Flu: What You Can Do – Caring For People At Home

Statewide Educational Campaign

Allison Hackbarth, MPHHealth Education Unit Manager and Epidemiologist

Massachusetts Department of Public HealthDivision of Epidemiology and Immunization

October 15, 2008

Summarize the impact of seasonal flu and a flu pandemic

Describe current pandemic planning educational initiatives at DPH and how the current campaign relates to them

List the goals and objectives of the campaign

Summarize the development and implementation of the campaign

Summarize evaluation data (pre- and post-testing)

Identify how businesses can potentially incorporate using campaign materials to educate their employees

Learning Objectives

Impact of Seasonal Influenza

Approximately 36,000 influenza-associated deaths during each influenza season in the US (1990 – 1999)

– 19,000 deaths from 1976 – 1990, increasing in part due to the larger population of older person

– Note that there is higher mortality in seasons in which influenza A virsus’ predominate

Average of 226,000 influenza-related excess hospitalizations

Millions more affected

The term “flu” is used very generically, leading to a perception that it’s not serious

In Massachusetts

– Season peaks in January - February and can last into April or May

– ~800 residents die from complications of flu

– 2,600 - 5,000 excess hospitalizations

– 300,000 – 1.3 M residents get the flu

– Puts a surge on the healthcare system

Impact of Seasonal Influenza

Pandemic Flu

Flu virus is constantly changing

Drift: Minor change due to constant mutation– A reason why flu vaccine must be updated each year

Shift: Major change with new virus causing human infection– Pandemic potential

Pandemic: A sudden, widespread outbreak caused by a new strain of an influenza virus

Pandemic Flu

Because the virus is new, virtually no one is immune - all exposed could get sick

Pandemic influenza may occur at any time of year, but conditions most favor rapid spread during regular flu season

Occurred in 1918, 1957, 1968

Spread rapidly throughout the world

Result in an unusually high number of cases and deaths

Duration of 1-2 years; may have second wave

Impact of an Influenza Pandemic

In Massachusetts – 2 million clinically ill– 80,000 hospitalizations– 20,000 deaths

High volume of outpatient visits and hospitalizations

Existing facilities will be overwhelmed

Vaccine and antivirals will be in short supply

Up to 40% absenteeism in all sectors

Why is a pandemic different from other disasters?

Every community will experience the pandemic as a local event

There will be little help available from the federal or state govt.

No community or hospital will be able to respond alone

The entire community will need to work together to respond effectively

– e.g., when schools close, the parents must keep the children at home for the strategy of social distancing to be fully effective

Impact of an Influenza Pandemic

Vaccine, antivirals, antibiotics will be in

short supply

Existing facilities will be overwhelmed

Impact of an Influenza Pandemic

MBTA cuts back service

Delivery of goods curtailed

Impact of an Influenza Pandemic

Prisons and jails on 24-hour lock-down

Day care centers for children and

the elderly are closed

Impact of an Influenza Pandemic

The ultimate toll that a pandemic takes on the community (and its mitigation) will be a direct reflection of:

community and individual awareness

the level of community and individual preparedness

the use of community containment measures

community resiliency

With many people ill and heavy demand on the health care system, it is important that people are prepared to care for family with cases of the flu at home

Impact of an Influenza Pandemic

1,000,000

920,000

80,000

2 Million Ill in Massachusetts(30% Attack Rate, Population 6.4 Million)

Ill, No Care Needed Outpatient Care Only Hospital Level Care

Pandemic Planning Activities

Continuity of Society

– State agency and provider COOPs and COGs

– Supply chain

– Community containment

– Provider payment

– Indemnification

Surveillance and Reporting

– Sentinel / influenza-like illness

Policy Direction

– Command and control

– MEMA

– Emergency Service Functions (ESFs)

Healthcare Providers

– MA System for Advanced Registration (MSAR)

– MA Reserve Corps (MRCs)

– Indemnification

Pandemic Planning Activities

Healthcare Surge

– Flu surge and gap analysis

– Materials and equipment (SNS)

– ISCU development

– Altered standard of care / liability

– Care at Home

Pandemic Planning Activities

Fall 2005: Public Engagement Project – input at the community

level, ongoing

Winter 2006: Harvard School of PH study

Spring 2006:

– ‘Be Prepared for Pandemic Flu’ education & training

program for local health departments

– MDPH ‘Flu Forums’ – education for schools,

businesses, faith-based organizations, colleges & universities

Pandemic Planning Educational Initiatives at MDPH

Pandemic Planning Educational Initiatives at MDPH (cont.)

Fall 2006: ‘Flu Facts’ statewide educational campaign

4 main messages for the general public

1) Wash your hands

2) Cover your mouth when you cough or sneeze

3) Get a yearly flu vaccine

4) Make a family emergency plan

Use of the media (TV and transit) to distribute info

Flu Facts Campaign

Pandemic Planning Educational Initiatives at MDPH (cont.)

Fall 2007: ‘Flu: What You Can Do’ statewide educational campaign

Expansion of the ‘Flu Facts’ campaign

As there are less cases in avian flu cases in Asia/Europe, less attention here but a pandemic is real

Focus on flu care at home during both yearly seasonal flu and a flu pandemic

A reinforcement of the message that caring for a someone with the flu during a pandemic will be very similar to what the general public already does during each regular flu season

Public and Private Partnership

Content development and review:

Boston, Amherst and Needham Health Departments

Harvard School of Public Health

Harvard Vanguard Medical Associates - Atrius Health

Home Health Care Alliance of Massachusetts

Massachusetts Chapter - American Academy of Pediatrics

U-Mass Memorial Health Care, Dept. of Pediatrics

Public and Private Partnership

Financial support from:

Blue Cross Blue Shield of MA

Harvard School of Public Health

Harvard Vanguard Medical Associates - Atrius Health

Massachusetts Medical Society

Target Audience and Goals of the Flu: What You Can Do Campaign

Target Audience: The general public

Two Main Goals:

1) To build community preparedness and resiliency that will become very important during a pandemic

2) To reduce the potential surge of patients seeking care at hospital emergency rooms and alternative care sites during a pandemic

Note that these goals will not be achieved in the short-term and the campaign will need to be carried out over multiple years.

Learning Objectives of the Campaign

To increase the knowledge regarding the similarities and differences between seasonal and pandemic flu

To provide information and tools to care for persons with influenza at home

To provide information and tools to simplify communication with health care providers and help determine when an office visit or emergency medical help is indicated

A reinforcement of the message that caring for a someone with the flu during a pandemic will be very similar to what the general public already does during each regular flu season

Development of the Campaign

Formative Research

Focus groups held with the public to learn about:

– Their understanding about flu care issues

– Understanding of a pandemic

– Types of information they need

– Preferences for receiving flu care information

Key Findings:

People have experience treating the flu, but need more info

Want specific instructions and details on:– Symptoms, illness duration– Prevention, treatment and preparation– When to call a doctor or get medical care

Fear regarding a pandemic

Information should be comprehensive and provide:

– Resources to help other family members prepare for and

understand flu care at home

– Simple, consistent messages in easy-to-read formats

Development of the Campaign

Two Main Educational Materials: Booklet and DVD

Contain information on the following

1) Reduce the Risk, Reduce the Spread:– How flu is spread, vaccines and other medications, and methods to reduce risk and spread

2) What to Look for, What to Do:– Flu symptoms and home treatment, when to seek medical advice or care

3) Prepare Yourself, Prepare Your Home:– Supply list, information summary for the doctor, summary of personal contact information

Development of the Campaign

Flu: What You Can Do DVD

DVD is 22-minutes, same topics as booklet, but less detailed info

Flu: What You Can Do Website

Implementation of the Campaign

Fall 2007 (Passive Education):

Statewide mailing of letter (from MDPH Commissioner), booklet and DVD samples to local boards of health, community health centers, school nurses and some healthcare providers

DVD also sent to local cable access stations

Order form as the mechanism to obtain more copies

Available for download on MDPH website

Booklet available in Spanish, Portuguese, Chinese, Vietnamese and Haitian Creole

DVD available in Spanish (more languages dependent on funding)

Fall 2007 (Active Education):

Goal was/is to recruit locally-based educators to help DPH

implement the campaign around the state

Locally-based educators trained on the content through train-the-

trainer sessions, taught by a group of MDPH staff

Educators then turn around and educate in their communities

Through distribution of materials, giving educational

presentations (at such places as senior centers, libraries,

schools, etc.), or bringing info to already established events

Implementation of the Campaign

Community education strategy development:

Who is your target audience?

How can they be reached?

Are there any unique issues to address for your audience?

How will you promotion, plan and identify community partners?

Are there any barriers such as language and being homebound?

Implementation of the Campaign

Active Education

Step 1: Training of DPH staff to implement T-T-T sessions

Step 2: Preparing local educators through the T-T-T sessions

Step 3: Outreach and education to the general public

MDPH Staff

• Local Board of Health Staff

• School Nurses

• CHC Staff

• MRC Volunteers

• Health Plan Staff

• VNA Nurses

• Library Seminar

• Church Group

• High School Health Class

• Mother’s Group

• PTA Meeting

• Senior Center

• Health Plan Ed Classes

Response To-Date

Overwhelming positive response

Large demand for booklet; distribution to-date of more than 330,000 booklets

Highest demand from schools (elementary, middle & high schools)

Distribution of more than 1,000 DVDs

Implementation of 23 train-the-trainer sessions across the state resulting in the preparation of 275 participants to become part of the education team.

Current Flu Season: 2008 - 2009

Development of a lower literacy educational item

Provide another round of 14 train-the-trainer sessions

Expand the campaign to reach even more residents, including greater numbers of people who do not read English, and those who may need special assistance during an emergency

Increasing partnerships with community members that represent diverse populations

Challenge of sustaining campaign with decreasing federal funds

Evaluation Data

Pre- and post-testing of knowledge, behaviors in the home, and perceptions of various aspects of seasonal and pandemic flu

Group of 100 participants – 50% read the booklet; 50% viewed the video

Age range of 18 – 60+

Household income: 82% reporting under $50,000

Education level: – 67% had completed high school, trade school or some

college– 17% had completed college– 16% had completed graduate level work

81% own a thermometer

Evaluation Data (cont.)

Knowledge:

Of the 32 measures, small - large improvement on 26 (81%)

A few examples:

Knowledge already quite high for understanding flu symptoms and spread

– Largest change was understanding that diarrhea and vomiting are often not a symptom

Large change regarding differences between seasonal vs pandemic flu

Large change regarding understanding that rubbing alcohol should not be applied to the skin

No change for contacting a doctor when someone is having trouble breathing and other emergency situations

Evaluation Data (cont.)

Confidence:

Largest changes in confidence:

– Taking care of someone at home for both seasonal and pandemic flu

– Treating dehydration

– When to call a doctor

Already high confidence with taking a temperature

Evaluation Data (cont.)

Intention to change behaviors in the home:

Nearly all state that they currently wash their hands and cover their mouths while coughing/sneezing (98%)

Many got the flu vaccine last season (64%)

Greatest intention to make changes in the home are with:

Checking cleaning supplies

Stocking up on appropriate foods and fluids

Cleaning/disinfecting surfaces and objects

Stocking up on medicines

Involvement of Businesses

Can business get involved? Certainly

How?

Putting a link to the campaign website on your own website

Ordering and distributing materials to employees

- Note that quantities are limited but the files can be provided if you want or can produce quantities on your own

Conducting education within your business through your occupational health department or other means (MDPH can provide a T-T-T session)

Become part of the partnership by financially supporting the campaign

T-T-T sessions coming up

– October 22: Weston, 6 – 8 pm

– October 29: Fall River, 1 - 3 pm

– November 5: Martha’s Vineyard, 5 – 7 pm

– November 12: Easthampton, 6 – 8 pm

To register, go to the Local Public Health Institute website at: www.masslocalinstitute.org

Involvement of Businesses (cont.)

Harvard Vanguard Medical Associates

Became a partner in the campaign last fall

Purchased and distributed booklets & videos (for all their sites) Put booklets in waiting rooms, registration counters, etc Played video in waiting rooms

Infection Control Manager attended one of the DPH T-T-T sessions

Recruited and organized an in-house T-T-T session for 15 staff (mostly nurses but 1 physician assistant)

These staff then educated patients during visits, education series and through their patient newsletter

Support of Infection Control Director (Dr. Ben Kruskal) and other Senior Leadership

Harvard Vanguard Medical Associates (cont.)

Seasonal Influenza

Preparedness

PandemicInfluenza

Preparedness

Campaign Website and Contact Information

Campaign website: www.mass.gov/dph/flu

On the right side of the page under ‘Featured Links’, click on ‘Flu: What You Can Do’

Allison Hackbarth, MPHHealth Education Unit Manager and Epidemiologist

Massachusetts Department of Public Health

Division of Epidemiology and Immunization

Work: (617) 983.6800

Email: allison.hackbarth@state.ma.us