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(April 2017) An online tool promoting shared decision making about HIV-prevention among men who have sex with men (MSM) is being evaluated in two clinical settings--Beth Israel Deaconess Medical Center and Fenway Health. HCC worked with Douglas Krakower, MD, the study’s principal investigator, to develop UP: Understanding PrEP, a decision tool for men and their healthcare providers. (Because it is part of ongoing research, right now it is accessible only by login by study participants.)

The HCC team named the decision aid, developed its content and visual approach, and built and programmed the tool.

A promising option but barriers exist

The majority of new HIV infections in the US occur in MSM. Pre-exposure prophylaxis with a daily pill is more than 90% effective in preventing HIV transmission for this priority population. However, limited knowledge about PrEP among MSM and primary care physicians, and potential misconceptions about this promising intervention, are barriers that may limit its impact in clinical settings.

The purpose of the decision aid is to help healthcare providers and MSM make informed, collaborative decisions about PrEP by increasing their knowledge and facilitating their engagement in brief, goal-oriented discussions about whether PrEP is an appropriate option.

UP was developed through an iterative process using the Ottawa Decision Support Framework (ODSF). Qualitative interviews assessed how MSM and providers weigh the risks and benefits of PrEP use and decide whether to initiate PrEP. Prototypes were tested and refined before HCC began developing the online tool.

Four steps to an informed decision

The decision aid integrates a decision-support tool for patients and a risk-prediction tool for providers. Users complete four steps--a brief survey of personal risk behaviors, a visual display of an individual’s estimated risk of acquiring HIV and the potential benefits of PrEP, interactive exercises to clarify personal values and preferences about using PrEP, and identification of an actionable next step. Notes can be added while progressing thru the steps, and a downloadable summary report can be printed at the end. To protect confidentiality, no data are stored on the website.

The tool can be completed by a patient in advance of a clinical visit, or initiated by the provider during a visit. Because men and providers may not always be fully comfortable talking about sexual health, supplemental content for patients offers guidance on how to initiate a discussion about PrEP with their providers, and a provider-facing section includes prescribing information, suggestions for incorporating the decision aid into clinical care, and additional resources (e.g., links to normative guidelines).

Communicating cultural relevance

Studies have found that many MSM, given the disproportionately high rates of new HIV infections in this community, have concerns about acquiring HIV that may negatively impact their sexual health and well-being. The benefit of reducing their worries about HIV while having sex was identified by participants in focus groups as a significant motivation for considering PrEP. HCC incorporated images that convey personal connection and intimacy to engage users and highlight the relevance of the tool to the intended audience.

The site’s visual approach also helps affirm the trustworthiness of the tool, a key concern for MSM who may use the tool and providers alike.

Next steps

After the current study is completed, Dr. Krakower’s goal is to test UP more broadly in a larger study and/or to make this tool accessible for public use. Although several online PrEP decision aids currently exist, UP has the advantage of having been developed using a rigorous, evidence-based process. So far, public health leaders and LGBTQ advocates have been enthusiastic about this project, its completion, and its eventual dissemination for use online and in clinical settings.

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Image of ABC Trial website

(December 2016) Aspirin for Breast Cancer (ABC) Trial is a new research study led by Dana-Farber researcher Wendy Chen with co-PIs Michelle Holmes (Brigham and Women’s Hospital) and Eric Winer (Dana-Farber).

First in the U.S.

The study seeks to discover if aspirin can keep breast cancer from returning in people who previously had node-positive breast cancer. It is the first U.S. study to try and answer this question and is recruiting nearly 3,000 people who previously had breast cancer (download a flyer about the study).

ABC online

The Health Communication Core (HCC) developed and launched the website for the ABC Trial as an informational site for people who have joined the study and for those who may be interested in joining.

An informed strategy

HCC worked with the study team, including patient advocates who helped to develop the study and who are active advisors throughout the study, to develop a communication strategy to guide the site’s development. The strategy included study background, site audiences, calls to action—along with motivations (including the study’s simplicity and non-toxic approach) and barriers to those calls—and key messages that the site needed to convey.

Relying on simplicity

HCC edited the site’s content for clarity and appropriateness for a range of literacy levels.

The design of the site began with the logo that the study team developed, and relied on those themes of clarity and simplicity that originated with the study name and logo. The site’s colors and photography were carefully selected to support these themes, as well as to further an emotional connection between the study and its audiences.

Contact us for a free consultation on how we can help you develop a strategic online presence for your study or lab.

 

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I Bike Boston billboard, a communication campaign to address health disparities

(March 2017) Once again this summer, gridlocked Boston drivers will idle next to MBTA buses that display happy, mobile Boston residents and their bikes on their exteriors. Pedestrians walking by or waiting at public transit shelters will read about why their neighbors choose to bike.

The transit displays are part of a public awareness campaign developed by the Health Communication Core (HCC) promoting bicycling as a form of active transportation to help address health disparities in Boston neighborhoods. Boston Public Health Commission (BPHC) selected HCC after putting out a request for proposals.

Neighborhood disparities

When stratified by neighborhood, the data in the most recent Health of Boston report show that health outcomes vary dramatically by location. “Neighborhoods serve as the physical and social environments of our daily lives. In other words, place matters,” its authors wrote. Levels of physical activity are demonstrably lower among Blacks, Latinos, and people with lower SES.

Learning from residents

In focus groups across the city, we asked residents why people do or do not bike in their neighborhoods. The primary barriers they talked about were:

  • Cost of obtaining and repairing a bike
  • Safety issues--traffic and lack of knowledge about safety
  • Perceiving that biking is for people who are either young, primarily white, male, or “tourists and hipsters”

They also shared their motivations--saving time and money, health, recreational benefits, green transportation, and the freedom and convenience of not depending on a car or public transit.

Real people

Residents felt strongly that the campaign should show “real people with their real bikes” to affirm that bicycling is not just for people with specialized, costly biking attire and equipment. We worked with BPHC to identify six residents from across the city who incorporate biking into their regular routines and were willing to be the campaign’s models.

“I Bike”

The campaign’s title, “I Bike,” conveys that people to whom we can easily relate--our neighbors and peers--choose to bike. When we presented the campaign to residents, its emphasis on biking as an individual choice was one of the characteristics they most appreciated.

From billboards to bike lights

The campaign’s formats--from billboards to bike lights--required that content be brief, direct, and action oriented. Each person communicates his or her reason for choosing to bike (highlighting benefits and motivations) in a few words.

Resources to help address the identified barriers to biking are highlighted, followed by a call to action (“Find”) and the URL of BostonBikes, a city-wide resource for all things biking.

Multiple channels and formats help the campaign reach a wide audience:

  • Billboards in English and Spanish
  • Bus shelters and bus exteriors/interiors
  • Posters in English, Spanish, Portuguese, Haitian-Creole, Vietnamese
  • Promotional items like reflectors, stickers, and reflective wrist bands
  • Social media graphics for sharing on BPHC and its partners’ social media networks

Campaign launch

The campaign originally launched on May 20, 2016 during Boston's Bike to Work Day celebration at City Hall Plaza with a banner hanging from City Hall and photo booth where people and their bicycles posed against the campaign’s backdrop.

It was relaunched in March 2017 against a backdrop of Boston snow. 

"For both youth and adults to gain the physical activity benefits from bicycling, it is critical to inform them about options in their communities," said BPHC Executive Director Monica Valdes Lupi, JD, MPH. 

In partnership with the Boston Transportation Department and Boston Bikes, the campaign is also expanding access to subsidized Hubway bike-share memberships, providing bike repair at farmers markets, and making bikes and helmets available to low-income residents. The campaign is funded by a three-year cooperative agreement award received by BPHC in September 2014 from the Centers for Disease Control and Prevention.

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Homepage of new Nurses' Health Studies website that HCC developed

(March 2016) Marking its 40th anniversary, HCC developed a new logo for the Nurses' Health Study and launched its first dedicated website. The September issue of the American Journal of Public Health was devoted to honoring the contributions of the Nurses' Health Studies. All articles are open access. In an introductory article, AJPH's editor in chief writes, "Nurses rallying around their study explain its success. It provided a model for many other cohort studies launched on other continents. This is indeed a very noteworthy public health anniversary."

A rich, continuing history

The Nurses’ Health Studies are among the largest investigations into the risk factors for major chronic diseases in women. Starting with the original Nurses’ Health Study (NHS) in 1976, the studies are now in their third generation with Nurses’ Health Study 3 (which is still enrolling male and female nurses) and count more than 275,000 participants. The studies’ regular follow-up of study participants since 1976 and repeated assessment of health and lifestyle factors have played an instrumental role in shaping public health recommendations.

Site strategy

The Health Communication Core (HCC) worked with NHS leadership to develop a communication strategy that identified the website’s goals and audiences, key messages, and audience-appropriate approaches to its content and graphic design.

Branding

The study’s new logo and site design were developed to convey two key messages: The dedication and commitment of the participating nurses to improving public health, and the link between the studies’ rich past and its ongoing cutting-edge scientific research on chronic disease.

From content to launch

HCC edited site content for maximum online readability and organized it to enhance site usability.

The NHS site was developed in Drupal, HCC’s platform of choice, which is open source and free. Drupal’s user-friendly content management system makes it easy for clients to keep their sites up-to-date after they are launched. (Download our Drupal guide.)

Lastly, HCC coordinated redirection of the study’s original, long-standing URL to the new site, added keywords for search engine optimization, programmed Google Analytics (a free website traffic tracking program that HCC includes in all sites that we build), and trained NHS staff in the content management system so they can easily and independently keep the site up to date.

Mobile usage trends: Access and visibility

Visitors accessing the new NHS website with their mobile devices (phones and tablets) represent more than 20% of its traffic, according to site traffic data from Google Analytics.

Mobile sites are also favored in Google’s search algorithm and appear higher in search result rankings. Older websites that do not display responsively based on the user’s device are becoming rapidly obsolete. HCC has developed a streamlined, cost-effective process for rebuilding outdated sites so they are as cutting-edge as their research focus. Contact us for a free consultation on how we can help you develop a new, strategic, technologically updated online presence.
 

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Belfer Center for Applied cancer Science logo

(October 2015) 2015 has been an extraordinary year for Dana-Farber Cancer Institute’s Robert and Renée Belfer Center for Applied Cancer Science. First, a new $10 million gift from the Center’s long-standing supporters, Mr. and Mrs. Belfer, was announced--earmarked for paving the way to the next generation of cancer treatments. “Dana-Farber is a national treasure that deserves support from across the country,” Mr. Belfer said.

Next, the Belfer Center’s offices, laboratories, investigators, and staff were painstakingly moved into a new, state-of-the-art research home in the recently completed Longwood Center.

This all took place within a research environment where the “extraordinary”--drug discovery, novel targets, cutting-edge approaches, new predictive models--is everyone’s everyday goal.

A new online presence

The Center’s original website, however, was unable to keep up with all of these changes and achievements. Built several years ago, it did not allow Belfer Center staff to update its content without contracting with an external vendor—a costly and time-consuming process. To meet the Center’s need for a website that supports its partnerships and recognizes its achievements, the Health Communication Core (HCC) proposed to update and migrate the content and graphics of the site to an open-source platform with an easy-to-use content management system.

Screenshot of Belfer Center's homepageThis transition solved the practical problems experienced by staff charged with keeping the site vital and accurate, and also provided an opportunity for further improvements that were incorporated into the site development process, like responsive display on mobile and tablet devices. Instead of investing resources in simply replicating the current site, the Center was able to benefit from a new, strategic, technologically updated presence.

Strategic updates

Development of the new site began with a series of “discovery discussions” and creation of an audience- and goal-focused communication strategy to guide decisions about messaging, structure, and functionality.

HCC then worked with Belfer Center leadership to update the site’s content, including a new section on its key corporate and academic collaborations, which are a cornerstone of the Center’s work. Graphic design also refreshed the site’s visual approach while retaining the Belfer Center’s well-established and respected identity.

Visit the Belfer Center online: belfercenter.dfci.harvard.edu

HCC’s web development platform of choice is Drupal--a widely used, open-source, free platform with an easy-to-use content management system for keeping websites up-to-date. HCC has developed a Drupal user guide to assist our clients in keeping their site content current, and we’re always available to provide technical assistance and support.

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(June 2015) The Health Communication Core (HCC) is providing patient-centered communication services for four PCORI-funded projects in which patients help guide the research process and contribute to the results of exciting new initiatives. The Patient-Centered Outcomes Research Institute (PCORI) was created in 2010 by the Affordable Care Act to provide evidence-based information for making healthcare decisions.

Here’s how HCC’s patient-centered communication services are contributing to four PCORI projects.

Cancer treatment symptom assessment and self-management

PI: Mary Cooley, PhD, DFCI

Screenshot of a welcome page for a PCORI project using patient-centered communication services

An overwhelming majority—95%—of cancer patients report valuing quality of life over survival, but only 28% say they have discussed quality of life with their clinicians. “Decision Support for Symptom and Quality of Life Management” received PCORI funding to innovatively enhance patient engagement in cancer treatment symptom management, facilitate communication among patients and clinicians, and improve patient-desired outcomes.

Working with Dr. Cooley’s research team, HCC created prototypes for a symptom assessment and self-management tool on an iPad to help patients self-manage their symptoms, or, equally important, know when they should contact their doctors. Focus group reports guided our initial development of text, layout, and visuals for patients to interact with. Numerous rounds of testing with patients and feedback analysis informed ongoing revisions (and more testing) to help ensure that everything from colors to navigation were what patients wanted and needed. The prototype now provides the foundation for a larger study to assess the impact of clinical decision support on enhancing patient-provider communication and outcomes such as improved SQL management and decreased hospital and emergency room visits.

Improving informed consent for palliative chemotherapy

PI: Deborah Schrag, MD, DFCI

Booklet cover of a PCORI project using patient-centered communication services

Chemotherapy treatment to ease the symptoms of metastatic cancer—but not to attempt to cure it—is a counter-intuitive concept for many patients. “Improving Informed Consent for Palliative Chemotherapy” is exploring the consent process as a potentially valuable opportunity to provide patients with the information they need to make well-informed medical decisions. Working with Dr. Andrea Enzinger and others on Dr. Schrag’s study team, HCC created a booklet that presents easy-to-understand information about the benefits, risks, and limitations of palliative chemotherapy in an easy-to-read format. Much of the information is presented in patients’ own words. Patients also participated in filming a companion video. Patients and advocates reviewed the materials and suggested improvements throughout a thoughtful, iterative process.

HCC is also developing a website where the video and booklet will be accessible online to participants in a randomized controlled trial evaluating the effectiveness of this novel library of communication tools.

MoodNetwork: Patient-powered research

PI: Andrew Nierenberg, MD, MGH

Flyer for a PCORI project using patient-centered communication services

Depression and bipolar disorder affect millions of people, but many find that available treatments are either ineffective and/or have high side-effect burden. MoodNetwork is one of 18 Patient-Powered Research Networks (PPRNs) funded by PCORI. MoodNetwork’s goal is to recruit 50,000 people with mood disorders to help identify research priorities and generate “big data” for treatment research.

When the MoodNetwork website (www.moodnetwork.org) launched in March 2015, the study team contracted with HCC to develop and implement an outreach plan for recruiting and retaining network members. Using social media, print, and digital channels, we’re developing targeted strategies and tools to help MoodNetwork reach its goal of 50,000 participants.

YES Health (Your Experience: Speak up for better health care)

PI: Lisa Iezzoni, MD, MGH

YES Health logo

Integrated health care—from long-term services and supports in the community to hospital and medical services—holds tremendous promise for improving the wellbeing of persons with complex medical, behavioral, and functional needs. With PCORI’s support, this project is engaging low-income people ages 21-64 with significant physical and/or mental health disabilities to help define and monitor quality-of-care measures that are relevant to their lived experience and priorities.

HCC is working with the study team to develop an accessible website where people with significant physical disabilities and/or mental health needs can easily report concerns about the quality of their care. After collecting their input, the study team will deliver reports to participating teams of healthcare practitioners and monitor reported quality of care over time.

Contact us to explore how HCC's patient-centered communication services might contribute to your PCORI project or grant application.

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Dr. Ann Partridge's Young and Strong logo

(January 2015) Ann Partridge, MD, received a $1.75 million, five-year grant from the Centers for Disease Control and Prevention (CDC) in October to expand the Young and Strong program to Dana-Farber Cancer Institute (DFCI) satellite sites and community network locations in Massachusetts, New Hampshire, and Connecticut.

More than 10% of new cases of breast cancer in the US are found in women younger than 45 years of age, who face unique concerns about fertility, genetics, work, lifestyle, family, and survivorship. Dr. Partridge created the Young and Strong program at DFCI in response to the needs of this group.

Print and online intervention materials developed by the Health Communication Core (HCC) for Dr. Partridge’s recently concluded RCT will be updated and disseminated under the CDC grant. The intervention website and companion booklet provided information about topics ranging from fertility to self-image. HCC’s services included development of the study’s logo, content for the website and print materials, graphic design for all materials, and site development and hosting.

Read more about the grant in DFCI’s press release

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Image of the depression research recruitment subway ad

(April 2014) Depression research presents unique barriers to recruitment, ranging from challenging protocol requirements to overcoming the feelings of hopelessness that prevent people with depression from taking action. The Health Communication Core is working with the Depression Clinical and Research Program (DCRP) at Massachusetts General Hospital (MGH) to address these recruitment challenges and increase participation in depression research.

Addressing barriers to research participation

Based on information collected during discussions with the program’s investigators and staff, and published data on depression recruitment, we developed a communication strategy and key messages to address participation barriers and to leverage what is important to potential participants. While working on a new website for the program, we were asked to develop subway ads for a study on anxious depression in women.

Having messaging already developed and graphic direction already underway allowed us to quickly respond with two ads—one running inside subway cars and another on external signage at subway stations. The ads highlight benefits of participation, such as free medication and follow-up care, and leverage MGH’s leadership in depression research to assure potential participants that “We understand depression.” The graphic approach affirms that, although things feel dark, MGH can help people with depression find their way forward into clarity and brightness.

Women who respond to the ads will be asked, as part of their screening process, what attracted their interest and motivated them to contact the DCRP. This feedback will help inform further development of the program’s visuals and messages.

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(January 2014) Researchers with a new end-of-life communication study that garnered recent media attention, including from The Boston Globe and local NPR station WBUR, turned to the Health Communication Core (HCC) to help maximize the readability of its innovative "checklist." Boston Globe newspaper headline: Checklist theory used in creating end-of-life talk guide

The study is being conducted at Dana-Farber Cancer Institute by Susan Block, MD and Rachelle Bernacki, MD, in collaboration with Atul Gawande and Ariadne Labs, a joint center for health systems innovation at Brigham and Women's Hospital and Harvard School of Public Health.

An end-of-life conversation guide

The study builds on common palliative care communication approaches and applies the checklist method, which Gawande first applied to reducing surgical errors and then to safer deliveries in India, to end-of-life conversations. It aims to help doctors conduct difficult end-of-life conversations with patients by providing a checklist with seven questions to guide the conversation.

HCC consulted with the study team to assess the literacy level and cultural competency of the checklist and the study’s patient materials, ensuring that the language, examples, and tone would be relevant and easily understood by patients of all backgrounds and education levels.

The checklist seeks to help doctors understand patients’ wishes when they have a life-threatening illness. After the conversation, doctors and patients are surveyed about their experience. Their responses will be compared with doctors and patients who didn’t use the checklist.

The study’s ultimate goal is improved patient care. "The goal of the study is to see if we can improve the number of patients who get the type of care they want at the end of life," said Rachelle Bernacki, MD.

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