Boot Camp Translation
Boot Camp Translation
The High Plains Research Network has completed BCT with our CAC on 4 topics, identifying "what is the message" and "how to disseminate the message" for prevention of colon cancer, asthma, home monitoring of high blood pressure, and the patient-centered medial home (PCMH). Several other boot camps are underway for hypertension, health risk assessments, and behavioral health in primary care.
The HPRN received a grant from the Centers for Disease Control and Prevention to conduct a community-based intervention to improve colorectal cancer screening in rural and frontier eastern Colorado. The HPRN uses a community-based participatory approach in all research and has an active CAC comprising local farmers, ranchers, school teachers, hardware store owners, and a few others. The first step of was for the community members to gain expertise in colorectal cancer screening. Colon Cancer Boot Camp consisted of a full-day retreat followed by 4 half-day retreats and 8 half-hour phone calls. The first day included a full-length continuing education presentation identical to one being given to primary care providers in the state. We spent a half day on this presentation, allowing community members to interact, ask questions, and make comments. Community members had the opportunity to do a colonoscopy in our simulation laboratory. Ultimately, the community members became colorectal cancer screening experts. Based on their expertise from living in rural eastern Colorado, they changed the project's original language and approach to make the intervention more accessible to their rural communities. First, they changed the word colorectal to colon cancer to make the topic easier to talk about in public. Second, given the complexity of the concept of "screening" (primary, secondary, etc), they eliminated this language and instead used the term testing. The CAC learned and was struck by the fact that the removal of polyps can actually prevent colon cancer. As a result, the community changed the title and focus of the project to "Testing to Prevent Colon Cancer." The final set of main messages was short and simple: Colon cancer is the second leading cause of cancer death in the United States. Colon cancer is preventable. Testing is worth it. Talk to your doctor today. To move these messages and more detailed information about colon cancer throughout the target community, the group developed a multicomponent, multistrategy dissemination plan that used a combination of newspaper stories about local community members, a standard agricultural communication tool in the form of a farm auction flyer, a series of small pocket-sized cards with local personalities and messages, community talks, and a travel mug with messaging about colon cancer. A random digit dial survey revealed that the dissemination reached 65% of the target population and resulted in an increase in testing to prevent colon cancer. A full description of the results of this trial is beyond the scope of this manuscript and will be presented elsewhere. This program has received additional funding for replication in another rural region of Colorado.
A similar process and results occurred for the asthma boot camp, during which the community targeted and created language to increase awareness of asthma. This intervention, called Community AIR, linked community members to a practice-based asthma diagnosis and management program called Asthma Toolkits. What to say in the message was crucial because the CAC wanted to target several groups in rural Colorado and educate people who do not have a diagnosis of asthma about the common symptoms so that they would access their local health care provider (Asthma: do you have it?). They also wanted to dispel the myth that people with asthma have to limit their activities through appropriate treatment and self-management (You can control it). The CAC pushed use of "controller" medications over "inhaled corticosteroids" and helped develop a patient "toolkit" that local clinics hand out to their patients (Get your FREE Asthma Toolkit today). A common local remedy was to use an inexpensive dust mask to prevent asthma. The CAC identified this, and our team reviewed the literature about the common dust mask, finding them ineffective for controlling asthma. The CAC included in their messaging to rural famers that common dust masks are not adequate to control asthma. Dissemination of the message engaged more than 40 high schools to distribute edgy asthma educational posters, t-shirts, dust masks with the message that they are not adequate asthma care, and newspaper articles.
In our home blood pressure program, the CAC changed our language by eliminating the term hypertension in favor of the more accessible high blood pressure. They linked the primary care practice to the patients through a message promoting home blood pressure monitoring. They included messaging about many behavioral lifestyle changes (nutrition, diet, exercise, stress management, and sodium intake) with a balance of information and action steps. BCT for the PCMH was a long process, lasting a year. Initially put off by the language of the PCMH, the CAC was excited to try and translate the medical jargon into patient-centered language. They learned the National Committee for Quality Assurance components of a PCMH and the current local, state, and national work on implementing PCMHs. The CAC used an appreciative inquiry approach to identify successful PCMH events from community members. The final product was a poster of quotes about successful medical home events that provide tangible activities that might be expected in a medical home. These messages will provide the topics for newspaper articles about the medical home as it is implemented in each rural community.
As part of an Agency for Health Research and Quality task order, the CAC has begun an abbreviated BCT on health risk assessments. The first day-long meeting was dedicated to learning the science and evidence for health risk assessments and reviewing the language of common assessment tools and processes for patient completion of health risk assessments. Ongoing work on this topic is to provide local, culturally appropriate methods for how and when to conduct health risk assessments in rural Colorado. Figure 1 provides information about each boot camp topic, schedule, and outcomes.
Results
The High Plains Research Network has completed BCT with our CAC on 4 topics, identifying "what is the message" and "how to disseminate the message" for prevention of colon cancer, asthma, home monitoring of high blood pressure, and the patient-centered medial home (PCMH). Several other boot camps are underway for hypertension, health risk assessments, and behavioral health in primary care.
Specific Examples of Boot Camp Translation in the HPRN
The HPRN received a grant from the Centers for Disease Control and Prevention to conduct a community-based intervention to improve colorectal cancer screening in rural and frontier eastern Colorado. The HPRN uses a community-based participatory approach in all research and has an active CAC comprising local farmers, ranchers, school teachers, hardware store owners, and a few others. The first step of was for the community members to gain expertise in colorectal cancer screening. Colon Cancer Boot Camp consisted of a full-day retreat followed by 4 half-day retreats and 8 half-hour phone calls. The first day included a full-length continuing education presentation identical to one being given to primary care providers in the state. We spent a half day on this presentation, allowing community members to interact, ask questions, and make comments. Community members had the opportunity to do a colonoscopy in our simulation laboratory. Ultimately, the community members became colorectal cancer screening experts. Based on their expertise from living in rural eastern Colorado, they changed the project's original language and approach to make the intervention more accessible to their rural communities. First, they changed the word colorectal to colon cancer to make the topic easier to talk about in public. Second, given the complexity of the concept of "screening" (primary, secondary, etc), they eliminated this language and instead used the term testing. The CAC learned and was struck by the fact that the removal of polyps can actually prevent colon cancer. As a result, the community changed the title and focus of the project to "Testing to Prevent Colon Cancer." The final set of main messages was short and simple: Colon cancer is the second leading cause of cancer death in the United States. Colon cancer is preventable. Testing is worth it. Talk to your doctor today. To move these messages and more detailed information about colon cancer throughout the target community, the group developed a multicomponent, multistrategy dissemination plan that used a combination of newspaper stories about local community members, a standard agricultural communication tool in the form of a farm auction flyer, a series of small pocket-sized cards with local personalities and messages, community talks, and a travel mug with messaging about colon cancer. A random digit dial survey revealed that the dissemination reached 65% of the target population and resulted in an increase in testing to prevent colon cancer. A full description of the results of this trial is beyond the scope of this manuscript and will be presented elsewhere. This program has received additional funding for replication in another rural region of Colorado.
A similar process and results occurred for the asthma boot camp, during which the community targeted and created language to increase awareness of asthma. This intervention, called Community AIR, linked community members to a practice-based asthma diagnosis and management program called Asthma Toolkits. What to say in the message was crucial because the CAC wanted to target several groups in rural Colorado and educate people who do not have a diagnosis of asthma about the common symptoms so that they would access their local health care provider (Asthma: do you have it?). They also wanted to dispel the myth that people with asthma have to limit their activities through appropriate treatment and self-management (You can control it). The CAC pushed use of "controller" medications over "inhaled corticosteroids" and helped develop a patient "toolkit" that local clinics hand out to their patients (Get your FREE Asthma Toolkit today). A common local remedy was to use an inexpensive dust mask to prevent asthma. The CAC identified this, and our team reviewed the literature about the common dust mask, finding them ineffective for controlling asthma. The CAC included in their messaging to rural famers that common dust masks are not adequate to control asthma. Dissemination of the message engaged more than 40 high schools to distribute edgy asthma educational posters, t-shirts, dust masks with the message that they are not adequate asthma care, and newspaper articles.
In our home blood pressure program, the CAC changed our language by eliminating the term hypertension in favor of the more accessible high blood pressure. They linked the primary care practice to the patients through a message promoting home blood pressure monitoring. They included messaging about many behavioral lifestyle changes (nutrition, diet, exercise, stress management, and sodium intake) with a balance of information and action steps. BCT for the PCMH was a long process, lasting a year. Initially put off by the language of the PCMH, the CAC was excited to try and translate the medical jargon into patient-centered language. They learned the National Committee for Quality Assurance components of a PCMH and the current local, state, and national work on implementing PCMHs. The CAC used an appreciative inquiry approach to identify successful PCMH events from community members. The final product was a poster of quotes about successful medical home events that provide tangible activities that might be expected in a medical home. These messages will provide the topics for newspaper articles about the medical home as it is implemented in each rural community.
As part of an Agency for Health Research and Quality task order, the CAC has begun an abbreviated BCT on health risk assessments. The first day-long meeting was dedicated to learning the science and evidence for health risk assessments and reviewing the language of common assessment tools and processes for patient completion of health risk assessments. Ongoing work on this topic is to provide local, culturally appropriate methods for how and when to conduct health risk assessments in rural Colorado. Figure 1 provides information about each boot camp topic, schedule, and outcomes.
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