Using the Arts to Advance Health Literacy A Successful Public Private Partnership Suzanne Thompson, M.S. The Clorox Company Jennifer Cabe, M.A. Canyon Ranch Institute Institute of Medicine Roundtable on Health Literacy September 24, 2012
The Clorox Company Founded in 1913 Sales of $5.5 billion 8,400 employees Headquartered in Oakland, CA More than two dozen plants in the United States Manufacture products in 25 countries Market products in 100 countries Six R&D facilities Traded on NYSE: Market Cap $9.2 B
Canyon Ranch Institute Founded in 2002 501(c)3 non-profit public charity 7 Board members, 8 employees, 40 volunteers, 90+ funders Deliver best practices of Canyon Ranch and our partners to health-disparate communities Inform health policies in all sectors Partner with universities, grassroots organizations, corporations, and foundations
Why Do Clorox and Canyon Ranch Institute Partner? Complementary Missions, Visions, and Values Clorox We make everyday life better, everyday Canyon Ranch Institute The power and possibility of a healthy world Clorox Values Do the Right Thing Stretch for Results Take Personal Ownership Work Together to Win CRI Values Evidence-based Approaches Eliminate Health Disparities Honor Cultural Diversity Work with Partners
Why This Program? Clorox Disinfecting Heritage and Focus on Improving Health Through Hygiene Canyon Ranch Institute Translate best practices of health literacy to help educate, inspire, and empower all people to prevent disease and embrace a life of wellness Improving Health is a Priority for Both
How Do We Partner? Public Private Partnership Clear Roles and Responsibilities Outlined Ongoing Communication and Collaboration Leverage the Strengths of Each Organization The Clorox Company Funding Microbiology, Public Health and Peru Business Experience Identified University of Arizona College of Public Health for microbiology partnership Canyon Ranch Institute Overall Program Leadership Social Science and Health Literacy Expertise Identified Boston University College of Fine Arts as arts partner Identified Peruvian arts and social science partners
Arts for Behavior Change Program Pilot Unbranded health literacy pilot program using performing arts to improve personal and household hygiene behaviors Piloted in 2011 in two shantytowns outside Lima, Peru Key Outcomes Exceeded expectations for attendance Increased knowledge and understanding of hygiene Improved personal and household hygiene behaviors in areas targeted by the intervention Reduced microbiological burden in areas targeted by the intervention
Causes of Disease in Peru Diarrhea, acute respiratory infections, and other infectious diseases are the leading causes of death among children under 5 years and the elderly. Only 6% of mothers wash hands before cooking; only 14% do so after using toilet. Between 11-15% of households living under $1 a day in Peru report having a member either bedridden for at least a day or requiring a doctor in the past month. 54% of Peruvians live below the poverty line.
Program Site: Shantytowns of Lima, Peru
Program Design Formative assessment in the two shantytowns to inform program design, including the stories and characters. In-depth interviews with 250 households before the start of performances and 249 households after the final performance. Observations conducted with 50 households before the start of performances and after the final performance. 12 weekly performances structured as a tele-novela. 240 post-performance interviews (20 individual interviews immediately after each of 12 performances). Pre and post microbiological studies in 30 households. Intensive and diverse community engagement throughout.
Training and Preparation The artists were trained in health literacy principles and the science of personal and household hygiene. Then, the scientists and artists cocreated the tele-novela and its characters.
Community Engagement Mayor Estelle championed the program. Community leaders informed residents about the performances. On performance days, community members developed solutions to household and community problems through interaction with the actors and the Joker.
Performances The Play: Siempre Always The characters: Two families (Maranas and Buendias) The intrigue: Father is missing, Mother says he s dead but Father is seen with a younger woman, etc. The situation: Both families have ongoing health problems related to poor hygiene. The onstage presence of the Joker a physician and public health practitioner kept the performances grounded in science. Onstage: An actress, a community member, and the Joker Jose Vinoles, M.D., M.P.H.
Evaluation Local social science researchers interacted with community members to inform program development, establish a baseline, and gather information about any changes. This is a great and unique opportunity to learn about how to have a healthier family. -Community participant
Outcomes Overall, there was strong diffusion of information through the community and behavior changes based on the performances: 97.6% of respondents were aware of the performances. 69.6% of respondents attended the performances. 91.3% of respondents said they learned something from the performances. 77.2% of respondents said the performances were very important or important to their lives. 57.4% of respondents said that there have been changes in household hygiene behaviors in the past 3 months. Of those, the majority said it was because of the performances (Mean of 3.15 on a 4-point scale).
Outcomes - Microbiological Overall, the microbiological load was high both before and after the program, with improvements seen only in areas targeted by the performance messages. Microbiological testing could have been more closely linked to household and community situations and performance messages. The greatest improvement was in food preparation areas (34.4% decrease overall in percent positive rates of E.coli and listeria). This change correlates with the performance messages, which featured why and how to clean food preparation areas.
Conclusions The Arts for the Behavior Change Program pilot demonstrated the effectiveness of community engagement and using the performing arts to advance health literacy and improve health-related behaviors. The Clorox Company and Canyon Ranch Institute have demonstrated the power of a public private partnership to achieve meaningful community health benefits. There is great opportunity to improve public health by replicating the program in different communities and cultures.
Next Steps Identify and implement lessons learned from the Program pilot to improve overall outcomes of future programs. Communicate processes and findings through publications and presentations. Expand by identifying additional funding sources and partners. We are so lucky to have this program in our community, so everybody should come. -Community participant
Thank you! We wish to also thank all of our dedicated collaborators at Canyon Ranch Institute, The Clorox Company, Boston University College of Fine Arts, Mel and Enid Zuckerman College of Public Health at the University of Arizona, Kallpa, and Instituto de Investigación Nutricional. Suzanne Thompson, M.S. Vice President, R&D, Global Stewardship & Innovation The Clorox Company Suzanne.Thompson@clorox.com www.thecloroxcompany.com Jennifer Cabe, M.A. Executive Director and Board Member Canyon Ranch Institute Jennifer@canyonranchinstitute.org www.canyonranchinstitute.org