Mobile Technology Training for a Public Health Response to Disasters



Sara Hurley
Amy Scheller
Debra K Olson


Consider this scenario: A series of storms and the resulting flooding carves an unusually large path of damage.  In the disaster’s aftermath, the county health department is responsible for ensuring the public’s health – overseeing things like clean water, temporary housing shelters, vulnerable populations, monitoring for post-flood diseases, and supporting the psychological health of those suffering particularly difficult losses.   

What kind of mobile technology access, content, and knowledge do public health emergency responders need to have in place to effectively address this problem?

Behind the scenes of any emergency response are countless hours of education and preparation, combined with ongoing relationships and collaborations between multiple state and county departments of health, institutions like the University of Minnesota, and funding agencies like the Centers for Disease Control and Prevention (CDC).  The work of the Centers for Public Health Education and Outreach (CPHEO) at the School of Public Health, with grant sponsored efforts such as, in this instance, the University of Minnesota Simulations Exercises and Effective Education (U-SEEE) grant from CDC, is to build and deliver education and provide tools for public health professionals.  

With the broad and rapidly increasing adoption of mobile technologies and social media, it is important for public health emergency response training and tools to incorporate and adopt these concepts into their culture now so that they are ready to address the immediate emergencies and crises that require immediate response.

Finding out what life is like now
A mistake that is often made on the institutional level is to design the solution before we understand the problems users need to solve.  CPHEO programs have served public health emergency responders for over a decade, yet we did not know their day-to-day use of mobile technologies, nor were we sure of what the practices were in their work lives.  To find out, we surveyed over 400 Medical Reserve Corps (MRC) volunteers and coordinators from Minnesota, Wisconsin, and North Dakota in the spring of 2011.

We found that over half of the emergency responders surveyed had a smart phone now or would within the next year, and that during an emergency the primary way they use their cell phones are to call other responders (66%) or friends and family (53%); they also text (34%), access emergency-related information on the Internet (26%), use emergency response apps (7%), and tweet emergency information (2%).  We were also interested in how they prepared their phones for emergencies.  While 91% had updated contact lists, only 19% bookmarked relevant websites and 14% stored reference information.  A surprising 8% stored no response-related information.  The survey is being conducted again in 2012 to track the rate of change and to continue to inform our work.

What are the barriers?
We know that we cannot understand the potential of a technology if we do not use it.  While the use of social media is exploding in society, and social media is a valuable tool for getting communication out during an emergency, 73% of our respondents had these features of their phones blocked by their agencies.  Additionally, 96% received no guidance from their organization on what to use. These decisions result in barriers to having the most effective emergency response possible.

“We can’t use our county email addresses on our phones (even our smart phones), they don’t allow us to.”

“[I] end up using my personal cell phone because it has so much better capabilities.”

What do responders want?
Our responders want training and education (71%), the ability to browse the Internet (75%), access to emergency response apps (76%), and to text other responders (82%).  In short, they want to understand how to use their devices best,  access to the full range of a device’s potential, and the opportunity to communicate with others during an emergency.

Education and organizational change
We are able to provide guidance on how to prepare a cell phone as a response tool and to develop educational resources optimized for mobile delivery, but we have also come into a new role: advocates for technology.  If the responders do not have access to the software or hardware on a regular basis, they will not be able to apply these new understandings during an emergency.  When we presented at the Public Health Preparedness Summit in February 2012, we advocated in our presentation that organizations change how they treat the full spectrum of technology: social media is not to be feared, technology is not to be feared.   Part of developing new tools and trainings for public health emergency responders is advocating for cultural change in the organizations and providing them with examples of why ongoing engagement with technology is important.  

Building networks that work
Part of advocacy is understanding what structural barriers exist and providing people with the capacity to create change with compelling reasons for change.  Social media, such as Facebook or Twitter, is often seen by organizations as a distraction that is not understood as potentially contributing to work, so they block access.  In emergency response and preparedness, part of the job for many people is to understand when, how, and where to communicate when emergencies happen.  Social network usage nearly doubled between 2008 and 2010 (from 26% to 59%) [1]  and social networking apps are the second most valued feature on smart phones (GPS was the most valued) [2].  Tapping into these networks takes time, however, and building relationships with the public on social sites well before emergencies happen will mean having a powerful means through which to disseminate information and identify areas in crisis.

User as innovator/collaborator
The first barrier that must fall is that organizations must stop blocking features so that responders and staff can use the full power of mobile tools and participate in innovation.  When we started delivering trainings and games, we had to make sure they were perfect before they went out the door because they were on CD-ROM. There were no easy updates, quick downloads, or possibilities for rapid feedback loops in those days.

For any outreach effort, the people in the field will always know more about the intricacies of their work lives than we can.  The beauty of iterative technology: the ability to update apps, software, training, etc. is that the people who will use our apps or apply the knowledge they gain in our courses can provide feedback or tell us what they need more of—and we can change and adapt more quickly because of the technology we have available to us.

What we’re crafting
After obtaining the encouraging information that half of our survey respondents had or planned to have a smart phone in the next year, we set two goals for the U-SEEE Preparedness and Emergency Response Learning Center.  The first was to impact the culture so that our target audience would begin to think of their cell phones as a powerful response tool.  To do this, we launched a Mobile Preparedness and Response website (http://www.sph.umn.edu/ce/perl/mobile) offering tips on preparing cell phones as a response tool as well as links to apps, news and other resources that connect people’s mobile phones and their response duties.

Our second goal is to create a mobile optimized training tool, advocate for its use, and gather feedback on its usefulness.  Our first app, a Psychological First Aid Tutorial, is under development for Android, iPhone and as a mobile website.  This topic was chosen as it is applicable to a wide range of emergencies and because many responders receive training in advance of deployment, necessitating a just-in-time (JIT) refresher.  A mobile phone is capable of delivering a JIT refresher-level training, and making it widely accessible during the hectic time leading up to and during deployment.  

It’s all about intersections
As we move forward in designing trainings and tools in our constantly evolving mobile and social contexts, we are in a feedback loop between change and improvement and reality.  We get to bring people along on this journey, and they remind us of what they need right now and what needs to change.  We have always reached well beyond the walls of the University, but it is exciting to change from a model in which we present content and eventually receive feedback on what needs to change. Instead, we have myriad intersections where we stop and check in, potentially changing routes midcourse.

Acknowledgement
This project was supported in part through a grant from the Centers for Disease Control and Prevention (CDC), Grant/Cooperative Agreement Number 5U90-TP000418, Debra Olson PI.  Its contents are solely the responsibility of the authors and do not necessarily represent the official views of CDC.


References
[1] Mark Hampton, K., Sessions Goulet, L., Rainie, L., & Purcell, K. (June 16, 2011). Social networking sites and our lives. Pew Internet and American Life Project. Retrieved from http://www.pewinternet.org/Reports/2011/Technology-and-social-networks/Summary.aspx

[2] Nielsen (2011). State of the Media: The Social Media Report. Retrieved from http://blog.nielsen.com/nielsenwire/social/



  

Sara Hurley <hurley@umn.edu>
Sara Hurley, MFA, Ph.D. Candidate has over 10 years of experience working in technology and education. In her current work as an Instructional Designer in the School of Public Health she focuses on engaging with faculty to develop new strategies for online pedagogy, online course design, and technological innovation. As a Ph.D. candidate in the Curriculum and Instruction program at the University of Minnesota, Sara is researching social media, public pedagogy and the "It Gets Better" Project.
Amy Scheller <sche0526@umn.edu>
Amy Scheller, MPA is an Educational Specialist in the School of Public Health where she leads teams to produce innovative technology-based learning tools for public health professionals. Her current projects include mobile just-in-time training tools and online simulations for public health emergency responders.
Debra Olson <olson002@umn.edu>
Debra Olson, DNP, MPH RN, COHN-S, FAAOHN, is the Associate Dean for Education at the University of Minnesota School of Public Health and is responsible for developing strategic partnerships for the delivery of lifelong learning opportunities for interdisciplinary health professional students and the public health practice community. These programs are developed to increase the availability of public health education and to enhance the capability of working professionals through the application of innovative teaching techniques such as technology-enhanced learning.