Interactive Kiosks Enhance Access to Health Care Information for Underserved Women, Leading to Increased Motivation to Adopt Healthier Behaviors

Problem Addressed

• More uninsured, with less access to regular medical care: According to data from the National Health Interview Survey, 37.4 percent of adults living below the U.S. Census Bureau’s poverty threshold lacked health insurance in 2008, as compared to only 11.9 percent of adults with incomes greater than 200 percent of the poverty threshold.¹ Uninsured adults are twice as likely to have no regular source of health care, and four times more likely to delay or forgo needed medical care than the insured, putting them at risk for serious and long-term health problems.²
• Limited access to information: While many common diseases and health conditions in women can be controlled or even prevented through lifestyle changes, many underserved women do not have access to information to help them make these changes. Only 35 percent of homes with less than $50,000 in annual income have broadband Internet access, compared to 76 percent of households earning more than $50,000 per year.³ Those underserved women who do have home Internet access often lack the technical knowledge and time to retrieve authoritative medical information from the Web. 

Description of the Innovative Activity

• Interactive women’s health information: The program provides women’s health information, focusing on prevention and education, via touch-activated kiosks. Provided in both English and Spanish, all information has been customized to reach a lower income, low-literacy audience. Key components include:
  • Authoritative, medically vetted content: Content comes from leading health care sources such as the Pennsylvania Department of Health, the Centers for Disease Control and Prevention, the American Cancer Society, and other respected organizations. Users can choose among 19 different health-related topics, including heart disease and stroke, breast cancer, cervical cancer, ovarian cancer, lung cancer, colon cancer, skin cancer, asthma, diabetes, depression, domestic violence, diet and exercise, HIV/AIDS, smoking, sexually transmitted diseases, and weight management. Each topic covers disease signs and symptoms, prevention, personal patient vignettes, questions to ask a doctor or health care provider, insurance options, and referrals for locating free or reduced cost treatment.
  • Interactive component: Users navigate the information using touch screens. Each screen is narrated, making the content accessible for a low-literacy audience; however, users can elect to turn the sound off and quietly read the information presented. The program delivers personal vignettes for each health topic in a conversational “question-and- answer” format, allowing users to engage more closely with the material.
  • Referrals and followup: Many health topics provide followup contact information (mostly hotlines) for users who wish to speak to a health professional for more information. Examples of referral hotlines include the Pennsylvania Breast Cancer Coalition, the Pennsylvania Coalition Against Domestic Violence, the American Cancer Society, and the Pennsylvania Commission for Women.
• Moveable kiosks, placed in locations where underserved women congregate: The stand-alone kiosks are moveable, allowing the program to offer health education in a variety of settings. Thirteen Women’s Wellness Guide kiosks are currently distributed to numerous sites throughout Pennsylvania. Project leaders select sites where large numbers of underserved women generally gather. Current sites include women's prisons; prison waiting rooms; public assistance offices; Women, Infants, and Children centers; supermarkets; and health care facilities. Within a site, the kiosks are placed in easy-to-find locations, with signage used to help attract and direct potential users. While a grant allows current sites to receive their kiosks for free for a period of 4 years, other organizations will be able to purchase kiosks for permanent use in the future.  
• Corresponding Web site: While not yet live, a Women’s Wellness Guide Web site will be available for those women able to access the Internet from home. The site will mirror the kiosk in content, with interactive material and links to relevant resources.

References/Related Articles

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Results

• Many women served: A kiosk placed at Camp Hill Prison received 11,413 “hits” (specific touches where users seek information) from January 20, 2008 to April 28, 2009. Many users would likely not have had access to such information in the absence of the kiosk program.
• An impetus to make lifestyle changes: Roughly 9 in 10 (89 percent) respondents to an internal self-assessment questionnaire indicated that were likely, more likely, or most likely to make positive lifestyle changes after using the kiosk. 
• Positive feedback from users and staff: An internal self-assessment questionnaire embedded into five health topic modules found that 92 percent of respondents at the Camp Hill Prison site characterized their kiosk experience as helpful, somewhat helpful, or very helpful. Staff at sites where kiosks have been placed report that the kiosks are frequently used, and they appreciate the added service it provides to their patients and clients.

Evidence Rating (What is this?)

Context of the Innovation

Planning and Development Process

• Developing and customizing content: St. Andrew Development compiled health care content from a variety of authoritative sources. The Pennsylvania Commission for Women edited the content for appropriateness and consistency, sending it to two Commissioners who were also physicians for approval. The Commission also reviewed all graphics to ensure that they represented the diversity and experiences of the target audience.
• Conducting focus group: St. Andrew Development conducted a focus group of 15 users from a nearby inner-city community. Company representatives led a question-and-answer session with participants, then observed them as they used the kiosk. Results informed the kiosk development process.
• Establishing participating sites: The Pennsylvania Commission for Women identified sites across the state frequented by underserved women, and then contacted representatives from these sites to request their participation in the program.
• Placing kiosks and training site staff: St. Andrew Development staff placed each kiosk and offered brief training to site staff on the basics of operating the unit.

Resources Used and Skills Needed

• Staffing: Existing staff at the Pennsylvania Commission for Women and St. Andrew Development participated in the development and ongoing maintenance of the program, with no new staff being hired or allocated to the project. No new staff were added at kiosk sites.  
• Costs: The Pennsylvania Commission for Women pays annual maintenance fees of $1,200 per kiosk. Eventually, kiosks will be available for purchase at a cost of $9,400 each.

Funding Sources

Highmark Foundation; Pennsylvania Department of Public Welfare

Getting Started with This Innovation

• Have a clear vision: Determine goals and priorities early, and ensure that the project is guided by them throughout.
• Be willing to adapt: Remain true to project objectives, but be flexible enough to adapt along the way as new ideas or challenges arise. 
• Build a solid vendor-client partnership: A mutually-beneficial, trusting relationship is at the heart of any collaborative project.

Sustaining This Innovation

• Always look ahead: Keep abreast of current trends and technology, modifying or adding program elements as appropriate. The Pennsylvania Commission for Women hopes to integrate the Women’s Wellness Kiosk with women’s personal communicators (e.g. cell phones) in the future, in order to communicate newsworthy health items and other helpful information.