C4H: The effectiveness of participatory video for .... Fong Chiu The... · cancer and screening for improving health literacy among minority ethnic women in the UK ... (breast and

11-13/4/2007 HPH Conference

The effectiveness of pictorial presentation of risks of breastcancer and screening for improving health literacy among

minority ethnic women in the UK

Dr. Lai Fong ChiuSenior Research Fellow

Institute of Heath SciencesUniversity of Leeds


Health LiteracyHealth 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


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)


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


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

http://healthcommunication.leeds.ac.uk/C4h


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

opportunity for an exploration of this link


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


Key risk message 1


Key risk message 2


Key risk message 3


Key risk message 4


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


• Cantonese• Mandarin• Bengali• Pakistani

-women aged between 40 – 85 -the role of younger women in thesegroups as “significant others”

Target audience


Audience

• A total of 115 women from four ethnic groups took part in previewing the video

• Experimental (58) and control (57) groups


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


Field trial design

Shown slides then watch film

Watch film only

Discussion Discussion

Individual Interviews Individual Interviews

Experimental Control


Slides shown to experimental group


Results

2.00 4.00 6.00 8.00 10.00

R a tin g o f film

0

10

20

30

40

Freq

uenc

y M ean = 8.2212Std. Dev. = 2.00464N = 104

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


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 r eE n o u g h i n f o r m a t i o n to m a k e a c h o i c e ?

0

2 0

4 0

6 0

8 0

1 0 0

Freq

uenc

y

8 4 .2 1 %

3 .5 1 %

1 2 .2 8 %

N = 1 1 4


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

correct incorrect

one in nine

0

10

20

30

40

50

Cou

nt

GroupExperimentalControl

one in nine * Group Crosstabulation

Count

50 47 978 9 17

58 56 114

correctincorrect

one innine

Total

Experimental ControlGroup

Total

Z= -0.340 p=0.734


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

correct incorrect

Call back

0

10

20

30

40

50

Cou

nt


Call back * Group Crosstabulation

Count

46 32 7812 25 3758 57 115

correctincorrect

Call back

Total


Total

Z=2.6 p=0.008


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

0

10

20

30

40

50

Cou

nt


Risk of diagnosed of cancer * Group Crosstabulation

Count

48 35 8310 22 3258 57 115

correctincorrect

Risk of diagnosedof cancer

Total


Total

Z=-2.5 p=0.01


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

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

Estimated age risk

0

10

20

30

40

50

Cou

nt

Estimated age risk * Group Crosstabulation

Count

3 14 177 8 15

45 31 763 4 7

58 57 115

40-5060-7080-85over"unsure"

Estimatedage risk

Total


Total

Z=-2.31 p=0.02


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.


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


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


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

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

mental and social) of health literacy is necessary


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


Thank You for listening!grazie per ascoltare!

Gracias por escuchar!

Documents

C4H: The effectiveness of participatory video for .... Fong Chiu The... · cancer and screening for improving health literacy among minority ethnic women in the UK ... (breast and