How we spent the week before spring break with several hundred teenagers!

Kathy Smart, MS, RN (KS): A significant strength of the Children’s Health Resource Center (CHRC) collection at Advocate Lutheran General Children’s Hospital (ALGCH) is the depth of educational resources we have for parents and children. As CHRC coordinator, I noticed an increase in requests for sensitive teen health information. To address this need, I met with hospital professionals and community stakeholders to discuss our perceptions of teen health information needs. While these discussions provided valuable information, I wondered, How will I truly assess what our local teenagers want to know about their health unless I ask them? Nurse that I am, I did not want to ask teenagers about their health information needs without giving them any resources to guide them in return.

Lisa Jacob, MALS (LJ): For several years as an Advocate Library Network librarian, I had been forwarding the GMR consumer health funding announcements to Kathy. She took the bait in 2007 and was told she needed a GMR member to be her sponsor so she came back to me. Together we decided to develop a presentation featuring MedlinePlus® to educate teens about how to find reliable health information on the Internet.

KS: We combined the teen health information assessment and the Internet health information training projects and we submitted a proposal to the NN/LM GMR. We had three goals:

• Investigate adolescents’ beliefs about their current health information needs;
• Assess teens’ preferences for acquiring health information;
• And instruct teens on finding reliable health information on the Internet.

Grant writing is not even remotely in my expertise. While overwhelming at first, it was less daunting than I thought. Luckily I had a lot of help. I explained the purpose to the Advocate Health Care Charitable Foundation grant writing team, shared an initial literature search, and a grant writer prepared a draft. Lisa helped clarify goals and procedures. My supervisor assisted with editing and regularly reminded me to keep the scope of the project realistic in light of my other responsibilities. She also referred me to a nursing research adviser who assisted in the application to the Advocate Institutional Review Board. The NN/LM GMR provided valuable support during the process, answering many questions and pointing out potential areas of concern. We submitted the proposal the day it was due without a moment to spare.

The project received an Outreach Express Award that provided funding for a laptop computer and accessories, a microphone for recording focus group sessions, printing of flyers, and purchasing of handouts and mousepad giveaways. NN/LM GMR also supplied MedlinePlus pens and brochures. Several months into the project I obtained additional funding from the Advocate Lutheran General Hospital Nursing Endowment Fund for data analysis software and professional transcription services.

Through past collaborations with many community organizations including teen centers, local schools and faith-based organizations, identifying adolescents to study was easy. Actually my challenge was to narrow the population. In the end we chose to pursue our strongest ties. ALGCH collaborates with a local high school through a school-based clinic and a healthcare career class. The school’s Director of Physical Education and Health is a board member of the Advocate Lutheran General Hospital (ALGH) Men’s Association. The hospital also has a strong partnership with a local junior high school, partnering in several community outreach initiatives there. Both schools agreed to participate.

The plan was to conduct six to eight focus groups of six to ten students each with a total of 50-90 adolescents participating. I knew conducting research with minors would be a challenge. It required approval from department heads, the principals and in the case of the junior high, the district school board. Once all agreed, scheduling the project was difficult. However our school contacts worked diligently to make it happen. Both schools requested that the study fit into their health curricula, narrowing the population to health class students. Working with the health teachers, we developed a plan. Focus group students were excused from health class to participate in confidential focus group sessions. Focus group participation was voluntary. I created colorful flyers for the students and letters for the parents explaining the project. Many colleagues expressed concern that it might be hard to get students to talk so we settled on $10.00 mall gift cards as an incentive for participation. Fortunately some funding from a previous charitable gift covered this expense. The gift card incentive worked! Well over 100 students volunteered. In fact we held a lottery at the high school because there were more volunteers than spaces available.

Over the course of two days, I conducted focus groups with 101 volunteer students from eleven health classes at two schools. Participants discussed their health information needs and information seeking behaviors. Focus group sessions were digitally recorded. While not ready to report official results, I can say that the students’ responses were very candid and they were surprisingly at ease sharing thoughts and feelings in mixed gender groups. On the whole they seemed genuinely pleased that someone was willing to ask for their opinions.

LJ: Instructional sessions were arranged to teach all health classes how to find health information using MedlinePlus and other reliable resources. After Kathy completed the two days of teen focus groups, we followed up immediately with two days of eleven instructional sessions for over 300 students. That was my first impression, but back up a bit for more back story on this scene.

Kathy’s goal, proposal, planning and organizing got us to this point. The objectives and her plan to reach them were clear. She was committed to the goals and wanted to make a difference. This appealed to me also, since, like horses can smell fear, teenagers can smell apathy and insincerity. Also, the project would gather enough data to affect a real end product. This was critical. Kathy was not just looking to have her own and her colleagues’ presumptions confirmed. She truly wanted to develop resources that would be useful to AND be used by teens.

Developing the teaching tool was critical. Our approach was the who/what/when/where/why/how of site evaluation. Kathy developed a table for the handout and I adapted it into a webpage with links to examples of “good” and “bad” sites. I consulted with my local middle school media assistant (my offspring) who confirmed that the page had to have lots of pictures and a lot more color. Kathy and I had an epiphany when I made the background black. Whoa! It worked well, but not for projection, so I projected the white background page and the students had black backgrounds on their screens that made the linked images pop. A junior high school librarian commented that she didn’t like the white lettering on black but that the students would. My media assistant/offspring approved.

Entering the classroom, the students were hours away from spring break. They seemed glad to have different teachers for a day, and pleased to access the Internet instead of taking a test or reading a book. The junior high health classes were ending, and I was concerned because they would not be graded on their learning or participation. The high school students on the other hand would return from spring break to health topic research projects so the teachers immediately saw and communicated the value of MedlinePlus. The different settings in the two schools meant the junior high would be interactive and senior high presentational. This was lucky since the junior high students needed the hands on class to keep them engaged and the senior high students were better listeners.

It went well. I had imagined spitballs in the junior high and sleepers at the senior high. I was mostly wrong. At the junior high, curiosity about anything computer related got the best of them. At the senior high, very real concerns about stress, fitness, diet, sports, disease, sex and drugs woke them up and made them ask questions even in a dark room on a warm day before spring break. We pointed out how they should question the information they were being given, showed them where to look for evidence that a site was worthwhile, and how to determine what might be suspect. They liked looking at the “bad” sites and trying to figure out what was wrong or misleading. One of my soap boxes is the high fructose corn syrup (HFCS) that is included in almost all snacks, soft drink, or fast food. The older students had samples of it in their hands for direct reference and I could use their sodas and snacks as teaching tools. I linked to a site produced by the Corn Refiners Association to demonstrate how information can be true but not always healthful. They noted the multi-lingual aspects of several sites including MedlinePlus and several were interested in the videos of surgeries and procedures. For me, the most enlightening interaction with these teen health information seekers was about their expectations concerning the currency of information. When asked how old the information should be for the doctor to use it to make decisions, they all said days, hours, minutes. I told them they were going to be very demanding health consumers and that the clinicians were not quite ready for them yet.

There were no spitballs and only a few sleepers. A pretest and a posttest were given to further evaluate health information seeking behaviors and the presentation. On first review, these tests seem to indicate that the young people benefited from the instruction even without the motivation of grades or gift cards. I came away with a reinforced belief that the Internet as container for all health information will be the norm in just a few years and that the packaging of the information had better not be child-proofed, written only for adult clinicians, teachers, parents and/or marketers to prescribe and administer to these teens. These young people want, need, expect, and deserve good and healthful information NOW … before they take their afternoon naps, go out on Saturday night for a bit of risk taking, run onto the courts, tracks and fields with steroids and painkillers to win, or take the next stressful college entrance exam all while sipping their favorite flavors of HFCS or caffeine or something else.

KS: The entire project took about seven months from initial planning to completion of focus groups and presentations. Focus group interactions were transcribed and will be reviewed using qualitative data analysis in order to identify fundamental discussion themes. That data analysis is still in process. Atlas ti software will be used to systematically analyze the results. So stay tuned! I look forward to not only analyzing the results but also to collaborating with the schools in the coming months and years to help meet at least some of the important issues these teenagers raised.

PARTICIPANTS:

Primary investigator:
Kathryn Smart MS RN CRRN
Coordinator, Children’s Health Resource Center (CHRC)
Advocate Lutheran General Children’s Hospital

Co-investigators:
Lisa Jacob, MALS
Manager, Advocate Library Network

Randy Spreen Parker, Ph.D., RN C.
Director, CREAD-LGH, Advocate Health Care

Focus Group Assistants:
Grace O’Connor, M.Ed.
Office Coordinator, CHRC
Advocate Lutheran General Children’s Hospital

Jenny Zbikowski
Teen Life Intern, Child Life Department
Advocate Lutheran General Children’s Hospital

Community Partners:

Gemini Junior High School
Kristin Ulery, Assistant Principal
Suzanne Barker RN, School Nurse
Robin Olson RN, School Nurse
Marge Melfi, Health Teacher
Melissa Roberts, Health Teacher
Kris Nielsen, School Librarian
Gemini Junior High School students in 8^th grade health classes

Maine East High School
Scott Chovanec, Department Chair, Physical Education & Health
Angie Nichols, Health Teacher
Ronald Clark, Health Teacher
Maine East High School students in sophomore health classes

This project has been funded in whole or in part with Federal Funds from the National Library of Medicine, National Institutes of Health, Department of Health and Human Services, under Contract No. N01-LM-6-3503 with the University of Illinois at Chicago.

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