Conferences were selected by type of attendees. We targeted conferences with primary care providers (physicians, nurses, nurse practitioners, and physician assistants) and allied health professionals. These conferences included those sponsored by non-profit professional medical societies and national for-profit set conferences aimed at attracting primary care providers. At some of these conferences a CDC or CFS expert submitted a paper presentation, making these highly targeted conferences. We also selected conferences pertaining to CFS or specialized providers who may be more apt to treat chronic fatiguing illnesses. Last, conferences that targeted less represented medical groups were included on a periodic basis to identify emerging opportunities (i.e., medical societies for different gender/ethnic providers). The CFS provider education booth displayed the self-study courses and CFS provider education materials such as bibliographies, conference materials, and resource guide.

To evaluate effectiveness of distributing CME materials through provider education booths at conferences, we tracked booth attendance, compiled entries to reply devices at the booth, and tracked use of conference ID badges to request additional information. Ethical consent was not required as most conferences now use electronic tracking devices for outreach and promotional purposes. For each conference, staff kept records regarding CFS presentations the number of CME course requests and the number of training materials disseminated. At selected conferences promotional activities to direct conference attendees to the booth included pre-conference direct mailings to registered attendees, printed advertisements in conference packets or programs, web advertisements for selected health care sites, conference signage, and sponsorships.

Because booth attendance varies directly with the size of the overall conference, crude attendance counts do not permit standardized comparisons across multiple variables nor do such counts reflect interest by or penetration of the target population. Thus, our analysis involved booth attendance rate, calculated as the number of booth visits divided by the total number of conference attendees. The conference sponsor provided the overall conference attendance number. The average booth attendance rate for all conferences was 5%, and for one-quarter of the meetings at least 15% of all attendees visited the CFS continuing education booth. Thus we defined a 15% booth visit rate (the upper quartile) as successful conference exposure to continuing education materials.

We coded conference type into the following categories: primary care (e.g., family physicians, nurse practitioners or physician assistants), allied professional (e.g., physical or occupational therapists), illness related (e.g., CFS or fibromyalgia), and special mixed population (e.g., health educators, gender/ethnic medical organizations, or medical specialists). Information on the geographic scope of the conference was categorized as National (national membership and conference held in a major U.S. city), Regional (conferences attracting participants from particular geographic regions), and State (sponsored by a state medical societies or attracting attendances from one state).

Conference size was categorized as n < 1000 persons for small conferences, and n > 1000 for large conferences. CFS presentations at conferences were coded yes or no. We used both descriptive statistics and logistic regression analysis (SAS version 9.1, SAS Institute, Cary, North Carolina) to analyze conference data.

Experts in CFS from the CDC, academic institutions, clinical practice, and patient advocacy organizations convened to develop a continuing education self-study CFS course with the following objectives: 1) to outline the process for proper evaluation of persons suspected to have CFS; 2) to present a diagnostic algorithm for CFS, according to criteria of the 1994 International Case Definition; 3) to discuss management strategies for CFS; and 4) to improve providers' understanding as to the wide-ranging impact of CFS on patients' lives.

CDC served as sponsor organization for all continuing education accreditations: 1) the Accreditation Council for Continuing Medical Education for physician credits; 2) the American Nurses Credentialing Center's Commission on Accreditation for nursing, 3) and, the International Association for Continuing Education and Training for continuing education units. Certification was awarded for the following groups: 1) continuing medical education physicians (CME-P), 2) continuing medical education non-physician (mostly physician assistants and nurse practitioners) (CME-N), 3) continuing nursing education (CNE), 4) and, continuing education units (CEU) (other health care professionals such as occupational and physical therapists). Course participants were given two opportunities to score 70% or higher on a learning assessment and were required to complete a course evaluation.

Continuing education materials were promoted by paid advertisements at conferences, on websites, and in peer reviewed journals. The CME course was promoted at the CFS Provider Education booths through all mediums: print, DVD/video, and online. Print courses were distributed on site at conferences, DVD/video requests were taken on site or through a postcard, and the online course was advertised on handouts.

The self-study course was made available free of charge as printed text, a DVD or VHS video, and online. It was distributed at conferences and made available through advertisements in peer review journals. The print and online courses have indexed printed text and two case study reviews. The video presentations provide a fundamental overview of CFS, two case study reviews, and patient interviews. The materials were approved for continuing education credit, based on the average time for course completion and type of credit, as determined by course reviews performed by multidisciplinary professionals. The print and online course credits are based on a two-hour completion time, while the video course credit is based on a three-hour completion time. After completing the didactic part of the print or video module, health care providers submit a completed post-test and course evaluation by fax or postal mail and receive continuing education credits verified by a certificate of participation. Submission of information by web users occurs at the end of the online session, at which time they can print a certificate of participation. Providers registering for the online course were asked to voluntarily provide anonymous data on race, sex, age, and geographic region. As with all CME courses, no ethical approval is required as persons receive credit for course completion.

Between May 2000 and June 2006, the provider education project exhibited at 57 conferences, attended by 232,779 individuals and disseminated materials to over 11,000 persons (5% of attendees). Conference attendance size ranged from 75 to 12,000 with an average of 4,083. Audiences were diverse and included physicians, physician assistants, nurses, nurse practitioners, public health professionals, allied health professionals (psychologists, physical therapists, and occupational therapists), medical residents and students, disability attorneys, and medical specialists.

Seventy-seven percent of the conferences were National (n = 44), followed by 12% Regional (n = 7), and 11% State (n = 6). On average large conferences cost $5,490 while smaller and regional conferences cost approximately $1,750. Costs include exhibit related expenses, materials, travel, and conference fees. A CFS expert from CDC or an academic institution participated as a speaker or presented a poster at 22 of the conferences. Fourteen conferences (25%) met the 15% booth visit rate criteria and reached 2,140 providers (see Table 1).

Further analysis of these 14 conferences showed that conference type, geographic scope, presentation of CFS research at the meeting, and magnitude of meeting attendance impacted booth visit rates.

The classification of conferences resulted in 8 allied professional, 5 illness related, 30 primary care, and 14 special mixed population (data not shown). Ten (71%) of the 14 conferences that met the 15% attendance criteria were classified as illness related (n = 4) and special mixed population (n = 6). State-level conferences had higher rates of booth visits implicating that geographic scope was a factor. Eighty-three percent of state level conferences met criteria for successful outreach compared to 20% of national conferences.

Conference size impacted interest at the CFS booth exhibit with smaller conference audiences attracting more booth visitors. Of the 57 conferences, 19 were small conferences, and 13 of the 14 conferences meeting the 15% criteria fell into this category (n < 1000). Of the 38 large conferences, only one met the booth visit criteria at 25%. When cross referencing geographic scope with conference size, 6 State (100%) level conferences fell into the small conference size category with only 1 Regional (14%) conference and 12 National (27%) conferences in this category.

The presence of a program about CFS delivered by a CFS expert or CFS researcher at a conference resulted in 9 of the 14 conferences meeting the 15% booth rate criteria and the overall highest booth visit rates, 92%, 53%, and 40%. Three of the 14 conferences had promotional activities.

Seventy-five percent (n = 43) conferences did not meet the booth rate visit criteria. Booth visits rates at these conferences ranged from 0.3% - 14% as compared to 15% - 92% for those conferences meeting cut-off criteria. Further analysis of the 43 conferences indicated that type of conference also impacted booth visit rates. For the non-successful conferences, 88% of both primary care and allied professionals types did not meet the criteria whereas only 20% of the illness related and 42% of the special mixed population did not meet the criteria.

Conference size was related to non-successful booth attendance; only 1 of the large size conferences met the 15% booth visit criteria. While the greatest number of booth visits were generated at large conferences (38 large sized conferences contributed a total of 9,655 booth visits compared to 19 smaller conferences with 1,793 total booth visits), the booth visit rates at large conferences was 4% compared to 19% of small conferences.

Table 2 presents results from the univariate logistic regression analysis. Conference type, conference size, and CFS presentation are significantly associated with successful conferences as measured by booth visits. For conference type, illness related conferences were more likely than primary care conferences to be successful (OR = 36.0; 95% CI 2.97, 436.34). Small conferences (OR = 80.17; 95% CI 8.80, 730.25) were more successful than large ones and a CFS presentation at the conference contributed to a greater likelihood of success (OR = 4.15; 95% CI 1.16, 14.83).

When all significant variables were entered into the model (conference type, conference size, and presentation), only conference size remained significant (OR = 48.39; 95% CI 3.88, 603.49) (see Table 3). However, this result is not surprising as chi-square tests show that conference size is significantly associated with conference type (23.0, p < 0.0001) and presentation (4.48, p < 0.05).

Self-study course requests suggested that print and video materials from conferences yielded 3.8 times more requests as compared to requests stemming from advertisements in journals (see Table 4). For conferences, print requests were approximately 3 times greater than for the video materials. Print requests from journal advertisements were the most requested medium and greatly outnumbered any other types of requests stemming from journal advertisements.

Between January 2002 and June 2006, 4,686 providers requested print, video, and online self-study materials (Table 5). The online course accounted for 42% of the requests (n = 1,951), print for 41% (n = 1,927), and video for 17% (n = 808). About half (43%) of those who took the course online were awarded certificates. While print generated a large number of requests, only 7% of those who requested the print course submitted documentation to obtain credits. Video requests had both the lowest request and completion rates, only 2% of those who requested the video course were awarded certificates.

Table 6 summarizes CFS education award certificates according to provider category. Allied health care professionals accounted for the most continuing education credits (CEU - 32%) followed closely by nurses (CNE - 31%), and physicians (CME - 25%). While non-physicians (CME-N) was low at 12%, this category comprised mostly of physician assistants and nurse practitioners is part of a large provider occupation base. Across all occupation categories the online course resulted in the most continuing education credit awards. The non-physician group had the highest print award numbers (n = 52) and the allied health group the highest online completions (n = 291).

Table 7 presents demographic characteristics of persons who registered for the online CFS self-study course. The majority of registrants for the web-based self-study course were women (74%) and predominately white (85%). In terms of age, 36% fall into the 50-59 age category and 28% reported being age 40-49.

Dissemination of provider education materials is a challenge for CFS and other illnesses such as autism, Lyme disease, and chronic interstitial cystitis, and many outreach programs rely on the traditional method of continuing education to reach and educate providers. Health education and continuing education programs wishing to distribute provider medical education materials for awareness and continuing education credits awards may find these results useful in guiding resource planning and outreach efforts.

Healthcare conferences are still a popular event among providers and offer an opportunity to disseminate education materials through educational booths. Results of this research show that educational outreach efforts could benefit from conducting a needs assessment of how to reach the primary audience and best utilize resources. This assessment would include looking at the conference type, conference size, and investing in expert speakers at conferences. The types of materials handed out at such conferences should also be examined in the context of the project objectives. While print materials were the most popular in this research, they yielded the half the award certificates as the online course. Educators need to develop methods for steering potential educational booth visitors to the Internet. Dissemination of CME self-study courses as conferences was more successful than advertising the same course in journals.