Summary

Do No Harm?

It’s estimated that 75% of healthcare is self-care. And, competent clinicians inform and activate people about what works and where to find it (Wagner, 1998). 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?

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 that it’s accessible digitally – for FREE!  Our collective silence may lead millions to:

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

The ‘Ask your doctor’ message has had phenomenal success. Don’t we wish we had a way to flood the zone with messages about evidence-based practices like Big Pharma does?

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 professions programs don’t offer collective social media training.

As a Georgetown University Sleep Clinic Fellowship faculty member & a former 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 a wide array of community engagement 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 & promote the first ‘SPEAK UP’ Challenge

Intern 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).

Speak Up Challenge

Paul and Joe prototyped a ‘Speak Up’ Challenge for students to compete to have the most impact, via their 1-minute video addressing 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.

Pilot: Service-Learner Led Challenge

Question:  Can service-learners collaborate across courses and semesters to design & pilot ONE health communication campaign?

GMU Distinguished Professor Gary Kreps led the pilot to determine if service-learners could develop a health communication campaign that would make it ‘easy, fun, & popular’ to join (lessons learned from VERB).

Over the span of 3 semesters (2010 – 2011), a group of graduates and undergrads from 4 classes opted into service-learning projects for the pilot. They chose to target weight gain (‘Freshman 15’) and designed & piloted a physical fitness challenge.

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 join the project and to compete in the pilot
• Competing for ‘bragging rights’ was fun enough 
• Most strongly believed that future service-learners could use social media to grow their Challenge into an annual intercollegiate fitness competition – which they envisioned as March Madness for Total Fitness.
• Faculty suggested 2 main reasons educators might participate:
  • It was easiest to offer this project if their existing syllabi already included service-learning or a student-selected project.
  • This project would enable tenure-seeking faculty the opportunity to develop a line of community-engaged research.

Community Engaged Scholarship

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

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

• We presented at the  2011 Teaching Prevention conference of the Association for Prevention Teaching & Research – Leveraging Technology to Impact Health in the Community symposium.
• We wrote a chapter in Technology Innovations for Behavioral Education (2011), edited by Mary Gregerson.
• Retired US Air Force Lt. Colonel Mark Bates, PhD and I presented the pilots as a way to translate the DoD’s ‘Total Force Fitness’ culture to civilian campuses at George Mason’s 2012 Living and Leading with Resilience Conference.
• Dr. Kreps and I submitted a Robert Wood Johnson Foundation grant application, as well.

Conclusion

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

Evidence suggests that people are 3 times more likely to use a digital self-help tool … when it’s recommended by a healthcare system or staff.  We propose that the next step is to pilot an intern-led  ‘Speak Up’ competition to promote the Path to Better Sleep program (which includes free self-help CBT-I for insomnia).

We propose that educators in ANY health profession from ANY school – could LEAD together. Let the games begin!

Proposed ‘Speak Up for Insomnia’

Question:  Can a new online ‘Speak Up’ Internship develop the platform and design, create, and pilot the ‘Speak Up for Insomnia’ Challenge in which service-learners anywhere compete to promote the Path to Better Sleep to have the most impact?

Educators could require learners at any level (undergraduate, graduate) to go to Speak Up, a non-profit Intern-led platform, to participate in the ‘Speak Up for Insomnia’ social media challenge. Learners would earn a certificate of completion when they complete the steps to promote the free, evidence-based Path to Better Sleep:

1. Promote the Path to Better Sleep on social media (e.g., share a post, create a new post)
2. Measure that post’s impact (using Speak Up-defined metrics)
3. Share results on social media, urging school peers to compete to increase their team’s impact.

Speak Up Interns would develop the platform to inform participants about insomnia, CBT-I, Path to Better Sleep, and social media tips. They would design, develop, lead & promote the competition. They’d update and share the leaderboard results on social media – spotlighting the current top performers – learner, course & professor, school, health profession. As well, Interns could use the Speak Up platform to conduct and present their community-engaged scholarship.

Educators:  We look forward to partnering with public health-minded faculty and learners  … who will have the social efficacy to ‘Speak Up’ and LEAD.

If you want to help pilot ‘Speak Up for Insomnia’ to (1) develop the Speak Up Internship, or (2) engage learners in the Speak Up Challenge  … please contact drcary@mac.com.

The Speak Up Network

Ultimately, interns could develop & sustain an intercollegiate competition that would enable healthcare learners – anywhere, anytime – to compete to have the most impact. And, we could all share bragging rights for collectively increasing traffic to evidence-based resources.

Social enterprises have grown out of community-based projects begun by just a handful of academics. And, tens of millions of lives have been saved by students of schools of health professions who were required to train online at the IHI Open School!

In the future, we hope to develop a non-profit social enterprise – Speak Up for Health Network – that can support many competitions that promote evidence-based resources for:

• Prevention (vaccines)
• Chronic illness (obesity, pain)
• Lifestyle health & wellbeing (stress management)
• Advocacy (gun safety, women’s reproductive care).

It may be easier than you think … for the healthcare academic community to not only fight the hype of commercial industries, but also to fight the medical misinformation spread by powerful social influencers. Together as one, we need to ‘Speak Up’ and LEAD.

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.  See more here.  

Disclosure: Dr. Cary has made donations to the 501c3, the onAir Network – a ‘Peoples Platform’ to inform and engage the public on important issues.