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Project H.E.R.O.

Bringing Hope Efficacy and Resilience to Osteoporosis Patients

Photo of Estela Kennen

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What challenges or opportunities are you trying to address within the problem? (200 characters or less)

A fall, a break, dignity gone, replaced only by pain and despondency. A fall, a break, the beginning of the end: for too many people that’s how the story goes. Let’s change the narrative.

Despite all we know about the dire effects of an osteoporotic break on a patient’s’ quality of life (see, for instance, Al-Sari et al, 2016 and Jung et al, 2017), and despite the high degree of mortality associated with — but not directly caused by — fragility fractures — there has been an almost systematic negligence of the emotional and psychological effects of such fractures. 

Why do some patients bounce back whereas others don’t? In no small part due to their mindsets and the stories they tell themselves. A patient's degree of hope and optimism improve a variety of disease outcomes, such as mortality, pain, and physiological markers — regardless of health status (Rasmussen et al, 2012; Schiavon et al, 2016). The patient’s sense of self-efficacy may be a better predictor of fall risk than balance or mobility measures (Pang & Eng, 2007).

A hope-less patient is a non-compliant patient, and all the interventions in the world will not help if the patient doesn’t use them...and post-fracture geriatric patients have a high degree of noncompliance. This intervention exists to improve patients’ mindsets, to dispel any mistaken beliefs about the “preordained” outcomes of falls, to catch depression early and encourage patients and caregivers to seek treatment for it, and to establish a sense of hope, efficacy, and resilience against osteoporosis (HERO).

The intervention would include:

  • debunking common myths about fragility fractures and osteoporosis (it’s inevitable, it’s the beginning of the end)
  • emotional fitness strategies (acceptance vs ruminations, overcoming avoidance)
  • cognitive fitness/mindset strategies (you can still learn, your life still has purpose)
  • a self-administered depression screen 
  • a token (perhaps in the shape of a washable bracelet) with a visual reminder of why the struggle is worth it 

In order to maximize reach, the education materials would be provided as a large-font workbook and as online or app-based video instructions (this intervention could be packaged with or within one of the other interventions from the Challenge.)

To maximize impact, caregivers (family members) should be made aware of the mental difficulties that patients can go through and what might help. This could be done as a note to caregivers within the workbook and stand-alone information in the form of a brochure and web-based information. A CME module for health care providers could increase their awareness of the problem, and the potential malleability of mindset to achieve better outcomes.

Who is your target end user and why will they be interested? (650 characters or less)

The target users are all non-dementia patients experiencing a geriatric fracture. For some, the materials would just be an inoculation -- a head’s up regarding thoughts and feelings they might experience and ways to cope. For others, they could prove to be a lifeline -- a reminder that getting out of bed every day is crucial and there is something to live for. Additiobal users of side components would be caregivers and health care professionals that can remind the patients’ of important mindsets or mantras to help them through hard times and encourage their compliance with treatment.

How is your idea scaleable? (650 characters or less)

The different components of the intervention (booklet, video, reminder) are designed to be inexpensive to mass produce and deliver. A colleague and I can translate materials into Spanish to further the intervention’s reach. Distributing the materials could be performed quickly, and would ideally be part of a health care system’s post-fracture protocol/order set in order to ensure delivery. However, the materials should also be available via website so that caregivers and patients can access them in case the local health care system does not provide them.

What do/will you measure to know if your solution worked? (500 characters or less)

Primary Measures: Pre/post: Quality of Life, hope, resiliency, self-efficacy, treatment efficacy scores. Caregiver and provider knowledge, attitude, and believes around the topics. Secondary Measures: Levels of depression, adherence to treatment regimen (to include PT, anti-osteoporotic medicine, and other interventions as applicable) Tertiary Measures: Secondary fracture rates, bone density scores

What is the current stage of development of your idea?

  • Blueprint: We are exploring the idea and gathering the inspiration and information we need to test it with real users.

If you were to become a Top Idea, would you want to actively participate in piloting your idea?

  • I want my idea piloted, and I prefer to do my own piloting in collaboration with the health system and with assistance from the Challenge partner
  • I want my idea piloted, but I’d prefer not to be involved in the pilot and prefer that the health system adopts my idea for piloting with assistance from the Challenge partner

Tell us about yourself or your team (500 characters or less)

I conducted public health and health communications research at LSU Health Sciences Center and was the Geriatrics and Palliative Care Education Coordinator at Mercer University School of Medicine. That combination gives me some insight into elder care and how health systems work. But my guidance was my two grandmothers. Both lived into their 90s, but with very different mindsets. One independent and active until the day she died; the other was fearful of falls and scaled her world down smaller and smaller in her quest for safety.

Location (50 characters)

Osan Air Base, South Korea

What is your legal / organizational structure?

  • We are individuals

Innovator/Organizational Characteristics

  • Female-led organization
  • Women’s health/rights focused organization

How did you hear about the Challenge?

  • OpenIDEO announcement email

Why are you participating in this Challenge?

As I read through the challenge brief and supporting documentation, it struck me that the osteoporosis care gap is a civil rights issue, and I got mad, and I got activated. I am here because osteoporosis may affect me as a daughter, a wife, a mother, a friend, a citizen—- and as the owner of a skeletal system. It is too prevalent and too costly a disease to shy away from.


Join the conversation:

Photo of Manisha Laroia

Hi Estela Kennen 
Hope you are doing well.
Your idea Project HERO has reached the Shortlisted stage in the Healthy Bones, Healthy Aging Challenge and we have assigned you an Innovation Caoch Alan Bryant as mentioned in the introduction email sent to you on Aug 3, 2019.
He is here to support you through the Refinement Phase to prototype your idea, get user feedback and build on feedback from the community to better it.

He had reached out to you to schedule call to work together and is waiting for your response.
Do let us know if you are not able to reach him.
Alan's email is

Let me know if there is any concern or change in plans.

Any other questions, do feel free to write back.

Healthy Bones, Healthy Aging Challenge
OpenIDEO Global Community Fellow

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