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Reaching Patients Where They Are

As a health educator, I believe an informed public is a healthy public. But educating people isn’t just about imparting information.

Over the past decade, my colleague Charles Basch and I have shown that telephone outreach can increase screening for colorectal cancer in hard-to-reach, low-income, urban minority populations. But hundreds of telephone outreach calls have also convinced us that “cookbook approach” interventions, focusing on content and executed in a standardized fashion, simply don’t work.

You might think people would respond to the facts alone. Colorectal cancer is the third most commonly diagnosed cancer among U.S. adults and causes about 50,000 deaths annually. Removing polyps detected through screening can prevent cancer from occurring. Screening also helps detect cancer earlier, when it can often be cured.  

Yet, men and women over the age of 50 often resist having colonoscopy done. They tend to be unfamiliar with the test’s purpose or to view it as embarrassing. They are less likely than younger adults to perceive themselves as at risk, doubtful that peers have undergone screening, and fearful both of cancer and of the procedure itself. Their primary care physicians are often inconsistent in directly supporting colorectal cancer screening.  

Thus, we have learned to tailor our communications to each individual.  Sometimes that means abandoning efforts to promote colorectal cancer screening and instead talking to people about other pressing health issues, or simply addressing their fears.

We start with an approach we call “RESPECT,” for creating rapport, educating without overwhelming, starting with people where they are, having a philosophical orientation based on a humanistic approach to education, engagement, care and empathy, and trust. Unlike other widely used health behavior models, this approach is unique in being conceptualized as a set of general guidelines rather than as specific learning objectives, content or scripts to promote informed decisions about health.  

Once health educators have established rapport with patients, they can dispel myths about colorectal cancer and screening, make sure facts are understood and underscore the urgency of being tested. Only by creating such caring and trusting relationships can educators change attitudes, beliefs and behaviors.

We think these strategies would work well in almost any health care situation. Promoting them as a model is what, ultimately, health education is all about.  

Published Friday, Dec. 7, 2012