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

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Flu What You Can Do Caring For People At
HomeStatewide Educational Campaign
Allison Hackbarth, MPHHealth Education Unit
Manager and Epidemiologist Massachusetts
Department of Public HealthDivision of
Epidemiology and Immunization October 15, 2008
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Learning Objectives

• 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

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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 its not serious

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Impact of Seasonal Influenza

• 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

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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

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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

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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

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Impact of an Influenza Pandemic

• 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

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Impact of an Influenza Pandemic
Existing facilities will be overwhelmed
Vaccine, antivirals, antibiotics will be in
short supply
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Impact of an Influenza Pandemic
MBTA cuts back service
Delivery of goods curtailed
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Impact of an Influenza Pandemic
Prisons and jails on 24-hour lock-down
Day care centers for children and the
elderly are closed
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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

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(No Transcript)
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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

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Pandemic Planning Activities

• Policy Direction
• Command and control
• MEMA
• Emergency Service Functions (ESFs)
• Healthcare Providers
• MA System for Advanced Registration (MSAR)
• MA Reserve Corps (MRCs)
• Indemnification

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Pandemic Planning Activities

• Healthcare Surge
• Flu surge and gap analysis
• Materials and equipment (SNS)
• ISCU development
• Altered standard of care / liability
• Care at Home

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Pandemic Planning Educational Initiatives at MDPH

• 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

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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

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Flu Facts Campaign
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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

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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

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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

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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.

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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

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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

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Development of the Campaign

• 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

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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

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(No Transcript)
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Flu What You Can Do DVD
DVD is 22-minutes, same topics as booklet, but
less detailed info
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Flu What You Can Do Website
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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)

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Implementation of the Campaign

• 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

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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?

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Active Education
Step 2 Preparing local educators through the
T-T-T sessions
Step 3 Outreach and education to the general
public
Step 1 Training of DPH staff to implement T-T-T
sessions

• Library Seminar
• Church Group
• High School Health Class
• Mothers Group
• PTA Meeting
• Senior Center
• Health Plan Ed Classes

• Local Board of Health Staff
• School Nurses
• CHC Staff
• MRC Volunteers
• Health Plan Staff
• VNA Nurses

• MDPH Staff

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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.

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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

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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

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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

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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

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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

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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

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Involvement of Businesses (cont.)

• T-T-T sessions coming up
• October 22 Weston, 6 8 pm
• October 29 Fall River, 1 - 3 pm
• November 5 Marthas Vineyard, 5 7 pm
• November 12 Easthampton, 6 8 pm
• To register, go to the Local Public Health
  Institute website at
• www.masslocalinstitute.org

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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

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Harvard Vanguard Medical Associates (cont.)

• 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

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Seasonal Influenza Preparedness
Pandemic Influenza Preparedness
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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 [phone]
• Email allison.hackbarth_at_state.ma.us