INCREASING COMMUNITY BASED HEALTH PROMOTION THROUGH THE FAMILY HEALTH HISTORY TO ENHANCE COMMUNICATION BETWEEN PATIENT AND PROVIDER IN A PRIMARY CARE SETTING

Paula Winkler, M.Ed., Center DirectorSouth Central AHEC

SETTING THE STAGE

CLINICAL TRANSLATION SCIENCE AWARD (CTSA)

Community Engagement Core Function – 2008 - 2013

3 Legged Stool

PBRN – School of Public Health – Translational Advisory Board (AHEC)

Community Based Participatory Research (CBPR)

TRANSLATIONAL ADVISORY BOARD (TAB)SOUTH CENTRAL AHEC

TAB MISSION

The mission of the Translational Advisory Board (TAB) is to serve as a representative body which aims to improve community health through the facilitation of community-based participatory research and educational outreach activities in partnership with the UT Health Science Center at San Antonio.

GOALS OF THE TAB

Settingthehealthresearchagendainthecommunity

Partneringwithresearcherstodevelopandrefinehealthresearchprotocolsinthecommunity

Participatingindatacollectionandanalysis

Reportinghealthresearchfindingstocommunitymembers

Seekingsustainableresourcesforcommunityhealthresearchinitiativesandprograms

Facilitatingcommunityhealthresearchpartnerships

HEALTH DEMOGRAPHICS OF TABS

Statewide Prevalence of Diabetes

Source: CDC National Diabetes Surveillance System

7.5% 8.0% 8.5% 9.0%

Bexar

Comal

Frio

Gillespie

Guadalupe

8.7%

8.3%

8.5%

8.2%

8.2%

Percent

Cou

nty

Diabetes Prevalence in TAB Counties 2009

0.0% 1.0% 2.0% 3.0% 4.0%

Bexar

Comal

Frio

Gillespie

Guadalupe

3.3%

2.8%

3.9%

1.2%

1.5%

Percent

Deaths Caused by Diabetes in TAB Counties 2009

Source: Texas Health Data

HEALTH DEMOGRAPHICS OF TABS

21.0%

22.0%

23.0%

24.0%

25.0%

26.0%

Bexar Comal Frio Gillespie Guadalupe

22.6% 22.5%

25.4% 25.2%

24.0%

Perc

ent

Heart Disease Mortality in TAB Counties 2009

Source: Texas Health Data

HEALTH DEMOGRAPHICS OF TABS

0.0

20.0

40.0

60.0

80.0

100.0

120.0

53.1 54.3

103.4

93.4

40.3Rat

e pe

r 10

0k

Stroke Mortality Rates in TAB Counties 2009

0.0

10.0

20.0

30.0

40.0

50.0

60.0

Bexar Comal Frio Gillespie Guadalupe

22.7

18.5

36.9

51.7

22.5

Rat

e pe

r 10

0k

Breast Cancer (Female) Mortality Rates in TAB Counties 2009

Source: DHHS Community Health Status Indicator Report 2009

GENOMIC-BASED RESEARCH APPLICATIONS FOR COMMUNITY ENGAGEMENT: GRACE

Nedal Arar., MS., MA., PhD.Associate Professor

Department of Medicine/UTHSCSA.Health Research Scientist, South Texas Veterans Health Care SystemSan Antonio, TX

Email: ararn@uthscsa.edu.

Detailed Family Health History as a Genomic and Clinical Tool

CTSA PILOT GRANT 2011-2012

Expand GRACE to Community - $50K Dr. Nedal Arar - PI TABs recruit 20 participants per community TABs assist to identify facility/technology for

study AHEC housed Project Coordinator AHEC staff assisted Project Coordinator

FAMILY HEALTH HISTORY

FHH PURPOSE

To enhance participants' awareness/knowledge regarding the importance of FHH information.

To collect FHH and establish extended three generations pedigree using SG online FHH tool.

To encourage participants sharing their FHH information with relatives and providers.

To document individuals actual behaviors regarding the use of their FHH information by conducting a follow up visit after 6 months.

To assess consumers’ satisfaction regarding the utilizations of their FHH information, assessed by the American Customer Satisfaction Index (ACSI),

WHAT RUNS IN YOUR FAMILY?

Talk Health History Campaign Public Service Announcement (PSA) Video

MY FAMILY HEALTH PORTRAIT

MY FAMILY HEALTH PORTRAIT

Protects personal information by not saving it after the end of the session

Lets the user know exactly whose information to fill in and doesn’t require names

Keep the history to share with family and/or your doctor/other provider

Because of information security measures, requires users to print or save on desktop/other external devices

REMEMBER…

Any information you fill in is good information! Don’t get frustrated if you don’t know

everything about everyone!

GRACE: PARTICIPANT NUMBERS

Total of 75 participants between 5 counties

Bexar 17

Comal 20

Frio 9

Gillespie 12

Guadalupe 17

SUMMARY OF DEMOGRAPHICS

Summary of Demographics

Median Age|| 53.4

Age Range || 24.5 ‐ 57

% Non ‐ Hispanic White: Com, Gua, Gil || 88.9%

% Non‐Hispanic White: Bex, Fri || 17%

Marital Status || 49.8% Married

Average Income || 37% ‐ $30k/yr, 33% ‐ $50+/yr

Average Educational Level || 38% ‐ 4yr+ degree, 34% ‐ some college

PARTICIPANTS COMMENTS ON FACILITATION AND BARRIERS OF THE SURGEON GENERAL TOOL

Facilitation/Motivation Barriers

Having a mobile application available Lack of computer knowledge

Family helping to add to the family health history

Lack of computer/internet access

Being an online tool for the public to access

Time Constraints

Encouragement from family/doctor’s office

Lack of knowledge of family history-Not knowing their family-adoption

RESULTS

KAP Assessment Averages

Family health history refers to diseases and conditions that run in my family 90.3% Strongly Agreed

Knowing my Family Health History will help me to identify my risk for diseases 93.9% Strongly Agreed

Being aware of my FHH and making the right healthcare and lifestyle choices can reduce my risks 80.4% Strongly Agreed

My familial risk may increase if I have multiple family members with the same or related conditions 76.4% Strongly Agreed

I fell I have little control over risks to my health 21.5% Strongly Disagreed

There are things I can do to prevent or minimize my risks of developing common chronic diseases 67.6% Strongly Agreed

There is not much use in trying to knkow my family health history because the disease will develop anyway

52.5% Strongly Disagreed

Health care providers should help patients make informed choices about their health care plans based on their family health history

77.3% Strongly Agreed

WHERE DO USERS GO FROM HERE?

Finding health information online isn’t always easy

MEDLINEPLUS

MEDLINEPLUS

Reliable health information in lay language

Available in English, Spanish, and other languages

Provides links to other trusted health information sources

Not easy to browse to family health history health topic page –opportunity for education

FUTURE DIRECTION

National Library of Medicine Grant application – awaiting results

PCORI Grant Opportunities

NIH Grants

Expand to Science Teachers in Classrooms

Residency Training –Community Medicine Blocks

PBRNs

THANK YOU!