1. Evaluating Health Promotion Materials in an Immunization Registry
Dahlia Kupfer, Deborah Usinger, University of Washington;
Denise Farrand, Public Health–Seattle and King County; Janna Halverson, Washington State Department of Health
March 19, 2003 NIC

2. WHAT IS CHILD PROFILE?
Washington State’s health promotion system and immunization registry aimed at assuring children receive the preventive health services they need from birth to age six.
There are 2 components (next slide)
March 19, 2003 NIC

3. Here’s what we want:
March 19, 2003 NIC

4. Immunization Registry component
A central registry of individual child health information
Built using birth certificates
Accessible by public and private providers who link with the registry
March 19, 2003 NIC

5. Health promotion component
Built from demographic birth certificate information.
17 mailings sent to parents of children birth to age six with age-specific information (30 materials in total). All provided in English and Spanish.
Information includes immunization and well-child reminders, parenting, safety and health information.
March 19, 2003 NIC

6. Health promotion materials also include:
“Fact sheet” with the immunization schedule and other immunization information
Immunization record and holder
Well-child booklet
Development charts and brochures describing typical age-specific development
Nutrition brochures
March 19, 2003 NIC

7. KEY QUESTIONS Are parents satisfied with the materials?
Are the materials useful, easy to read and relevant for parents of all age groups and geographic areas?
Do materials help remind parents to get children immunized, get well-child checkups and about other health and safety issues?
Do materials increase knowledge and/or change behavior?
Dahlia:
These were the questions we were trying to answer:
March 19, 2003 NIC

8. How do we ensure CHILD Profile Health Promotion system is meeting its goals?
Focus groups
Pre-testing
Parent surveys
Results feed back into system
The cycle includes both qualitative and quantitative evaluation. We have a comprehensive evaluation plan in place with evaluation questions and strategies attached to goals and activities, stratified by short term, intermediate and long term goals.
focus grouping new materials and existing materials;
annual pretesting of all new and revised materials parent review team comments being incorporated into annual revision to further ensure content is relevant & useful
3. Statewide parent surveys done every 2 years.
All results directly feed back into system
March 19, 2003 NIC

9. Health Promotion Evaluation Results
Parents report high satisfaction with materials:
85-90% say they read, or save letters for later;
Over 65% say letters have answered parenting qx;
About 60% say letters help remind them about imms and next well-child visit;
Between 66% - 76% say the imms information was useful or very useful.
In 2002, over 6800 parents (including Spanish parents) were surveyed statewide, with a 48% response rate. We had 5 survey populations, divided by age.
Survey results show—I have graphic representations of materials:
Last bullet: Imms qx re “how useful was the following information?”
March 19, 2003 NIC

10. CHILD Profile Results Dahlia:
Highest %s were information on imms (18-29%), safety (17-19%), growth and devt (40-45%), reminders and advice (22%) and eating habits and nutrition (23-30%)
March 19, 2003 NIC

11. CHILD Profile Results Dahlia:
74%-80% said they read it when they get it. Another 9-11% save to read it for later.
March 19, 2003 NIC

12. CHILD Profile Results Dahlia:
When asked what behavior changes, answers w/highest rankings included changing eating habits and providing reminders about well child and needed imms.
March 19, 2003 NIC

13. CHILD Profile Results
Dahlia:
Range from 59-63%
March 19, 2003 NIC

14. CHILD Profile Results
About 25% said they’d be interested in getting their materials electronically.
March 19, 2003 NIC

15. Email pilot survey results
Maintaining good addresses is challenging;
.Pdf files may not be the best delivery method;
60% said were more likely to read electronic version; 49% said electronic version made the info more useful; and 94% said want their future mailings electronically;
Electronic delivery will save the program money.
Currently testing electronic delivery of the materials, via reminders to a small group of 500 parents.
Remember this pool said they’d be interested in elect delivery
After #2: since some home computers cannot handle the files
March 19, 2003 NIC

16. Focus groups
Provide qualitative data on potential format/content revisions, and for developing new materials.
Explore how to ensure the materials are useful to more parents - i.e., Hispanic parents, those who don’t read the materials.
Able to further explore survey results; key findings support survey results.
Under bullet 2: In October 2002, we conducted focus groups across Washington State to gather information from new parents, parents of of older children, Hispanic parents, and non-readers of the materials. In these focus groups, were able to probe more than in surveys, and probe on information from surveys (electronic delivery, sponsorship).
We gained specific information on:
format and content changes that might make the materials more appealing to parents, and esp. those who consider themselves “non-readers” of the materials.
issues like potential corporate sponsorship of the materials, electronic delivery, ways to increase use of website.
March 19, 2003 NIC

17. Focus group recommendations
Emphasize that imms info is continually updated;
Work with provider offices to promote the program;
Explore sending materials to older kids (>6) and include activities for them;
Listing corporate sponsorships on the materials may make parents less likely to read them;
Further examine materials for cultural appropriateness.
Program people will be following up the recommendations with next steps.
Bullets 2 and 3 may “convert” non-readers to readers
March 19, 2003 NIC

18. Conclusions
Health promotion materials provide useful information for parents of young children, and help change attitudes and behavior.
Parent surveys effective way to quantitatively evaluate health promotion materials.
Focus groups assist with qualitative information; provide additional information (content and format) unattainable via surveys.
Evaluation cycle ensures materials remain useful and relevant to parents over time.
March 19, 2003 NIC

19. Next steps
Continue to pilot electronic delivery of health promotion to determine satisfaction and effectiveness.
Continue parent satisfaction surveys to examine satisfaction, attitude and behavior changes over time.
Conduct further research with businesses & parents on corporate sponsorship of materials
March 19, 2003 NIC

20. CONTACT INFORMATION
Dahlia Kupfer
University of Washington/CHDD
Box
Seattle, WA
March 19, 2003 NIC