Abstract

Keywords: Women’s health, women’s wellness, interactive health education, minority health, women’s obesity, women’s depression, health disparities, internet access, kiosk, underserved populations, health care, health insurance.
Citation: Reardon C, McKee FX, Stiles L. Women’s wellness guide kiosks: empowering women to take charge of their health. J Participat Med. 2011 Jun 27; 3:e28.
Published: June 27, 2011.
Competing Interests: The authors have declared that no competing interests exist.
 
Computerized kiosks are becoming ubiquitous in America’s retail landscape. Kiosks at the grocery store help you locate products and alert you to useful coupons. Instead of waiting in line to be checked in at the airport, you can walk up to a kiosk and quickly print out your boarding pass. If your favorite department store doesn’t have an item you want, you can order it through a kiosk and have it conveniently shipped to your house.

The most successful of these devices are designed with users in mind. Touch-screen technology, audio and video components, and easy-to-understand language mean that even computer novices can find the experience engaging and enlightening.

The benefits of kiosks are not limited to the retail world, as illustrated by the work of a private-public partnership to develop kiosks that empower women to take control of their health. The Pennsylvania Commission for Women and St. Andrew Development Inc., a health education and learning technology company in York, Pennsylvania, joined forces to design and implement the Women’s Wellness Guide, a program that uses kiosks to deliver relevant, understandable information on a variety of women’s health topics.

The goal of the Women’s Wellness Guide initiative is to reach out to women who are often overlooked in the health care system: Those without the time, money, or other resources to access doctors and other sources of medical information. The program reaches these women where they are; the roughly 30 kiosks currently in the field have been placed in settings as varied as grocery stores, health care clinics, and prison waiting rooms. The kiosks currently reach nearly 140,000 Pennsylvania women each year.

Women’s Wellness Guide: An Introduction

The Women’s Wellness Guide is the brainchild of Leslie Stiles, who was executive director of the Pennsylvania Commission for Women until January 2011. While at a conference several years ago, Stiles heard about the work of St. Andrew Development, which has extensive experience developing health education kiosks on topics such as cancer prevention, breast health, and asthma detection.

A breast cancer survivor who is passionate about helping women participate in the health care system, Stiles saw how St. Andrew Development’s kiosks could be used to engage hard-to-reach women who don’t have steady access to health care providers because of lack of insurance or because the busy nature of their daily lives — such as juggling multiple jobs and caring for children — makes it difficult to see their own health care as a priority. Stiles has stated that connecting with these women is especially important because of the key roles they play in society and in the economy as mothers, wives, heads of households, and workers. “I thought kiosks would be a marvelous way to help women take control of their health,” she said. “If women aren’t healthy, it doesn’t matter much whether they’re climbing the corporate ladder. They’re the nucleus of their families, and without them everything falls apart.”

Stiles approached St. Andrew Development with her idea, and company president Frank McKee helped make her vision a reality. The result is the Women’s Wellness Guide kiosks, which offer information on 20 women’s health care topics. The topics range from traditional offerings, such as heart disease, cancer, and osteoporosis, to more sensitive topics like domestic violence, depression, and HIV/AIDS. Each touch-screen kiosk includes:

• A main menu where users can choose a topic of interest.
• Topic modules that have brief introductions and allow users to navigate to other pages that discuss risk factors, symptoms, tips for prevention, and questions to ask their doctors or health care providers. The content was carefully evaluated by focus groups. For users who listen to the program, each module is “led” by a woman who provides her name and talks about her experience with the health issue and how she empowered herself in relation to it.
• A page with information about low-cost or free health care and health insurance options.
• Access to additional tools, such as a body mass index calculator and text4baby, a free mobile information service designed to promote maternal and child health.
• The ability to access content in either English or Spanish, prepared at a fifth grade reading level.
• The ability to have the information read aloud or mute the system for privacy.

Funding for the initial placement of kiosks was provided by the Pittsburgh-based Highmark Foundation and the Pennsylvania Department of Welfare.

The Women’s Wellness Guide was an enormous undertaking because of the sheer number of topics it encompassed. Crafting each module required an intense process of gathering evidence based information from reputable sources such as the American Heart Association, the American Cancer Society, Pennsylvania Perinatal Partnership, Pennsylvania Department of Health and others, synthesizing it and making it understandable to people with limited health literacy. There are two primary reasons why the Women’s Wellness Guide offers such a broad menu of options. First, the kiosks demonstrate recognition that women’s health is much more extensive than can be captured in a single topic like heart disease or breast cancer. Second, putting the guide under the umbrella of women’s wellness allows information about more sensitive issues to be accessed anonymously without drawing a lot of attention. For example, most women wouldn’t be willing to openly access a kiosk that focused only on domestic violence or sexually transmitted diseases, but they might be willing to access that information under the banner of a more general kiosk.

Bridging the Digital Divide

If anonymity is of such import, then why not do a purely internet-based approach that allows women to access information from the privacy of their own homes? There are many examples of how the Internet has been used to promote health education among patients with cancer and chronic diseases such as diabetes and depression.[1] The internet also has been used to engage traditionally underserved populations, such as rural women and low-income women in urban areas.[2][3][4]

Yet, despite the explosive growth of the Internet during the past two decades, America’s digital divide persists, especially among vulnerable populations. A 2010 survey from the Pew Research Center’s Internet & American Life Project found that 21 percent of respondents did not use the internet, and internet use was less likely among African Americans, poor people, those living in rural areas, and those without any college education.[5] Some health education projects have tried to bridge this gap by providing participants with computers and internet access, but that does not always ensure success. For example, many participants in a study of the use of telemedicine to help indigent pregnant women manage gestational diabetes mellitus struggled to find the time to use the system, even when they were provided with refurbished computers and dialup internet access.[3]

The Women’s Wellness Guide kiosks may be the best way to reach the significant number of women who do not have internet access or do not have the money, time, or privacy needed to access information in their own homes, said Estelle Richman, chief operating officer at the US Department of Housing and Urban Development. Richman was secretary of the Pennsylvania Department of Public Welfare when the agency decided to provide financial support to the Women’s Wellness Guide program.

The kiosks provide “light bulb moments” that teach women new things about health or remind them of things they already knew, said Yvonne Cook, president of the Highmark Foundation. And the portability of the kiosks means they can be moved from place to place as needed.

“We needed to get a message out and educate women about prevention and early detection. We also wanted to reduce health disparities by getting information out to people who might have limited access to traditional health care services,” Cook said. “We thought that [the kiosks were] an innovative and effective way to deliver information in a non-threatening, easy-to-navigate way.”

Measuring Success

Judging by the experience of organizations that host Women’s Wellness Guide kiosks, the program is reaching its intended audience. One such organization is Dress for Success South Central PA, which serves nearly 2,000 disadvantaged women per year by providing professional attire and career development tools. A Women’s Wellness Guide kiosk, installed in October 2010 in the waiting room of Dress for Success’ Harrisburg boutique, has proved popular with clients, most of whom struggle with health issues and/or lack of insurance. Many clients have dropped traditional waiting room fare, such as magazines, in favor of the kiosk, said Ruth Koup, founder of Dress for Success South Central PA.

“People just gravitate to the kiosk, which is awesome,” Koup said. “The kiosk is special because it’s interactive. With the kiosk, you know that [clients have] at least heard about something and that it’s something that is relevant to them. It brings it to a more personal level than a handout or an article.”

Another kiosk site is State Correctional Institution-Cambridge Springs, a minimum-security women’s facility in northwest Pennsylvania. This type of anecdotal evidence of the project’s success is a good start. Each kiosk gathers hard data by tracking how many people use it and for how long. Several of the modules on each kiosk include two questions that ask women whether the information was helpful and whether it makes them more likely to change their behaviors.

A study of two kiosks used during a three-month period in 2009 showed that the information is producing some positive effects.[6] Ninety percent of respondents said the information was helpful, somewhat helpful or very helpful, while 87% reported that they would be likely, more likely, or most likely to change their lifestyles.

“Do we know that [a user] went out and got a mammogram? No, we don’t,” McKee said. “But they’ve indicated that they are going to do that, and they now have the education to know why it is critically important.”

Moving Forward

The Women’s Wellness Guide program is poised to expand quickly over the next two to three years, when the number of kiosks is expected to rise to 300. The dispersion is expected to conform to both rural and urban areas throughout the United States.

The kiosks have already reached beyond Pennsylvania’s borders into Kentucky, where a kiosk was placed in a community health center in January 2011. A dozen kiosks are expected to be placed in the state by the end of 2011, said Eleanor Jordan, executive director of the Kentucky Commission on Women.

Jordan knows firsthand the impact the kiosks could make. The idea to tap into Pennsylvania’s project came when Jordan — who had previously read about the kiosks — was approached by a woman who told of having to covertly bring a friend to a doctor each year for a gynecological exam because the friend’s husband did not approve of anyone else looking at his wife’s anatomy.

“That’s when it hit me about that kiosk project. That’s when I saw how this could be useful in Kentucky. I thought ‘This may be what we might need to reach these disenfranchised women,'” Jordan said. “We’ve got to try it. What else can we do? We can’t just print brochures and hope women will read them, or point them to a website when we know there’s still a digital divide.”

Stiles hopes the Women’s Wellness Guide is just the beginning. More kiosks are needed, she said, and much of the kiosks’ information could be delivered through mobile phones, as well. “From my perspective, you can never have enough kiosks out there,” Stiles said. “There’s a real hunger for this information and, however you reach out to women, it might just be enough to get them to go out and make a change.”

References

1. Dumrongpakapakorn P, Hopkins K, Sherwood P, Zorn K, Donovan H. Computer-mediated patient education: opportunities and challenges for supporting women with ovarian cancer. Nurs Clin N Am. 2009; 44(3): 339-354. ↩
2. Atkinson NL, Billing AS, Desmond SM, Gold RS, Tournas-Hardt A. Assessment of the nutrition and physical activity education needs of low-income, rural mothers: can technology play a role? Journal of Community Health. 2007; 32(4): 245-267. ↩
3. Homko CJ, Santamore WP, Whiteman V, et al. Use of an internet-based telemedicine system to manage underserved women with gestational diabetes mellitus. Diabetes Technology & Therapeutics. 2007; 9(3): 297-306. ↩
4. Weinert SC, Hill WG. Rural women with chronic illness: computer use and skill acquisition. Women’s Health Issues. 2005; 15(5): 230-236. ↩
5. Pew Research Center Internet & American Life Project. Demographics of Internet Users. Available at: http://www.pewinternet.org/Static-Pages/Trend-Data/Whos-Online.aspx.
   Accessed on April 1, 2011. ↩
6. St. Andrew Institute. Outcome-Based Learning Systems: The Efficacy of Health Education Kiosks Deployed in Public Settings. Available at: http://www.standrew.com/DVAS%20-%20Outcome%20Based%20Learning%20Systems.pdf.
   Accessed on April 2, 2011. ↩

Copyright: © 2011 Christina Reardon, Francis X. McKee, and Leslie Stiles. Published here under license by The Journal of Participatory Medicine. Copyright for this article is retained by the author, with first publication rights granted to the Journal of Participatory Medicine. All journal content, except where otherwise noted, is licensed under a Creative Commons Attribution 3.0 License. By virtue of their appearance in this open-access journal, articles are free to use, with proper attribution, in educational and other non-commercial settings.