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

11-13/4/2007 HPH Conference

The effectiveness of pictorial presentation of risks of breast cancer and screening for improving health literacy among minority ethnic women in the UK

• Dr. Lai Fong Chiu

Senior Research Fellow Institute of Heath Sciences University of Leeds

11-13/4/2007 HPH Conference

Health Literacy

Health Literacy is the ability to make sound health decision in the context of every day life – at home, in the community, at the workplace, the health care system, the market place and the political arena. It is a critical empowerment strategy to increase people’s control over their health, their ability to seek out information and their ability to take responsibility.

Kickbusch, Maag, Health Literacy: towards active health citizenship 2005

11-13/4/2007 HPH Conference

Informed decision and choice

• The significance of health literacy
• personal, social, economic and inequalities
• The choice agenda in health

– In danger of disenfranchising vulnerable groups i.e. less educated, disabled, elderly and socially excluded (migrants and minority ethnic communities)

11-13/4/2007 HPH Conference

Informed decision and choice

• Successful access to increasingly complex

health systems requires people to have high level of health literacy

– How do migrant and minority ethnic communities fare ?

• More likely to use accident and emergency services
• Less likely to use preventive services (breast and cervical

screening)

• Providing (translated) information is not enough

– Other strategies i.e. Community Health Educator model are needed

11-13/4/2007 HPH Conference

Communication For Health (C4H) Project

• Participatory Action Research approach to improve health

literacy through the production of health videos ‘Your Health, Your Choice’

– Involving 4 language communities:

• Mirpuri/Pakistani, Syhleti/Bengali, Cantonese and

Mandarin/Chinese The Process – documented in an audio/visual report: ‘Reflection’ can be view on http://healthcommunication.leeds.ac.uk/C4h

• Audience evaluation to assess outcomes

11-13/4/2007 HPH Conference

Informed Choice and the understanding of risks

• Rationalists’ estimations of risks

– Probabilities of good and adverse outcomes as decision making tools

• Probabilities are used in health resources to aid informed

choice

• Lay people appreciate the need to take risks in order to

come to a diagnosis

• Understanding of risks expressed in basic numerical

forms is not well understood

• Embedded messages in video provided a good
• pportunity for an exploration of this link

11-13/4/2007 HPH Conference

Presentation of risks

• Context

– Consultation, teaching, conversation, media

• What is being presented?

– Probabilities in numerical terms as constructed by epidemiologists

• How are these messages being presented in the video?

– Biographically through narration of individual life stories – Verbal didactic materials – Visual representations

11-13/4/2007 HPH Conference

Key risk message 1

11-13/4/2007 HPH Conference

Key risk message 2

11-13/4/2007 HPH Conference

Key risk message 3

11-13/4/2007 HPH Conference

Key risk message 4

11-13/4/2007 HPH Conference

Aims of the evaluation

• To observe women’s responses to the video
• To investigate the effectiveness of the video in facilitating

informed choice of breast screening

• The effectiveness of the novel presentation of four key

risk messages in improving informed choice

Hypothesis: Risk messages would more likely to be understood and retained using a combination of visual and aural representations

11-13/4/2007 HPH Conference

• Cantonese
• Mandarin
• Bengali
• Pakistani
• women aged between 40 – 85
• the role of younger women in these

groups as “significant others”

Target audience

11-13/4/2007 HPH Conference

Audience

• A total of 115 women from four ethnic groups

took part in previewing the video

• Experimental (58) and control (57) groups

11-13/4/2007 HPH Conference

Training of Community Health Educators

• Familiarising CHEs with the content of the video
• Understanding conventional research ethics and

procedures

• Micro-teaching and audience research

– Facilitating discussion – Individual interviewing – Non-literate environment – Adaptation of research material e.g. questionnaire with visual material for memory retention test

11-13/4/2007 HPH Conference

Field trial design

Shown slides then watch film Watch film only Discussion Discussion Individual Interviews Individual Interviews

Experimental Control

11-13/4/2007 HPH Conference

Slides shown to experimental group

11-13/4/2007 HPH Conference

Results

2.00 4.00 6.00 8.00 10.00

Ra tin g o f film

10 20 30 40

Frequency

M ean = 8.2212

• Std. Dev. = 2.00464

N = 104

H o w did yo u fin d th e film ?

11-13/4/2007 HPH Conference

Results (cont.)

After watching the film, do you think you have enough information to make a choice?

y e s n o n o t s u re

E n o u g h in f o r m a t io n to m a k e a c h o ic e ?

2 0 4 0 6 0 8 0 1 0 0

Frequency

8 4 .2 1 % 3 .5 1 % 1 2 .2 8 %

N = 1 1 4

11-13/4/2007 HPH Conference

Risk message 1: How many women develop breast cancer in the UK?

correct incorrect

• ne in nine

10 20 30 40 50

Count

Group

Experimental Control

• ne in nine * Group Crosstabulation

Count 50 47 97 8 9 17 58 56 114 correct incorrect

• ne in

nine Total Experimental Control Group Total

Z= -0.340 p=0.734

11-13/4/2007 HPH Conference

Risk message 2: For 100 women screened how many will be called back?

correct incorrect

Call back

10 20 30 40 50

Count

Group

Experimental Control

Call back * Group Crosstabulation Count 46 32 78 12 25 37 58 57 115 correct incorrect Call back Total Experimental Control Group Total

Z=2.6 p=0.008

11-13/4/2007 HPH Conference

Risk message 3: For eight of the women who are called back, how many will likely be diagnosed with cancer?

correct incorrect

Risk of diagnosed of cancer

10 20 30 40 50

Count

Group

Experimental Control

Risk of diagnosed of cancer * Group Crosstabulation Count 48 35 83 10 22 32 58 57 115 correct incorrect Risk of diagnosed

• f cancer

Total Experimental Control Group Total

Z=-2.5 p=0.01

11-13/4/2007 HPH Conference

Risk message 4: The incidence of breast cancer increases with age

40-50 60-70 80-85over "unsure"

Estimated age risk

10 20 30 40 50

Count

Estimated age risk * Group Crosstabulation Count 3 14 17 7 8 15 45 31 76 3 4 7 58 57 115 40-50 60-70 80-85over "unsure" Estimated age risk Total Experimental Control Group Total

Z=-2.31 p=0.02

11-13/4/2007 HPH Conference

Some comments from groups

• Very clear and easy to understand what breast

screening is about

• Good to see women from our own communities talking

about this issue

• It [the film] is new in style and not boring
• “It seems fun”- some women would like to be involved in

making films like this

• “What about me?” – one woman (53yrs of age) asked

about screening after watching the film.

11-13/4/2007 HPH Conference

Other comments...

• Too noisy in community centres
• The volume of the film was too low, can’t hear

well

• Need more information
• Lessons learnt:

– Select good venue – Ensure good equipment available – Give time for discussion

11-13/4/2007 HPH Conference

Conclusion (1)

• The film was well received by target audience
• Most women felt that the film provided adequate

information to make a choice

• The majority of women were able to understand the key

risk information contained in the film

• Those women who were shown the slides about

numerical risks appeared to have retained those messages better than those who were not

11-13/4/2007 HPH Conference

Conclusion (2)

• Participatory approach is an important strategy to

develop health literacy among migrants and minority ethnic communities

• This trial demonstrates a possibility of helping minority

ethnic women with low health literacy to understand risks in numerical terms

• Health literacy is a complex concept, the link between

‘information’ and ‘choice’ is tenuous

– Other barriers stopping women to access services e.g. fear, lack

• f language support or lack of transport.
• Further exploration of the different dimensions (i.e.

mental and social) of health literacy is necessary

11-13/4/2007 HPH Conference

Key points

• Videos are only tools for developing health literacy
• Improving the understanding of risk and probability is

important but it is not the only way to facilitate informed choice

• Presentation of risk and probability information in a novel

way can stimulate interests for the topic among vulnerable groups

• Specifically, presenting both aural and visual information

increase the chance of helping people to understand and retain abstract information such as cancer and cancer screening risks

11-13/4/2007 HPH Conference

Thank You for listening! grazie per ascoltare! Gracias por escuchar!