The effectiveness of pictorial presentation of risks of breast - PowerPoint PPT Presentation

The effectiveness of pictorial presentation of risks of breast cancer and screening for improving health literacy among minority ethnic women in the UK Dr. Lai Fong Chiu Senior Research Fellow Institute of Heath Sciences University of Leeds 11-13/4/2007 HPH Conference

Health Literacy Health Literacy is the ability to make sound health decision in the context of every day life – at home, in the community, at the workplace, the health care system, the market place and the political arena. It is a critical empowerment strategy to increase people’s control over their health, their ability to seek out information and their ability to take responsibility. Kickbusch, Maag, Health Literacy: towards active health citizenship 2005 11-13/4/2007 HPH Conference

Informed decision and choice • The significance of health literacy -personal, social, economic and inequalities • The choice agenda in health – In danger of disenfranchising vulnerable groups i.e. less educated, disabled, elderly and socially excluded (migrants and minority ethnic communities) 11-13/4/2007 HPH Conference

Informed decision and choice • Successful access to increasingly complex health systems requires people to have high level of health literacy – How do migrant and minority ethnic communities fare ? • More likely to use accident and emergency services • Less likely to use preventive services (breast and cervical screening) • Providing (translated) information is not enough – Other strategies i.e. Community Health Educator model are needed 11-13/4/2007 HPH Conference

Communication For Health (C4H) Project • Participatory Action Research approach to improve health literacy through the production of health videos ‘Your Health, Your Choice’ – Involving 4 language communities: • Mirpuri/Pakistani, Syhleti/Bengali, Cantonese and Mandarin/Chinese The Process – documented in an audio/visual report: ‘Reflection’ can be view on http://healthcommunication.leeds.ac.uk/C4h • Audience evaluation to assess outcomes 11-13/4/2007 HPH Conference

Informed Choice and the understanding of risks • Rationalists’ estimations of risks – Probabilities of good and adverse outcomes as decision making tools • Probabilities are used in health resources to aid informed choice • Lay people appreciate the need to take risks in order to come to a diagnosis • Understanding of risks expressed in basic numerical forms is not well understood • Embedded messages in video provided a good opportunity for an exploration of this link 11-13/4/2007 HPH Conference

Presentation of risks • Context – Consultation, teaching, conversation, media • What is being presented? – Probabilities in numerical terms as constructed by epidemiologists • How are these messages being presented in the video? – Biographically through narration of individual life stories – Verbal didactic materials – Visual representations 11-13/4/2007 HPH Conference

Key risk message 1 11-13/4/2007 HPH Conference

Key risk message 2 11-13/4/2007 HPH Conference

Key risk message 3 11-13/4/2007 HPH Conference

Key risk message 4 11-13/4/2007 HPH Conference

Aims of the evaluation • To observe women’s responses to the video • To investigate the effectiveness of the video in facilitating informed choice of breast screening • The effectiveness of the novel presentation of four key risk messages in improving informed choice Hypothesis: Risk messages would more likely to be understood and retained using a combination of visual and aural representations 11-13/4/2007 HPH Conference

Target audience • Cantonese • Mandarin • Bengali • Pakistani - women aged between 40 – 85 -the role of younger women in these groups as “significant others” 11-13/4/2007 HPH Conference

Audience • A total of 115 women from four ethnic groups took part in previewing the video • Experimental (58) and control (57) groups 11-13/4/2007 HPH Conference

Training of Community Health Educators • Familiarising CHEs with the content of the video • Understanding conventional research ethics and procedures • Micro-teaching and audience research – Facilitating discussion – Individual interviewing – Non-literate environment – Adaptation of research material e.g. questionnaire with visual material for memory retention test 11-13/4/2007 HPH Conference

Field trial design Control Experimental Shown slides then Watch film only watch film Discussion Discussion Individual Interviews Individual Interviews 11-13/4/2007 HPH Conference

Slides shown to experimental group 11-13/4/2007 HPH Conference

Results 40 H o w did yo u fin d th e film ? 30 Frequency M ean = 8.2212 Std. Dev. = 2.00464 N = 104 20 10 0 2.00 4.00 6.00 8.00 10.00 Ra tin g o f film 11-13/4/2007 HPH Conference

Results (cont.) After watching the film, do you think you have enough information to make a choice? 1 0 0 8 0 Frequency 6 0 N = 1 1 4 8 4 .2 1 % 4 0 2 0 1 2 .2 8 % 3 .5 1 % 0 y e s n o n o t s u re E n o u g h in f o r m a t io n to m a k e a c h o ic e ? 11-13/4/2007 HPH Conference

Risk message 1: How many women develop breast cancer in the UK? 50 Group one in nine * Group Crosstabulation Experimental Control Count 40 Group Experimental Control Total 30 Count one in correct 50 47 97 nine incorrect 8 9 17 Total 58 56 114 20 10 Z= -0.340 p=0.734 0 correct incorrect one in nine 11-13/4/2007 HPH Conference

Risk message 2: For 100 women screened how many will be called back? 50 Call back * Group Crosstabulation Group Experimental Count Control Group 40 Experimental Control Total Call back correct 46 32 78 incorrect 12 25 37 30 Total 58 57 115 Count 20 Z=2.6 p=0.008 10 0 correct incorrect Call back 11-13/4/2007 HPH Conference

Risk message 3: For eight of the women who are called back, how many will likely be diagnosed with cancer? 50 Risk of diagnosed of cancer * Group Crosstabulation Group Experimental Count Control Group 40 Experimental Control Total Risk of diagnosed correct 48 35 83 of cancer incorrect 10 22 32 Total 58 57 115 30 Count 20 Z=-2.5 p=0.01 10 0 correct incorrect Risk of diagnosed of cancer 11-13/4/2007 HPH Conference

Risk message 4: The incidence of breast cancer increases with age 50 Estimated age risk * Group Crosstabulation Count Group 40 Experimental Control Total Estimated 40-50 3 14 17 age risk 60-70 7 8 15 80-85over 45 31 76 30 Count "unsure" 3 4 7 Total 58 57 115 20 Z=-2.31 p=0.02 10 0 40-50 60-70 80-85over "unsure" Estimated age risk 11-13/4/2007 HPH Conference

Some comments from groups • Very clear and easy to understand what breast screening is about • Good to see women from our own communities talking about this issue • It [the film] is new in style and not boring • “It seems fun”- some women would like to be involved in making films like this • “What about me?” – one woman (53yrs of age) asked about screening after watching the film. 11-13/4/2007 HPH Conference

Other comments... • Too noisy in community centres • The volume of the film was too low, can’t hear well • Need more information • Lessons learnt: – Select good venue – Ensure good equipment available – Give time for discussion 11-13/4/2007 HPH Conference

Conclusion (1) • The film was well received by target audience • Most women felt that the film provided adequate information to make a choice • The majority of women were able to understand the key risk information contained in the film • Those women who were shown the slides about numerical risks appeared to have retained those messages better than those who were not 11-13/4/2007 HPH Conference

Conclusion (2) • Participatory approach is an important strategy to develop health literacy among migrants and minority ethnic communities • This trial demonstrates a possibility of helping minority ethnic women with low health literacy to understand risks in numerical terms • Health literacy is a complex concept, the link between ‘information’ and ‘choice’ is tenuous – Other barriers stopping women to access services e.g. fear, lack of language support or lack of transport. • Further exploration of the different dimensions (i.e. mental and social) of health literacy is necessary 11-13/4/2007 HPH Conference

Key points • Videos are only tools for developing health literacy • Improving the understanding of risk and probability is important but it is not the only way to facilitate informed choice • Presentation of risk and probability information in a novel way can stimulate interests for the topic among vulnerable groups • Specifically, presenting both aural and visual information increase the chance of helping people to understand and retain abstract information such as cancer and cancer screening risks 11-13/4/2007 HPH Conference

Thank You for listening! grazie per ascoltare! Gracias por escuchar! 11-13/4/2007 HPH Conference