1. Paying Attention to Evaluation & Key Stakeholders: Uncovering Relevant Core Health Messages for Rural Mothers Teresa McCoy, Assistant Director Evaluation & Assessment University of Maryland Extension Mili Duggal, School of Public Health University of Maryland

2. Eat less, move more Eat more fruits and vegetables Lose weight Exercise more Start exercising Take care of yourself Stop stressing Get more sleep

3. Window of Opportunity Opens Rural Health & Safety Education Competitive Grants

4. What content is truly effective? Core Health Messages: A User-Focused Health Literacy Initiative: Evaluate use of clicker technology in focus groups Distinguish core health message preferences among low-income, rural mothers Determine how to apply findings

5. How do we create messages that could help improve health outcomes for rural women with young children ?

6. We knew: Poorer health outcomes - Limited availability and access to health services - Inadequate health insurance coverage – Low levels of health literacy Attention to health messages - Understanding of messages - Actions in response to messages - Preferred channels of receiving messages But, we did not know:

7. Empowerment Framework Multi-disciplinary Team Learner Centered Utilization-Focused Evaluation

8. Project Overview (for those who like the details)

9. Fluoride prevents cavities. Drink water with fluoride. And use toothpaste with fluoride when you and your children brush your teeth. Fluoride prevents cavities. Many rural water sources do not have fluoride added. Many bottles of water on store shelves do not have fluoride added. Drink water with fluoride. And use toothpaste with fluoride when you and your children brush your teeth. As a dentist, I see a lot of cavities in rural children, especially in baby teeth. Tooth decay hurts and costs you money and time. Many rural water sources do not have fluoride added. Many bottles of water on store shelves do not have fluoride added. Fluoride prevents tooth cavities. Mothers and their children should drink water with fluoride. And use toothpaste with fluoride when you and your children brush your teeth. Authority Voice with small, medium, and large content Hi, I’m Mary. I have two kids and I am always busy and pinched for money! I want my children to be healthy. We drink water with fluoride and I always buy toothpaste with fluoride. Hi, I’m Mary. I have two kids and I am always busy and pinched for money! I want my children to be healthy. I don’t want my kids to have cavities like I did. Our dentist told me that my kids might get cavities if they don’t drink water with fluoride and use toothpaste with fluoride. I’ve been buying bottled water and toothpaste with fluoride added to prevent cavities. Hi, I’m Mary. I have two kids and I am always busy and pinched for money! I want my children to be healthy. My oldest had several cavities by the time he was three. He was hurting. I had to take off work to drive him a long ways to the dentist. The dentist said that since I lived out in the country, my water probably didn’t have fluoride. He asked if we used toothpaste and drank bottled water with fluoride. We didn’t, but now we do. My oldest hasn’t had any more cavities. And my youngest has none. Peer Voice with small, medium, and large content

10. FINAL MESSAGE #1 Empathetic about their busy life Tells a short story or includes simple steps that the mothers find easy to do Positive – what good can happen after you do the action In mother’s voice citing an authority figure (e.g., “my dentist told me…” “My health educator told me…”) Medium amount of content The Core Health Message Template ©

12. Positive Short Story with empathy Mother’s voice citing authority figure Medium amount of content Good will happen Simple, easy steps 1 1 2 2 3 3 4 4 5 5 6 6 1 1 2 2 3 3 4 4 5 5 6 6

14. Clicker Use in Focus Groups Received well by participants (feels like a cell phone) Used for comfort levels in disclosing Varying levels of technology comfort with facilitators Does limit flexibility of facilitators Transcription considerations for coders have to be in design of the focus group What were they reacting to? I didn’t see the vote!

15. Dissemination of Core Health Messages: Using Community-Based Participatory Research to Strengthen the Health of Rural, Low-Income Families Project Description: The project will determine the most effective electronic and non-electronic dissemination methods for core health messages by identifying factors which help or hinder their adoption by rural, low-income mothers and the professionals who serve them. The dental, food security, and physical activity core health messages are learner-driven and based on findings from the Rural Families Speak and Rural Families Speak about Health multi-state research projects. Year

16. Whose interests and what decisions and relationships are driving the evaluation context? How can evaluators attend to important interactions amidst competing interests and values through innovative methodologies, procedures, and processes?

17. Bonnie Braun, PhD., Professor & Faculty Scholar Herschel S. Horowitz Center for Health Literacy University of Maryland-College Park School of Public Health 301-335-4335 bbraun@umd.edu

18. This research project was supported by the Rural Health and Safety Education Competitive Program of the USDA Cooperative State Research, Education and Extension Service, grant number 2010-46100-21791. Research Team: Sheila Mammen, Yoshie Sano, Bonnie Braun, Elizabeth F. Maring Linda Aldory, Teresa McCoy, Brad Paleg, Crystal Terhune Graduate Assistants: Mili Duggal and Amanda Ginter Partners include: University of Massachusetts, Amherst, Washington State University, University of Maryland Extension, Rural Maryland Council Maryland Rural Health Association University of Maryland School of Public Health, Herschel S. Horowitz Center for Health Literacy And 14 Rural Families Speak state research teams. Acknowledgements