Get Patients to Collaborate

For Joyce Lee, the idea for an innovative patient-centered approach to health care came from her son, who has life-threatening allergies.

Lee, who has a joint appointment in the U-M SPH Department of Nutritional Sciences and the U-M Medical School's Department of Pediatrics, was frustrated with the complex handout patients are typically given so that they can inform caregivers about how to respond to allergic reactions. In collaboration with her then-six-year-old son, who narrated and provided illustrations, she created a YouTube video that describes warning signs and what to do in various scenarios. This became the prototype for an idea Lee calls "participatory design" - a way of transforming the health care model from one in which doctors are the experts, to a collaborative system where patients are involved in designing health care.

"Design is this powerful force to bring the health care provider and patient together to collaboratively solve problems and treat each other as equal partners," Lee says. She's involved in many initiatives to make this happen, including collaborative design workshops with patients and caregivers, and a diabetes emoticon app. The app will allow teens to text their parents about blood sugar levels using emoticons, a language that is more familiar to young people.

"If you don't live with the disease, you don't understand the problems," Lee says. "We're trying to demonstrate to patients and caregivers that they do have knowledge and expertise," and when joined with designers and programmers can come up with "incredible solutions that solve their problems."

Her son, now eight, has his own blog, and she's teaching him how to program an app. "He's continuing to create the tools he needs for his health and that's what I want every patient to do."

Joyce Lee tweets and blogs. You can also watch a video of her TED talk.

- Julie Halpert

Ditch the Added Sugar

In 2012, Jacqueline Smith, MPH '11, noticed a problem: she had good health habits in all areas of her life except one. She ate copious amounts of added sugar - not just by way of desserts and candy but hidden in pre-packaged foods like pasta sauce, bread, and breakfast cereal. And that wasn't good. Not only does added sugar lack nutritional value, but it contributes to inflammatory conditions like type 2 diabetes and dyslipidemia, and a growing body of evidence suggests it may be addictive as well.

Inspired to do something about her problem, Smith quit cold turkey—and felt more energetic, healthy, and finally free of the grip that foods with added sweeteners had had on her. With her personal success came the realization that she could help others do the same. Armed with her SPH degree and knowledge of behavior change, Smith scoured the literature and applied her previous experience as a teacher to develop Go Sugar Free, a 67-day online course designed to help adults eliminate - or at least reduce - the habit of consuming added sugars. She first gave it to 20 people in January 2013, and the course was a hit. "We're now in our seventh round of Go Sugar Free," says Smith, who is thrilled with both her post-SPH trajectory and her clients' changing palates. "I get to help people prevent long-term problems on a daily basis. SPH set me up to do that."

- Nora White

Enroll Now

Now that the Affordable Care Act is up and running, most Americans who have been uninsured can get coverage - but the process can be daunting, especially to low-income and immigrant populations.

Why do I need insurance? What does the term "copay" mean? What's a "deductible," and how much does it cost? What's an "exchange"?

These are the kinds of questions that keep people from getting insurance and prevent navigators - hired by federally qualified health centers and social service agencies to help walk people through the process of getting health insurance - from providing the most effective enrollment assistance, say SPH faculty members Minal Patel and Richard Lichtenstein. In a project funded by the National Institute of Healthcare Reform, Patel and Lichtenstein are partnering with eight community-based organizations to develop a website to address these issues. The website will contain engaging videos aimed at educating and empowering vulnerable members of Detroit's African-American, Latino, and Arab-American communities - with the goal of helping them enroll in Medicaid or private health insurance plans and using their insurance effectively.

To date, the team has identified key issues facing Detroiters, both with and without health insurance, and the group is now developing content. Topics include "enrolling in the right plan for you," "how to identify a plan whose network includes your preferred provider," and "what documents to bring when you visit a navigator." The group will begin disseminating and evaluating their website next year and eventually hope to see it used nationwide.

Navigate the System

The original idea - an app to help people with HIV manage their health and well-being - won first place in last year's SPH Innovation in Action (IIA) competition. But follow-up research showed that people living with HIV, as well as the case managers and community organizations who serve them, were in greater need of assistance navigating the health system at large - not just hospitals and clinics but "all those underlying things that go into good health, that people often take for granted until they actually need them or struggle to get them," says Ryan Gourley, one of three members of the winning IIA team.

Welcome to LivWel, the new web app under development by Gourley, a recent U-M; Ryan Sanii, a recent SPH graduate; and Maria Gosur, a graduate student in the U-M School of Information.

Still in the early stages of development, LivWel is designed to provide a personalized, interactive way for people living with (or at risk for) HIV - and eventually others - to find and engage the social services they need. Web- and mobile-friendly, LivWel aims to reduce health disparities by being free and accessible to as many people as possible.

Retrofit the Bus

Air pollution is bad for you.

We know this, says Sara Adar.

The John Searle Assistant Professor of Public Health at SPH, Adar wants to find out what more we can do to protect people who are exposed to air pollution - like school kids. Especially school kids with asthma.
One answer is to retrofit school buses with clean-air technology and run them on cleaner fuels. Adar recently completed a study of two school districts in Seattle that did just that, and her findings are revelatory. In both districts, elementary schoolchildren who rode retrofitted, cleaner-fuel buses had lower exposures to airborne particles and overall improved health. What's more, asthmatic children - in particular severe asthmatics - had fewer missed days of school. As any parent, teacher, or employer knows, absenteeism affects not just kids but also the family and the workplace. So the potential economic impact of cleaner school buses is huge. Adar estimates that the recent nationwide switch to cleaner fuels resulted in 14 million fewer school absences a year. More could be realized with the adoption of clean technologies.

The clean air technologies Adar studied are commonly used in new school buses to meet the Environmental Protection Agency standards for new vehicles. But the agency also provides grants to school districts to retrofit old buses, and Adar is hopeful her research will help build momentum in that direction. "For as little as $3,000, a bus can be retrofitted to emit lower amounts of particles," she says. "We can really make a difference in kids' health."