Providing Internet Based Health Information

to Underserved Populations a Promotora Model

Barbara Hau RN, MS

La Plaza Telecommunity

Taos, New Mexico

bhau@laplaza.org

505-758-1836

Taos County

• Rural – Population density 9.8 per Sq Mi• Median Household Income $24,831• Tricultural

– 67% Hispanic– 7% Native American– 26% Anglo

• 28.2% less than H.S Education

La Plaza Telecommunity

• Community Technology Center established in 1994• Mission: To provide rural tri-cultural communities with:

– Access to information technology resources– Education in Computer and Internet technology– A Virtual Library of Community Resources

• Internet Access (ISP) 2200 dial in users• 4 public access computer centers• Free or low cost classes in Internet technology• Local and regional information on website: www.laplaza.org

Diabetes Wellness Connection

• Department of Commerce TIIAP (TOPS)

• Technology Demonstration Project

• Health Category

• 1996-1998

Goals

• Provide Internet access to 3 rural clinics– Taos~Picuris Indian Health Center– PMS Questa Health Center– HCNNM Penasco Clinic

• Provide Internet training for health care providers and consumers

• Provide health content related to diabetes on La Plaza’s Website

Access

• Tech assessment (no capacity)• 12 months to build technical capacity• Installed phone lines and dial up connection• Installed computers

– consumers - 1 desktop on roll cart in clinic lobby available for public access 10 hrs/week

– Providers - 1 laptop available for “check out”

Website Content

• Focus groups:– POSITIVE Information re diabetes– Culturally sensitive messages– Trusted/familiar sources– Local resources/programs– Nutrition/diet/recipes– Exercise information/motivation– Emotional support

Diabetes Wellness Connectionhttp://laplaza.org/health/dwc/

• Links to National Websites – American Diabetes Association– Eli Lilly

• Mark Up of Existing Health Education Materials

• Personal Stories “Living Well with Diabetes”

Promotora ModelCommunity Outreach Trainers

• Native residents of respective communities

• Bilingual (Spanish/Tiwa)• Strong desire to learn computer and

Internet skills• Strong desire to help community

members to learn skills

Train the Trainer Model

• Conducted 6 computer/Internet trainings with COTs

• COTs present 10 hours/week at clinic sites (lobby) homes, H&H agencies

• Logged encounters on Excel spreadsheet

• Submitted monthly Excel reports of client encounters

Curriculum

• Hardware software (unpack, assemble, set up dial up connection)

• Keyboard/Mouse/Windows

• WWW navigation, search, bookmarks

• Email send, receive, address, files, attach

• MS Word

• Excel (logs)

Excel Logs

• Date

• Provider/Consumer

• Sex

• Age

• Search/Topic

Evaluation Data

• Intervention time - 8 months

• 1835 hours of Internet access for health providers and COTs

• Trained 27 health care providers

• COTs provided 297 individual training encounters in clinics

• 23,358 website “hits”

Evaluation Data

% pre % post

• Seeking health info daily 37 50• Using computer daily 42 69• Access health info via

computer 57 75• Access to health info good 44 61• Comfortable using computer 55 69

Lessons Learned • Perform a technical assessment prior to

implementing technology based health education projects

• Adapt existing health information for website content

• COT’s effective in introducing Internet based health information to peers AND HCP

• Personal stories and culturally appropriate health information was most popular

• Internet information interest broader than “health”

• Community members desired participation in development of health content

Recommendations

• Increase Internet access through wireless broadband microwave radios

• Increase pubic access computer sites in Taos County - 26

• Continue the COT Model – 6 COTs

• Continue to develop locally and culturally appropriate information on La Plaza Website

Current Health Projects• Internet a Change agent for Rural

Muticultural Adults– NCI 2000-2004– Partners

• AMC Cancer Research Center, Denver• University of New Mexico• Colorado State University

– Determine most effective strategies for training rural multicultural adults in using computers and Internet technology

– Determine efficacy of website promotingincreased intake of fruits and vegetables among residents of the Upper Rio Grande Valley

Current Projects cont.

• CyberYouth Project– New Mexico Department of Health

Holy Cross Hospital– Train “at risk” youth in:

• TUPAC Issues• Media Literacy• Website Design

– Create websites addressing TUPAC issues– “World Premier” at Taos Talking Picture

Film Festival, April 2002