relationship

Apr 26

I came across an intriguing post on Pharmalot about a woman dying of Stage 4 breast cancer who used YouTube to plead with the Food and Drug Administration (FDA) to allow her access to pertuzumab, an investigational cancer drug. The video featured the woman, Diane Gant, reading several letters for her son, since she does not believe she will live long enough to see him grow up. Gant initially directed her plea to the FDA, but then learned that the ball is actually in Roche’s court, the pharma manufacturer of the investigational drug. A few days after uploading the video, Gant’s video gained the attention of Roche, and the company agreed to make pertuzumab available to Gant based on compassionate use.

While this mom’s story pulled at my heartstrings, it also got me thinking just how much social media really can change the game for patients. Gaining access to trial drugs through compassionate use is typically a long and arduous process. Usually, the patient’s doctor must contact the pharma company and then submit an application to the FDA for approval. For the FDA to even consider a compassionate use request, a patient must meet certain criteria, including that the disease is serious or immediately life-threatening, no treatment is available or approved treatments can’t help, and the drug company that manufactured must agree to provide the drug.  Gant used social media to elevate her plea when she could not get access to the drug even after following the necessary processes.

Gant’s situation is certainly one-of-a-kind, and experts do not anticipate that her situation will change the way that patients get investigational drugs. However, I’m not so sure that this is true. This situation shows that pharma companies have an interest in engaging with their audiences in online communities. That said, pharma faces many obstacles in engaging with patients, which perhaps explains the experts’ hesitancy to view it as a game changer.

Pharma companies have deeply invested in online marketing, spending more than $1 billion last year, but when it comes to social media they have been cautious about their engagement. Many were hoping that the social media draft guidelines provided by the FDA late last year would provide guidance, but, unfortunately, the guidelines did little to clear the confusion. It will be interesting to see how the major pharma companies interpret these guidelines and to the extent that they will actively engage with patients online moving forward.

Do you think we’ll see a shift in how patients and pharmaceutical companies interact?

A Dying Mom, YouTube Plea

The Fight Against Polio: Health Communication Lessons from India’s Success

Apr 24

“Polio can be stopped when countries combine the right elements: political will, quality immunization campaigns and an entire nation’s determination. We must build on this historic moment and ensure that India’s polio program continues to move full-steam ahead until eradication is achieved.” – Bill Gates

Indian child receiving oral polio vaccine dropImage credit: Gates Foundation, Flickr

Earlier this year, the global health community was witness to a huge achievement, which involved overcoming one of the world’s historic public health challenges. This past January, India recorded a full year without a new case of polio, moving it one step closer to being officially removed from the list of four countries where the disease remains endemic. The other three countries are Nigeria, Afghanistan, and Pakistan. As a Pakistani-American and with a family member who has a form of polio, I am personally fascinated by this public health success and the lessons that we, as social marketers and public health communicators, can glean from this monumental effort.

Polio is a highly infectious viral disease, mainly affects children under five years of age, and leads to irreversible paralysis. While it cannot be cured, it can be prevented through drops of oral polio vaccine given to children under five years of age. As long as a single child remains infected, children in all countries are at risk of contracting polio.

In 1988, at a time when the virus was paralyzing 1,000 children around the world every day, half of them in India, the World Health Organization, Rotary International, the US Centers for Disease Control and Prevention, and the United Nations Children’s Fund launched the global campaign to eradicate polio.  In 1995, after garnering political will, support and manpower, India began its mass vaccination campaign, but volunteers were faced with skeptics and rampant rumors that the polio vaccine caused illness and infertility and that the vaccination campaign was a Western conspiracy to curb the growth of Muslims. Thus began a massive public education and advocacy campaign that focused on building confidence and credibility in the polio eradication initiative.

Early on in the initiative, it became clear that information alone is not sufficient to encourage behavior and social change. A paper in the Bulletin of the World Health Organization outlines key strategies and lessons learned from polio eradication efforts in India and Pakistan, which continue to tackle deep rooted religious, socio-cultural and political resistance to eradication:

  • Engage influencers as spokespeople. The polio campaign gained the support of religious and community leaders, who became strong community allies and were able to convert their communities. Messaging was infused into religious sermons and mosque announcements to reach community members, and Imams (religious leaders) welcomed families to vaccination booths.
  • Carefully segment the target audience and reach them through interpersonal communication. With the backing of community leaders, the campaign targeted women and female caregivers, the primary decisionmakers on child health. Trained female health workers were able to convey the safety, efficacy and benefits of the vaccine.
  • Location, location, location. Take the product to the audience.
    In addition to a house-to-house strategy, vaccination booths were set up across the country. Taking into account constant migration, booths were also set up at train and bus stations and border posts to ensure that hard-to-reach children, including those of migrant workers, were vaccinated.
  • Constantly monitor and track data. A disease surveillance system facilitates case reporting and enables swift responses if a case is found. Volunteers set out every day to examine babies and collect stool samples for testing. Health centers, doctors and even spiritual healers are trained to report the first sign of symptoms that might indicate polio.

The routine monitoring of epidemiological data and disease surveillance is especially important to ensure full eradication of the virus. India will not  be certified completely polio-free until it goes at least three full years without a case. On the race to wipe out a fatal disease ingrained in the country’s history, it is nearly at the finish line.

Although the campaign has been successful — testament to its strategic and synergistic communication efforts — it has also been controversial. Some argue that the campaign is narrow-minded; that it is only focused on eradicating polio, to the detriment of other pressing public health issues in the region, such as malaria, malnutrition, and maternal health.

Still, India’s success serves as a blueprint for other countries, motivating them to use the same model to tackle other critical public health challenges. The world awaits for Nigeria, Afghanistan and Pakistan to follow in India’s footsteps and achieve a similarly successful outcome.

What are your thoughts on this global health communication effort? What other lessons can we learn?

Event Wrap-up: Socially Responsible Behavior Change as a Business Imperative

Apr 20

Ogilvy Public Relations has been a leader in social marketing for nearly three decades. We’ve helped government agencies and Fortune 500 companies change minds, shift attitudes, redefine norms, and support sustained individual and community behavior change.

Today, we were joined by three experts in corporate social marketing to discuss how companies across a wide range of industries can become agents of socially responsible behavior change, building on corporate responsibility commitments to contribute even more so to the well-being of individuals and society:

  • Nancy Lee, Consultant, Author and Adjunct Faculty Member, the University of Washington Dan Evans School of Public Affairs, Seattle University’s Institute for Public Service and the University of South Florida’s School of Public Health
  • Michael Sachse, Vice President, Regulatory Affairs and General Counsel, Opower
  • Vidya Plainfield, North America, Senior Category Marketing Manager, Nutricia

Our conversation was led by Robert Terry, Managing Director of the Washington Business Journal, our event partner.

Crowd of attendees at Ogilvy Exchange, April 19, 2012

Several themes emerged during our discussion —

Authenticity is essential. One of the toughest challenges for businesses interested in implementing corporate social marketing initiatives is remaining authentic. Nancy Lee emphasized that companies must build programs that are congruent with their business objectives and brand identity. Companies who use corporate social marketing programs solely as a mechanism to combat critics can come off as inauthentic, instead of genuine.

Providing consumers with actionable information will help gain their loyalty. During the panel discussion Vidya Plainfield noted that today’s businesses need to help people live the lives they want to live. The goal should be not to push people, but to find them where they are, and give them information that’s useful to them. This includes providing them with reasonable advice for changing their behaviors–it’s not enough to simply ask people to change. Businesses must give consumers the knowledge and tools to change.

Corporate social marketing can deliver a double bottom line. All of the panelists noted that corporate social marketing initiatives can have an impact on a company’s revenue and a specific societal issue concurrently. Case in point, Michael Sachse noted that Opower helps its clients bolster their revenue while helping consumers reduce their energy consumption. This “double bottom line” can reap enormous benefits for corporations.

Results can be a business’ best friend. When it comes to behavior change, consumers want to understand the return on their investment. For example, if they consume less gasoline each month, how much money will they save? If they eat fewer calories, how many pounds will they lose? Hence, sharing metrics on corporate social marketing initiatives can help drive the success of these initiatives. Michael Sachse suggested that companies should build a compelling case for their programs by embracing their data, and using it as a proof point to build a case with consumers. He also commented that programs that can’t make a compelling, data-driven case, just won’t stick around.

Today’s panelists emphasized another key insight as well – driving business is already about driving behavior change. So, driving socially responsible behavior change is a natural fit for companies who wish to build brand loyalty among their consumers, increase revenue, and contribute to the wellbeing of their communities.

Let’s keep the dialogue going online–how do you believe companies can become agents of socially responsible behavior change? Share your thoughts here.

Donate Life Month-How Behavioral Economics Could Increase Organ Donation

Apr 19

In 2004 my father was diagnosed with acute renal failure caused by hypertension. He was advised to start dialysis and the kidney transplantation process by getting on the National Transplant Wait List.  His transplant coordinator said it could be several years before he received a kidney.  At that point, I made a personal decision to see if I was a match to become a living donor… I was.

April is Donate Life Month and the deteriorating health of our nation may imply that some of us will experience or know someone who will experience the need for a transplant. Health issues like diabetes, obesity and hypertension increase the risks for organ failure. According to the U.S. Department of Health and Human Services, more than 113,000 people need an organ transplant and 18 people will die each day waiting for an organ.

The majority of Americans, nearly 90 percent according to Donate Life, support organ donation, however only 40 percent of all U.S. residents age 18 and older are enrolled in state donor registries.  Given the shortage of donors, the gap between approval and action is a matter of life and death.

In addition to supporting activities that encourage a healthy lifestyle, donor registration has to increase to fill this need. Legislation has been proposed Illinois, Pennsylvania and Texas for an opt-out policy for organ donation.

Speculations on why the proposed bills have not left the committees stem from ethical and practical issues involved with changing from an opt-in to an opt-out policy. A Donate Life survey provides insights into a belief that some American’s feel physicians may not work as hard to save a patient if that patient is a registered donor. This goes against professionalism and ethics of medicine and clearly shows barriers, misconceptions and the lack of comfort most people have with discussing death and organ donation.

Best Practice

The opt-out policy for organ donation is not a new concept. A study conducted by researchers at Columbia University show that an opt-out policy for organ donation proved effective in countries including Austria, France, Belgium, Hungry and Poland with registration rates averaging 98 percent of their population.

If preferences for becoming an organ donor are given, the defaults can influence participants in the following ways:

  1. Defaults suggest a recommended action
  2. Making a decision takes effort-accepting the default is effortless
  3. Many would rather avoid making an active decision about donation, an unpleasant and somewhat stressful topic

More people will register for organ donation with an opt-out policy.

Behavioral Economics

Behavioral economics as a strategy for social marketing is a growing practice in public health and other industries. Specifically, defaults—what you get if you don’t actively make a choice—work by instilling a perception of ownership before an action takes place. Because the pleasure we perceive from gains is less intense than the pain from equivalent losses, “unchecking the box” to not become an organ donor would have more of an emotional impact than opting in as an organ donor, our current standard.

An opt-out policy for organ donor registration may not be in our immediate future. Until this option is seriously considered in legislation, increasing organ donation registration is the best we can do. One organ donor can save up to eight lives. Health and Human Services’ web site provides resources for those interested in learning more about ways to support organ donation, state registration and provides great information for starting the conversation with family. Visit http://www.organdonor.gov/index.html.

My father and I had our surgeries seven years ago and we are both in excellent health and enjoying life. We personally understand how the nation’s need for organ donation could have impacted our family.

The Role of Promotores in Community Health

Apr 17

Over the last decades, there has been an increasing interest in the development of “promotores,” or community health worker (CHW), programs to improve public health in underserved communities. But, what exactly are promotores and what is their role in these communities?

Promotoras/es are leaders, predominantly in Hispanic communities, that provide relevant health information and promote healthy behaviors to those with less knowledge and/or access to health care within their communities. Other commonly used terms for promotores are peer leaders, patient navigators, health advocates, and lay and outreach workers. Although their responsibilities may vary from programs to regions, the main role of promotores usually is to raise awareness about health issues, preventive care, disease management, and follow-up care, and to improve communication with health care providers, among other roles. The study Community Health Workers: Who Are They and What They Do, references that 66% of CHWs are women, 77% of these are women of color and 58% has a high school degree or less.

According to the World Health Organization (WHO), CHWs should be:

  • members of the communities where they work,
  • selected by the communities,
  • answerable to the communities for their activities,
  • supported by the health system but not necessarily a part of its organization, and
  • have shorter training than professional workers.

Health care providers, community clinics and state health departments have acknowledged the value and key role of promotores in promoting community-based health education and prevention. One of the main reasons why promotores have a great impact and are so effective with their outreach efforts is that they are trusted leaders in their communities. They personally know and understand what community members are going through and they can explain certain health issues, instructions and more technical terms in an easy-to-understand way, relieving patients of the burden of having to decipher a doctor’s explanations and recommendations by themselves.

The CHW concept has been used for at least 50 years. If we go back in time, we will find that the first forms of what are now promotores or CHWs took place in the 17th century, in Russia, where farm workers were called “lay people” and they would receive one year of training so that they could care for the individuals in the military. At the same time, there were similar groups in China, Kenya, Liberia and Latin America. In 1987, WHO adopted a definition for health counselors and identified some of their key roles:

  • education focused on prevention and the control of health problems,
  • promotion of healthy practices,
  • prevention and control of local and common health problems,
  • treatment of common illnesses, and
  • providing essential medicines.

WHO suggests that the first formal CHW programs were implemented in the United States during the 1950s and 1960s. These were developed with the interest of creating health resources that were accessible and appropriate for communities that did not receive services via the traditional medical system.

Many studies have shown that there are many implementation problems when it comes to promotores programs, such as the lack of resources, standardized information on promotores programs, certification issues, and organizational costs. Nonetheless, it has been proven that promotores/CHWs can make a significant and positive difference in the health of their community members. It will be interesting to see how the promotores programs movement evolves in the coming years as an essential part of the health system, as well as a communications strategy for reaching out to particular groups and communities.

A Twist in the Patient and Provider Dialogue

Apr 12

There seems to be a bit of press this month around patients having more to say about their medical care, as in the April edition of the New York Times, “Do Patients Want More Care or Less?” One of the key overall benefits of the Affordable Care Act is that millions of Americans who may not currently have any coverage at all can be insured. If the law works as planned many will have the opportunity to talk about needed medical tests and treatments with the doctors who serve them. Thanks to the internet, social media networks, and a new campaign – “Choosing Wisely” – many may come into these conversations with preconceived ideas of the care they need and even some skepticism about the services these doctors recommend.

Led by the American Board of Internal Medicine, “Choosing Wisely” aims to foster better dialogues between consumers and providers in conversations about which procedures are medically necessary. The campaign has united at least nine national medical associations, which include the American College of Cardiology and the American Academy of Family Physicians, to actually identify some of the common test s and procedures that warrant further discussion and question between the provider and the patient. Tests such as CT scans, cardiac workups and prescribing antibiotics for example, have all been noted as procedures or tests that should be up for discussion or question. There is even a list of 45 things doctors and patients should question and coming up later this month in Boston is an actual conference on “Avoiding Avoidable Care” that will convene physicians and other experts to discuss unnecessary medical care.

This consensus by some of the top tier societies is a move forward in my opinion. Dr. Christine K. Cassel, president and CEO of the ABIM Foundation, said in a written statement: “Today these societies have shown tremendous leadership in starting a long overdue and important conversation between physicians and patients about what care is really needed.” “Physicians, working together with patients, can help ensure the right care is delivered at the right time for the right patient. We hope the lists released today kick off important conversations between patients and their physicians to help them choose wisely about their health care.”

It would be wonderful if the “Choosing Wisely” campaign supports an open dialogue and encourages more providers not to take consumer questions as a personal affront. It may also lead to greater acknowledgement that some of the tests and procedures recommended and actually performed weren’t really necessary, which could lower medical spending. According to the New York Times article, some sources say that one-third of these expenditures in the U.S. are for unnecessary treatments.

As citizens of the U.S., we want access to the best, affordable care possible. Yet learning the pros and cons and side effects of potentially unnecessary procedures can still be daunting to the average consumer. Hopefully, medical school curriculum will include some guidance for future physicians who want to help patients through the process of making an informed decision. I’d also be interested to know what insurance companies have to say on this topic and am looking forward to skimming through a copy of “Overdiagnosed: Making People Sick in the Pursuit of Health” by H. Gilbert Welch, which should shed some light on how this new shift on consumer attitudes has come about. I also at least know now that the dynamic will not be so foreign to my provider should I so choose to question a recommendation.