By Kellie Woodson

As an instructional designer, I use my expertise in teaching and learning to create learning experiences on a wide variety of health topics. Whether I’m developing a course on breast cancer genetics  or oral health, a significant part of the process is partnering with experts in the field to develop courses that are informative, engaging and effective.  Since many of these courses are written for frontline health workers, they must also motivate participants to make positive changes in their communities.

Overcoming Barriers to Healthy Choices

A typical course not only provides information on health conditions; it also teaches strategies to effectively guide others in making healthier choices. To do this, it is important to acknowledge the barriers to healthy living that many people face.

For example, we know that regular health checks and healthy eating are important to overall health. But the truth is, getting to the doctor or grocery store can be very difficult for individuals who are disabled, elderly, or who live in rural areas. 

The courses I write challenge participants to acknowledge and reflect on the realities of others that they might otherwise take for granted. How does a person who struggles to get around their own home travel to regular doctor’s visits? How can a person make healthier food choices if they only have access to neighborhood convenience stores?  Does the disproportionate number of tobacco advertisements in low-income communities affect smoking rates in these areas? How does one’s education level affect their ability to complete an application for financial healthcare assistance?

How does a person who struggles to get around their own home travel to regular doctor’s visits? [Tweet this]

The truth is that for many individuals, factors such as age, disability, geographical location and education level pose significant barriers to staying healthy. These barriers in turn give rise to health disparities, or preventable differences in the rate of disease and access to health services among specific groups of people.  While health disparities can and do affect all people, they are more common among minorities and the socio-economically disadvantaged.

When writing a tobacco cessation course for the state of Washington’s Community Health Worker Training program, I learned that African Americans, Asian Americans, members of the LGBT community and American Indians use tobacco products in disproportionate numbers when compared to other groups in Washington.

Across the nation, individuals with lower income and education levels are also more likely to use tobacco.  These disparities then give rise to tobacco-related illness and disease. Due to the lack of quality health care, individuals living in rural areas, those who are living at or below the poverty line and those who have lower education levels are more likely to die as a result of tobacco-related disease.   

Health Disparities Reach Farther Than You Think

It’s important to understand that health disparities aren’t simply the result of groups of people making bad choices. Disparities are systemic, complex and cyclical in nature. For example, groups of people who migrated to the U.S. have been found to have high rates of mental disorder and trauma due to the hardships they experienced during migration.  Racism and oppression often result in trauma-related mental illness. To make matters worse, marginalized groups of people often avoid diagnosis and treatment which further perpetuates these disparities. Consider these statistics:

• Asian-American women over age 65 have the highest suicide rate of all similarly-aged women in the United States.
• LGBT youth are about 2 1/2 times more likely to attempt suicide than their peers.
• Only about ten percent of physicians practice in rural America.
• People who live and work in low socioeconomic circumstances have an increased risk for mortality, unhealthy behaviors, reduced access to health care and low quality of care.
• Due to trauma experienced before and after immigration to the United States, Southeast Asian refugees have an increased risk for posttraumatic stress disorder.
• Native Hawaiians and Pacific Islanders are 30 percent more likely to be diagnosed with cancer than whites.
• Close to a third of Hispanics get regular health care, including those with chronic health conditions.
• African-American adults with cancer are significantly less likely to survive prostate cancer, breast cancer and lung cancer than their white counterparts.

These alarming statistics only represent a small fraction of the disparities that exist in our country. Remember that health disparities are found in every group in the U.S. and in every part of the body.

Frontline Health Workers and Communities

Being a frontline health worker is not just about giving guidance and advice– it’s a call to action and advocacy. These people and their employers their community members better than anyone else, and they understand the communities’ challenges, weaknesses and strengths.  As they educate and guide clients to achieving better health, they have the responsibility to acknowledge barriers to care and why they exist. This understanding will help them to better anticipate their client’s needs and respond appropriately and effectively.

Frontline health workers take different paths to solving problems. Many take it upon themselves to create much needed resources and programs in their communities. Others see themselves as organizers who unite members of the community to create solutions where none exist. Whatever the response, you are in the position to make a tremendous impact.

At the end of the day, the goal is to build communities where race, sex, sexual identity, age, disability or socioeconomic status never, ever affect one’s ability to be healthy.

Kellie Woodson is an expert in teaching, learning, and instructional design with content area specialization in health, science, and mathematics. She has extensive experience developing curriculum and learning programs for schools, organizations, and national and international publishers. 

Everybody knows they need to exercise more and eat less. They probably even know that getting some physical activity—even walking for 20 minutes—can reduce the chance of getting diseases like heart disease and hypertension, controlling stress and keeping the brain engaged. Plus, studies show that people who spend more time each day sitting (watching TV, driving around or sitting at a desk) are more likely to die early than those who don’t.

That’s all real. We know it, and that’s why we promote health in the communities where we live and work. But then the unrealisitc excuses kick in. That you have to run a marathon to be in shape. That you have to exercise by yourself. That you’ll never be able to fit in another thing with work, school, family…whatever's taking up time.

We need to correct that and show people that you can see real health gains by taking a short walk, and that getting any exercise is better than none.

America’s Walking Renaissance

You don’t have to take my word for it. Listen to Heidi Simon and her colleagues at America Walks and the Every Body Walk! Collaborative, who just released a new (free!) book: America’s Walking Renaissance.

“America’s Walking Renaissance is a journey across the US, taking a look at walkable cities of all shapes and sizes and providing resources and information on the growing walking movement,” Simon said in an email interview. “From Phoenix to Birmingham to Northeast Iowa, we look at how the US is taking steps towards walkability and look at lessons [from] other communities.”

She, along with Jay Walljasper and Kate Kraft, spent more than a year interviewing, researching and visiting locations all around the States to document successful walking programs. The aim in this project is to share information along with actionable tips, so more organizations and health educators can spark walking programs where they are.

Successful Walking Programs to Copy

A few examples from the free ebook:

Vision Zero, active in more than a dozen cities to reduce the number of walkers who are killed when crossing the street. Vision Zero pushes campaigns through local law enforcement and public education.

Better Bridges Bash, in St. Paul, MN, which puts on street parties in urban environments that are bisected by freeway bridges and overpasses.

Arlington, VA, a success story among suburban cities. Arlington has been named the most walkable suburb in the country. The city transformed itself over years, revamping everything from sidewalk space to accessibility of stores.

“It is our hope that this book will serve as an inspiration for communities looking to embrace walking and motivation for those already on the walking path,” says Simon.

Download the Free Ebook

Download America’s Walking Renaissance for free.

Many find the advice of exercise for disease management a bitter pill to swallow, even when faced with a scary diagnosis like diabetes or hypertension. Thinking of exercise as doctor-ordered medicine makes it seem too tedious and boring. Simply “exercising for 30 minutes a day” can feel like too much of a time commitment. Sitting still is easier. This is why sedentary lifestyles lead to as many as 1 in 10 premature deaths around the world.

But what if exercise could be fun rather than a chore?

I saw this in action the other day at the gym. Looking out the window, trying to forget I was on the elliptical machine, I saw swarms of kids running, spinning around and racing each other everywhere. It’s the kind of behavior I hadn’t seen since I was about 12.

I wondered what on earth could push kids of all shapes and sizes to voluntary physical fitness. After all, these are the same children who statistically spend more than seven and a half hours a day in front of a screen.

They were playing Pokémon GO.

Making Physical Fitness a Game

Pokémon GO, for the uninitiated, is a wildly popular game for mobile devices that sends players on real-world scavenger hunts for online characters. Players see their real environment through their phones but with an image of a Pokémon character.

The unintended benefit of this game is that the kids in my neighborhood are becoming more physically active. Why? Because it’s fun.

This is the message we push in our work with schools, companies and communities. Make regular exercise fun, and people will keep doing it. Getting in 30 minutes per day does not have to be drudgery—honestly!

Ideas for Promoting Healthy Living

Pokémon GO is one suggestion for making healthy kids. Here are some other ideas from some of the people who participated in our Promoting Healthy Lifestyles course:

For two clients who are in wheelchairs but need physical activity:

“I recommend hand bikes, stretchy bands, leg lifts (if they are not paralyzed), and/or pool exercises.”

For a 16-year-old girl unhappy with her weight who loves animals:

“Volunteering at an animal shelter to walk the dogs/socialize with the animals is a low-cost way to get some exercise without ‘overtly’ exercising.”

For someone with arthritis pain to work healthy habits into his life:

“Since one of his barriers is pain in his joints, I advised him to start small by parking his car farther away from the entrance when he went shopping.”.

For motivating a family member to exercise regularly:

“My daughter was overweight and a loner. We started to go to Zumba classes together. She enjoys it and she has lost weight. She has maintained her weight and she changed her diet on her own.”

Share these ideas with someone who could use a little motivation for active living today.

Think you’re immune to stereotyping the people in your community? That you never notice a person’s skin color, what they’re wearing, what their gender is?

Then look at this cartoon and think about your reaction:

It comes via the article “The Bubbles Inside Our Heads,” by Marilyn Gardner, educator, nurse, trainer, thinker, “third-culture kid” (and sometimes Talance collaborator) who writes about culture and sometimes health care on her blog Communicating Across Boundaries.

It’s a great article that examines what happens when we get caught up by our stereotypes, particularly those about muslims, and how that affects our work in neighborhoods, workplaces, and health centers.

To get a sense of the article and how these thoughts can be bad for community health, here are some excerpts from Marilyn, originally published on her blog:

“The problem with stereotypes is not that they are incorrect; it’s that they are incomplete.”

The cartoon characters have formed opinions based on stereotypes. Neither of them are capable of complexity, of seeing beyond the surface and trying to understand each other. It’s an excellent cartoon showing the great divide between cultures and the danger of stereotyping.

I call this picture “The Great Divide.” There is this chasm separating these two that has far more to do with the bubbles inside their heads than reality. Indeed, research tells us that if they did get to know each other, they may find they may have much in common.

…

If we are honest with ourselves, we will recognize that much of the time we are like this cartoon. We live according to the bubbles inside our heads. None of us are immune. We form opinions and assumptions based on our cultural values, our religious views, our socioeconomic status, the media we listen to, watch or read, our countries of origin, the countries that adopted us, the families in which we were raised, and the list could go on.

Bubbles aren’t inherently bad — often they help us to make good choices; but other times they prevent us from seeing people as they really are. They float down through our brains and cloud our vision.

My African American friends often fall victim to head bubbles. At one time, the director of my program was an African American woman raised in Ohio and transplanted to the East Coast. She was amazing and had degrees after her name that I could only dream about. But no matter where it was, when she walked into a new doctor’s office or clinic, immediately the person behind the desk asked for her Medicaid card. The bubbles above their heads told them that she was black, so she was poor. She was black, so she must have public assistance in everything from food to insurance.

…

The challenge is to be aware of them, to recognize them for what they are: stereotypes and biases that are rooted in our subconscious, and must be recognized and confronted.

Timing is everything when it comes to breast cancer. Early screening and detection can save a life, and dealing with a diagnosis requires knowing what to expect and when. Susan G. Komen knows all this, and they also know that patient navigator training for breast cancer is the key to improving outcomes in detection and treatment.

The challenge is making sure those navigators have access to the right training to improve the quality of care among patients in underserved communities.

“Many [patient navigators] lack specific training in breast health and/or cancer and/or navigation itself,” says Julie McMahon, director of mission at the Susan G. Komen affiliate in Columbus, Ohio. 

The patient navigator online training program at Ohio’s Susan G. Komen Columbus improves the quality of care for women receiving abnormal screening results with 100 percent satisfaction for participants. The organization’s ultimate goal is to reduce the number of women who fail to follow up on treatment and improve outcomes.

McMahon's program launched an elearning program to improve skills among patient navigators around the state. You can read more details in the case study, but here are three top takeaways you can apply to your own program right now:

1. Balance independence and collaboration.

The people who signed up for Komen’s program distributed all around the state—and Ohio is a big one, with remote pockets. It ranges from urban areas like Cincinnati to remote Appalachian counties.

Bringing everyone together for three months for training is a realistic impossibility, so the solution was to offer courses online, and then supplement learning with plenty of opportunities for collaboration. So, while people worked independently most of the time, they came together for key events, namely:

• “Meeting” each other during a live kickoff webinar
• Talking about weekly assignments in discussion forums
• Concluding the training program with a live conference call featuring case presentations

This mix allowed patient navigators the flexibility to work when it suited them (at work, at home, during breaks from seeing patients). It also gave them opportunities to ask each other questions, check in with the expert facilitator and create a collaborative learning environment.

2. Let people learn from each other.

Collaboration was an important part of the training program, because it opened up the doors for peer-based learning. Participants in the program had a wide range of experience: some were brand new at their jobs with little experience, and others were veteran nurses who had years of on-the-job experience. Many of them had personally faced breast cancer challenges and were driven to help others who find themselves in similar situations.

Creating opportunities for participants to talk to each other on calls and write to each other in forums let them share experiences and build off the basic skills that were in the course.

This is where many self-guided learning programs—those where participants click through screen after screen—fail. If everyone is working independently all of the time, they never learn tips and tricks that their coworkers have discovered. This collaboration is particularly useful in jobs like patient navigation, where community partners and resources are so valuable to clients and patients.

3. Find the right topics for the job.

The evaluations that came out of Komen Columbus’s program had extremely high ratings. People said they were 95 percent satisfied with the program and they found that 100 percent of what they learned was relevant to their job.

The moral? If you want training that sticks, make darn sure it’s relevant. It makes for happier participants who can immediately take what they learn and  apply it to their job.

In this case, the program covered these training modules:

• How to learn online and introduction webinar
• Organizational and documentation skills
• Disparities and social determinants of health
• Assessment skills
• Breast Continuum of Care (from intro and diagnosis methods to treatment and survivorship)
• Navigating Health Insurance
• Service Coordination
• Breast Cancer Genetics and Genomics
• Health Coaching and Motivational Interviewing
• Resources, wrap-up and case presentation

Follow these smart practices to any program you have, and you have a much higher chance of making it a success.

Want to learn more? Read about how their online training program was created.