An Interactive, Mobile-Based Tool for Personal Social Network Data Collection and Visualization Among a Geographically Isolated and Socioeconomically Disadvantaged Population: Early-Stage Feasibility Study With Qualitative User Feedback.

BACKGROUND: Personal social networks have a profound impact on our health, yet collecting personal network data for use in health communication, behavior change, or translation and dissemination interventions has proved challenging. Recent advances in social network data collection software have reduced the burden of network studies on researchers and respondents alike, yet little testing has occurred to discover whether these methods are: (1) acceptable to a variety of target populations, including those who may have limited experience with technology or limited literacy; and (2) practical in the field, specifically in areas that are geographically and technologically disconnected, such as rural Appalachian Kentucky. OBJECTIVE: We explored the early-stage feasibility (Acceptability, Demand, Implementation, and Practicality) of using innovative, interactive, tablet-based network data collection and visualization software (OpenEddi) in field collection of personal network data in Appalachian Kentucky. METHODS: A total of 168 rural Appalachian women who had previously participated in a study on the use of a self-collected vaginal swab (SCVS) for human papillomavirus testing were recruited by community-based nurse interviewers between September 2013 and August 2014. Participants completed egocentric network surveys via OpenEddi, which captured social and communication network influences on participation in, and recruitment to, the SCVS study. After study completion, we conducted a qualitative group interview with four nurse interviewers and two participants in the network study. Using this qualitative data, and quantitative data from the network study, we applied guidelines from Bowen et al to assess feasibility in four areas of early-stage development of OpenEddi: Acceptability, Demand, Implementation, and Practicality. Basic descriptive network statistics (size, edges, density) were analyzed using RStudio. RESULTS: OpenEddi was perceived as fun, novel, and superior to other data collection methods or tools. Respondents enjoyed the social network survey component, and visualizing social networks produced thoughtful responses from participants about leveraging or changing network content and structure for specific health-promoting purposes. Areas for improved literacy and functionality of the tool were identified. However, technical issues led to substantial (50%) data loss, limiting the success of its implementation from a researcher's perspective, and hindering practicality in the field. CONCLUSIONS: OpenEddi is a promising data collection tool for use in geographically isolated and socioeconomically disadvantaged populations. Future development will mitigate technical problems, improve usability and literacy, and test new methods of data collection. These changes will support goals for use of this tool in the delivery of network-based health communication and social support interventions to socioeconomically disadvantaged populations.

What can health communication science offer for ACA implementation? Five evidence-informed strategies for expanding Medicaid enrollment.

CONTEXT: Implementing the Affordable Care Act (ACA) in 2014 will require effective enrollment and outreach efforts to previously uninsured individuals now eligible for coverage. METHODS: From 1996 to 2013, the Health Communication Research Laboratory conducted more than 40 original studies with more than 30,000 participants to learn how to improve the reach to and effectiveness of health information for low-income and racial/ethnic minority populations. We synthesized the findings from this body of research and used them to inform current challenges in implementing the ACA. FINDINGS: We found empirical support for 5 recommendations regarding partnerships, outreach, messages and messengers, life priorities of low-income individuals and families, and the information environment. We translated these into 12 action steps. CONCLUSIONS: Health communication science can inform the development and execution of strategies to increase the public's understanding of the ACA and to support the enrollment of eligible individuals into Medicaid or the Health Insurance Marketplace.

Mobile technology, cancer prevention, and health status among diverse, low-income adults.

PURPOSE: Characterize mobile technology ownership, use, and relationship to self-reported cancer prevention behaviors and health status in a diverse, low-income sample of callers to 2-1-1. DESIGN: Secondary analyses of cross-sectional survey data from a larger trial collected from June 2010 to December 2012. SETTING: United Way Missouri 2-1-1 serves 99 of 114 counties and received 166,000 calls in 2011. SUBJECTS: The respondents (baseline, n = 1898; 4 month, n = 1242) were predominantly female, non-Hispanic Black, younger than 50 years, with high-school education or less and annual income <$20,000. MEASURES: Cell phone ownership and use and its relationship to cancer prevention services and health status were assessed via telephone-based survey, using items adapted from previous research and the Behavioral Risk Factor Surveillance System. Smartphone ownership and use were also assessed. ANALYSIS: Descriptive statistics and bivariate and multivariate associations between cell phone ownership and prevention and health status are reported. RESULTS: Three-fourths (74%) of study participants owned a cell phone and 23% owned a smartphone. Text messaging was the most popular use. Ownership was significantly associated with good to excellent health status and presence of smoke-free home policies in multivariate models. CONCLUSION: Cell phone ownership is growing and has potential to deliver health information to low-income populations. With 16 million calls annually, the national 2-1-1 system may be a promising model and platform.

Exploring 2-1-1 service requests as potential markers for cancer control needs.

BACKGROUND: Delivering health information and referrals through 2-1-1 is promising, but these systems need efficient ways of identifying callers at increased risk. PURPOSE: This study explores the utility of using 2-1-1 service request data to predict callers' cancer control needs. METHODS: Using data from a large sample of callers (N=4101) to United Way 2-1-1 Missouri, logistic regression was used to examine the relationship between caller demographics and type of service request, and cancer control needs. RESULTS: Of six types of service requests examined, three were associated with one or more cancer control needs. Two of the service request types were associated also with health insurance status. CONCLUSIONS: Findings suggest routinely collected 2-1-1 service request data may be useful in helping to efficiently identify callers with specific cancer prevention and control needs. However, to apply this approach in 2-1-1 systems across the country, further research and ongoing surveillance is necessary.

Cancer control needs of 2-1-1 callers in Missouri, North Carolina, Texas, and Washington.

Innovative interventions are needed to connect underserved populations to cancer control services. With data from Missouri, North Carolina, Texas, and Washington this study a) estimated the cancer control needs of callers to 2-1-1, an information and referral system used by underserved populations, b) compared rates of need with state and national data, and c) examined receptiveness to needed referrals. From October 2009 to March 2010 callers' (N=1,408) cancer control needs were assessed in six areas: breast, cervical, and colorectal cancer screening, HPV vaccination, smoking, and smoke-free homes using Behavioral Risk Factor Surveillance System (BRFSS) survey items. Standardized estimates were compared with state and national rates. Nearly 70% of the sample had at least one cancer control need. Needs were greater for 2-1-1 callers than for state and national rates, and callers were receptive to referrals. 2-1-1 could be a key partner in efforts to reduce cancer disparities.

Proactive screening for health needs in United Way's 2-1-1 information and referral service.

Cancer disproportionately affects the underserved. United Way 2-1-1 is an information and referral system that links underserved populations to community services. This study explores the feasibility of integrating proactive screening and referral to health services into 2-1-1. A cancer risk assessment was administered to callers (n=297), measuring their need for six cancer control services. A subset of respondents was randomized to receive generic or tailored referrals to needed services. Nearly all participants (85%) needed at least one of the services. Those who received tailored referrals were more likely to make appointments. Future research will explore approaches to address and eliminate health disparities through 2-1-1.