Development of Theory-Driven Injury Prevention Communication Strategies for US Army Medical and Health Education Personnel

Background:  Unintentional nonfatal injuries are a significant problem in the U.S. Army, resulting in over 1.2 million medical encounters among active duty Soldiers in 2012.¹ These injuries are largely preventable, yet yield millions of dollars in health care costs and lost duty days each year.² In the Army, medical providers serve as gatekeepers of health information, informing patients about their health status, treatment options, and methods of prevention.³ Evidence has suggested that effective communication between providers and patients can positively impact patient health behaviors.^4,5 Accordingly, education of Army providers and health educators on evidence-based injury prevention strategies is crucial to ongoing Army injury prevention efforts.

Program background:  In support of the public health approach to prevention, the U.S. Army Public Health Command (USAPHC) develops and distributes educational materials and facilitates training opportunities for various audiences, including Army medical and health education personnel. To prioritize future product development, a 2014 online needs assessment conducted by the USAPHC Injury Prevention Program (IPP) measured knowledge and awareness of the impacts, risk factors, and prevention strategies for musculoskeletal, heat, and cold injuries among Army medical and health education personnel.⁶Respondents identified running (76%), weight training (68%), agility/calisthenics/stretching (68%), and extreme conditioning programs (60%) as activities about which they’d like additional injury prevention information. Preferred product types included electronically-available factsheets (31%) and brochures and tip cards (25%).

Evaluation Methods and Results:  The P Process™ framework ⁷ was applied to guide the assessment and revision of the USAPHC IPP’s existing communication strategy. This five step process developed by Johns Hopkins Bloomberg School of Public Health Center for Communication Programs provides a systematic process for planning health communication activities. As the USAPHC had defined current injury rates¹ and identified key audience interests⁶, the remaining component of the first step of the P Process™ was to identify potential barriers to and gaps in effective communication. A gap analysis was conducted to compare existing USAPHC educational materials by topic (e.g., sports injury) and type (e.g., fact sheet, brochure) with topics and materials identified in the needs assessment. The USAPHC fact sheets and Health Information Products e-Catalog were searched for materials addressing injury prevention or physical activity. Of the 589 existing health education materials identified, twenty-one (3.6%) met inclusion criteria. Several topics, such as road marching and knee injuries, were not addressed by existing materials, while topics like stretching and weight training were covered but required repurposing and/or updating. Eight (38.1%) materials matched the desired product types identified by the audience (e.g. fact sheets & brochures).

Conclusions:  The gap analysis uncovered discrepancies between material needs and preferences identified by audience members and materials currently available from the USAPHC. Additionally, existing materials on preferred topics require updates to reflect current scientific evidence for injury prevention strategies. These gaps are critical barriers to injury prevention goals.

Implications for research and/or practice:  These findings support the next step in the P-Process™ framework, to develop a more effective, evidence-based IPP communication strategy including scope and objectives, product prioritization, messaging, dissemination strategies, and evaluation planning.