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Lessons Learned from a Black and Minority Health Fair’s 15-Month Follow-up Counseling

In health information outreach, one of the most common ways to connect with the public is through a health fair.  Recent literature has shown that school health fairs improve health knowledge in the short term (Freedman, 2010) and health fairs can be a valuable way to enhance public awareness of specific health professions or services (Stamat, Injety, Pohlod, & Aguwa, 2008).  Additionally, participating in health fairs as exhibitors is a manageable outreach activity that can help to address health literacy and health information inequalities in specific communities (Pomerantz, Muhammad, Downey & Kind, 2010). For non-profit health organizations and medical libraries, health fairs provide important outreach opportunities and  ways to reach beyond a traditional sphere of users.  Exhibitors can share targeted information for a population demographic or demonstrate new online resources and applications for health information access and health literacy.

Even though the aforementioned studies show positive trends for short-term effects of health fairs on health information and health literacy, it can be difficult to evaluate long-term effects or to determine participant behavior changes from attending health fairs. As such, it can also be difficult to justify the staff time and monetary expenses for hosting a health fair.  However, results from a recent research study show that health fairs have potential to provide a foundation for ongoing and integrated outreach. In a study conducted in Indiana in 2006-2007, health professional contact 10 and 15 months following a health fair (to determine health fair effectiveness) led to more in-depth and personalized involvement with participants that resulted in greater changes in health behavior and attitudes.  Librarians can use health fairs to begin an engagement process with targeted individuals.   Additionally, librarians can evaluate health fairs using similar pre and post test methods as this study used, but focus more on assessing changes in health information literacy and knowledge from health fair participants.

The study published in 2011 evaluated both the short-term and long-term health effects of attending a health fair, and assessed the impact of personalized follow-up health counseling sessions for select participants.  The Indiana Black and Minority Health Fair included more than 100 health education booths and addressed a variety of health topics, including prevention and screening, as well as general healthy living.  Sponsored by the Indiana State Department of Health, the annual health fair is part of an ongoing effort to develop health literacy skills. The study was constructed as a pre-post test evaluation with baseline data collection at the health fair and then again after 10 and 15 months.  All participants from the original sample group received health education materials between the 10 and 15-month posttests, and a select group participated in health counseling sessions with a registered nurse. The researcher designed the study to explore a paradigm where, “health fair encounters were aimed to translate from episodic experiences to long-term educational experiences via 15-month follow-up health counseling sessions in a partnership among the state government…local government…and a university…” (p. 898).

With a stationed booth at the health fair, the researchers evaluated a baseline level of willing participants’ health information knowledge through a pretest. In this study, the pretest was a 16-item short-form questionnaire.  This questionnaire was adapted from the Behavioral Risk Factor Surveillance System questionnaire and included questions on “perceived body weight, vigorous and moderate physical activity, TV/video watching hours, fruit and vegetable consumption, tobacco use, and perceived health status” (p.899).  The pretest evaluated the major health indicators and behaviors of health fair participants.

The first posttest was conducted 10 months later in a follow-up mail survey to all health fair participants in the form of a 99-item long-form questionnaire, also adapted from the Behavioral Risk Factor Surveillance System.  This round had a response rate of 47%, with 266 participants responding. This posttest evaluated if attending the health fair had any short-term effects on the participant’s health knowledge and other health habits. It looked at the “participants’ health knowledge, eating behaviors, sedentary behaviors, exercise self-efficacy, exercise goal setting and adherence, and changes in health status” (p. 899). Results from this posttest showed that more people perceived themselves as overweight (an increase of almost 7% from the baseline measure) and fewer people watched TV/videos 4 hours or more on a usual weekday (a drop of almost 22%) 10 months following the health fair. These behavioral changes were not matched by any other changes in notable health behaviors or conditions included in the questionnaires.

This lack of health behavior change is an important aspect of this study, and a revealing situation for librarians.  Health fairs may not produce immediate changes but they can provide an educational space where health professionals and librarians can connect with at-risk health populations and start a conversation about their health behaviors. This potential was seen in the intervention step of the study from which participants’ health information materials and personalized counseling over the course of three to four months offered another opportunity to connect health information professionals with targeted populations.

All participants from the posttest received mailed health educational materials, and this was considered the comparison group. A small subset agreed to personalized health counseling by a registered nurse via phone. The intervention group set at least one health goal and received four counseling phone calls over the course of 12-16 weeks.  Then all comparison and intervention group participants received a second posttest questionnaire 15 months after the health fair (the same 99-item long form questionnaire from the first posttest).  This second posttest evaluated the effect of the personalized follow-up health counseling sessions, as well as the effect of receiving the health information materials.  Of the initial 266 participants, 188 followed through with the second posttest. The second posttest showed some increases in self-reported measures of general health status, with the percentage of overweight or obese participants decreased in both the intervention and comparison groups.  Additionally, participants in the intervention group showed a significant increase in choosing leaner meats, and showed improvements in exercise self-efficacy, exercise goal setting and adherence, and health knowledge.  However, there was little significant gain in health knowledge, as the emphasis in the intervention group was on addressing individuals’ health concerns.  A takeaway message from this study is that long-term follow-up interventions have the potential to provide health support over a longer period of time, which can increase the likelihood of healthy outcomes and health literacy.

Yet, this study shows that health fairs can be an important stepping-stone for health information outreach and evaluation.  Due to the inherent nature of health fairs, they are typically a one-time interaction, and participants run the risk of information overload in unfocused health fairs.  Librarians can use health fairs as an initial contact setting for population groups, and develop an ongoing relationship by providing consistent and meaningful health information materials and personalized outreach to former health fair participants.  Furthermore, evaluations of this ongoing outreach in the form of written or online questionnaires, in-person focus groups, or even individual case studies, can be compelling support for continued participation in health fairs.

For the long-term, Seo also states that the findings of this study have other implications for health promotion and education, in particular, “explor[ing] the possibility of utilizing BMHF [Black and Minority Health Fair] participants as lay health workers or social support groups in their own communities to address low health literacy and high-risk lifestyles in this population” (p. 903).  In other words, you can reach new (and possibly elusive) groups of people or target small specific high-risk populations by investing in a small group of participants over a long-term period, as initiated by a simple health fair.  Short-term and long-term evaluation can complement this long-term outreach program by evaluating changes in teaching methods, changes in health information literacy within communities, or even show differences over time in health knowledge and health information literacy for the lay health workers.  This study shows how heath information professionals can build long-term relationships with targeted populations by using health fairs as an initial contact point. With coordinated evaluation strategies, health information professionals can ensure that their long-term health outreach activity is consistently meaningful, relevant, and adaptive to their targeted populations’ needs.

References:

Freedman, M. R. (2010). School Health Fairs Show Potential to Improve Short-term Learning. Journal of Nutrition Education and Behavior, 42(2), 137–138. doi:10.1016/j.jneb.2009.08.005

Greenseid, L. (2012, March 25). Lija Greenseid on Conducting Mixed-Mode Surveys. AEA 365: A Tip-a-Day by and for Evaluators. Retrieved April 2, 2012, from http://aea365.org/blog/?p=5814

Pomerantz, K. L., Muhammad, A.-A., Downey, S., & Kind, T. (2010). Connecting for Health Literacy: Health Information Partners. Health Promotion Practice, 11(1), 79–88. doi:10.1177/1524839908318166

Seo, D.-C. (2011). Lessons learned from a black and minority health fair’s 15-month follow-up counseling. Journal of the National Medical Association, 103(9-10), 897–906.

Stamat, H. M., Injety, K. R., Liechty, D. K., Pohlod, C. A., & Aguwa, M. I. (2008). Osteopathic Medicine and Community Health Fairs: Increasing Public Awareness While Improving Public Health. JAOA: Journal of the American Osteopathic Association, 108(8), 397–403.

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