Medical Device Daily Washington Editor

WASHINGTON — The annual meeting of the American Public Health Association (APHA; Washington) included several sessions on behavioral health, including one that dealt with health behavior change through the use of innovations in technology. While the populations in question were college-age and younger — and hence, more likely than their antecedents to be techno-savvy — the sessions hinted at the possibility that modern electronic media might be used to trim the nation’s healthcare bill if the results of several studies can be extrapolated successfully to other slices of the demographic pie.

Erin Edgerton of the National Center for Health Marketing at the Centers for Disease Control and Prevention (CDC; Atlanta), described the agency’s program designed to influence vaccination usage.

Edgerton described briefly the information-seeking behaviors the agency had tracked in a portion of its site devoted to influenza, saying that “the vast majority of those who search for health information start with a search engine,” which also picks up social portals, such as patient groups.

“Seasonal flu is a good example because it shows how we can use different sites and different tactics” to “reach new and diverse audiences,” Edgerton said. As one example of strategic collaboration, CDC recently started getting local vaccination clinics involved in the CDC web site so that those looking for vaccinations would be able to find a local public health facility that offered vaccinations.

However, pictures still count for a thousand words, and last year’s click count from the CDC web page for vaccinations showed that a picture of a sick-looking snowman generated the most clicks. Edgerton also noted that, perhaps predictably, Google accounted for about 5.4% of the click-throughs to the CDC site, and flushot.org was second.

As part of an outreach, CDC also held a web seminar, or webinar, for healthcare bloggers, which reviewed “the most effective messages to make people want to get vaccinated.” About 15 bloggers initially indicated they were interested in the webinar, but only seven bloggers actually dialed in. On the other hand, the session was not for naught. The seven bloggers, she said, often drew as many as 10,000 hits a day.

CDC’s “Whyville” web site is “specifically geared for 8-11 years old,” Edgerton said, a demographic of interest because after seeing the site, “they went home and talked about vaccinations to their families.” The site is of sufficiently low data intensity that it can be accessed via a dial-up connection, making it accessible to households that lack high-speed connections. Edgerton said the site drew 134,000 trips to the site’s vaccination station and almost 20,000 visitors were vaccinated.

Kiosk in doc office can change behavior

Wendy Shields, a research associate at the Johns Hopkins Bloomberg School of Public Health (Baltimore), discussed the effect of a computer kiosk in pediatric emergency rooms on safety practices in the home, which was the subject of a study financed by the National Institute of Child Health and Human Development (NICHD) at NIH.

“Injuries are the leading killer of children 14 and under in the U.S.” and in many other developed nations, Shields said, and low income correlates positively with a higher incidence of serious accidents.

The kiosk study, dubbed Safety in Seconds, is a controlled, randomized trial designed to establish whether updating the participants’ knowledge of three safety risks would prod a change behavior. The three areas were use of car seatbelts, installation and maintenance of home smoke alarms, and childproof storage of poisonous substances. “They’re particularly large problems,” Shields said, adding that “there are things you can do about these” without asking more than a parent could manage, which is part of the reason the program went after these three areas.

The kiosk was set up in the pediatric emergency room at Johns Hopkins University Hospital and involved an assessment that took about ten minutes. “The whole theory behind this is the precaution adoption process model,” which Shields said consisted of seven steps for smoke alarms, ranging from utter unawareness to routine maintenance. However, the researchers discovered that the model needed tweaking in some instances, because “just having a car seat” for infants and toddlers, let alone routinely using it “is really four behaviors,” rather than just one.

The trial enrolled primarily women who were the mothers or stepmothers of the child, and the data suggested significant gains in awareness “for smoke alarms, poison scores and total knowledge scores,” and “a significant difference on car seat use,” Shields said.

As for whether those differences in perception were followed by behavioral changes, Shields said the study noted a significant difference in the use of car seats and smoke alarms, but poison storage did not show a significant difference. Shields said, “it’s great that we are able to prepare tailored messages” to change knowledge and, to some extent, behavior, and “it was great that it needed no intervention at all from the physician.”

However, she also reminded the audience self-reporting is not always reliable, and the primary study data relied on self-reports. To check on the data, the team observed outcomes in 100 homes, and Shields said, “although there is over-reporting,” the results of this live observational follow-up suggested that over-reporting did not fully negate the self-reported changes.

Shields told Medical Device Daily that such an approach could work for a Medicare population partly because this group has “similar issues for literacy,” but the presentation, as well as the information, would have to be revamped “for their issues.” Shields also mentioned the possibility of locating kiosks in other places, but said they would not likely show up at a free-standing location in a mall because usage would more likely be tied to a location in a store that has a product to sell the population in question.

She said that “it’s really the maintenance, such as paper loading,” that’s the issue with regard to plunking a kiosk down in a free-standing location.