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3. IMPROVING ACCESSIBILITY AND QUALITY OF MEDICAL CARE, EDUCATION, AND REFERRAL SERVICES 18 Research has shown that applying inappropriate strategies to some barriers has had minimal success (Bero et al., 1997, Davis et al., 1995). But barriers often overlap and require multifaceted strategies. Therefore, the following needs to be established before any intervention: â¢ Identification of specific target audiences for the intervention. Who are the target audiences of an intervention? The current grantees appear to have focused primarily on potentially eligible uranium miners and secondarily on ore transporters, uranium millers, downwinders, and onsite nuclear-test participants. We believe that HRSA should require clear identification of the multiple community groups, including the staff of local health-care organizations and clinicians, as well as the potential RECA recipients. â¢ Clear identification of the barriers HRSA and its grantees are trying to address and the outcomes they seek. Future grantees should be encouraged to state clearly what outcomes they seek to achieve. They may need to use a multifaceted intervention aimed at different behavior-change objectives. Some assumptions may need to be re-examined. For example, with respect to improving accessibility to services, the current grantees seem to assume that minersâ lack of knowledge about RECA legislation is the single barrier to be faced and that they will use the provided services more if this is remedied. What evidence supports this assumption? Potential knowledge-deficits are important barriers to examine, but usually there are several barriersâsuch as interpersonal tensions, organizational limitations, and public- policy issues for the audience in questionâ that must be overcome by the grantees to accomplish their objectives (Davis et al., 1995). We describe below one of the barriers and behavior-change strategies mentioned in the table above. Deficits in knowledge and knowledge-based skills Every education program should include learning outcomes and an assessment plan that documents the degree to which the granteesâ objectives are met by their proposed program. We suggest that among the outcomes is a decrease in the knowledge deficit regarding exposure and risk, the diseases identified by the RECA legislation, the benefits and harms of screening and evaluation, referral services, medical treatment, and follow-up care. An educational program should also address new laws and regulations and technical changes. Barriers Deficits in knowledge and deficits in knowledge-based skills, such as communication and critical thinking, are the main barriers in educating the target populations. HRSA and its grantees should take advantage of available health-education and communication programs (particularly risk communication). However, one