The purpose of this commitment is to bring together the core competencies and expertise of Pro Mujer, Sesame Workshop, and the Mayo Clinic to develop a remote training program to enhance the professional skills and referral abilities of Pro Mujer's health staff, and to develop mobile programs to promote healthy behaviors among Pro Mujer's clients and their families, with a particular focus on reaching their children. Pro Mujer has the capacity to reach large, vulnerable populations through its strong health training and direct services infrastructure. Sesame Workshop uses a research-based approach and its iconic Muppets to deliver educational messages to families through engaging international media projects. The Mayo Clinic is a worldwide leader integrating clinical practice, education, and research with plans to reach larger audiences through enhancing its international networks. This partnership is based on best practices, and will utilize a tested methodology to address chronic disease prevention and healthy behavior from multiple angles, promoting change at the household level.
With an emphasis on engaging clinician staff, Pro Mujer clients, and the children of these clients, this project sets out to address diabetes, hypertension, obesity, mental health, breast and cervical cancer, and dental care, among others. Because behavior modification is crucial for chronic illness prevention, this collaboration will include research-based social marketing campaigns, such as original video and web content targeted to Pro Mujer's client base. Because mobile technology has proven to be an effective way of transmitting information and communicating with high volumes of people in low-resource settings, and because almost all Pro Mujer clients have cell phones, the project will also explore the use of mobile applications, providing clients will tools they can use directly on their phones. Sesame Workshop's proven expertise in interactive media that is appropriate, engaging, and relevant for both parents and children will further contribute to the development of these educational tools.
In addition, access to input from specialists through Mayo Clinic's AskMayoExpert (AME) program will enhance Pro Mujer physicians' capacities by being enabling them to consult medical specialists on patient treatment. AME is a provider-to-provider web-based application that delivers medical knowledge right to the desktop. With all content written and vetted by Mayo Clinic staff, AME is a culmination of best-practice advice on hundreds of medical conditions. With access to diagnostic and treatment input from specialists through Pro Mujer clinics, clients will receive convenient, high quality care that is responsive to their limited time and financial constraints. The Mayo Clinic will also use web-based platforms to organize trainings for Pro Mujer health staff, offering professional development opportunities for health practitioners in five countries.
By educating families and children, and by directly engaging physicians, this commitment sets out to tackle the chronic disease burden from two different angles, which effectively work together to incite behavior change and ensure the prevention of costly and devastating diseases.
Planning Sessions and Focus Groups (Fall 2013/Winter 2014): The project partners will conduct research, market studies, produce baseline data, prioritize health needs, assess staff training needs, and develop a project framework.
Design and Test 'Ask Mayo Expert' (2014): Pro Mujer clinicians will be able to consult Mayo Clinic specialists via the Ask Mayo Expert online platform. This will enhance Pro Mujer medical service delivery and ensure that clients receive input from specialists in a convenient, inexpensive way. Mayo Clinic and Pro Mujer will test the remote consultation interventions in select clinic sites, prioritizing the most common diagnoses referred to outside providers.
Design and Test Remote Training Systems (2014): Pro Mujer's clinicians will receive professional development from Mayo Clinic experts via remote training enhancing the professional capacities of health workers on the ground. This will not only improve the services that clients receive in the clinics but will also bring new knowledge, skills, and capacities to the health workers.
Social Marketing Materials Development and Testing (2014-15): Community events, print materials, and videos for use in Pro Mujer clinics, in the women's homes, and beyond will promote healthy behavior among at-risk clients using tested methods and involving evaluations. Sesame Workshop will use a tailored curriculum combining original with existing content; Pro Mujer will also create material. The social marketing component will be organized as a campaign in order to stress targeted health messages, and will engage not only the female Pro Mujer clients, but also their families, with a focus on reaching their children.
Mobile Technology Exploratory Phase (2014-15): Pro Mujer will explore mobile technology options (apps, segmented messaging, forums, and support groups) to be used on clients' existing phones and will consult with the Mayo Clinic and Sesame Workshop. Implementation sites will be selected based on internet connectivity and market penetration of cell phones.
Web Hub Development (2014-15): Several systematic literature reviews have demonstrated that social marketing and internet education can effectively be used to promote behavior change and reach low-income populations. As more of Pro Mujer's client base starts to use the internet, it can be a key tool in promoting healthy behavior. Sesame Workshop and Pro Mujer will start development of an educational web hub to address disease prevention by making health information more accessible to Pro Mujer families.
Ask Mayo Expert and Training Rollout (2015-16): Ask Mayo Expert and the training services will be available in Bolivia, Peru, Mexico, and Nicaragua in a select number of sites.
Mobile Technology Testing and Web Hub Launch (2015-16): Pro Mujer will test use of this technology in one country with plans to roll-out this intervention in other countries the following years. The website will be made publicly available.
For the 167 million people in Latin America living in poverty, access to affordable, high-quality health care is scarce. Due to the difficulty many have in accessing preventive services, public health problems are quickly evolving, with chronic diseases (diabetes, hypertension, obesity, and breast and cervical cancer) comprising the leading cause of mortality in the region. Chronic diseases now account for 68% of mortality in Latin America and lead to billions of dollars of losses in economic production. 35% of deaths in the region are caused by cardiovascular diseases alone. In the five Latin American countries where Pro Mujer operates, the average obesity levels among women are 29.9%; high blood pressure levels are 22.6%; and elevated glucose levels are 10.2%. Experts predict that mortality from diabetes, heart disease, and stroke will triple in the next two decades.
Forward-thinking and dynamic solutions to promote better health outcomes will be critical to tackling the enormity of the chronic disease burden. One such approach is to utilize online, video, and mobile technologies as effective tools to reach large populations of low-income people, who are increasingly at risk for these chronic conditions. Latin America's online population grew faster than any other global region in 2011, rising 16% to 129.3 million visitors in December 2011, according to comScore. According to eMarketer, Internet user penetration will exceed 52% of the population in Latin America by 2016. Furthermore, The GSM Association reports that Latin America is the third largest mobile market in the world, and that there are currently a greater number of mobile phones in the region than people.
While studies show that there is still a disparity in internet usage for remote and rural areas, and for those of low-income status, this is rapidly changing. New initiatives from the UN Broadband Commission for Digital Development and Inter-American Development Bank (IDB) aim to increase internet penetration of low-income populations in Latin America by encouraging partnerships between governments and the Telecom industry to develop regulation, increase infrastructure, and lower costs of service. This growth, and particular interest in reaching low-income populations, presents great opportunities for disseminating health messages, and for connecting general practitioners to their own clients and to specialists in other countries.
Pro Mujer works with more than 270,000 women in Mexico, Peru, Argentina, Nicaragua, and Bolivia, providing health services via 111 health clinics and 154 doctors and nurses. The clients are low-income women who work in the informal sector: this demographic is at high risk for developing chronic illnesses due to poor nutritional habits and sedentary lifestyles. Many of the women do not detect health problems until costly complications arise because they have high opportunity costs to accessing preventive services. Through this commitment, Pro Mujer, the Mayo Clinic and Sesame Workshop will work to design new technologies to provide health education to Pro Mujer families and their children, as well as platforms to enhance the professional development of Pro Mujer clinic staff, with the ultimate goal of preventing chronic illnesses among Pro Mujer's clients and their families.