ACFW collaborating to build better futures: Developing HealthyU

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A group of University of Nebraska-Lincoln researchers at the Academy for Child and Family Well Being (ACFW) are collaborating with a select team of multidisciplinary professionals from Oregon, Alabama, University of South Florida and Lincoln Public Schools to create a web-based health literacy curriculum to help transition-age adolescents navigate the health care system.

Alex Trout, a research professor in the Department of Special Education and Communication Disorders, saw the need for improving youth health literacy while working on an aftercare program she developed in partnership with Boys Town. On the Way Home was designed to help youths leaving residential programs like Boys Town return to their homes and community schools. But, Trout and her colleagues realized many of the adolescents did not have the knowledge to independently manage their own health care needs.

“This is just needed for ALL kids because the health curricula may address some aspects of health literacy, such as how to read food labels, but what’s an explanation of benefits (EOB)?” Trout said. “How do you interpret those? How do you access insurance? How do you switch from a pediatric to an adult doctor? These skills are not typically taught in existing curricula, and that’s what HealthyU has to offer.”

Now in the second year of a four-year, $1.5 million grant from the U.S. Department of Education-Institute of Education Sciences, Trout, along with four colleagues in the Academy – research professor Kristin Duppong Hurley, research assistant professor Jacqueline Huscroft-D’Angelo, assistant professor Matt Lambert and postdoctoral fellow Jennifer Farley – have worked closely with Trifoia, a learning design company out of Oregon, and their nationally based consultant team on the development of HealthyU.

During the initial project year in 2016, the Academy team, content consultants, and Trifoia collaborated to refine and update the curriculum and develop a custom logo, color pallet, and design guide. In fall of 2017, the first five of what will eventually be nine total modules in the curriculum were tested with 10 students with school-identified high-incidence disabilities attending Lincoln Public Schools. Each module contains a pre- and post-test, videos, learning activities, and satisfaction surveys. The data from surveys and assessments, as well as analytics that show how long students use various tools and the amount of time they spend on each area, will be used to refine the current modules and inform the process of building the last four.

In the fall of 2018, another trial involving all nine modules will be done with a group of 10-12 students. After further refinement, a randomized controlled trial will be conducted in 2019-20. The randomized controlled trial will include a group of students who receive the traditional health curriculum from the school and another group who also receive HealthyU. The groups will then be compared to determine how HealthyU benefits youth health literacy and preparedness to independently manage personal health care needs.

The HealthyU curriculum was based on a paper version created by four researchers, including Janet Hess, an assistant professor in public health at the University of South Florida. Hess and her colleagues created “What’s health got to do with transition? A student curriculum” with its most recent revision in 2009.

Trout noted that Hess has been an instrumental consultant and team member as the Nebraska researchers revise the original curriculum for the web-based HealthyU curriculum. In addition, Matt Avey, a health curriculum specialist at Lincoln Public Schools, has helped modernize the content to make it more relevant for current students.

“Some of the original content is still in there, but we had to do a lot of modifications,” Trout said. “The old curriculum was really developed for students in Florida with low-incidence disabilities; students who were really having significant health issues, like cerebral palsy, Down syndrome, or significant cognitive delays. So, HealthyU is designed to target students in high school with high-incidence disabilities, but ultimately, we see a lot of avenues for kids in general.”

In late fall, Trout and Huscroft-D’Angelo added a consultant to the project after attending a technology conference in October. It was at the TIKTOC RERC: State of the Science Conference, organized by the Technology Increasing Knowledge: Technology Optimizing Choice Rehabilitation Engineering Research Center at the University of Michigan, that the pair met Daniel Joye.

Joye, the CEO of the software development company ChartAssist, was a panelist on a session about engagement and tailoring of mobile technologies for health self-management. While listening to Joye speak about using analytics and intuitive UI/UX design to improve a platform’s engagement and effectiveness, Trout and Huscroft-D’Angelo knew he would be able to help with HealthyU. While Hess and Avey have served as consultants for the content portion of the curriculum, Trout knew they could use help with engagement and sustainability.

After speaking with Joye at the conference, he agreed to serve as a consultant for the project. The contributions from Joye and ChartAssist are focused on three areas. The first is Behavioral Modeling Theory, which is the motivational approach the company has used to drive engagement with other web-based programs. Joye also has expertise in predictive analytics and machine learning, so he is helping the group determine how to incorporate and use those data to improve the program and usability. Finally, he is helping with sustainability, scalability, and system integration challenges, the back-end coding challenges that are faced when trying to develop a product like this to be used by a large number of individuals.

As HealthyU continues to be refined and developed, Trout is excited about the progress that has been made, but knows it is going to keep getting better with the help of everyone involved.

“I like what we’re doing, but I know there is always room for improvement. I think that’s the role of consultants – to be able to expand what you’re doing. Having a consultant on this development project is very exciting because it gives us another set of eyes, experience and knowledge to help refine and improve what we currently have.”

To learn more about HealthyU, visit https://go.unl.edu/health-literacy. The development of HealthyU is supported by grant number R324A160170 from the U.S. Department of Education, Institute of Education Sciences. The statements in this document do not necessarily represent the views of the U.S. Department of Education.