The document outlines a health literacy initiative focused on increasing flu vaccination rates among hard-to-reach populations in Wisconsin, detailing the program's goals and strategies. It emphasizes collaboration with community organizations and the use of plain language materials to address health misconceptions. Evaluation results indicate improvements in participants' understanding and intentions regarding flu vaccinations.

1. LET’S TALK ABOUT THE FLU
Communicating Health Prevention
to Hard-to-Reach, At-Risk Populations
Steve Sparks
Director
Wisconsin Health Literacy
a division of Wisconsin Literacy, Inc.
March 13, 2015
PLAIN TALK
in Complex Times

2. Division of Wisconsin Literacy
 73 member literacy agencies
18,000 adult learners; 3300 volunteer tutors
Training, Consultation and Interventions
on Health Literacy
Health Literacy Summit: April 14-15, 2015
WisconsinHealthLiteracy.org
Wisconsin Health Literacy

3. Why focus on Flu?
U.S. adults
receiving flu shots
Wisconsin adults
receiving flu shots

4. IS IT A FLU SHOT?
Or an influenza immunization?

5. The intervention:
“Let’s Talk about the Flu”
Program Goals:
1. Increase health knowledge
2. Increase flu vaccine rates
3. Collect baseline data about barriers to vaccination
4. Foster relationship with members, communities and
funders

6. Logic Model

7. The strategy
Focus on groups with anticipated lower health
literacy and lower immunization rates
• Adults with low literacy
• Disadvantaged adults
• Immigrants/refugees
• Homeless adults
• Racial/ethnic groups
• Seniors

8. Ethnic minorities & health literacy
Below basic health literacy:
• 9% - Caucasians
• 25% - American Indians and Alaskan Natives
• 24% - African Americans
• 41% - Latinos
NAAL, 2003

9. The strategy
Offer workshops in partnership with trusted
organizations, including:
• Adult literacy agencies
• Neighborhood centers
• Homeless shelters
• Refugee health
programs
• Senior centers

10. Program Elements
1. One-hour workshops
2. Workbook in plain language
3. Voucher or access to free vaccine

11. Program Elements
Flu Prevention Kit as incentive

12. Program Resources
1. Instructor Guide
2. Myths and misconceptions
3. Partner Stipends
4. Promotional Support

13. Flu prevention project: 2010
51 workshops conducted
1,128 participants

14. Flu prevention project: 2010
What we learned:
• Need to measure behavior
change
• Consider flu clinics
• Confirm understanding:
“I heard you can get
immunity from the shot.”
• Answer common questions

15. Flu prevention project: 2010
Common comments and questions:
• I know someone who got sick from the shot.
• How often do I need the shot?
• How long does immunity take?
• What is stomach flu?
• Does flu cause pneumonia?
• Where can I get a free shot?

16. Flu prevention project: 2011
53 workshops conducted
943 participants

17. Flu Shot Voucher
17% used

18. Flu prevention project: 2011
What we learned:
• Challenge to measure
actual vaccination rates
• Need child care
• Address cultural myths
• PowerPoints optional
• Adapt for educational vs.
non-educational settings

19. Flu prevention project: 2013
21 workshops conducted
467 participants

20. The booklet
Tested through literacy
partners

21. Designed with health literacy principles
Many
photos
supporting
message

22. Designed with health literacy principles
Lots of white space
Larger type,
plain language

23. Designed with health literacy principles
Easy-to-follow
organization

24. Designed with health literacy principles
Making it
personal

25. Designed with health literacy principles
Check for understanding

26. Types of Evaluation
• Needs assessments – What do we need?
• Previous workshop experience
• Interviews with public and community health authorities
• Literature reviews
• Process evaluations – How did we do it?
• Staff survey
• Feedback from community contacts
• Outcome evaluations – What happened as a result?
• Participant pre-and post-tests
• Change in vaccination intention
• Change in vaccination behavior
• Public relations outcomes

27. Pre- and post-tests

28. Outcome Objectives: Know, Think, Do
• KNOW (Learning objectives)
• Ex. By the end of the workshop, all 750 learners should be able to
identify symptoms of the flu, including cough, sore throat and fever
• THINK (Belief objectives)
• Ex. By the end of the workshop, all 750 learners should be able to
discuss personal beliefs about flu vaccines, including whom they
trust to make important health care decisions
• DO (Behavioral objectives)
• Within 3 months of the workshop, 400 learners will obtain a flu
vaccine

29. Results – Outcome objectives
KNOW (Learning objectives)
• Average pre-test score: 55.7%
• Average post-test score: 82.7%
THINK (Belief objectives)
• Intend to vaccinate before workshop: 73.9%
• Intend to vaccinate after workshop: 83.1%
• Open-ended responses to reasons why/why not vaccinated in the past
DO (Behavior objectives)
• Vaccinated before workshop: 12.2%
• Used Walgreens voucher: 17.1%
• Obtained on-site flu vaccine: 13.1%
• Obtained flu vaccine in clinical setting: unknown
• Total vaccinated (minimum): 42.4%

30. Results
33% Hispanic/Latino
30% Caucasian
18% African American
19% Other
Outcomes (2011, 2013) Before After
Average pre-test score 53.3% 82.5%
Planned to get vaccine 798 953
3 years…..125 workshops…..2,516 participants

31. #1 reason people got a shot:
(of those who gave a reason)
“I want to protect myself.
I don’t want to get sick”
Other common reasons:
Doctor recommended it
In a high risk group (age, health condition)
Required (by employer, school, prison)

32. #1 reason people didn’t get a flu shot:
(of those who gave a reason)
“I am healthy,
never had the flu”
Other barriers:
Worried about side effects; made me or someone I know get sick
Just don’t want it; don’t think it’s necessary
Couldn’t afford it; don’t have insurance
Hurts; hate needles

33. What we’d do different in the future
• Provide materials translation
• More on-the-spot clinics following workshops
• Offer program for general audiences

34. The future of “Let’s Talk about the Flu”
Steve Sparks, Health Literacy Director
steve@wisconsinliteracy.org