Autism: New Course Helps Underserved Families in Washington

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The number of children who have been diagnosed with Autism has increased sharply in recent years—at least for some children.

White children in the U.S. are tested for Autism Spectrum Disorder (ASD) as a part of regular care. This means they can be diagnosed earlier and go down a road for intervention and services that tremendously helps both them and their families reach their fullest potential.

Hispanic or Latino and Black children, on the other hand, are less likely to be diagnosed with ASD than white kids. Hispanic children are 65% less likely to be diagnosed, and Black children 19% less likely, according to a study in the American Journal of Public Health.

A new project from the Washington State Department of Health aims to reduce those disparities and add support to vulnerable families in the state. They plan to use the help of community health workers (CHWs) through an online course called Understanding Autism Spectrum Disorder.

Understanding Autism Spectrum Disorder

“This project is really exciting! It gives CHWs a better understanding of what autism is and helps them build their network of resources to share with families going through diagnosis and afterwards. That will be fundamental in helping families in Washington State,” says Nikki Dyer, Family Engagement Coordinator in the office of Prevention and Community Health at the Washington State Department of Health.

Understanding Autism Spectrum Disorder was built by online training agency Talance, Inc., and is offered for no cost as part of Washington’s Community Health Worker Training Program. More than 2000 people from around the state have participated in the 10-week online blended learning program. It is designed to strengthen the common skills, knowledge, and abilities of community health workers. Past participants are eligible to enroll in any of the free Continuing Education Health Specific Modules, including Understanding Autism Spectrum Disorder.

Understanding Autism Spectrum Disorder “lets CHWs get a grasp of what kind of resources they have locally around diagnosis, referral, and how to navigate a family,” says Dyer. It also exposes CHWs to services for kids with Autism who have already been diagnosed through to transitioning to adulthood services.

“Transition’s a huge issue that has been largely unexplored and leaves a big gap for autistic youth and their families when making that leap to adult services,” Dyer says.

Early Autism Diagnosis

One of the main goals of the course is to encourage earlier and more equitable access to diagnosis. This is especially important for families who face health disparities because of race, ethnicity, and cultural needs.

“Pre-diagnosis is a chaotic time in a family’s life,” says Dyer.

Families might:

  • Not be able to recognize the early signs.
  • Feel confused and isolated when their child is diagnosed with ASD and immediately after.
  • Suspect their child has autism but wait to get a diagnosis. Or, they may feel too overwhelmed by the reality of the diagnosis to know where to find services and supports.

Diagnosing ASD early can help families cope. Early interventions are also critically important to helping children with ASD develop social skills and improve their quality of life.

“Early diagnosis provides the best possibility to be proactive and provide the child with services to reach their fullest potential development,” says Dyer.

Health Disparities and ASD

Here’s where many Black and Hispanic or Latino families are left behind. If their children are never diagnosed, or diagnosed later in life, they miss out on these important support mechanisms and adjustments to help families and youth. Outreach campaigns to have all children screened for ASD can catch some of the people who fall through.

The number of white children diagnosed with ASD compared to Black and Hispanic children is much higher. Source: CDC.

Some communities have a cultural stigma or other expectations of childhood development. That can prevent early diagnosis and put a stop to families seeking a diagnosis even when their provider or child’s teacher may encourage it.

Working Across Washington

Dyer and her colleagues in the Children and Youth with Special Health Care Needs program knew of the challenges of supporting families in Washington.

“They turned their eyes toward CHWs and began investigating collaborative opportunities with the Department of Health’s CHW Training Program for developing training resources,” says Scott Carlson, Community Health Worker Training System Supervisor at the Washington State Department of Health.

CHWs work in the homes of families all around the state, and—importantly–in the most underserved areas. With the right kind of training, CHWs can make referrals to ASD specialists and provide other resources.

Family Navigators and Community Health Workers

“Family navigators” are healthcare workers who regularly support families with an ASD diagnosis. But—like CHWs—they don’t have a clear definition. It’s a catch-all term for someone who provides families with extra care coordination. There are no training requirements or standard services provided by family navigators.

The upshot: CHWs can be family navigators. They can use the skills provided through the Washington CHW program and through this training to serve families in a culturally and linguistically competent and relevant way.

“We would like to promote the CHW program by creating this course and making it open to partners who are doing peer mentoring and navigation for people with special health care needs, even if they are not trained CHWs,” says Dyer.

Doing so opens up employment possibilities for participants who want to be CHWs but might not know about the number of available jobs labeled as “family navigation.”

“We would also like to promote the program as a whole and encourage our partners who may receive access to this module without being a CHW to take the initial training in those basic skills.”

CHW Family Navigation Skills

People who participate in Understanding Autism Spectrum Disorder will gain skills that support families in many areas, including:

  • Understanding what ASD is and its stages of severity
  • Advocating for early testing and diagnosis through referring clients and providers
  • Care coordination for connecting families to needed services, supports, and therapies. This is the case even outside of the healthcare field, specifically through a customized resource directory

So far, learner feedback has been overwhelmingly positive for the course. In a survey, 92% found it interesting and easy to follow. Another 95% were able to find ASD resources that were local and relevant to their jobs.

“This information will be applied immediately,” says Najja Brown, who recently completed the training. Brown works with ASD clients as part of her work through DSHS/DDA. “We will understand our clients better, be able to recommend resources/support groups, and make appropriate suggestions based on the information learned. We will also use the proper language when references to ASD.

“I know so much more than before. When I resume providing services, I will have a better understanding of my clients, whom are all ASD.”

Additional Training

Anyone interested in taking Understanding Autism Spectrum Disorder can learn more at Washington’s Community Health Worker Training website.

Dyer suggests participating in these courses as a “Family Navigation track”:

  • Providing Social Support
  • Immunizations Across the Lifespan
  • Navigating Health Insurance
  • Health Advocacy
  • Social Determinants of Health & Disparities
  • Depression, Anxiety, & Stress

How to Write Survey Quiz Questions: A Guide

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By Gabrielle Carrero
Feedback is one of the best ways you can enhance your program, whether it’s an assessment in a training program or a survey aimed at your community members as part of user research.

When you ask your learners to complete a survey or assessment, you can learn the opinions, perspectives, and judgements of your practices and programs directly from the people who use them.

You should have clear objectives of what you want to learn from participants before deciding what types of questions you want to use. When you can define those goals, you can begin to choose what types of questions will yield appropriate data.

This article will introduce you to the most common types of questions used in assessments and surveys and help you decide which will get you the feedback you want. We’ve included examples and suggestions to help you create your own.

Types of questions

In the question hierarchy, there are two types:

  1. Close-ended questions that produce quantitative data. These can be answered with a “yes” or “no” or have a limited set of answers, as in a multiple-choice quiz.
  2. Open-ended questions that produce qualitative data. These allow someone to give freeform responses, usually in a sentence, paragraph, or longer.

Open-ended questions are helpful when you don’t want to influence the kind of response you’re looking to collect. You might use these when doing research into a community’s needs or asking for suggestions.

When testing learners in assessments, prioritize close-ended survey questions. They produce the most manageable results. You will also learn where open-ended questions fit in the design of your survey.

Close-ended survey questions

Close-ended survey questions provide a fixed set of options. Data from close-ended questions is quantitative and can be calculated into figures like percentages, statistics, or scores.

Common close-ended questions include:

  • multiple-choice questions
  • rating scale questions
  • Likert scale questions
  • semantic differential questions
  • ranking questions
  • dichotomous questions

Read on for more information about each type of question and examples.

Multiple-choice questions

Multiple-choice questions are questions with a pool of answers. They produce clean data for you to analyze and are easiest for participants to complete. Here’s an example from a behavioral health course:

When creating multiple-choice questions, it is important to create a direct and simple question with a comprehensive set of answers. Do your best to create answers that cover all options but do not overlap with one another.

One way to avoid biased results and limitations in your answer set is to give the respondent an “Other” option. Although adding an option for “Other” may not allow the data to be as neat, participants can offer a perspective you have not considered.

Another consideration to make when developing multiple-choice questions is to decide whether you want a single answer or allow multiple answers.

Multiple choice = only one correct option

Multiple answer = more than one correct option

Use single-answer questions when you want the respondent to make one choice. You may only want a single-answer because you want the participant to make a decision or because there is only one answer to choose like age. In general, multiple-choice questions are effective for collecting demographic information.

Use multiple-answer questions when you want participants to select all answers that apply. For instance, participants can select more than one service or product they use.

The example above could be rephrased as a multiple-answer question this way:

Choose all of the examples of items that can make someone more at risk of a behavioral health disorder.

Rating scales

Rating scale questions allow participants to rate or assign weight to an answer choice. Use rating scale questions when you want to learn what a respondent thinks or feels across a scale.

An example of this is a confidence scale about health self-management:

Source: Howsyourhealth.org

When using a rating scale question, you are asking the respondent to measure where their response lies a scale like 0 to 10, 1 to 5, or 0 to 100. You might ask the participant to rate their happiness, satisfaction, likeliness to do something, and experience with your organization.

Rating scale questions can be an effective tool to evaluate change, growth, or progress over time.

For example, if you utilize them as an assessment tool at the beginning of a new program, you can use the same question later or at a final stage of a program to measure changes in sentiment among participants.

When designing the rating scale question, the scale must clearly label the difference in relationship between the numbers.  If you choose a rating scale between 0 and 10, what will 0 represent and what will 10 represent?

Likert scales

A Likert scale measures a participant’s agreement with a question or statement. They are useful for measuring attitudes and behaviors because they ask the respondent to select how much they agree or disagree.

Here’s an example from a quantitative patient survey:

A Likert scale question is a type of rating scale question, but it specifically labels each answer with a level of agreement or likelihood from “strongly disagree” to “strongly agree” or “not at all likely” to “highly likely.”

Use Likert scale questions to measure participant attitudes, opinions, and beliefs and use the 5- or 7-point scale with clear labels.

Semantic differential questions

A semantic differential question is another tool for rating and understanding opinion and attitudes. It asks participants to rate something on a scale between two opposing statements, and emphasizes two opposite adjectives at each end.

You see these questions in customer satisfaction surveys, as in the Net Promoter Score:

Semantic differential questions help you gather multiple impressions about one subject area.

For instance, you would define polar opposite statements like strong-weak, love-hate, exceptional-terrible, expensive-cheap, likely to return-unlikely to return, or satisfied-unsatisfied and include multi-point options in between.

You can acquire multiple attitudes about a service like “What is your impression of Service A?” and have options rate between “Hard to Use” to “Easy to Use,” “Weak” to “Strong,” and “Cheap” to “High Quality,” all to learn more about Service A.

Use semantic differential questions when you want to collect many opinions in one question.

Ranking

Ranking questions lets participants compare list items with another and assign an order of preference to them.

Ranking question data will show the level of priority or importance multiple items has to them, but will not offer insight into “why.”

If you want to look closely at individual respondent preference, then a ranking question is appropriate because it shows the relationship of how much they prefer one option to another. This can be more difficult when analyzing large sets of data because instead of learning how much more an item is preferred to another, the data would offer insight into what item is generally preferred.

Use ranking scale questions to learn what your participant values and prioritizes most.

Dichotomous questions

Dichotomous survey questions gives respondents two answers to choose from such as Yes/No and True/False.

These questions are simple and quick for respondents to answer, and they offer you clean data to analyze. The weakness of dichotomous questions is there is no room for preference, and leaves you little to interpret.

Use a dichotomous question if you want a participant to make a strict decision.

Open-ended questions

Instead of giving participants a set of answers to choose from, open-ended questions allow participants to respond in their own words in a text box. We use these in evaluation surveys often.

The data from open-ended questions is qualitative and less focused on measurement.

Open-ended question responses offer insight into learner impressions, opinions, motivations, challenges, and attitudes. They do take a level of interpretation on your end, and it may help to put their answer in context with any information provided about themselves and their other survey selections.

Although open-ended questions and qualitative data require more attention, they can fill gaps in the story of what your survey wants to learn. You can pair an open-ended question with a close-ended question to understand more about their decision: “What is the reason for your selection/score/ranking?” You may also include them independently: “How do you think you can improve as a business?”

The general advice is to use open-ended questions sparingly and strategically.

Like creating any kind of educational or survey content, coming up with effective and clear assessments takes practice. Great training content is always a work in progress.

How To Use Goals To Help Your Staff Succeed

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Helping your employees set and reach goals is a critical part of your job as a supervisor or program manager. Setting and reaching goals is also important to your staff, who needs to see how their work fits in with the larger objectives of your agency. Taking the time to work with them to set targets helps them understand how they’re part of the organization and will positively affect their performance.

Setting up this kind of regular goals check-in on can feel like a lot of pressure, especially if you’re dealing with a new hire or a person who’s been on staff for a while.

Fortunately, going through this process at regular intervals is helps you do your job more easily. It gives you a framework that helps you organize your time and tasks, and establishes benchmarks that will help drive your whole team. You’ll find this especially useful if you work as part of a multidisciplinary team or some of your workers are out with clients most of the time.

Goal-setting such as this helps you all work better together and gives you a concrete instrument for giving feedback day to day and during annual reviews. Setting targets and keeping an eye on them, means you can give your staff input on their performance at any time–while you’re motivating them do more.

Read on to see some best practices for using goal-setting as a way to help your team succeed.

Set goals together—then get out of the way

Working together on setting those goals is important. If your staff doesn’t meet them, it has negative consequences for them, you, your agency, and possibly even your community. So you really need to get involved in helping employees set and meet goals.

Plus, collaborative involvement pays off. Staff members who are told what goals to pursue don’t fare as well as those who explore along with their managers. That leads to a lower job performance.

A top-down approach can leave someone at a loss for why or how their goals fit in. Or they might lack the confidence to meet them. If staff work with you to set goals and decide what strategies they’ll use to meet them will perform better and have higher confidence.

So collaborating at first makes sense, but then step back and let your team get to work. That’s a manager’s job: enable, support, and then provide a boost when necessary, depending on your staff’s capabilities.

Fill gaps with learning goals

What kinds of goals you set with your staff depends largely on what they do and your agency’s requirements. Those might be tied to data or quality improvement outcomes that are measured by numbers.

Once you set them, then look at what might make them more difficult to reach. In many cases, there could be a training gap. The gap might be:

  1. Individual. If one person lacks the skills to complete a task, they have an individual training gap. For example your new hire needs to do community outreach for your agency, but they don’t have any outreach skills.
  2. Team. Your whole team might lack skills to carry out an initiative, so they have a team learning gap. An example almost everyone can relate to is setting up new protocols for Covid-19.
  3. Organizational. Entire agencies sometimes have a gap in an area and have an organizational learning gap. Many organizations recognize they have gaps in cultural competency and have needed to supplement training in that area.

Conducting a training needs assessment is a critical step when you’re on the path to a goal. You’ll need to know where your team excels and where they need more help. Then, you can acquire new training—either create your own custom training or buy it off the shelf–to help everyone reach goals.

Learning goals might even reach into the future, and they can dovetail nicely with personal goals of your team. You can ask your employees what they’d like to learn in the next month, quarter, or year, and then provide them with training opportunities to get there.

Set regular intervals for goal review

Once you have your goals set with your team, set in a structure to monitor them. Do this early on, and you’ll be glad you did. Checking in early and regularly can help reveal problems before they get too big. Why wait to review goals until a set check-in? Make a habit of reviewing them every week as part of your employee check-in.

Here are some helpful performance review templates you can adapt to your goal reviews:

Why Teaching About Health Disparities Transforms Communities

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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. 

Originally published August 16, 2016, updated October 23, 2020.

How Stereotypes Are Bad for Your Health

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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.

Originally published July 06, 2016, updated October 23, 2020.

Susan G. Komen Uses Talance to Empower New Patient Navigators

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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.

Originally published June 22, 2016, updated October 23, 2020.

How to Actually Succeed at Behavior Change

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Here’s a harsh bit of reality for you: there is no magical method to making healthy lifestyle changes. Fad diets and exercise crazes might make it seem like there is, but they’re wrong. Sad news for the members of your community who want to change thier behavior.

The truth is that the secret to meeting overall health recommendations, from quitting smoking to getting more exercise, is to put one foot in front of the other–and keep doing it. Changing the way you live is simply hard. It just is.

However, there is one technique that actually can make that tough transition easier: setting SMART goals.

SMART Goals

SMART goals break down any task that seems too big to meet by breaking it down into what’s Specific (S) about the goal, how you can Measure (M) it, making it Achievable (A), and also Realistic (R) or Relevant, and setting up a Timeline (T) to complete it.

We talk about SMART goals all the time in our health education materials because they are so effective.  They make big lifestyle changes more manageable.

For example, think about someone who feels overwhelmed by a new diagnosis of hypertension. Their doctor tells them they need to exercise more and lose weight. They might start thinking “I have to run a marathon!” even though they’ve never walked further than the mailbox, or “I need to lose 20 pounds this month!” without considering what needs to change in their diet. Those goals are discouraging and impossible to achieve–a real setback for successful self-management.

Now, when you put a goal like “exercise more” into a SMART format, it changes from “run a marathon” to “walk around the block twice this week.” The difference is huge and makes behavior change something that most people can actually do.

SMART Goals and Behavior Change

Here are some examples of how SMART goals work with different health motivations. To take a SMART approach, they answer these questions (copy them down so you can use them with yourself or a client today):

  • What is Specific about the goal?
  • How will you Measure the goal to know it’s been achieved?
  • Is it Achievable?
  • Is the goal Realistic?
  • Is the goal on a Timeline?

Hypertension

Unspecific goal: “Follow the DASH diet.” The DASH (Dietary Approaches to Stop Hypertension) is a diet that many health providers recommend to patients.

SMART approach: “This week I will eat two cups of fruits and vegetables with dinner and lunch.”

Exercise

Unspecific goal: “Get healthy.” This very fuzzy goal is all too common among people who are trying to build more physical activity into their lives.

SMART approach: “I will meet with a mall walking group on Saturday morning.”

Dieting

Unspecific goal: “Lose 40 pounds.” Many people know they need to lose weight, and even how much, but that’s difficult without a path.

SMART approach: “This month I will lose 5 percent of my current weight. This will allow me to meet my goal by the end of the year.”

Smoking

Unspecific goal: “Stop smoking.” This is a common and clear directive. People need to stop but don’t know how.

SMART approach: “Tomorrow I will replace all the ashtrays in the house with a pack of Nicorette gum.”

Drinking Alcohol

Unspecific goal: “I shouldn’t drink so much.” Breaking through the habit of drinking is hard without a plan.

SMART approach: “I will pick two days this week when I won’t drink.”

Do you see how these short goals seem like something you can do? Meeting one goal makes it easier to move on to a new one. And that is the secret to better health: one step at a time.

Free Ebook: America’s Walking Renaissance

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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

“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.

Popular Healthy Community Courses Now Available in Spanish

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Release Date: Aug. 1, 2016

Learners can learn about diabetes, health literacy and health insurance in Spanish or English

WOBURN—Talance, Inc., today expanded the reach of its popular courses in health education and promotion. Now, three of the most popular courses are available in Spanish as well as English: Health Literacy: A Start, Navigating Health Insurance and Diabetes and Prediabetes.

The Spanish version of the online courses feature the same interactive curriculua as their English counterparts, and are accessible from nearly any screen from talance.com. They also allow learners to ask questions and have discussions in Spanish. The courses also contain new and updated on-the-job resources available for Spanish speakers.

“Having these courses available in Spanish is a powerful tool for spreading information about these vital health topics,” says Monique Cuvelier, president and co-founder of Talance, which provides training to groups, teams and organizations across the US. Past projects from Talance include courses in Hebrew, French and English as a second language.

“Spanish is the biggest non-English language spoken in this country, and having courses available to this huge swath of the population is important.”

Health Literacy: A Start (Entendiendo la Información Sobre Salud: Primeros Pasos) offers an introduction to health literacy and why it matters, including assessment and communication skills for addressing literacy gaps.

Navigating Health Insurance (Entendiendo los Seguros Médicos) introduces the terms and concepts related to health insurance so participants can help clients get insured.

Diabetes and Prediabetes (Diabetes y Prediabetes) introduces non-clinical community and health workers to diabetes and prediabetes so they can support their clients’ management of the disease.

Talance’s ready-to-go courses take place over one week and feature expert facilitation by fluent Spanish speaking instructors. They’re designed to build healthy communities in schools, worksites, health care and community-based settings. Talance also creates custom curricula for clients who want to build their own healthy communities.

For more information on these courses and other educational materials from Talance, please visit talance.com or contact Monique Cuvelier at (888) 810-9109.

Exercise for Disease Management Is a Bitter Pill To Swallow

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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.