Engaging Diverse Populations in Chronic Disease Self Management Programs

Quarterly Self-Management Webinar SeriesOregon Health Authority

September 19, 2012

Phone conference line: 1-888-232-0366Participant code: 309902

Moderator

Laura Chisholm – (formerly Saddler)Self-Management Technical Lead, Oregon Public Health Division

Oversees statewide self-management program sustainability efforts

Learning Objectives

– Identify effective ways to engage members of diverse populations in self-management programs through targeted marketing

– Articulate culturally specific ways to encourage continued participation in programs (retention)

– Share successes and challenges in engaging people in programs who experience social stigma as a result of their chronic condition(s)

Some Requests

– Please mute your phone: #0, option 1 = mute/un-mute

– Use the chat function for questions

– Please participate!

Let’s hear from the audience!

– Poll: What is your main role with self-management programs?

– Poll: What populations do your programs serve now?

Presenters

John Motter – Speakers Bureau Coordinator, Cascade AIDS Project

Leads HIV Basic and Positive Self Management Programs

Presenters

Catherine Potter – Eastside Program Director, Parish Health Promoter Program

Coordinates trained Latino immigrant volunteers from faith communities who carry out programs, including Tomando Control de su Salud

Community characteristics

Parish Health Promoter Program serves:– Low-income Latino immigrants in Portland– Focus on faith communities– Health promoters are dedicated volunteers from

participating parishes– “Tomando Control” classes are 1 of several regular

ongoing activities

Community characteristics – Tomando Control participants

– Most participants are working adults– People hear about classes through word of mouth and

through their churches– Less than half of participants “register” ahead of time– Important that class is free, food is provided– Sometimes childcare is needed

Successful recruitment – Tomando Control

– Volunteers and past participants are best spokespeople

– Promote class at health screening events– Explain class well – Communicate what they will gain from it– Location is key

Successful recruitment – Tomando Control

– Announcements at church are our best strategy– Personal contact with class leaders before class is

important– Make use of community partners in recruiting– Partner with local clinics that don’t offer classes but

want patients to attend

Common Characteristics – People Living with HIV

– Numerous co-morbidities (i.e. diabetes, bone density problems, Hepatitis C, etc.)

– Medication adherence problems– Medication side effects– Mental Health and/or Substance Abuse (not all)– Disease discrimination and stigma

Distinct Characteristics

It’s some of the distinct characteristics that create barriers in engagement.– Males who identify as gay– Socio-Economic Status (Employed vs. Disability)– Heterosexual Women– Heterosexual Men– Intravenous Drug Users (IDU)

Positive Self-Management Program

– PSMP was first piloted in 1994– 7 weeks instead of 6 weeks– In studies:

– Improvements in symptoms– Significantly better medication adherence– Better HIV suppression in blood after 6 months– No more side effects than non-PSMP participants

What should recruiters be aware of?

– HIV+ individuals can benefit from attending CDSMP (Living Well) workshops if a PSMP workshop is not currently scheduled.

– Evening workshops may be more effective in order to reach those individuals who still work

– Many individuals aren’t likely to be clients of, or affiliated, with an HIV/AIDS organization

– There can still a significant level of stigma associated with coming to a program sponsored by Cascade AIDS Project (CAP)

What means of recruitment are likely to be successful?

– Facebook and other social marketing– Personal connections with direct phone calls– Housing and Medical Case Managers– Mailings to CAP’s “Positive Directions” list– Marketing to a specific target group (i.e., Kid’s

Connection, Women of Wisdom, Oregon Bears)

What means of recruitment are likely to be unsuccessful?

– Housing and Medical Case Managers– Individuals can feel pressured– Afraid of losing services for not attending

(MYTH)– Mailings to CAP’s Positive Directions

Participant retention – Tomando Control

– Lots of phone contact important (between each class)– Make sure people understand class well before

starting– Give out books at 2nd class– Explain incentives for workshop completion

(certificate, book, gifts) at beginning

Materials – Tomando Control

– Flyers serve as reminders (date, time, place)– Flyers should include photos with variety of ages – Make sure language is appropriate for group– (sample flyer)

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Retention is an Issue for PSMP

– Retention rates have ranged from 25% to 70%– Newer workshops have been at the higher range– Improved due to:

– Better screening of participants at time of sign-up– Targeted audience workshops– Gift card incentives each week (insure that

everyone has received one by final day)– Providing food and/or child care

Marketing Materials and Distribution - PSMP

– Flyers– Direct phone calls– How do you distribute them?

– Listservs– Direct mailings to clients– Facebook

What messages about self-management seem to resonate best?

– Knowledge that at least one leader is also HIV+– Being able to improve treatment adherence– Being able to address side effects

Corrections Population

– Community characteristics– Marketing

– What works?– What messages resonate best?

– Participant retention

– How to reach people who’ve been recently released?

Questions for the presenters?

Let’s Hear from the Audience!

– Poll: What is your biggest challenge in terms of recruiting

and retaining a diverse population of participants in your programs?

– Discussion question: How have you overcome this challenge?

Who’s Attending Our Programs?

In 2011, participants statewide were:– 75% female, 25% male– 1% African American– 4% American Indian/Alaska Native– 6% Asian/Pacific Islander– 81% White– 18% Latino/Hispanic ethnicity– Aged 13-96 (average age 60)

Who’s Attending Our Programs?

Chronic ConditionPercent (number) attending

LW/TC/PSMP/DMSP statewide in 2011

Arthritis/fibromyalgia 48% (1,002)High blood pressure 42% (890)Chronic pain 38% (789)Depression 41% (869)High cholesterol 34% (714)Diabetes 32% (667)Cancer survivors 11% (225)HIV+ 2% (33)

2012 Living Well Data Report: http://public.health.oregon.gov/DiseasesConditions/ChronicDisease/LivingWell/Documents/Reports/statedata12.pdf

Who’s Attending Your Programs?

– See county reports at http://public.health.oregon.gov/DiseasesConditions/ChronicDisease/LivingWell/Pages/pubs.aspx#county

Let’s Hear from the Audience!

– Who are your programs effectively reaching?

– Who are they not reaching?

– How can you overcome this challenge?

Let’s Hear from the Audience!

– What is your #1 take-away from the discussion today?

Presenter Contact Information

John P. MotterSpeakers Bureau Coordinator

jmotter@cascadeaids.org

Catherine PotterEastside Program Coordinator

Parish Health Promoter Programcatherine.potter@providence.org

Thank you for participating!

Oregon Living Well ProgramOregon Public Health Division

living.well@state.or.us(888) 576-7414 or (971) 673-0984www.healthoregon.org/livingwell