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The Promises and Perils of Digital Strategies in Achieving Health Equity: Workshop Summary (2016)

Chapter: Appendix A: Examples of eHealth Solutions Featured at the Workshop

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Suggested Citation:"Appendix A: Examples of eHealth Solutions Featured at the Workshop." National Academies of Sciences, Engineering, and Medicine. 2016. The Promises and Perils of Digital Strategies in Achieving Health Equity: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/23439.
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A

Examples of eHealth Solutions Featured at the Workshop

COMMUNITY HEALTH ENGAGEMENT SURVEY SOLUTIONS (CHESS)

Denise Stevens, Matrix Public Health Solutions

Community Health Engagement Survey Solutions (CHESS) is a novel “mHealth” or mobile health strategy for addressing gaps in racial and ethnic health equity developed by Matrix Public Health Solutions in New Haven, Connecticut. CHESS partners with nonprofit youth groups and community improvement organizations to collect data on the neighborhood environment using mobile technology. These data provide a starting point for dialogue and strategic planning to take action on health promotion and disease prevention in the neighborhood.

CHESS’s mobile technology tools include surveys and geographic information system (GIS) mapping to systematically assess four health risk factors in a neighborhood: food, physical activity, tobacco, and alcohol. Participants such as a youth “health explorer” team in the Williamsburg neighborhood of Brooklyn, were trained to use a CHESS app on a digital tablet to survey the streets, food stores, restaurants, fitness facilities, and parks, among other features, within a 400-meter walking radius of their school. The work helped the youth to understand how the environments where they live encourage or discourage healthy eating, physical activity, and tobacco use, which in turn influences their behavior and resulting health.

CHESS analyzes and interprets the gathered data through visual maps and quantitative summaries and then, based on that evidence, applies public

Suggested Citation:"Appendix A: Examples of eHealth Solutions Featured at the Workshop." National Academies of Sciences, Engineering, and Medicine. 2016. The Promises and Perils of Digital Strategies in Achieving Health Equity: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/23439.
×

health expertise to identify potential strategies for intervention and community development to improve access to healthy food and opportunities for physical activity in the neighborhood. For more information, visit http://www.matrixphc.com/chess and watch a video at vimeo.com/104497828.

DOUBLE UP FOOD BUCKS

Liz Kohn, Fair Food Network

Double Up Food Bucks (http://doubleupfoodbucks.org) is a healthy food incentive project of the Fair Food Network, a national nonprofit based in Ann Arbor, Michigan. Launched in 2009, Double Up makes it easier for low-income families in the federal food stamp program—the Supplemental Nutrition Assistance Program (SNAP)—to eat fresh fruits and vegetables while supporting local farmers and economies. When recipients spend SNAP dollars at farmers’ markets, they receive up to $20 of matching credit in Double Up Food Bucks that they can use to buy additional Michigan-grown produce. The project has been an innovator in developing new mobile payment processing technology for use at the markets.

Since its initial start in five farmers’ markets in Detroit, Double Up has spread to more than 150 sites across Michigan and northern Ohio with the help of funding from George Soros’s Open Society Foundations. In 5 years, the project tallied more than 200,000 SNAP/Double Up customer visits at participating sites and more than $5 million of income earned for Michigan farmers and vendors. In 2013, Double Up began expanding into some grocery stores in a partnership with the U.S. Department of Agriculture.

The Double Up model includes a uniform design and brand, centralized administration, and a comprehensive communications strategy, including dynamic social marketing. It depends on strong partnerships with local and statewide organizations and agencies. Evaluation work shows that SNAP customers at farmers’ markets report eating more produce and buying fewer unhealthy snacks.

EATFRESH.ORG

Adrienne Markworth, Leah’s Pantry

EatFresh.org is a healthy eating resource that offers multilingual information via its website, social media, and mobile technology to low-income Californians who receive food stamp assistance through CalFresh and SNAP. Funded with support from the Aetna Foundation, the website is a project of the Human Services Agency of the City and County of San Francisco, with nutrition and culinary content managed by Leah’s Pantry (http://leahspantrysf.org/what-we-do-1). The EatFresh site launched in October 2013 with the goal of encouraging cooking at home with fresh foods and

Suggested Citation:"Appendix A: Examples of eHealth Solutions Featured at the Workshop." National Academies of Sciences, Engineering, and Medicine. 2016. The Promises and Perils of Digital Strategies in Achieving Health Equity: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/23439.
×

minimally processed, nonperishable ingredients. Content can be viewed in Chinese, English, and Spanish.

The website has more than 400 recipes for tasty and healthy yet affordable dishes as well as a “Discover Foods” section that gives basic information on food ingredients. EatFresh hopes to help users better understand the link between lifestyle or diet choices and prevention of chronic diseases, and to show them that healthy change can happen even though barriers exist. The site also offers healthy lifestyle tips and an “Ask the Dietitian” community forum.

CalFresh, county health departments, food banks, and other agencies around California have integrated EatFresh.org as a nutrition education tool. As of September 2014, nearly 45,000 unique visitors had frequented the EatFresh.org website, 25 percent of them through a smartphone. Users may sign up to receive weekly EatFresh tips via e-mail or text. The project’s educational materials are available at http://leahspantrysf.org/eatfresh-toolkit.

FIND MI CARE

Hanna Harp, Greater Detroit Area Health Council

Find MI Care is a free website and mobile application that simplifies the task of finding local, low-cost health care in Michigan. Recognizing a need for patients to receive better coordinated health care treatment close to home, the nonprofit Greater Detroit Area Health Council—a coalition addressing health care quality, access, and cost in Southeast Michigan—created this search tool with a grant from the Robert Wood Johnson Foundation. Visitors to the www.findMIcare.org website can select the health services they are looking for from a menu of options (ranging from primary care and specialty services to medication assistance), and then specify their zip code or region. A list of clinics in the area is generated, with a brief description of each facility and important notes, such as whether it provides care to uninsured individuals. Hospitals, physicians, and community groups can use Find MI Care to help connect Michigan residents to health care resources. The tool can be downloaded as a free smartphone app.

GET CONNECTED

Jose Bauermeister, University of Michigan School of Public Health Jimena Loveluck, HIV/AIDS Resource Center

Get Connected is a tailored, Web-based health intervention that aims to increase awareness about sexually transmitted illnesses (STIs) among young men who have sex with men (YMSM), and to link them to health clinics

Suggested Citation:"Appendix A: Examples of eHealth Solutions Featured at the Workshop." National Academies of Sciences, Engineering, and Medicine. 2016. The Promises and Perils of Digital Strategies in Achieving Health Equity: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/23439.
×

that can provide testing for those diseases in a culturally sensitive manner. This work builds upon an existing community-based participatory research project on HIV and STIs at the University of Michigan. Researchers at the university’s Center for Health Communications Research and the Center for Sexuality & Health Disparities created the Get Connected website with support from the Centers for Disease Control and Prevention and the National Association of County and City Health Officials.

Get Connected seeks to reach young gay or bisexual men in Southeast Michigan who use e-technologies such as websites and smartphones to meet partners. The Web intervention was developed with input from a youth advisory board, community provider advisors, and local HIV/AIDS organizations. The website provides information on STIs, walks users through the thought process of why they would or would not wish to undergo testing, and uses tailored messaging on values and barriers to try to motivate them to get tested.

Get Connected also offers an STI testing-site search tool that helps users find high-quality, local clinics with the services they need, and the website generates a list of questions, which users can print out or receive by e-mail or text to ask the health provider during their appointment. The researchers have been studying whether Get Connected effectively increases STI testing among the website’s users (see http://chcr.umich.edu/project.php?id=1108), and the researchers are expanding their intervention to mobile devices.

LET’S GET HEALTHY! AND 5-2-1-0 KIDS!

Sharon Milberger, Henry Ford LiveWell

Let’s Get Healthy! is a healthy living education program developed for overweight children ages 9 to 13 by the Henry Ford Health System’s LiveWell division. The 10-week program partners each youngster with a parent to work with a multidisciplinary team that includes a pediatrician, behavioral therapist, registered dietitian, and athletic trainer. This team offers guidance and insight, with a goal of education and behavioral changes rather than weight loss. The dietitian helps each family to build healthy meal plans and realistic lifestyle changes. The team instructors try to convey engaging messages to reshape the way the child thinks about food, nutrition, and exercise.

Participants learn about mindful eating, portion sizes, label reading, fast food and snack choices, quick and healthy meals, smart grocery shopping, and maintaining a food journal. Behavioral modifications are encouraged through setting goals and maintaining and celebrating successes, and through conversations on topics such as staying motivated, stress, and time

Suggested Citation:"Appendix A: Examples of eHealth Solutions Featured at the Workshop." National Academies of Sciences, Engineering, and Medicine. 2016. The Promises and Perils of Digital Strategies in Achieving Health Equity: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/23439.
×

management. Kids and families also learn fun and affordable ways to exercise and tips on maintaining an active lifestyle.

Let’s Get Healthy! recommends the “5-2-1-0” guidelines for daily nutrition and fitness: 5 fruits and vegetables, 2 hours or less of screen time, 1 hour or more of physical activity, and 0 sugar-added beverages. Henry Ford LiveWell has created a fun, interactive game app called “5-2-1-0 Kids!” with messages about eating right and staying active. Families can download the game for free from the Apple and Android app stores. For more information about Let’s Get Healthy! visit http://henryfordlivewell.com/body.cfm?id=991&fr=true.

MOBILE DAD

Shawna Lee, University of Michigan School of Social Work

Mobile Dad (mDad) Baby Book is an interactive mobile technology application that enhances the engagement of fathers with their families. Researchers at the University of Michigan created this smartphone app at the request of the U.S. Air Force (USAF) to help military members who are fathers stay involved with their young children while deployed away from home, and to ease the transition when they come back.

Mobile Dad is a cross between a digital baby book and a parent education resource, and fathers can use it independently or with spouses or partners. The app allows users to upload pictures, videos, and audio recordings of their child to track his or her growth. Twice a week, fathers receive brief messages on their iPhone, iPad, or iPod Touch that are tailored to their child’s age and developmental milestones. If an infant turns 6 months old, for instance, the parent will receive a notification that the baby can soon start eating solid food. The app can provide more detailed information about that milestone, along with tips on parenting and fun activities to support the child’s healthy growth.

The app is tailored for helping fathers balance military and family life, and users can benefit from advice shared by other military dads. mDad was field tested with 200 USAF mothers and fathers. For more information, visit http://chcr.umich.edu/project.php?id=1104.

PLAN PILOT

Tessie Guillermo, ZeroDivide

Plan Pilot is a prototype mobile technology application that draws on health plan datasets to make shopping for health insurance an easier and

Suggested Citation:"Appendix A: Examples of eHealth Solutions Featured at the Workshop." National Academies of Sciences, Engineering, and Medicine. 2016. The Promises and Perils of Digital Strategies in Achieving Health Equity: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/23439.
×

less confusing experience. It was developed by the San Francisco–based consulting organization ZeroDivide, which seeks to transform underserved communities through technology, including eHealth or electronic health resources tools. The Plan Pilot app is a finalist in the Plan Choice Challenge sponsored by the Robert Wood Johnson Foundation in summer 2014 to spark the development of new apps and tools that allow consumers to compare costs, features, and ratings of health insurance plans and choose the best plan to suit their needs in the new marketplaces created by the Affordable Care Act (ACA). App developers were given access to a set of data on cost-sharing features of plans offered in the health insurance marketplaces in every state and Washington, DC.

ZeroDivide describes Plan Pilot as “a responsive Web application that helps consumers make wise decisions, live healthier lives, and save money on the true total cost of health care.” Many Americans who enrolled in health plans through the insurance marketplaces under the ACA have reported dissatisfaction with their choice, and only 60 percent were confident they would be able to pay for a major illness or injury. ZeroDivide’s consumer research identified confusion, complexity of choices, and poor customer experiences as the major challenges in making good decisions about buying health insurance. The Plan Pilot app will help users “navigate their health care coverage with personalized recommendations about plan and provider quality as well as savings for prescription drugs.”

Y-MVP TEEN FITNESS CHALLENGE

Lori Benson, YMCA of Greater New York

The Y-MVP Teen Fitness Challenge is an 8-week YMCA training program that is innovatively integrated with a digital game to get teenagers engaging in moderate to vigorous physical (MVP) activity every day. The YMCA of Greater New York developed the challenge to incorporate online game design techniques that grab the interest of young people. What started as a pilot program in spring 2013 at the Bedford-Stuyvesant Y in Brooklyn and the Harlem Y in Manhattan is expanding to all YMCA sites across New York City by 2015.

Teens who register for Y-MVP meet once per week in small classes with a trained coach who takes them on a series of fitness “quests” or activities. At the end of each session, participants are assigned a fitness “mission” that they must complete before they meet next. An accompanying interactive digital app and a dynamic badge system tracks, motivates, and rewards the teens’ efforts. The youths access the Y-MVP app on a tablet at the gym to record their workouts and monitor their progress toward successfully reaching the activity goals set by their coach. Along the way, they earn and

Suggested Citation:"Appendix A: Examples of eHealth Solutions Featured at the Workshop." National Academies of Sciences, Engineering, and Medicine. 2016. The Promises and Perils of Digital Strategies in Achieving Health Equity: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/23439.
×

accumulate digital badges that can ultimately be exchanged for incentives such as t-shirts and water bottles. Participants share their accomplishments on social media sites.

Y-MVP is supported by Aetna Foundation, American Express, the Hive Digital Media Learning Fund, and the PepsiCo Foundation. For more details, visit http://www.ymcanyc.org/association/pages/y-mvp or watch a video at www.youtube.com/watch?v=9x7t2k_4Kdo&feature=youtu.be.

Suggested Citation:"Appendix A: Examples of eHealth Solutions Featured at the Workshop." National Academies of Sciences, Engineering, and Medicine. 2016. The Promises and Perils of Digital Strategies in Achieving Health Equity: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/23439.
×

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Suggested Citation:"Appendix A: Examples of eHealth Solutions Featured at the Workshop." National Academies of Sciences, Engineering, and Medicine. 2016. The Promises and Perils of Digital Strategies in Achieving Health Equity: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/23439.
×
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Suggested Citation:"Appendix A: Examples of eHealth Solutions Featured at the Workshop." National Academies of Sciences, Engineering, and Medicine. 2016. The Promises and Perils of Digital Strategies in Achieving Health Equity: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/23439.
×
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Suggested Citation:"Appendix A: Examples of eHealth Solutions Featured at the Workshop." National Academies of Sciences, Engineering, and Medicine. 2016. The Promises and Perils of Digital Strategies in Achieving Health Equity: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/23439.
×
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Suggested Citation:"Appendix A: Examples of eHealth Solutions Featured at the Workshop." National Academies of Sciences, Engineering, and Medicine. 2016. The Promises and Perils of Digital Strategies in Achieving Health Equity: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/23439.
×
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Suggested Citation:"Appendix A: Examples of eHealth Solutions Featured at the Workshop." National Academies of Sciences, Engineering, and Medicine. 2016. The Promises and Perils of Digital Strategies in Achieving Health Equity: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/23439.
×
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Suggested Citation:"Appendix A: Examples of eHealth Solutions Featured at the Workshop." National Academies of Sciences, Engineering, and Medicine. 2016. The Promises and Perils of Digital Strategies in Achieving Health Equity: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/23439.
×
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Suggested Citation:"Appendix A: Examples of eHealth Solutions Featured at the Workshop." National Academies of Sciences, Engineering, and Medicine. 2016. The Promises and Perils of Digital Strategies in Achieving Health Equity: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/23439.
×
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Suggested Citation:"Appendix A: Examples of eHealth Solutions Featured at the Workshop." National Academies of Sciences, Engineering, and Medicine. 2016. The Promises and Perils of Digital Strategies in Achieving Health Equity: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/23439.
×
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Health care is in the midst of a dramatic transformation in the United States. Spurred by technological advances, economic imperatives, and governmental policies, information technologies are rapidly being applied to health care in an effort to improve access, enhance quality, and decrease costs. At the same time, the use of technologies by the consumers of health care is changing how people interact with the health care system and with health information.

These changes in health care have the potential both to exacerbate and to diminish the stark disparities in health and well-being that exist among population groups in the United States. If the benefits of technology flow disproportionately to those who already enjoy better coverage, use, and outcomes than disadvantaged groups, heath disparities could increase. But if technologies can be developed and implemented in such a way to improve access and enhance quality for the members of all groups, the ongoing transformation of health care could reduce the gaps among groups while improving health care for all.

To explore the potential for further insights into, and opportunities to address, disparities in underserved populations the National Academies of Sciences, Engineering, and Medicine held a workshop in October 2014. The workshop focused on (1) how communities are using digital health technologies to improve health outcomes for racial and ethnic minority populations, (2) how community engagement can improve access to high-quality health information for members of these groups, and (3) on models of successful technology-based strategies to reduce health disparities. This report summarizes the presentations and discussions at the workshop.

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