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: [email protected]
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