Glaucoma Awareness Campaign Provides Free Screenings to Black Individuals in Philadelphia

By Rebecca Salowe

Scheie Vision Summer 2021

 

In 2018 and 2019, a team at the Scheie Eye Institute conducted a multimedia messaging campaign throughout Philadelphia on glaucoma risk in Black individuals. Recently, the team published articles in Preventive Medicine Reports and Health Communications that analyzed these efforts. These articles focused on the yield of messaging approaches and the personal experiences of participants, respectively.

 

Why a Campaign?

 

Black individuals are underrepresented in medical research and face inequalities in access and quality of care. Glaucoma is one disease that exemplifies this disparity.

 

“Individuals of African descent are five to six times more likely to be diagnosed with glaucoma than European Americans, and up to 15 times more likely to experience vision loss from this  disease,” said Joan O’Brien, MD, Chairman of the Ophthalmology Department. “However, the majority of glaucoma studies to date have been conducted in cohorts of European or Asian descent. This not only limits understanding of disease biology, but also impedes translation of findings into clinical action for the most affected group.”

 

Dr. O’Brien is the Principal Investigator of a glaucoma genetics study in African Americans, which has enrolled over 10,200 individuals since 2010 to address this disparity. In 2018, the Primary Open-Angle African American Glaucoma Genetics (POAAGG) study team launched a multimedia messaging campaign throughout the city of Philadelphia.

 

The campaign had three main goals. First, the team aimed to increase awareness of elevated glaucoma risk in Black individuals, emphasizing the importance of early treatment to prevent irreversible vision loss. Up to 50% of individuals with glaucoma are unaware that they have this disease. Second, they sought to provide free glaucoma screenings to any interested individuals, especially those without access to healthcare providers or insurance. Finally, these individuals were offered the opportunity to enroll in the POAAGG study, if eligible.

 

“We saw these goals as complementary,” explained Dr. O’Brien. “We sought to address the more immediate need to provide earlier diagnosis and treatment to patients without access to care, but also to contribute to the long-term goal of discovering genetic variants associated with this disease and improving treatment options for future generations.”

 

The team chose to pursue these goals through a marketing campaign due to a strong precedent for using this approach. Prior groups have shown that marketing campaigns strengthen community connections and are a powerful method to recruit underrepresented populations to research studies.

 

A Variety of Messaging Strategies

 

The campaign consisted of multiple unique messaging approaches to reach the target audience. The majority of approaches stemmed from a partnership with WURD Radio, the only Black-owned health talk radio station in Pennsylvania. With WURD Radio, the study team recorded commercials, patient testimonials, physician interviews, and show sponsorships. Messages mentioned the importance of early diagnosis and the availability of free glaucoma screenings, while also emphasizing that glaucoma is familial and disproportionately affects the Black community.

 

“We were connected to WURD Radio and met with Sara Lomax-Reese (President and CEO) and Monica Lewis (Director of Sales and General Manager), where we learned about their  commitment to addressing racial health inequities in Philadelphia through messaging to their loyal listeners,” said Ava Kikut, a current PhD student at Annenberg School for Communication who previously worked on the campaign. “Their openness to working with us to help others learn about glaucoma was integral to this project. And so began a meaningful partnership.”

 

In addition to messaging approaches with WURD Radio, the study team also created postcards, outreach event flyers, and social media posts to reach the Black community.

 

All messaging approaches provided a phone number to call to schedule a free glaucoma screening. Individuals were scheduled in either a private screening room at the Scheie Eye Institute or at a future outreach event. Exams were conducted by fellowship-trained glaucoma specialists and included a full suite of glaucoma equipment to allow for certain diagnosis.

 

“The glaucoma screenings were useful in recruiting patients from the community to the POAAGG study, but their deeper importance lay in connecting community members with key glaucoma care resources,” said Selam Zenebe-Gete, the lead Clinical Research Coordinator for the POAAGG study. “The glaucoma specialists consulted with patients on their screening results and potential treatment options. Participants could also opt in to be contacted post-screening for help with insurance concerns and setting up regular appointments at Scheie.”

 

Comparing the Efficacy of Messaging Approaches

 

At the conclusion of the campaign, the study team sought to understand which messaging approaches were most effective. This information could help inform future campaigns or recruitment efforts in minority populations.

 

Throughout the campaign, the team carefully tracked how many phone calls resulted from each messaging approach, using the TrialX iConnect recruitment tracking and analytics system. The results of this investigation were published in Preventive Medicine Reports in 2020.

 

Overall, the six-month campaign led to 154 patient inquiries, with a total of 98 individuals receiving free screenings with glaucoma specialists. Additionally, 60 of these individuals enrolled in the POAAGG study.

 

WURD approaches reached the largest audience, with 77% of inquiries arising from these efforts. In particular, commercials were the most successful in reaching the target population, likely due to their high frequency. From a financial perspective, print methods (such as postcards) were the most inexpensive, but reached a smaller number of individuals.

 

“Overall, the campaign showed us that commercials played at high-frequency through a trusted community resource, as well as postcards distributed at targeted healthcare locations, are particularly effective and affordable options for connecting with the African American community,” said Dr. O’Brien. “Our hope is that these findings can help inform outreach and recruitment efforts for other understudied diseases in minority populations. The collegiality and trust that developed between community leaders and the study group was reinforced by working together as a team to serve this community.”

 

Interviewing the Participants

 

The study team also sought to understand what influenced individual decisions to respond to the campaign. The 60 patients who enrolled in the POAAGG study were asked to participate in open-ended interviews about their experience. Questions focused on motivations, reservations to join the study (and how they were overcome), feelings on genetic research, and how (if at all) African ancestry influenced the decision to enroll.

 

"The majority of participants expressed interest in potentially being involved with other research opportunities because of the positive impact the campaign had on the African American community,” said Marquis Vaughn, Community Outreach Coordinator, who conducted the interviews. “The combination of awareness, medical intervention, and customized access to care can be attributed to the success of the campaign."

 

The interviews were recorded with the consent of participants and were transcribed. The study team then conducted thematic analysis of the interview transcripts, guided by the integrated behavior model (IBM). Their findings were published in Health Communications in December 2020.

 

Overall, the study team found that the decision to enroll in the study was strongly influenced by a desire to learn more about personal health and to contribute to future care options for others. An important normative influence that encouraged enrollment was hearing about the study from a respected community media outlet, friends, and family.

 

Roughly one-third of respondents mentioned past and current racial discrimination in medical research as an important sociocultural frame within which they considered participation. Importantly, this was not an absolute barrier to participation, and could be overcome through a focus on the mutual goals of bettering the health of individuals and of others.

 

“Our research helps demonstrate how truly partnering with Black community members and leaders in Philadelphia can help researchers overcome distrust by emphasizing the value of the research in benefiting others, offering medical care during research appointments, removing barriers to access, and creating pathways of communication that emphasize improving health in the community,” said Mohima Sanyal, a prior MD/MPH student at the University of Pennsylvania who worked closely on this study. “We are deeply grateful to all those who participated in this study and offered their insights and suggestions about which aspects of this research study motivated their participation."