Nationwide, Hispanics have many barriers to accessing health information, and are subject to significant health disparities, including disproportionate burden of diabetes and mental illness. Hispanics are 1.7 times more likely to have been diagnosed with diabetes and 1.4 times more likely to report serious psychological distress, compared to non-Hispanics whites. Lack of access to useful and understandable health information represents a significant health disparity for Hispanics. Tailoring information culturally and geographically, and use of trusted community sites to disseminate information are effective approaches that can improve access to health information and reduce Hispanic health disparities. The goal of our project is to develop, disseminate, and evaluate two novel, contextualized ?Conexion? health information resources for a low-income Hispanic population. The essential concept of a Conexion resource is to combine high quality health information resources that are already publicly available (e.g., links to Medline Plus) with local resources, local flavor, and endorsement from locally known trusted entities. To disseminate Conexion resources, we will leverage an existing platform, GetHealthyHeights.org (GHH), which our team developed as an online community to engage people in the Washington Heights-Inwood community to share resources about health. Additional preliminary work for this project includes established partnerships among community based organizations (CBOs), and the GHH Steering Committee, which consists of 24 CBO members.
Specific aims are to (1) develop Conexion localized health information resources on diabetes and depression for the existing GHH platform through a participatory, user-centered design process that: (a) engages consumers, service providers, medical experts, and medical librarians, and (b) demonstrates usability and understandability of the final design products; (2) disseminate Conexion to the targeted population of low-income Hispanics in Washington Heights-Inwood through two CBOs, a primary care setting, and direct access through GHH, and apply the RE-AIM framework to assess reach, adoption, implementation, and maintenance of the dissemination strategies; and (3) conduct a randomized controlled trial of 200 consumers to examine impact of Conexion on: (a) depression or diabetes knowledge, (b) self-efficacy to use depression/diabetes information (e.g., to communicate with providers or family members, to seek professional help and services, or to participate in treatment decisions), and (c) patient activation. The primary endpoint for the Aim 3 trial is patient activation, which will be assessed at one- month follow up. We will also examine barriers to implementation and sustainability after the trial ends. This proposal, which involves an active collaboration between CBOs, a medical librarian, and a nurse practitioner primary care provider site, seeks to overcome barriers to health information access in a population of low- income Hispanics. Conexion provides a generalizable model for a health information resource that can be replicated in other communities once it is tested and lessons learned are documented.
The Conexion project represents an innovative localized and community-engaged approach to the design and dissemination of a high-quality, useful, usable, and understandable online health information resource. The project responds to high priority information needs around diabetes and depression, and contributes to reducing health disparities among low-income Hispanics. The project will document a replicable model that can be implemented for entire communities, creating a broad potential population-level reach and health impact.