Fluff and Read: Cancer Study Places Health Kiosks in Laundromats
MADISON - What's an effective way to get crucial breast cancer information into the hands of the people who most need it?
Go to the laundromat, quite obviously.
Cancer researchers from Washington University in St. Louis recently completed a four-year study during which they placed more than 100 computerized kiosks in locations frequented by low-income, African-American women over the age of 40. The kiosks, stationed in churches, health centers, social services venues, beauty salons, libraries and laundromats in northcentral St. Louis, disseminated information about the importance of regular breast cancer screening and early detection, and posed questions to respondents to gauge their knowledge about mammograms and their health habits.
Matthew Kreuter, MD, PhD, the study's lead investigator, delivered the results during an address at the UW Carbone Cancer Center's ninth annual symposium, "Advances in Multidisciplinary Cancer Care," on October 22 in Madison. What did he find?
"Laundromats were where all the action was," he said.
St. Louis served as a geographically pertinent host city for the study. Its urban corridor is almost exclusively African-American, and that geographic boundary also housed a dense population of African-American women who were 2.5 times as likely to have breast cancer as the general population.
That part of the city "is a clear hot spot for cancer disparities," said Dr. Kreuter.
Breast cancer proliferation often reflects a lack of early detection measures, which in turn suggest a paucity of viable health information. The African-American women in the study weren't getting regular screening mammograms, and many didn't identify mammograms as valuable methods of breast cancer prevention. And the data concerning the women who accessed the kiosks in laundromats was decidedly more pessimistic than those in the other kiosk locations:
- Only 47 percent of the women from the laundromat group ever had a mammogram. The other five locations reported percentages well above that, particularly women in churches, 86 percent of whom had undergone at least one mammogram.
- More than 43 percent of the laundromat respondents pointed to transportation as a barrier to mammograms, nearly twice the rate of the groups from health centers and libraries and nearly four times the rate of those from beauty salons.
- A nearly identical number said clinics weren't open during the times they could come for mammograms. Only 13 percent of the women in beauty salons and 17 percent of the women in churches reported a similar complaint.
Why laundromats? Dr. Kreuter and his team investigated their business models and found that laundromats opened in neighborhoods with characteristics identical to population subsets with high incidences of breast cancer.
"The blueprint for a profitable laundromat maximizes the number of renters rather than owners, people with children, a high-density population and low income, so they can't buy washers," he said. "That's a similar profile to people who suffer from health deficiencies."
That makes laundromats ideal venues for distributing targeted health information. Dr. Kreuter calls it high reach and high specificity.
"The challenge is getting it to as many people as you can and getting it to the right people," he said.
Of course, delivering the information is only half the battle. The message not only has to find the recipients but spur them to action, and Dr. Kreuter found stories to be much more effective for this purpose than flat, dry expositions of fact.
Physicians, Dr. Kreuter argued, rely on communication strategies consistent with their scientific training.
"We tend to use a didactic and expository approach. We give them all the reasons they should do something," he said. "We give them arguments and present them with data."
You're sick. You need treatment A because statistics tell us treatment A gives you a statistically better chance at getting well than treatment B. Too often that's the tack doctors employ, said Dr. Kreuter. Yes, it's accurate and responsible, but it doesn't penetrate patients' emotional cores. Stories, Dr. Kreuter found, work better than facts.
"Stories don't work by convincing," he said. "They work by engaging you in some interesting plot or action. Stories teach by modeling what a person does and showing consequences of action."
To demonstrate the efficacy of story-related motivation, Dr. Kreuter's team produced a DVD called "Living Proof" wherein women with breast cancer spoke in intimate fashion about their experiences. They provided autobiographies of illness, talking about what it felt like to be diagnosed, to interact with doctors and nurses, and to confront a substantial fear.
Dr. Kreuter showed the video to a group of 489 women with profiles similar to those in the laundromat study - low income, minimal access to health information and a high incidence of breast cancer. And he showed a second video, which relied on more traditionally clinical recitations of statistics and care recommendations, to a similar group. The reactions of the women validated his suspicion that stories were the best way to go when talking to patients.
"The stories elicited much more emotion and they increased recall of the cancer messages," Dr. Kreuter said. "The women were less likely to counterargue and more likely to talk to family members about videos and perceive cancer as a problem."
Most importantly, the women who watched the story-based video were more likely to say they intended to schedule a mammogram.
"The more we can personalize information, the more likely it is to act on our behavior," Dr. Kreuter said.
And behavioral changes are the ultimate goal of health information, and effective health care.
Date Published: 10/28/2010