FUTURE DIRECTIONS IN DISSEMINATING RESEARCH FINDINGS TO URBAN ALASKA NATIVE PEOPLE

Abstract

Southcentral Foundation (SCF), a tribal health organization based in Anchorage, Alaska, operates and plans health care services in response to the priorities and tribal values of Alaska Native and American Indian (AN/AI) people, including traditional concepts of wellness, reciprocity, and working in relationship. In an effort to better incorporate AN/AI priorities and values in research dissemination, the SCF Research Department hosted the Alaska Native Health Research Forum (Forum) in May 2016. In this paper, we describe the communication strategies used by the SCF Public Relations Department, which were shared with Forum attendees, describe attendee recommendations for researchers to consider and implement, and then discuss future directions for dissemination. Lessons learned through the Forum were 1) customer-owners are interested in learning more about research, 2) dissemination should be done throughout all stages of projects using a variety of media channels, and 3) SCF Research Department dissemination should continue to shape health care.

INTRODUCTION

A full description of Southcentral Foundation (SCF) is presented in an earlier chapter along with the mission, vision, and operational principles (see Dillard, Caindec, Dirks, & Hiratsuka, 2018, “Challenges”). Within the SCF health care system, customer-owners are treated as equals and share in decision-making around their health and wellness. The SCF Research Department engaged in the reciprocal relationship SCF has with customer-owners by seeking customer-owner feedback in regards to research dissemination methodologies and asking for guidance on future directions of dissemination. Additionally, these dissemination methods can be operationalized through close partnership between the SCF Research Department and SCF Public Relations (SCF PR).

As part of the Alaska Tribal Health System (ATHS; Sherry, 2004), SCF has many diverse audiences to serve when sharing information. For example, demographics such as geography, age, sex, cultural heritage and background, education, language, and varying health needs are all considered within the customer-owner population base. Other stakeholders who must be considered are Tribal leadership, employees, Tribal partners, funders, and community partners. SCF PR helps facilitate communication to its various audiences, who are both urban and rural. SCF PR creates and disseminates all internal and external communication for the organization’s audiences by collaborating with other departments and programs, such as the SCF Research Department. The aim of SCF PR is to ensure clear, consistent communication and outreach efforts that align with SCF’s vision, mission, and corporate initiatives (Dillard et al., 2018, “Challenges”).

SCF PR offers media outreach that falls into three categories: owned media, paid media, and earned media. Owned media is generated by an organization or its agents and is disseminated through channels it controls. Owned media includes fliers, brochures, social media, and posts on an official company blog or website. Paid media (commonly called advertising) is media activity generated by an organization. This may include sponsored advertisements on social media or the radio. Earned media refers to media activity that is not directly generated by the company but rather by other sources, such as journalists in traditional media sources (Stephen & Galak, 2012).

The primary method SCF PR reaches customer-owners is through owned media channels. This is also the most utilized mode for SCF Research. Communicating through owned channels allows SCF to directly deliver information to customer-owners. In addition, SCF PR efforts include internal messaging to employees and communication with Tribal partners and other organizations. As a non-profit organization, SCF’s efficient use of the advertising budget is used to promote the organization as a whole, rather than promoting individual services, programs, or departments. To raise awareness for a specific service, event, program, or department—like the SCF Research Department—SCF PR uses an integrated approach to its owned media channels to spread cohesive messaging through multiple platforms. In addition to utilizing SCF’s resources, individual departments and programs can budget or seek funding to assist with external advertisement fees.

Within the organization, SCF leadership continuously encourages employees to think innovatively. This approach indirectly encourages employees to reflect about how they contribute to the care offered to customer-owners (Gottlieb & Tierney, 2015). With a wide range of services offered, there is a large demand for employees to focus on customer service before developing processes that can improve the internal relationships in the organization. Nonetheless, most SCF employees are also customer-owners (55% of total employee population of AN/AI heritage) and work hard to stay true to the SCF mission, vision, and corporate initiatives (Gottlieb, 2013). For that reason, SCF PR and the SCF Research Department have taken a step toward increasing communication with customer-owners regarding research conducted within the organization.

The Research Forum

In May 2016, the SCF Research Department hosted the Alaska Native Health Research Forum (Forum). The Forum was convened to obtain feedback on outreach and research result dissemination strategies used by the SCF Research Department through community dialogue. A detailed description of attendee recruitment, data collection, and data analysis are described elsewhere (see Hiratsuka et al., 2018, “Approach and Methods”). In each Forum presentation, attendees were asked to share their views on the project presented. In relation to dissemination, responses to how and where results should be shared affect the SCF Research Department and SCF PR and the ability to increase their support for the benefit of customer-owners and the scientific community. SCF PR shared with Forum attendees information about the communication strategies they used in order to gather attendees’ feedback. Forum attendees then discussed operationalizing future directions for research dissemination in this urban Alaska Native community setting with SCF Research Department staff.

Attendees were interested in learning about the background for community-level research review and the development of the SCF Research Department. They expressed interest in knowing about the premise of past and current research projects. They were excited to see and discuss research projects and results with the research staff conducting the projects. Attendees appreciated the opportunity to provide feedback on the specific research projects presented at the Forum and the communication strategies used by researchers in research dissemination. Attendees thought of dissemination as a process that should occur across the lifespan of a research project and were most concerned with the implementation of findings into changes in clinical care.

SCF PUBLIC RELATIONS COMMUNICATION STRATEGIES

To maximize communication outreach, SCF PR works with other departments in the organization for communication planning. In this planning, the SCF Research Department and PR determine timelines and tactics to maximize reach for specific situations. Tactics are based on target audiences in each circumstance. For the SCF Research Department, audiences may include leadership, providers, and customer-owners. Once the audience is identified, the SCF Research Department may request specific types of tactics to use, and SCF PR will accommodate the requests with the resources available to their department. SCF offers a wide range of owned media tactics and have the connections to assist departments with paid media options. SCF-owned media includes the organization’s website, social media, internal audience blog format newsletter (the Communicator), external audience print newsletter (Anchorage Native News), fliers, and clinic-based media (Passive Education Panels [PEPs]). For this paper, each type of SCF-owned media will be introduced with examples of the SCF Research Department’s uses of these types of methods. It will end with a discussion about how the department hopes to increase its efforts of dissemination and encourage other health researchers to further use these methodologies as well as partner owned media and earned media opportunities.

Website

Southcentral Foundation’s website (https://www.southcentralfoundation.com/) is the external digital hub and online resource for information about the organization’s history, operational principles, Nuka System of Care, leadership, services, departments, and programs, as well as SCF news relevant to customer-owners found in the “Top Stories” section. SCF’s external web page averages 1,151 active users per day. Users visit an average of 1.87 pages per session with an average session lasting one minute and 40 seconds.

The SCF Research Department has a web page for SCF internal communications that contains a list of all the current staff members, their contact information, and a frequently asked questions page. Before the Forum, the SCF Research Department began developing an external web page through the main SCF website (https://www.southcentralfoundation.com/services/research/). This new external website includes staff biographies and photos of each member; a list of SCF Research Department projects, including their status (recruiting, ongoing, etc.); a complete list of the department’s peer reviewed publications; and information about the tribal review process that is required before any study can begin with customer-owners. This website is an example of how working in partnership contributes to successful dissemination with the community. In this scenario, SCF PR designed the pages to be consistent with the main SCF website, allowed the SCF Research Department to guide the direction of the content, and maintains the page so it is current and interactive. This web page is unique compared with other SCF service web pages because it relays general information about the department and is also a tool for the user to navigate the tribal review process and to seek opportunities to participate in studies. Before the website went live to external audiences in January 2017, articles appeared in Anchorage Native News (January 2017) and The Communicator (January 2017) to advertise this new resource.

Attendees of the Forum appreciated the scope of the main SCF website and noted the possible use of the SCF Research Department site for future reference. Attendees mentioned the importance of research projects having an internet presence, particularly for younger community member use. They were concerned that sole use of a website for dissemination would alienate older community members as Elders may have a harder time navigating the internet.

Social Media

Social media accounts are used for engaging customers and disseminating information. SCF’s most popular social media platforms are Facebook and Twitter. SCF’s corporate Facebook has more than 3,100 likes, and its corporate Twitter account (@SCFInsider) has more than 1,070 followers. Women make up 81 percent of SCF’s Facebook followers. The largest group of Facebook followers is between the ages 25–34, with 27 percent of that age demographic being women. Facebook posts with links (to SCF or other websites) have the highest average reach (1,339) among posts, with an average engagement of 61 post clicks and 33 reactions, comments, or shares. Women comprise 71 percent of SCF’s Twitter followers. The top age group of Twitter followers is 35–44 at 53 percent.

Prior to the Forum, the SCF Research Department had not used social media for recruitment. However, the Forum recruitment flier was shared on the SCF Facebook page along with more contact information for the SCF Research Department. SCF PR created three posts on the SCF Facebook page calling for participants to register for the Forum. The posts linked to a Forum registration form on SurveyMonkey, thus giving the SCF Research Department team the opportunity to verify eligibility before the Forum and to outreach by telephone to remind customer-owners of the Forum details the day beforehand. These three posts reached 3,507 people, received 218 post clicks (leading 68 individuals to the registration form), and generated 65 likes and 46 shares. With the possibility of increasing recruitment for participation in various studies at SCF, the SCF Research Department has begun to use social media for recruitment and for updating external audiences with project updates in ongoing studies.

Attendees supported the use of social media for ongoing communication about research projects. Attendees desired social media options beyond the current corporate accounts on the Facebook and Twitter platforms. Recommendations on social media content included the use of photos and videos, providing hyperlinks to web-based media including the SCF website’s pages, and directing people to additional research websites and media (e.g., National Library of Medicine).

Newsletter

The Anchorage Native News (ANN) is a print publication produced by SCF PR six times a year. It is a resource for SCF news, events, information, and health-related topics for customer-owners and the AN/AI community. Stories are typically between 250–500 words and are written at an eighth grade reading level. SCF PR prints 12,000 copies of each edition; 10,000 are mailed and 2,000 are printed and distributed on the Alaska Native Medical Campus. A PDF document is available on the website. Additionally, individual stories are placed on the organization’s website as Top Stories and posted on the organization’s social media channels, Facebook and Twitter, for integrated communication. An article, which recapped the Forum, appeared in the June/July edition of the ANN. The recap was also posted as a Top Story on the organization’s website.

Most of the SCF Research Department’s submissions for ANN articles are written by department staff involved in the projects. In the past, there have been efforts by SCF PR to write the articles. However, most of the articles written are informative, descriptive of projects, or contain technical language related to the science of these projects; therefore, it is easier for SCF Research Department staff to draft an article, route it internally for edits, and then send the final product to SCF PR. From that point forward, SCF PR streamlines the article for consistency within the entire ANN issue. The SCF Research Department includes administrative support and interns in the writing process of ANN articles. This helps to translate article content from scientific language to lay language. Forum attendees were aware of the ANN, but only Elder participants routinely read articles within the newsletter making this communication channel less ideal for community-wide dissemination.

Fliers

Fliers are printed handouts with information about SCF programs or services. SCF departments and programs provide relevant information (time, date, location, program description, etc.), and the fliers are edited and designed by SCF PR. Individual departments and programs are responsible for printing, disseminating, and tracking fliers. This includes budgeting for the supplies to print fliers or for printing fees if ordering through an external printing vendor.

In preparation for the Forum, the SCF Research Department and PR collaborated on creating a flier. The SCF Research Department presented the content, and PR designed the flier. The SCF Research Department and SCF PR used fliers to recruit from the targeted audience for the Forum. SCF Research Department staff distributed the fliers at various locations, both in SCF buildings and in external areas. The SCF Research Department placed fliers in lobbies, in external tribal and corporation buildings, and in locations frequented by customer-owners. Electronic versions were featured on the SCF Facebook page, Twitter, and in The Communicator. Fliers are the most common technique used by the SCF Research Department for recruitment.

Within the Forum, attendees endorsed continued use of fliers as a form of communication on open research studies. They expressed interest in continued use of hard copy fliers at clinic and community locations and cross listing of electronic fliers on websites and social media platforms. They also mentioned being interested in receiving the flier in their traditional mail, emailed to their personal addresses, and shared through SCF’s patient portal (see Dillard et al., 2018, “Challenges”).

Clinic-Based Media

Passive Education Panels (PEPs) are the television monitors throughout SCF’s campus and facilities that play a variety of educational, informational videos and slideshows. SCF PR works with SCF technical support on PEP content. In total, SCF controls 25 PEPs located throughout various facilities in Anchorage, Wasilla, McGrath, and Iliamna. The Anchorage Native Primary Care Center has approximately 9,800 customer visits per month; therefore, the potential reach for messages targeting the customer-owner population through this form of media is significant.

SCF PR reviews and oversees the content of all forms of media that represent SCF, including PEPs. Looking ahead, the SCF Research Department would need to work with the co-management of PEPs to develop this mode of communicating with customer-owners. PEPs offer a way to advertise recruitment, give study updates, and disseminate findings. PEPs are an area of interest for the SCF Research Department, and they are learning more about the process of getting content shared through this method, including software to develop content and networking to establish relationships with videographers. While further effort is made on this front, the SCF Research Department continues to value the face-to-face engagement of manning tables in Anchorage Native Primary Care Center and interacting with customer-owners. Attendees universally had awareness of the PEPs due to routine health care service utilization at SCF. Attendees commented on the lack of variety of information shared on the PEPs. Additionally, attendees noted that clinic based staff would turn down or off the audio, making video content less actionable. Regardless, attendees felt that the PEPs were under-utilized as a form of research project dissemination.

Partner-Owned Media

During the course of the Forum’s semi-structured facilitated discussion groups, attendees requested use of SCF community partner-owned media. Attendees suggested health researchers present their current projects and research results as call-in program discussions on AN/AI specific radio programming such as KNBA 90.3 FM, an Alaska Native radio station located in Anchorage, Alaska, and the Alaska Public Media’s weekly health program. Attendees spoke about wanting to see newspaper and newsletter stories on health research recruitment, conduct, and implications in rural Alaska newspapers, urban news outlets, and Alaska Native corporation newsletters. Attendees also mentioned interest in the use of earned television media spots on local and regional news programs for research project dissemination, in particular showcasing the translation of research into changes AN/AI clinical care.

DISCUSSION

Within other settings, researchers largely determine areas of research focus with limited input from patients or the health care system. Dissemination is usually a one-way channeling of information largely focused on scientific publication at the end of a project. Within SCF, however, there is a clear expectation of reciprocity among researchers, customer-owners, and the SCF health care system (Gottlieb et al., 2008). The SCF Research Department was created to address health topics prioritized by customer-owners and leaders, to improve care, and to create a healthier community. Reciprocity is a core value among most AN/AI communities. SCF exemplifies this value by operating in partnership with customer-owners around their health care decisions (Gottlieb et al., 2008). The SCF Research Department used the Forum to obtain feedback and plan for changes to their dissemination practices. We learned sharing research updates in addition to results is clearly an expectation of customer-owners in return for their participation in studies. Each of the lessons learned from the Forum fit within the cultural values that SCF is built upon.

Considering the quantitative and qualitative data presented in the three case studies as well as the summative evaluation, several key lessons learned through the Forum emerged: 1) customer-owners are interested in learning more about research, 2) dissemination should be done throughout all stages of projects using a variety of media channels, and 3) SCF Research Department dissemination should continue to shape health care. We apply these findings to futures directions of dissemination methods through interdepartmental partnership, connected by SCF values.

It was clear that customer-owners are interested in learning about research activities. Across the wide portfolio of research studies, customer-owners expressed continued willingness and interest to engage as participants, including discussing sensitive health topics. The high interest reflects the ownership that customer-owners take in shaping their health care. Contributions to studies illustrate the cultural value of reciprocity by forwarding the benefits onward. Customer-owners willingly participate with the expectation that their descendants will benefit from the research.

SCF PR’s goals include continued and expanded collaboration with SCF departments and partner organizations to develop strategic communication plans. This initiative will help meet the variety of media channels customer-owners are seeking from research. Rather than using a tactic-based approach (producing content and disseminating to customer-owners), SCF PR would like to use a strategy-based approach (using metrics, data, and current best practices) to create more defined objectives to attain organizational communication goals. The effort to use a strategy-based approach is ongoing, and collaborating with departments across the organization is crucial to successful research dissemination that reflects the community’s feedback.

SCF PR’s strategy-based approach is well suited for the SCF Research Department’s effort to improve the process of dissemination. Customer-owners voiced that they want to continue being involved and well-informed about the studies in their research department. The SCF Research Department’s web page has been customized with the input of SCF PR, making it engaging for customer-owners. In an effort to expand dissemination as an ongoing communication process throughout studies, as opposed to just an output once the project ends, the SCF Research Department, in partnership with SCF PR, has a wide range of tools to put this into practice. Going beyond a one-way program description, the web page is interactive—a place where customer-owners can go for current and completed projects, team biographies, and other research resources. These initial efforts into the web page design respond to the customer-owner request for a place where customer-owners can learn more about projects earlier in the research process. In addition to the web page, the SCF Research Department is increasing efforts into all SCF-owned media channels with more creative and strategic dissemination methods based on customer-owner feedback at the Forum. Attendees shared a wide variety of thoughts about methods of dissemination. This included their interest of being informed at all stages of research, more use of imagery, small amounts of information with direction to find more detailed information, suggesting use of humor, and providing positive feedback about incorporating more culture into dissemination methods, in particular AN/AI language.

By using the SCF Research Department’s web page as a central location for all research information, there is increased opportunity to promote and release information regarding research studies conducted by the organization. In the future, PEP monitors are an area the SCF Research Department hopes to use more, and then link materials back to the web page either through customer-owners being directed to the web page for more information or by uploading materials to the web page. Most methods of SCF-owned media can be linked back to the web page.

During the Forum, customer-owners described dissemination as a practice that is continuous. Research has conventionally approached dissemination as a final step in projects. This lesson learned from customer-owners re-defines dissemination as an ongoing piece built into all stages of the research project’s life. So in addition to expanding the material of dissemination, the effort to provide updates and transparency in research with customer-owner participants is important. Since the Forum, the SCF Research Department has been granted additional funding in order to continue the dialog about dissemination with customer-owners. For the next four years, the project team will hold quarterly discussion groups with customer-owners to gain feedback about the department’s different forms of dissemination methods, as well as new efforts incorporating this feedback. This will allow increased collaboration with the SCF Research and PR Departments. Conducting research within a tribal health organization such as SCF fosters the implementation of feedback, especially in exploring dissemination. Aligning with the value of reciprocity is again very fitting for this community. The willingness to engage and share provides the foundation for gathering data for research. In turn, this effort made by customer-owners can and should be reciprocated with transparency and project updates throughout project life.

The common thread of reciprocity informing dissemination moves into the third lesson learned from the Forum: attendees want SCF research findings to improve their services. Customer-owner-driven services mean continually shaping health care to the needs of the people (Gottlieb et al., 2008). The SCF Research Department aims to conduct meaningful research that aligns with the health priorities of the organization and community. Now when sharing about a study, the SCF Research Department has begun to state which corporate objective the study aligns with in order to more clearly illustrate how the study is contributing to the improved health of AN/AI community. Customer-owners continue to actively engage with and show high interest in participating in research. As discussed, attendees described dissemination as necessary in all stages and want it to be provided through multiple methods. A complete cycle of this process would be to ensure that findings and results return to the health care system, to inform providers and customer-owners and ultimately to improve services. With this third piece in place, attendees offer a model of dissemination that fits the health care model into which the SCF Research Department is built.

The customer-owner recommendations gathered at the Forum reflect organizational values that can continue to be integrated within the SCF Research Department’s dissemination process. The value of reciprocity interconnects the lessons learned and informs practice within research. Customer-owners demonstrated high interest in all the stages of research. Tribally owned and operated, customer-owners continually shape their health care system. Giving back is practiced across the organization in many forms. For research, customer-owners participate and drive the studies that directly impact their services. For the SCF Research Department, honoring contributions by redefining dissemination matches the values practiced as an organization. Collaboration between SCF PR and the SCF Research Department is a viable partnership in implementing the feedback from customer-owners in staying engaged through multi-directional modes of dissemination.

Table 1.

Dissemination Methods at Southcentral Foundation

Method	Target Audience	SCF Research Example
Website	Customer-owners Potential scientific partners	Online source accessible from all computers
Social Media	Customer-owners	Facebook
	External affiliates	Twitter
Newsletter	Customer-owners Employees	Anchorage Native News Communicator
Fliers	Potential study participants AN/AI community	Clinic based recruitment (tables or on message boards)
Clinic Based Media	Customer-owners in clinics	Passive Education Panels