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Nixon J, Turner J, Gray L, Scaife J. Communicating Actively, Responding Empathically (CARE): Perceptions of Cancer Health Professionals Attending Communication Training Workshops. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:288-295. [PMID: 32592036 DOI: 10.1007/s13187-020-01809-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Communication skills training is standardly offered to health professionals working in cancer; however, there is no consensus on the precise style or duration of training, which is most effective. This study aimed to examine the experiences of health professionals who had participated in either a 1-day communication skills training workshop focusing on experiential learning or a 2-h workshop in which participants discussed different communication styles demonstrated on purpose-designed videotapes. Twenty health professionals comprising ten from each workshop type participated in a semi-structured interview with an interpretative descriptive design. Participant characteristics were summarised using descriptive statistics. Thematic analysis was conducted. Consistent themes across both groups were the importance of good communication and perceived barriers. All participants strongly endorsed the value of their respective training experience and considered this was due in part to the skill of facilitators and the creation of a supportive learning environment. Role plays were reported to be helpful in promoting skill development, and some participants in the 2-h workshop indicated that they would have liked the opportunity to practice new skills through role play, which was not possible in the short workshop. Participants self-reported increased confidence following both workshops and perceived improvements in delivery of person-centred care. Both the 1-day and the 2-h communication workshops were a positive experience for the groups who attended. The 1-day communication workshop offered an opportunity for experiential learning, which the 2-h group felt would have been worthwhile; however, both groups found value in attending the workshops.
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Affiliation(s)
- Jodie Nixon
- Occupational Therapy Department, Princess Alexandra Hospital, Brisbane, Australia.
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia.
| | - Jane Turner
- Faculty of Medicine, The University of Queensland, St Lucia, QLD, 4027, Australia
| | - Lyndal Gray
- Occupational Therapy Department, Princess Alexandra Hospital, Brisbane, Australia
| | - Jessica Scaife
- Department of Palliative Care, Calvary Mater Newcastle, Edith Street, Waratah, 2299, Australia
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Schmälzle R, Wilcox S. Harnessing Artificial Intelligence for Health Message Generation: The Folic Acid Message Engine. J Med Internet Res 2022; 24:e28858. [PMID: 35040800 PMCID: PMC8808340 DOI: 10.2196/28858] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 05/21/2021] [Accepted: 11/21/2021] [Indexed: 12/04/2022] Open
Abstract
Background Communication campaigns using social media can raise public awareness; however, they are difficult to sustain. A barrier is the need to generate and constantly post novel but on-topic messages, which creates a resource-intensive bottleneck. Objective In this study, we aim to harness the latest advances in artificial intelligence (AI) to build a pilot system that can generate many candidate messages, which could be used for a campaign to suggest novel, on-topic candidate messages. The issue of folic acid, a B-vitamin that helps prevent major birth defects, serves as an example; however, the system can work with other issues that could benefit from higher levels of public awareness. Methods We used the Generative Pretrained Transformer-2 architecture, a machine learning model trained on a large natural language corpus, and fine-tuned it using a data set of autodownloaded tweets about #folicacid. The fine-tuned model was then used as a message engine, that is, to create new messages about this topic. We conducted a web-based study to gauge how human raters evaluate AI-generated tweet messages compared with original, human-crafted messages. Results We found that the Folic Acid Message Engine can easily create several hundreds of new messages that appear natural to humans. Web-based raters evaluated the clarity and quality of a human-curated sample of AI-generated messages as on par with human-generated ones. Overall, these results showed that it is feasible to use such a message engine to suggest messages for web-based campaigns that focus on promoting awareness. Conclusions The message engine can serve as a starting point for more sophisticated AI-guided message creation systems for health communication. Beyond the practical potential of such systems for campaigns in the age of social media, they also hold great scientific potential for the quantitative analysis of message characteristics that promote successful communication. We discuss future developments and obvious ethical challenges that need to be addressed as AI technologies for health persuasion enter the stage.
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Affiliation(s)
- Ralf Schmälzle
- Department of Communication, Michigan State University, East Lansing, MI, United States
| | - Shelby Wilcox
- Department of Communication, Michigan State University, East Lansing, MI, United States
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Atti del 52° Congresso Nazionale: Società Italiana di Igiene, Medicina Preventiva e Sanità Pubblica (SItI). JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2019; 60:E1-E384. [PMID: 31777763 PMCID: PMC6865078 DOI: 10.15167/2421-4248/jpmh2019.60.3s1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Stead M, Angus K, Langley T, Katikireddi SV, Hinds K, Hilton S, Lewis S, Thomas J, Campbell M, Young B, Bauld L. Mass media to communicate public health messages in six health topic areas: a systematic review and other reviews of the evidence. PUBLIC HEALTH RESEARCH 2019. [DOI: 10.3310/phr07080] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BackgroundMass media campaigns can be used to communicate public health messages at the population level. Although previous research has shown that they can influence health behaviours in some contexts, there have been few attempts to synthesise evidence across multiple health behaviours.ObjectivesTo (1) review evidence on the effective use of mass media in six health topic areas (alcohol, diet, illicit drugs, physical activity, sexual and reproductive health and tobacco), (2) examine whether or not effectiveness varies with different target populations, (3) identify characteristics of mass media campaigns associated with effectiveness and (4) identify key research gaps.DesignThe study comprised (1) a systematic review of reviews, (2) a review of primary studies examining alcohol mass media campaigns, (3) a review of cost-effectiveness evidence and (4) a review of recent primary studies of mass media campaigns conducted in the UK. A logic model was developed to inform the reviews. Public engagement activities were conducted with policy, practitioner and academic stakeholders and with young people.ResultsThe amount and strength of evidence varies across the six topics, and there was little evidence regarding diet campaigns. There was moderate evidence that mass media campaigns can reduce sedentary behaviour and influence sexual health-related behaviours and treatment-seeking behaviours (e.g. use of smoking quitlines and sexual health services). The impact on tobacco use and physical activity was mixed, there was limited evidence of impact on alcohol use and there was no impact on illicit drug behaviours. Mass media campaigns were found to increase knowledge and awareness across several topics, and to influence intentions regarding physical activity and smoking. Tobacco and illicit drug campaigns appeared to be more effective for young people and children but there was no or inconsistent evidence regarding effectiveness by sex, ethnicity or socioeconomic status. There was moderate evidence that tobacco mass media campaigns are cost-effective, but there was weak or limited evidence in other topic areas. Although there was limited evidence on characteristics associated with effectiveness, longer or greater intensity campaigns were found to be more effective, and messages were important, with positive and negative messages and social norms messages affecting smoking behaviour. The evidence suggested that targeting messages to target audiences can be effective. There was little evidence regarding the role that theory or media channels may play in campaign effectiveness, and also limited evidence on new media.LimitationsStatistical synthesis was not possible owing to considerable heterogeneity across reviews and studies. The focus on review-level evidence limited our ability to examine intervention characteristics in detail.ConclusionsOverall, the evidence is mixed but suggests that (1) campaigns can reduce sedentary behaviour, improve sexual health and contribute to smoking cessation, (2) tobacco control campaigns can be cost-effective, (3) longer and more intensive campaigns are likely to be more effective and (4) message design and targeting campaigns to particular population groups can be effective.Future workFuture work could fill evidence gaps regarding diet mass media campaigns and new-media campaigns, examine cost-effectiveness in areas other than tobacco and explore the specific contribution of mass media campaigns to multicomponent interventions and how local, regional and national campaigns can work together.Study registrationThis study is registered as PROSPERO CRD42015029205 and PROSPERO CRD42017054999.FundingThe National Institute for Health Research Public Health Research programme.
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Affiliation(s)
- Martine Stead
- Institute for Social Marketing, University of Stirling, Stirling, UK
- UK Centre for Tobacco and Alcohol Studies, UK
| | - Kathryn Angus
- Institute for Social Marketing, University of Stirling, Stirling, UK
- UK Centre for Tobacco and Alcohol Studies, UK
| | - Tessa Langley
- UK Centre for Tobacco and Alcohol Studies, UK
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | - Srinivasa Vittal Katikireddi
- Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Kate Hinds
- Institute of Education, University College London, London, UK
| | - Shona Hilton
- Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Sarah Lewis
- UK Centre for Tobacco and Alcohol Studies, UK
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | - James Thomas
- Institute of Education, University College London, London, UK
| | - Mhairi Campbell
- Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Ben Young
- UK Centre for Tobacco and Alcohol Studies, UK
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | - Linda Bauld
- UK Centre for Tobacco and Alcohol Studies, UK
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
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Kasteng F, Murray J, Cousens S, Sarrassat S, Steel J, Meda N, Ouedraogo M, Head R, Borghi J. Cost-effectiveness and economies of scale of a mass radio campaign to promote household life-saving practices in Burkina Faso. BMJ Glob Health 2018; 3:e000809. [PMID: 30057798 PMCID: PMC6058168 DOI: 10.1136/bmjgh-2018-000809] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 05/17/2018] [Accepted: 05/18/2018] [Indexed: 11/10/2022] Open
Abstract
Introduction Child health promotion through mass media has not been rigorously evaluated for cost-effectiveness in low-income and middle-income countries. We assessed the cost-effectiveness of a mass radio campaign on health-seeking behaviours for child survival within a trial in Burkina Faso and at national scale. Methods We collected provider cost data prospectively alongside a 35-month cluster randomised trial in rural Burkina Faso in 2012–2015. Out-of-pocket costs of care-seeking were estimated through a household survey. We modelled intervention effects on child survival based on increased care-seeking and estimated the intervention’s incremental cost-effectiveness ratio (ICER) in terms of the cost per disability-adjusted life year (DALY) averted versus current practice. Model uncertainty was gauged using one-way and probabilistic sensitivity analyses. We projected the ICER of national-scale implementation in five sub-Saharan countries with differing media structures. All costs are in 2015 USD. Results The provider cost of the campaign was $7 749 128 ($9 146 101 including household costs). The campaign broadcast radio spots 74 480 times and 4610 2-hour shows through seven local radio stations, reaching approximately 2.4 million people including 620 000 direct beneficiaries (pregnant women and children under five). It resulted in an average estimated 24% increase in care-seeking for children under five and a 7% reduction in child mortality per year. The ICER was estimated at $94 ($111 including household costs (95% CI −38 to 320)). The projected provider cost per DALY averted of a national level campaign in Burkina Faso, Burundi, Malawi, Mozambique and Niger in 2018–2020, varied between $7 in Malawi to $27 in Burundi. Conclusion This study suggests that mass-media campaigns can be very cost-effective in improving child survival in areas with high media penetration and can potentially benefit from considerable economies of scale. Trial registration number NCT01517230; Results.
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Affiliation(s)
- Frida Kasteng
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Simon Cousens
- Centre for Maternal Adolescent Reproductive and Child Health (MARCH), London School of Hygiene and Tropical Medicine, London, UK
| | - Sophie Sarrassat
- Centre for Maternal Adolescent Reproductive and Child Health (MARCH), London School of Hygiene and Tropical Medicine, London, UK
| | | | | | | | - Roy Head
- Development Media International CIC, London, UK
| | - Josephine Borghi
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
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Jacob V, Chattopadhyay SK, Elder RW, Robinson MN, Tansil KA, Soler RE, Labre MP, Mercer SL. Economics of mass media health campaigns with health-related product distribution: a community guide systematic review. Am J Prev Med 2014; 47:348-59. [PMID: 25145619 PMCID: PMC4682205 DOI: 10.1016/j.amepre.2014.05.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 05/05/2014] [Accepted: 05/28/2014] [Indexed: 10/24/2022]
Abstract
CONTEXT The objective of this systematic review was to determine the costs, benefits, and overall economic value of communication campaigns that included mass media and distribution of specified health-related products at reduced price or free of charge. EVIDENCE ACQUISITION Economic evaluation studies from a literature search from January 1980 to December 2009 were screened and abstracted following systematic economic review methods developed by The Community Guide. Data were analyzed in 2011. EVIDENCE SYNTHESIS The economic evidence was grouped and assessed by type of product distributed and health risk addressed. A total of 15 evaluation studies were included in the economic review, involving campaigns promoting the use of child car seats or booster seats, pedometers, condoms, recreational safety helmets, and nicotine replacement therapy. CONCLUSIONS Economic merits of the intervention could not be determined for health communication campaigns associated with use of recreational helmets, child car seats, and pedometers, primarily because available economic information and analyses were incomplete. There is some evidence that campaigns with free condom distribution to promote safer sex practices were cost-effective among high-risk populations and the cost per quit achieved in campaigns promoting tobacco cessation with nicotine replacement therapy products may translate to a cost per quality-adjusted life-year less than $50,000. Many interventions were publicly funded trials or programs, and the failure to properly evaluate their economic cost and benefit is a serious gap in the science and practice of public health.
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Affiliation(s)
- Verughese Jacob
- Community Guide Branch, Division of Epidemiology, Analysis, and Library Services, CDC, Atlanta, Georgia.
| | - Sajal K Chattopadhyay
- Community Guide Branch, Division of Epidemiology, Analysis, and Library Services, CDC, Atlanta, Georgia
| | - Randy W Elder
- Community Guide Branch, Division of Epidemiology, Analysis, and Library Services, CDC, Atlanta, Georgia
| | - Maren N Robinson
- Community Guide Branch, Division of Epidemiology, Analysis, and Library Services, CDC, Atlanta, Georgia
| | - Kristin A Tansil
- Community Guide Branch, Division of Epidemiology, Analysis, and Library Services, CDC, Atlanta, Georgia
| | - Robin E Soler
- Community Guide Branch, Division of Epidemiology, Analysis, and Library Services, CDC, Atlanta, Georgia
| | - Magdala P Labre
- Community Guide Branch, Division of Epidemiology, Analysis, and Library Services, CDC, Atlanta, Georgia
| | - Shawna L Mercer
- Community Guide Branch, Division of Epidemiology, Analysis, and Library Services, CDC, Atlanta, Georgia
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Atusingwize E, Lewis S, Langley T. Economic evaluations of tobacco control mass media campaigns: a systematic review. Tob Control 2014; 24:320-7. [PMID: 24985730 PMCID: PMC4484382 DOI: 10.1136/tobaccocontrol-2014-051579] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Accepted: 06/10/2014] [Indexed: 11/25/2022]
Abstract
Background International evidence shows that mass media campaigns are effective tobacco control interventions. However, they require substantial investment; a key question is whether their costs are justified by their benefits. The aim of this study was to systematically and comprehensively review economic evaluations of tobacco control mass media campaigns. Methods An electronic search of databases and grey literature was conducted to identify all published economic evaluations of tobacco control mass media campaigns. The authors reviewed studies independently and assessed the quality of studies using the Drummond 10-point checklist. A narrative synthesis was used to summarise the key features and quality of the identified studies. Results 10 studies met the inclusion criteria and were included in the review. All the studies included a cost effectiveness analysis, a cost utility analysis or both. The methods were highly heterogeneous, particularly in terms of the types of costs included. On the whole, studies were well conducted, but the interventions were often poorly described in terms of campaign content and intensity, and cost information was frequently inadequate. All studies concluded that tobacco control mass media campaigns are a cost effective public health intervention. Conclusions The evidence on the cost effectiveness of tobacco control mass media campaigns is limited, but of acceptable quality and consistently suggests that they offer good value for money.
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Affiliation(s)
- Edwinah Atusingwize
- Division of Epidemiology and Public Health, Nottingham City Hospital, University of Nottingham, Nottingham, UK
| | - Sarah Lewis
- Division of Epidemiology and Public Health, Nottingham City Hospital, University of Nottingham, Nottingham, UK
| | - Tessa Langley
- Division of Epidemiology and Public Health, Nottingham City Hospital, University of Nottingham, Nottingham, UK
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Miller-Day M, Hecht ML. Narrative means to preventative ends: a narrative engagement framework for designing prevention interventions. HEALTH COMMUNICATION 2013; 28:657-70. [PMID: 23980613 PMCID: PMC3795942 DOI: 10.1080/10410236.2012.762861] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
This article describes a Narrative Engagement Framework (NEF) for guiding communication-based prevention efforts. This framework suggests that personal narratives have distinctive capabilities in prevention. The article discusses the concept of narrative, links narrative to prevention, and discusses the central role of youth in developing narrative interventions. As illustration, the authors describe how the NEF is applied in the keepin' it REAL adolescent drug prevention curriculum, pose theoretical directions, and offer suggestions for future work in prevention communication.
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Lee CJ, Ramírez AS, Lewis N, Gray SW, Hornik RC. Looking beyond the Internet: examining socioeconomic inequalities in cancer information seeking among cancer patients. HEALTH COMMUNICATION 2012; 27:806-17. [PMID: 22356137 PMCID: PMC4209720 DOI: 10.1080/10410236.2011.647621] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
The gap in cancer information seeking between high-socioeconomic-status (high-SES) cancer patients and low-SES cancer patients deserves serious attention, considering the importance of information and knowledge in cancer control. We thus explored the association of SES, as measured by education, with cancer patients' overall cancer information seeking, and with seeking from each source (i.e., the Internet, mass media, medical sources, and nonmedical interpersonal sources) and across two topic categories (i.e., treatment, quality of life). We then asked whether the effect of education on treatment information seeking is reduced among those who are particularly motivated to control treatment choices. We conducted a survey with breast, prostate, and colon cancer patients diagnosed in 2005 (n = 2,013), who were randomly drawn from the Pennsylvania Cancer Registry in the fall of 2006. We found that education was more strongly associated with Internet use than with the use of other sources regardless of topics. Also, when information was sought from mass media, education had a greater association with treatment information seeking than with quality-of-life information seeking. Preference for active participation in treatment decision making, however, did not moderate the effect of education on treatment information seeking. The implications of these findings for public health research and cancer patient education were discussed.
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Affiliation(s)
- Chul-Joo Lee
- School of Communication, Ohio State University, Columbus, OH 43210, USA.
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Voluntary medical male circumcision: a qualitative study exploring the challenges of costing demand creation in eastern and southern Africa. PLoS One 2011; 6:e27562. [PMID: 22140450 PMCID: PMC3226625 DOI: 10.1371/journal.pone.0027562] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2011] [Accepted: 10/19/2011] [Indexed: 11/19/2022] Open
Abstract
Background This paper proposes an approach to estimating the costs of demand creation for voluntary medical male circumcision (VMMC) scale-up in 13 countries of eastern and southern Africa. It addresses two key questions: (1) what are the elements of a standardized package for demand creation? And (2) what challenges exist and must be taken into account in estimating the costs of demand creation? Methods and Findings We conducted a key informant study on VMMC demand creation using purposive sampling to recruit seven people who provide technical assistance to government programs and manage budgets for VMMC demand creation. Key informants provided their views on the important elements of VMMC demand creation and the most effective funding allocations across different types of communication approaches (e.g., mass media, small media, outreach/mobilization). The key finding was the wide range of views, suggesting that a standard package of core demand creation elements would not be universally applicable. This underscored the importance of tailoring demand creation strategies and estimates to specific country contexts before estimating costs. The key informant interviews, supplemented by the researchers' field experience, identified these issues to be addressed in future costing exercises: variations in the cost of VMMC demand creation activities by country and program, decisions about the quality and comprehensiveness of programming, and lack of data on critical elements needed to “trigger the decision” among eligible men. Conclusions Based on this study's findings, we propose a seven-step methodological approach to estimate the cost of VMMC scale-up in a priority country, based on our key assumptions. However, further work is needed to better understand core components of a demand creation package and how to cost them. Notwithstanding the methodological challenges, estimating the cost of demand creation remains an essential element in deriving estimates of the total costs for VMMC scale-up in eastern and southern Africa.
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Ma M, Dollar KM, Kibler JL, Sarpong D, Samuels D. The effects of priming on a public health campaign targeting cardiovascular risks. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2011; 12:333-8. [PMID: 21678029 DOI: 10.1007/s11121-011-0228-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Public health interventions are cost-effective methods to reduce heart disease. The present study investigated the impact of a low-cost priming technique on a public health campaign targeting cardiovascular risk. Participants were 415 individuals (66% female) ages 18 and older recruited through clinics and churches. The study consisted of three phases. In Phase I, participants completed a brief survey to assess knowledge of the cardiovascular health indicators. The survey served as the prime (intervention) for the study. At Phase II, participants were provided with access to a public health campaign consisting of an education brochure on cardiovascular health. Following the educational campaign, all participants completed a post-campaign survey in Phase III of the study. Participants who completed the surveys in both Phase I and III were placed in the intervention condition (26%) and those who only completed the Phase III survey were placed in the control condition (74%). Participants who were primed reported greater awareness of the public health campaign. Additionally, more intervention participants reported they had knowledge of their own and the normal ranges for cholesterol, glucose, and body mass index. For participants who were aware of the health promotion campaign, more participants in the primed group indicated they had knowledge of their own cholesterol and glucose levels and had made positive lifestyle changes as a result of the campaign. Results suggest the presence of a priming effect. Public health campaigns may benefit from the inclusion of a low-cost prime prior to intervention.
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Affiliation(s)
- Mindy Ma
- Farquhar College of Arts and Sciences, Nova Southeastern University, 3301 College Avenue, Fort Lauderdale, FL 33314, USA.
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Handley MA, Shumway M, Schillinger D. Cost-effectiveness of automated telephone self-management support with nurse care management among patients with diabetes. Ann Fam Med 2008; 6:512-8. [PMID: 19001303 PMCID: PMC2582479 DOI: 10.1370/afm.889] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE This study evaluated the cost-effectiveness of an automated telephone self-management support with nurse care management (ATSM) intervention for patients with type 2 diabetes, which was tested among patients receiving primary care in publicly funded (safety net) clinics, focusing on non-English speakers. METHODS We performed cost analyses in the context of a randomized trial among primary care patients comparing the effects of ATSM (n = 112) and usual care (n = 114) on diabetes-related outcomes in 4 San Francisco safety net clinics. ATSM uses interactive phone technology to provide surveillance, patient education, and one-on-one counseling, and was implemented in 3 languages for a 9-month period. Cost utility was examined using quality-adjusted life-years (QALYs) derived from changes in scores on the 12-Item Short Form Health Survey. We also examined cost-effectiveness for costs associated with a 10% increase in the proportion of patients meeting diabetes-specific public health goals for increasing exercise, as recommended by Healthy People 2010 and the American Diabetes Association. RESULTS The annual cost of the ATSM intervention per QALY gained, relative to usual care, was $65,167 for start-up and ongoing implementation costs combined, and $32,333 for ongoing implementation costs alone. In sensitivity analyses, costs per QALY ranged from $29,402 to $72,407. The per-patient cost to achieve a 10% increase in the proportion of intervention patients meeting American Diabetes Association exercise guidelines was estimated to be $558 when all costs were considered and $277 when only ongoing costs were considered. CONCLUSIONS The ATSM intervention for diverse patients with diabetes had a cost utility for functional outcomes similar to that of many other accepted interventions targeted at diabetes prevention and treatment, and achieved public health physical activity objectives at modest costs. Because a considerable proportion of costs were fixed, cost-utility and cost-effectiveness estimates would likely be substantially improved in a scaled-up ATSM program.
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Affiliation(s)
- Margaret A Handley
- Department of Epidemiology and Biostatistics, Division of Preventive Medicine and Public Health, University of California, San Francisco, San Francisco General Hospital, San Francisco, CA 94110, USA.
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Frick KD. Cost-effectiveness studies of behavior change communication campaigns: assessing the state of the science and how to move the field forward. JOURNAL OF HEALTH COMMUNICATION 2006; 11 Suppl 2:163-73. [PMID: 17148104 DOI: 10.1080/10810730600974894] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Affiliation(s)
- Kevin D Frick
- Johns Hopkins Bloomberg School of Public Health, Department of Health Policy and Management, Health Services Research and Development Center, Baltimore, Maryland 21205-1901, USA.
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Hutchinson P, Lance P, Guilkey DK, Shahjahan M, Haque S. Measuring the cost-effectiveness of a national health communication program in rural Bangladesh. JOURNAL OF HEALTH COMMUNICATION 2006; 11 Suppl 2:91-121. [PMID: 17148101 DOI: 10.1080/10810730600974647] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
In this article we examine the cost-effectiveness of the Smiling Sun multichannel media campaign, which was undertaken in Bangladesh from 2001 to 2003 and involved a nationally broadcast television serial drama supported by radio, television, newspaper, and billboard advertisements and local promotion activities. The goal was to encourage the use of a package of family health services at NGO (nongovernmental organization) Service Delivery Program (NSDP) providers. This analysis relates the costs of the Smiling Sun campaign at the national and local level to measures of change in the use of health services, namely, antenatal care and childhood immunizations. Effectiveness is measured using data from cross-sectional surveys conducted in 2001 and 2003 in NSDP catchment areas in rural Bangladesh. The statistical approach, bivariate probit estimation, controls for nonrandom exposure to the program's media messages, advertisements, and signs. Using national-level data, we find that the Smiling Sun campaign was both effective and cost-effective, inducing higher levels of service utilization for only $0.05 per additional antenatal care (ANC) user and only $0.30 and $0.36 for each additional child vaccinated for measles and DPT3, respectively. With respect to local promotion activities, the cost per attributable behavior change was considerably higher--nearly $8 per new ANC user, $37 per new DPT3 vaccination, and $32 per new measles vaccination.
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Affiliation(s)
- Paul Hutchinson
- Department of International Health and Development, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana 70112, USA.
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Guilkey DK, Hutchinson P, Lance P. Cost-effectiveness analysis for health communication programs. JOURNAL OF HEALTH COMMUNICATION 2006; 11 Suppl 2:47-67. [PMID: 17148099 DOI: 10.1080/10810730600973987] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
This article describes methods for analyzing the cost-effectiveness of health communication programs, focusing in particular on estimating program effectiveness with econometric methods that address experimental and quasi-experimental designs (and their absence), national or subnational program coverage, and endogenously targeting of programs. Experimental designs provide a gold standard for assessing effectiveness but are seldom feasible for large-scale health communication programs. Even in the absence of such designs, however, fairly simple methods can be used to examine intermediate objectives, such as program reach, which in turn can be linked to program costs to estimate cost effectiveness. When moving beyond program reach to behavioral or other outcome measures, such as contraceptive use or fertility, or when faced with full-coverage national programs, more elaborate data and methods are required. We discuss data requirements and assumptions necessary in each case, focusing on single-equation multiple regression models, structural equations models, and fixed effects estimators for use with longitudinal data, and then describing how cost information can be incorporated into econometric models so as to get measures of the cost-effectiveness of communication interventions.
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Affiliation(s)
- David K Guilkey
- Department of Economics and the MEASURE Evaluation Project, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA.
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