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Project H.E.R.O.

Bringing Hope Efficacy and Resilience to Osteoporosis Patients

Photo of Estela Kennen

Written by

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

Photo of Manisha Laroia

Hi Estela Kennen 
Hope your idea prototyping is on in full swing!
In gratitude and in support of your future work, we would like to invite you to join the final Innovation Coach Office Hours as you continue your innovation learning journey:

Make, Try, Show, Test, Build
Ashutosh Biltharia, Designer and Engineer, MFA, Interaction Design, Umea Institute of Design, Sweden. 10am PST August 5th.

Building Partnerships in Design
Susan Jackewicz, Principal at Takhi Associates, Boston, Massachusetts. 10am PST August 9th.

Love the Problem, Scale the Solution
Chris Cochella, Managing Partner at Sequoia Group, Salt Lake City, Utah. 9 am PST August 12th.

Sign up here to attend

Photo of Estela Kennen

Manisha Laroia , thank you for the invite. Unfortunately those times are in the middle of the night for me, so I have been unable to attend any of them. I hope you guys are able to record and share these coming office hours.

Photo of Manisha Laroia

Will forward you the decks and discussions!

Photo of Mojisola Adewumi

Thank so much Estela.
Best of luck too

Photo of Mojisola Adewumi

Estela, Thanks for sharing this great idea.

Photo of Estela Kennen

Mojisola, Thanks for the support! Best of luck with your Bridge Builder project, also a great idea.

Photo of Susan Jackewicz

Hi Estela Kennen 
Thanks for sharing this idea inspired by your grandmothers' experiences! Witnessing loved ones' health challenges puts families into a unique position of tacit knowledge - particularly in being able to ask the 'right' questions! Your idea tackling communication and education hits that sweet spot for individuals and families - peripheral knowledge, but no interest in delving further - until an incident hits home.

For your targeted users - you list patients who might need just heads up reminders, and those who are swimming and need a lifeline. And for others, you list caregivers (am assuming you mean family members?) and allied health professionals. Do you think it would add value to produce materials segmented to each of these populations? How might they be different, or similar?

Thanks again for your submission and commentary on other Challenge ideas - we'll look forward to this idea developing, along with your other post Media Matters !
OpenIDEO Innovation Coach

Photo of Estela Kennen

Susan, Thank you for your comments! Reading your message was a head-slapping d’oh moment. I have integrated additional components into the idea!

Photo of Susan Jackewicz

Thanks, Estela Kennen , for adding more. Will look forward to reading on in detail!

Photo of Ashutosh Biltharia

Hi Estela Kennen 

Thanks for submitting your idea and for adding your comments/feedback to others' ideas as well. It's great to have active participants like you on this platform.

Adding further to Susan Jackewicz 's point- You may quickly make low fidelity prototypes of the proposed material/design interventions (booklet, video, reminder) and test them with the mentioned users, it would also help in reflecting back on your thoughts or doubts/assumptions.

All the best!

Photo of Estela Kennen

Ashutosh - Absolutely! Won’t have time to do it before the deadline, but design is a reiterative process, and testing ideas and especially assumptions is key! Thank you for the reminder!

Photo of Manisha Laroia

Hi Estela Kennen 
Thank you for being super-active in the Ideas Phase of the Healthy Bones Challenge.

A checklist for your reference. Please make sure your idea does the following:
1) Clearly define the problem with respect to Osteoporosis
2) Connects to at least one opportunity area
3) States how & when user accesses the solution
4) Tells the story
5) Adding Images or sketches add detail to your idea.

Please make any last minute tweaks you wish to, asap. Like adding IMAGES or changes in text.
The DEADLINE for idea submission is Wednesday July 3rd, 2019 5pm PST.

Let me know if you need anything.
All the best for the next phase of the challenge.

OpenIDEO Challenge Team