For healthy behavior change, take the message into the community

Strategies for successful disease prevention programs

In September 2011, world leaders held the first General Assembly at the United Nations to address chronic disease, which caused an estimated 36 million deaths world wide in 2008. The declaration written by these leaders identified unhealthy behaviors such as smoking, excessive drinking, lack of exercise, and poor, diets dominated by fast food as the leading cause of cancer, diabetes, and heart and lung disease. The U.N. hopes to have a plan of action to promote healthy lifestyles by the end of 2012.

In the United States the Centers for Disease Control and Prevention reported this summer that education that results in healthy behaviors is needed to improve the lives of Americans. According to the CDC, people who don't smoke, exercise regularly, eat a healthy diet, and drink moderately are 63% less likely to die at an early age. When people practice the four behaviors, the risk of death from cancer and heart disease is about two-thirds lower.

Healthcare institutions should be leaders in delivering messages on healthy behavior because they have the expertise, says Barbara B. Mintz, MS, RD, assistant vice president, wellness at Newark (NJ) Beth Israel Medical Center. However, the education cannot be completed within the four walls of the hospital because people only come there when they are sick.

"The challenge is to execute successful programs that reach our community to prevent disease," Mintz says. "Treating disease is so much easier because they come to us. To prevent disease we have to be in the community."

This step is done at Beth Israel Medical Center by taking programs piloted at the healthcare institution out into the community. For example, a weight loss program with education on lifestyle changes named the Beth Challenge was first offered to employees. Now it is being used in the community setting offered through churches and worksites. The KidsFit program developed to address childhood obesity was first implemented within the medical center and is now part of school curriculum.

Because children within the community can weigh 300 pounds or more at 12 years old, treating obesity after the fact was not the answer, says Mintz. Now two dietitians are teaching school children how to eat healthy in the environment in which they live where access to fresh fruits and vegetables is limited. Also, they are teaching children how to exercise within their home when streets are not safe, by creating indoor obstacle courses or using stairs.

Children bring messages home

Children in schools are a captive audience, agrees Olajide Williams, MD, MS, chief of staff of neurology and associate professor of clinical neurology at Columbia University Medical Center in New York City and founder and director of Hip Hop Public Health. This organization has an office at Columbia University Medical Center and at Harlem Hospital and works within school curriculum to change health behaviors. For example, a school-based educational program on healthy eating and living aimed at children in middle school also engages parents by involving them in homework activities, such as tracking meals or learning about daily caloric expenditure.

"It is very hard to engage this group [working parents], but we think we have a way to do it through their children. They don't have time to manage their risk factors because they are so busy and challenged, but through their children, we can bring a lot of things to their attention," says Williams.

Children need to be excited and motivated about the intervention in order to follow through with the parental engagement, he says. The program generates this level of excitement by engaging children through hip hop music and culture using a multi-media approach that includes short, animated features, a series of comic books that complement the animation, and video games. The resources and curriculum are produced in-house. (To learn more about this program, visit the web site at hiphoppublichealth.org.)

"Piggyback on what is already a part of their life and culture," advises Williams. "Use what they are comfortable with and what they already love as a tool to empower them. I don't really see this as rocket science; we are basically using what the youth are already crazy about and use it effectively."

Look at popular forms of delivery

At MD Anderson Cancer Center in Houston, TX, technology is used to deliver prevention messages beyond the hospital walls. Messages are delivered via an online subscription newsletter called "Get Focused on Health" (www.mdanderson.org/focusedonhealth), a Facebook page (www.facebook.com/mdanderson.focusedonhealth) and Twitter (@focusedonhealth).

Adelina Espat, communications program manager in the Public Education Office at MD Anderson Cancer Center, says, "Its purpose is to educate people in a very consumer-friendly way on the various things they can do to make healthier choices in order to avoid getting cancer. We cover a lot of topics regarding nutrition, exercise, avoiding tobacco, obesity, and sun safety."

Delivering a message on healthy lifestyles through technology provides a way to reach a lot of people on a small budget, Espat says, and it's affordable. "Research shows people are looking for health information online by doing Internet searches. Also, people are going onto social networking sites discussing health questions with friends. We want to be present to proactively offer good information," she says.

To draw consumers to the web site, news releases are distributed to national and local media every month promoting the online issue. Also, the Public Education Office has partnerships with other web sites that repost articles, such as Everydayhealth.com and kevinmd.com. "Our online educational programs are geared to larger numbers and are more to increase awareness," says Espat.

Education is the spark that gets people thinking about their health behaviors, says Jason L. Bittle, community health improvement coordinator at Hanover (PA) Hospital Wellness and Education Center. In the Stages of Change Model, health education can take a person from a place where they don't realize certain behaviors are unhealthy to a later stage of behavior modification and lowered disease risk, Bittle explains.

"If health education can inform the person before disease sets in, we can save a tremendous amount of resources and energy rather than treating the disease," says Bittle.

Sources

• Jason L. Bittle, Community Health Improvement Coordinator, Hanover Hospital Wellness and Education Center, Hanover, PA. E-mail: BittleJ@HanoverHospital.org.

• Adelina Espat, Communications Program Manager, Public Education Office, MD Anderson Cancer Center Houston, TX. E-mail: ajespat@mdanderson.org. Get Focused on Health web site: www.mdanderson.org/focusedonhealth.

• Barbara E. Mintz, MS, RD, Assistant Vice President Wellness, Newark (NJ) Beth Israel Medical Center. Telephone: (973) 926-2663. E-mail: bmintz@barnabashealth.org.

• Olajide Williams, MD, MS, Chief of Staff of Neurology, Associate Professor of Clinical Neurology, Columbia University Medical Center, Director Hip Hop Public Health, New York, NY. E-mail: ow11@columbia.edu.