The Third National Conference on
Quality Health Care for Culturally Diverse Populations:
Advancing Effective Health Care through Systems Development, Data, and Measurement

October 2 - 4, 2002, Chicago, IL
Westin Chicago River North Hotel

Session D-6: Health Literacy: Strategies for designing and implementing effective written materials for diverse populations

How to Develop Effective Culturally Appropriate Preventive Messages and Printed Health Education Materials For Multiethnic Communities: Lessons From The Field

Objectives
We will present a framework to develop messages and materials using the Ethnic Social Marketing and Subjective Culture methodology. The presentation will describe the process to develop effective health messages to facilitate communication about preventive screening tests between healthcare providers and Medicare members in the physician office setting. We will present two case studies —mammography and colorectal cancer screening- describing focus group findings with physicians, other health professionals and Medicare beneficiaries regarding message framing.

Case A: Mammography Campaign targeting underserved Asian American and Pacific Islander (API) Medicare beneficiaries for breast cancer screening.
CMRI, Centers for Medicare & Medicaid Services (CMS) Region IX, Partnered for Progress, Pacific Asian Language Services (PALS) for Health, and the National Asian Pacific Center on Aging (NAPCA) have partnered to develop and disseminate the first breast cancer materials specifically designed to address the needs of API Medicare beneficiaries and their healthcare providers. Nineteen discussion groups were conducted by bilingual moderators from API communities in Cantonese, Mandarin, "Taglish" (Tagalog and English), Vietnamese, and in English for English-speaking South Asian, Hawaiian, Japanese, and Samoan women. Participants were asked to brainstorm about effective mammography messages and review materials for literacy and cultural sensitivity in their communities.

Case B: Colorectal Cancer Screening (CRC) materials to increase physician-patient communication.
CRC is a neglected disease. Very few people want to talk about "that part of the body." What process should healthcare providers use to develop effective communication messages that overcome massive social reluctance to talk? We tested messages in eight focus groups, six with Medicare beneficiaries and two with physicians. We framed messages using five categories: embarrassment, family orientation, new Medicare benefit, disease severity, and benefits of screening. We tested three formats. A "scientific" or factual approach, a "humorous" narrative with illustrations, and an "anatomical" or visual approach.

1. Mammography Messages: Participants preferred "Get a mammogram every year. Do It for Yourself. Do It for Your Family." Also, they stated that messages must clearly emphasize early detection, family, and intergenerations of women. Participants liked step-by-step pictures of mammography and doctors reading results. Participants wanted regional statistics for their communities. They requested phone numbers of organizations to call for more information. Participants preferred bright colors, larger print, a tri-fold format, and glossy paper.
2. CRC Messages: The use of gentle humor ("don’t die of embarrassment") can help to overcome fear of CRC. A key message is: "Colon cancer is preventable with regular screenings and appropriate follow-ups." A patient-physician prompt and an attractive visual poster for medical offices to help Medicare beneficiaries in their discussions of colon cancer with physicians were seen as desirable for initiating patient-physician discussion.
3. Use plain language, simple layout, and culturally appropriate style. Plain language, using culturally appropriate visually appealing styles is essential. Materials must take into account factors that impact any senior’s ability to read the materials — typesize, colors, white space, etc. To facilitate comprehension, materials should use informative headings, easy-to-read design features, and logical organization.
4. Pretest extensively. Effective adaptations and translations require extensive testing with the target audience during all phases of message development. When translations are required, healthcare providers should have a panel of multilingual experts adapt and translate messages.
5. Involve the target audience from the beginning. The target audience should be intensely involved in the conceptualization and development stages of the health messages. Team members should belong to the target audience to more genuinely reflect the cultural characteristics of the target population.

Recommendations
Healthcare providers must develop culturally competent skills to work with the unique needs of seniors from diverse cultural backgrounds by understanding their needs, beliefs, and behaviors. Although improving preventive screening for seniors is a major challenge, using Ethnic Social Marketing and Subjective Culture methodology to guide the development of effective messages is imperative to increase prevention awareness among Medicare beneficiaries. Cultural adaptation of preventive materials and messages to increase access to, and facilitate the benefits of, the Medicare preventive benefits are necessary.

Fabio Sabogal, PhD
Healthcare Information Specialist
Community-Based Quality Improvement
CMRI (California Medical Review Inc.)
One Sansome Street, Suite 600
San Francisco, CA 94104
Phone: 415-677-2158
Mobile: 650-315-8843
Fax: 415-677-2179
E-mail: capro.fsabogal@sdps.org
Web: http://www.cmri-ca.org

Fabio Sabogal, PhD is a health psychologist and Health Information Specialist at CMRI. Currently he provides expertise in the design of behavioral interventions for the Medicare+Choice Breast Cancer Screening and Cultural Competence Projects, Colorectal Cancer Screening and Mammography Campaigns for CMRI. He has extensive experience in cross-cultural community programs involving minority health services interventions. He has more than 20 years’ experience as a university professor, researcher, and writer of over 45 peer-reviewed journal articles. He has developed award-winning health education materials including TV commercials, radio public service announcements, and printed materials for diverse populations. He was an Associate Professor in the Division of General Internal Medicine, the Center for AIDS Prevention Studies, and the Medical Effectiveness Research Center for Diverse Populations at the University of California San Francisco. He has trained in health psychology, survey research methodology, behavioral change, ethnic social marketing, cross-cultural communications, focus groups research, and behavioral epidemiology.

Merry Tantaros, RN, MA, CPHQ
Project Manager
Managed Care/Community-Based Quality Improvement
Phone: 415-677-2002
Fax: 415-677-2195
E-mail: capro.mtantaros@sdps.org
Web: http://www.cmri-ca.org

Merry Tantaros, RN, MA, CPHQ is a project manager in the Managed Care department at CMRI Currently she oversees several national QAPI projects including Pneumonia, Breast Cancer Screening and Cultural Competence. She came to CMRI in 1997 to lead a pilot project to re-design the data collection and medical review procedures for handling Medicare beneficiary complaints. The revised process has been adopted by CMS as a national model. Ms. Tantaros has extensive experience in Managed Care both at the medical group and health plan level. Her clinical experience includes training as a specialist in home health, neurology and physical rehabilitation. She is also experienced in cross-cultural nursing, international healthcare and healthcare marketing. She has a BS in Nursing and a Master of Arts in Organizational Management from University of Phoenix.

Susan S. Merrill, PhD MPH
CMRI
One Sansome Street, Suite 600
San Francisco, CA 94104
Phone: 415-677-2132
Fax: 415-677-2191
E-mail: capro.smerrill@sdps.org

Dr. Susan Merrill is an epidemiologist with CMRI, the Medicare quality improvement organization for California. Dr. Merrill provides analytical expertise and designs evaluation plans for CMRI's breast cancer, diabetes, immunization, and women's health projects. She serves on several advisory groups for health entities in California and has published numerous papers on health and aging.

The use of multiple information mediums to provide diabetes information to Spanish-speaking Latinos

This workshop will provide an overview of first-hand experiences conducting a study designed to assess knowledge acquisition about diabetes among Spanish-speaking Latinos. The study’s main goal was to develop easy-to-understand materials based on personal testimonial accounts in order to assess whether easy-to-understand diabetes materials based on testimonies and delivered through an audiotape enhanced knowledge about diabetes compared to written informational materials. The study also examined the role of television and radio as mediums to disseminate information about diabetes among Spanish-speaking Latinos.

This workshop will illustrate: 1) how easy-to-understand materials focusing on diabetes were developed using a participatory approach with Latinos who have diabetes; 2) how participants who provided testimonial information about their experiences with diabetes were involved in research activities leading to the development of informational materials; 3) how easy-to-read and easy-to-understand diabetes materials were developed using a participatory approach; 4) how non-print materials compared to written materials in terms of consumers' preferences and knowledge acquisition about diabetes; 5) the role played by television and radio as health education outlets among Spanish-speaking Latinos.

Findings from the study indicated that non-print materials (i.e., audiotape) and a brochure developed using testimonial approach significantly increased knowledge about diabetes. Participants seemed to prefer the newly developed materials and seemed to recall more information obtained through the audiotape and new brochure. The study’s findings confirmed the need to develop strategies to further reinforce knowledge about diabetes management through innovative and culturally appropriate outlets.

Dharma E. Cortés received her Doctorate in Sociology from Fordham University in 1991. She is currently a Clinical Instructor and Research Associate at Harvard Medical School's Department of Psychiatry and a Senior Research Associate at the Mauricio Gastón Institute for Latino Community Development and Public Policy at University of Massachusetts, Boston. She has published over fifteen journal articles and chapters in the areas of acculturation, mental health, health, and substance abuse. Her current research is focused on the quality of mental health care among Medicaid and Medicare consumers, access to health care services and health literacy issues among Latinos; as well as the role of culture in the perception of early symptoms of Alzheimer's disease among Latinos. These research projects are supported by grants from the National Institute of Mental Health, the Centers for Medicare and Medicaid Services, and the Pfizer Pharmaceuticals Group’s Health Literacy Initiative, among others.

Dharma E. Cortés, PhD
Senior Research Associate
Mauricio Gastón Institute for Latino Community Development and Public Policy
University of Massachusetts Boston
100 Morrissey Boulevard
Boston, MA 02125-3393
Phone: 617-503-8469
Fax: 781-321-6964
E-mail: decortes@aol.com

NEXT >

essentials | models and practices | policy | legal issues | networking | table of contents | contact us | who we are

Copyright © 2003, DiversityRx; www.diversityRx.org, Last update: June 11, 2005

 Diversity Rx is sponsored by: