By Molly Lopez, MPH ’12 in Population and Family Health
I needed to learn more about the Dominican culture to best design an effective questionnaire and materials to promote healthier lifestyles.
The tour of the food market helped me to recognize local foods and dishes, such as la bandera Dominicana (the Dominican flag) a staple meal made of rice, beans and meat; pollo guisado, a stew-like chicken dish; and mangu, mashed plantains. I heard these and other common food terms used daily. They were frequent answers to patient questionnaires that a medical intern and I administered in the family consult waiting room.
Over the course of four weeks, we carried out the 38-question survey with a total of 83 patients. Nearly all of the participants – more than 90% – said they wanted to learn more about nutrition and exercise.
An important part of the questionnaire was asking people how they wanted to learn. Since the patients had varying levels of formal education – 18% had no formal education and 48% had only completed primary school while others had completed secondary school or were in college – we wanted to make sure that patients would understand the educational materials we created. Most patients wanted to learn via spoken classes or written manuals. We also asked people about their income levels, so that our recommendations for changing eating habits would be attainable.
On slower days, I sat among clinic patients waiting for those with family consult appointments to arrive. We often began chatting about what I was doing there, which led to conversations about nutrition and exercise. Thinking about Mailman School professor Bruce Armstrong’s use of “teachable moments” in the Young Men’s Health Clinic waiting room – where staff make use of the time that patients spend waiting for appointments by teaching them about health – I decided to create the nutrition and exercise classes earlier than planned so I could present them in the clinic. After days of compiling information that addressed the knowledge gaps that had begun to emerge during the questionnaires – as well as incorporating photographs taken during the food tour – I created five different PowerPoint classes and two informational manuals (one about nutrition, one about exercise).
With only a week to go at the clinic, an intern and I began piloting one class every morning to patients at the clinic. We presented the first class in the waiting room, which was shared with children awaiting vaccinations. The cries of babies who had just received their vaccination overrode our voices, making the classes difficult to hear. Another problem: we weren’t able to use the conference room with a projector, so we couldn’t show the PowerPoint, which further hampered the class.
We decided to improve our approach. I spent most nights that week pasting visuals from the PowerPoint onto large pieces of poster board. Each morning, I rolled one up, stuck it under my arm, hopped in a concho (a cross between a taxi and a subway) and rode off to the clinic. For the remainder of the week, we presented the classes in the clinic’s quieter counseling room, which had a more classroom-like atmosphere.
It was a vast improvement. Patients were interested and engaged, sometimes asking questions or making their own suggestions. Everyone eagerly took our informational handouts. At the end of the week, I gave the poster board presentation to the clinic’s education department, which planned to continue them in nearby communities. I also sent the PowerPoint presentation to two other doctors who wanted to continue the classes with community residents.
Knowing that the clinic has the resources to continue the classes is one of the most rewarding parts of the practicum. I also truly enjoyed compiling information and statistics that will enable clinic staff to effectively target areas for improvement in patients’ eating and exercise knowledge and practices. The experience solidified lessons learned at Mailman, and made me look forward to taking more quantitative analyses courses this semester!
See Molly’s previous post, First Steps in Planning an Intervention: Get to Know the Culture, to read more about her summer practicum in the Dominican Republic.