Myra Muramoto at Consumer Centric Health, Models for Change '11


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Communities at Change Agents. Helpers Program: A Social & Community Network Approach to Tobacco Cessation. The University of Arizona College of Medicine,
Department of Family & Community Medicine

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  • The 3 T’sCreate “motivational tension” in smoker’s environment.Trigger action in those who are contemplating quitting.Ensure that treatment, including brief counseling, is immediately available.
  • Key compo
  • Have the opportunity to help promote healthy behaviorsHave access to high-risk and hard to reach populationsMotivated, engaged
  • “Proxies” - non-smokers calling on a smokers behalf (Zhu, 2006)7% of all callers to California quitline (~22,000 in 7 years)Non-English lines had a more proxy callers
  • Randomized trial of brief intervention training for health influencersIn-person classroom trainingWeb-based trainingMailed materials with brief motivational sessionQuantitative OutcomesProportion of participants reporting providing BIsCompletion of “5 A’s”Qualitative study of health influencers experience with providing BIs
  • Worksite dissemination with Free & ClearUsed only Helpers Web componentsThree large national corporations3 month pilot, target audience of n=102,100Site utilizationCreated user account on site– 4727Registered for training – 1427Completed training – 766Clicks on referral links – 201Deployed nationwide across multiple corporation and ISP infrastructures with very few problems
  • Feasibility study of multiple Helpers components – still ongoingIn-person training (training of trainers)Helpers Community Resource Center web-site Quit KitsHelpers is a good fit with state tobacco program’s community-based approach to cessation Both in-person and web-being training in useTrainers starting to get creative about using Helpers training for outreach and engagement of community partners
  • RWJF Consumer Demand Roundtable project – to explore innovative ways of tobacco users to seek evidence-based treatmentDeveloped with IDEO – world-renowned design firmConsider: How are print and other distributed materials used to promote cessation?How could they be used more effectively?Possibilities:Outreach Kits to promoting organizations’ cessation activities/services to partnersGive-away’s at community eventsResources to mail or give to community members asking how to help someone quit
  • Myra Muramoto at Consumer Centric Health, Models for Change '11

    1. 1. Consumer-Centric HealthModels for Change ‘11
    2. 2. Communities as Change AgentsHelpers Program: A Social & CommunityNetwork Approach to Tobacco CessationMyra Muramoto, MD, MPHThe University of Arizona College of Medicine,Department of Family & Community Medicine
    3. 3. AcknowledgementsSponsorsNational Cancer InstituteThe Robert Wood Johnson FoundationArizona Department of Health ServicesThe University of Arizona Health NetworkUS Department of Defense
    4. 4. AcknowledgementsPartnersPima Community College  Partnership for Tobacco-Free MaineMaricopa Community College  Mississippi State UniversityMesa Community College  Northern Arizona UniversityFree & Clear (now Alere)  University of AlabamaICA Mississippi Head Start  University of MinnesotaArizona WIC Clinics  Mohave County health DeptOuter Limits  Tanner CorporationChild Time  Cortiva instituteArizona Smoker’s Helpline  New Jersey Tobacco ControlAmerican Specialty Health ProgramMaricopa county Health Dept.  Coconino County Health Dept.  The University of Arizona Health Network
    5. 5. Why?How do we reach people….… beyond the healthcare system?… beyond the worksite?… across barriers to access? Reach people where they are.
    6. 6. Social networks & smoking cessation Chance of smoking decreased:  67% if their spouse quit  25% if adult sibling quit  36% if their friend quit  34% if coworker quit “cascades of quitting” 3 degrees of separation (Christakis, 2007)
    7. 7. Networks of networksInfluencehealth anddiseaseat multiplelevels… Barabasi, 2007
    8. 8. Another Network Level -Organizations and Communities
    9. 9. Quitting is not always planned Patients’ report of quit attempts (Larabie, 2005)  51.6% unplanned, 64% unaided  Many reasons for unplanned successful quits National household survey (West, et al., 2006)  48.6% of most recent quit attempts were unplanned and acted on immediately  Unplanned attempts more likely to be successful  Decisions to change often impulsive (West, 2006)  Accumulation of nudges  3 T’s
    10. 10. Brief Tobacco Interventions Continuum of cessation services Interventions by multiple health professionals increase quit attempts and quits (An, et al., 2008) Population effect – “increase in quit attempts matters more than the same level of increase in the use of help.” (Zhu, 2007) Any attempt is better than no attempt
    11. 11. To Increase Quit Attempts Change social norms…  Quitting is normal  Repeated attempts are normal, so keep trying Help tobacco users feel more hopeful Reduce perceived barriers to cessation aids
    12. 12. Helpers…Who are they?What are their roles?
    13. 13. “Health Influencers”Family & friendsCo-workersEducatorsService providersStrangersHave motive…Have opportunity…Are engaged Campbell, et al., 2007
    14. 14. Decisions about medicaltreatments... ...frequently take place within household and friendship networks. Janzen 1987; Nichter 1996, 2006
    15. 15. “Trusted members of thecommunity…”....trusted byrelatives, friends, andco-workers, the verypeople for whom theinterventions weredesigned.” (Thomas, 2001)
    16. 16. Seeking help on behalf of others….….7% of all callers toCalifornia quit line, moreon non-English lines (Zhu, 2006)
    17. 17. Quitting tobacco is a process…“A journey of a thousand miles begins with a single step.” Lao Tzu
    18. 18. … a journey… Helpers encourage… … The first step … The last step … A step along the way … Not giving up on the journey.
    19. 19. What is the Helpers Program?What is underlying research?
    20. 20. The Helpers Program… Training, support, resources for “helping conversations” Foster communities of practice 5 main components
    21. 21. The Helping Conversation Awareness Understanding Helping Relating
    22. 22. Helpers Training Model Web-based or In-person Supportive non- confrontational approach Information about resources Referral skills
    23. 23. Helpers research and projects
    24. 24. Project Reach
    25. 25. What did we learn? Who came forward Increased knowledge, confidence, an d helping behavior Minimal intervention increased helping behavior Referred to services, discussed medications Contextual influences on helping Muramoto, et al, 2007; Castaneda, et al, 2008, Yuan, et al, 2010
    26. 26. Helpers Free & Clear study Worksite dissemination pilot Helpers Web components only Feasibility Utilization Muramoto, et al, 2010
    27. 27. Helpers New Jersey In-person & web training Community Resource Center Helpers Quit Kits Community creativity & experimentation
    28. 28. Helpers Quit Kits IDEO Facilitate helping conversations Integrate “Helpers Journey” experience Outreach & Graduation Muramoto, et al, 2008
    29. 29. Current work
    30. 30. Communities as change agents… Need community-based approaches Engage, activate social networks Foster communities of practice Helpers arose out of a decade of community- based research Still evolving based on community needs
    31. 31. Thank you!myram@email.arizona.edu