Summary

Do No Harm?

It’s estimated that 75% of healthcare is self-care.  Yet, in 2020 Dr. Halsted Holman of Stanford University School of Medicine sounded the alarm:

Sixty years ago, a new and dominating health problem emerged: chronic disease. It has now reached epidemic proportions, affecting 50% of the population and consuming 86% of health care expenditures. The fundamental responsibility of the medical profession is to create a health care system and a practice of medicine that meet the needs of current illnesses and patients. The profession has not done so. When will we awaken?

Chronic care providers need to inform people about ‘what works’ and activate them to find it (Wagner, 1998).  Case in point: About 1 in 3 adults have sleep problems. Yet, many don’t know about CBT-I (the gold standard for chronic insomnia) or where it’s available – for FREE!  Our collective silence may lead millions to:

• Spend billions on misguided solutions
• Take pills that warn of deadly accidents
• Stay hooked on pills that cease to work.

The ‘Ask your doctor’ message has had phenomenal success. What if the rest of us could ‘flood the zone’ with messages about evidence-based practices?

In fact, the Clinical Prevention & Population Health Curriculum specifies the need to learn to use social media to promote evidence-based healthcare – preferably via interprofessional hands-on experience. But, health programs don’t offer collective social media training.

As a former Georgetown University Sleep Clinic Fellowship faculty member & USU Medical Psychology Course Director & Practicum Coordinator, I believe that our pilots show ways that educators can close this training gap.

Pilot: Intern-Led Media Network

Questions:  Can an unpaid, online-based internship attract interns to develop & manage a platform (interprofessionally) – to inform & engage the public on an issue?
Could those interns develop a challenge for peers to compete to raise awareness and have the most impact (i.e., Speak Up GMU)?

US onAir Internship

George Mason University programs offer undergrads community-engaged internships – for 3 and 6 credits. Over 50 interns – from diverse programs (e.g., Sociology, Politics, Geographic Science) – took a risk on a new, unpaid, totally online internship.

From 2018 to 2023, they led the People’s Platform for Democracy  (the non-profit, non-partisan US onAir Network) to inform & engage their community.  Without any prior tech background and collaborating virtually, each cohort of US onAir interns learned just enough about Zoom, YouTube, Google, Canva, & WordPress to:

1.  Create & curate Profiles (e.g., US Representatives, US Senators)
2.  Create & curate Posts: (e.g.,  ’22 US House races, Democracy)
3.  Schedule and produce 1 on 1 ‘interview’ videos (e.g., in-person, online)
4.  Create brief ‘explainer’ videos (e.g., candidates, About Virginia onAir)
5.  Plan, schedule, produce, and host livestream discussions, aka Aircasts (e.g., with government representatives; with subject matter experts on issues of interest)
6.  Direct one of the 50 State Hubs on the platform (e.g., Virginia, Georgia, Michigan)
7.  Develop social media channels (i.e., VA onAir, US onAir)
8.  Establish a School Chapter
9.  Promote & run in-person events (e.g. Posts,  Livestream Videos)
10.  Promote the internship to other schools (e.g., recruitment video).
11.  Develop & prototype a video-based ‘Speak Up’ Challenge

Two interns, Paul and Joe, designed, prototyped, and promoted a video-based ‘Speak Up’ Challenge for students to compete to have the most impactful video, to address their local representative about what mattered to them. They created:  1) a ‘Speak Up’ post (with Google Docs for registration & a database), (2) a promotional poster, and (3) a YouTube playlist of 10 model entry videos.

Internship Feedback:

The vast majority of interns expressed positive experiences …

• Learning new knowledge and skills (digital media, communication, leadership)
• Becoming more visible in their field of interest; meeting local and national leaders
• Developing & leading a new ‘intern-led’ platform that informs & engages the public on democracy and the potential impact that could ensue.
  • One intern wanted to extend the Network – to develop ‘India onAir’
  • Several others remained as advisors after graduation (no credit/no pay).

Pilot: Service-Learner Led Challenge

Question:  Can service-learners collaborate across courses and semesters to design & pilot ONE health communication campaign – that’s easy, fun, & popular to join?

GMU Distinguished Professor Gary Kreps led the fitness challenge pilot, based on VERB, the health campaign that showed its success was largely due to being ‘easy, fun, & popular’ to join.  Spanning 3 semesters and 4 classes (2010 – 2011), a group of graduates and undergrads opted into service-learning projects. They designed & piloted a challenge to target weight gain (Freshman 15).

COMM 820:  One student reviewed the literature on campus fitness competitions.
COMM 391  A few students surveyed 100 Freshmen to identify how to make it ‘easy, fun, and popular’ to join.
COMM 404:  Using survey data, four students designed the challenge using: a cash prize, credit-based participation, and an App (Wizit) with QR codes to verify laps between the campus and Starbucks.
COMM 200:  Piloting that challenge, half the class competed with the other half, to win the most Wizit points.

COMM 200 Feedback:

• Earning service-learning credit made it easy to develop the pilot & to compete
• Competing for ‘bragging rights’ was fun enough (cash prize was unnecessary)
• They believed that they could use social media to make it popular – to evolve into an annual intercollegiate fitness competition – March Madness for Total Fitness.
• Faculty suggested 2 main reasons educators might participate:
  • It’s easy to add this service-learning project, relevant to their course.
  • Tenure-seeking faculty could develop a line of community-engaged research.

Community Engaged Scholarship

Combining service-learning with community engaged research resulted in presenting at 3 conferences, writing 1 book chapter and 1 grant application.

We displayed this health communication campaign poster at the 2010 mHealth Summit.

• At the 2011 Teaching Prevention APTR annual conference we presented at a symposium – Leveraging Technology to Impact Health in the Community.
• In 2011, I contributed a chapter in Technology Innovations for Behavioral Education.
• At a 2012 GMU Conference (Living and Leading with Resilience), retired US Air Force Lt. Colonel Mark Bates, PhD and I presented the pilots as a way to bring the DoD’s ‘Total Fitness’ culture to campus
• Dr. Kreps and I submitted a Robert Wood Johnson Foundation grant application.

Conclusion

Our pilots showed how educators can act as one to develop a health campaign, linking service-learning projects across semesters. As well, they showed how an online internship – learners from diverse programs – developed a platform to inform and activate the public on what matters, including a communication competition.

Next, we believe that a new online ‘Speak Up for Sleep‘ Internship could enable ANY educator in ANY health profession to LEAD together …

Path to Better Sleep is a free suite of VA-developed sites designed to provide (1) healthy sleep tips, (2) an assessment screen, (3) a CBT-I self-help course, and (4) sleep apnea tips.  Studies say people are 3 times more likely to use digital tools suggested by healthcare staff. And, “additional support & research is needed” – to encourage providers to prescribe these tools.

New Internship: ‘Speak Up for Sleep’

Question:  Can a new online ‘Speak Up’ Internship (1) develop the platform, & (2) design, create, and pilot the ‘Speak Up for Sleep’ social media challenge in which service-learners anywhere compete to promote the Path to Better Sleep to have the most impact?

For years, healthcare educators have integrated credit-based online projects (for QI) into classes & programs, saving millions of lives. For this project, educators who want learners to get hands-on interprofessional practice in health promotion could offer a service-learning online project. Learners would compete in an intern-led ‘Speak Up for Sleep‘ social media challenge to promote Path to Better Sleep – to have the most impact themselves and for their teams (class, school, profession).

To earn a certificate of completion, learners would acquire skills to:

1. Share their post on social media
2. Measure the impact of their post (using defined metrics)
3. Share results on social media, urging their team (class, school, profession) to compete

Interns would develop the ‘no code’ platform:

1. Inform learners about insomnia, CBT-I, apnea, Path to Better Sleep, and social media strategies
2. Activate learners to promote Path to Better Sleep in the competition they design, develop, promote & lead
3. Spotlight the posts of top performers (learner, course & professor, school, profession) on the platform leaderboard & on social media
4. Promote the internship to recruit the next cohort
5. Use the platform to conduct and present their community-engaged scholarship.

The Longer View

Community-engaged projects have generated social enterprises. In time, we envision a non-profit, the People’s Platform for Health Promotion, which could help close training gaps in Clinical Prevention & Population Health and in Chronic Care and contribute to:

Teaching:  Enable social media practice to ‘collectively prescribe & promote‘ what works
Research:  Test/Identify/Disseminate real-world best ‘collective social media‘ practices
Service:  Continuously improve health consumer awareness & demand for what works.

ANY educator could LEAD learners to compete – to collectively inform & activate patients & populations to find what works for:

• Prevention (vaccines, fluoride)
• Chronic illness (obesity, pain)
• Health & wellbeing (stress management)
• Advocacy (women’s reproductive care).

Finally, unlike birds who fight together to survive, health consumers are easy marks for predatory businesses & influencers. Although we’ve got tools to fight the hype & misinformation together … we don’t try.

We’re more like Seligman’s ‘learned helpless’ dogs … passively giving up even when we could obviously escape our pain.  Instead of giving up, it might be more easy, fun, & popular than we think to Speak Up together.

Educators:  If you want to (1) give an academic home to and develop a Speak Up Internship, or (2) engage learners in the Speak Up Challenge … We seek partners with a collective efficacy mindset who have expertise in community-engaged education & scholarship, public health, sleep, communication, social media, technology, social entrepreneurship, & the Path to Better Sleep.

Meredith Cary, PsyD  has over 20 years experience as an educator in Medical Psychology, Sleep Medicine, & Psychiatry Departments and over 30 years in clinical health psychology practice.  Contact:  drcary@mac.com

Disclosure: Donations to the 501c3, the onAir Network – a ‘Peoples Platform’ to inform and engage the public on important issues.