Nutrition Literacy: Approaches to Reach Spanish-speaking Audiences - PowerPoint PPT Presentation

Nutrition Literacy: Approaches to Reach Spanish-speaking Audiences L. Karina Díaz Rios, PhD, RD UC Cooperative Extension Specialist in Nutrition

Percentage of Adults at Each Health Literacy Level: 2003 ALL WHITE Below Basic Proficient Below Basic Proficient 9% 12% 14% 14% Basic 19% Basic 22% Intermediate Intermediate 52% 58% U.S. Department of Education, 2003 National Assessment of Adult Literacy

Percentage of Adults at Each Health Literacy Level: 2003 ALL HISPANIC Proficient 4% Proficient Below Basic 12% 14% Below Basic Intermediate Basic 40% 31% 22% Intermediate 52% Basic 25% U.S. Department of Education, 2003 National Assessment of Adult Literacy

Language other than English Hispanic/Latino ability to spoken at home: 2014 speak English: 2010-2014 20.9% of US population not at all Other 10% 4% Asian not well 16% 17% very well 55% Spanish Indo-European well 62% 18% 18% U.S. Census Bureau, American FactFinder U.S. Census Bureau, 2010-2014 American Community Survey 5-Year Estimates

Self-Reported Poor Health Status, 2007 California Health Interview Survey (CHIS) ALL LATINO Health Literacy Health Literacy low adequate low adequate English Proficient English Proficient 45.1% 41.1% 44.5% 42.4% 22.2% 13.8% 22.6% 17.3% Sentell & Braun. J Health Commun . 2012;17(Suppl 3):82-99

CLAS Principal Standard National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health and Health Care The National CLAS Standards are intended to advance health equity, improve quality, and help eliminate health care disparities by establishing a blueprint for health and health care organizations to: Principal Standard: “Provide effective, equitable, 1. Provide effective, equitable, understandable, and respectful quality care and services that are responsive to diverse cultural health beliefs and practices, preferred languages, health literacy, and other communication needs. Governance, Leadership, and Workforce: 2. Advance and sustain organizational governance and leadership that promotes CLAS and health equity through policy, understandable, and practices, and allocated resources. 3. Recruit, promote, and support a culturally and linguistically diverse governance, leadership, and workforce that are responsive to the population in the service area. 4. Educate and train governance, leadership, and workforce in culturally and linguistically appropriate policies and respectful quality care and practices on an ongoing basis. Communication and Language Assistance: 5. Offer language assistance to individuals who have limited English proficiency and/or other communication needs, at no cost to them, to facilitate timely access to all health care and services. services that are responsive 6. Inform all individuals of the availability of language assistance services clearly and in their preferred language, verbally and in writing. 7. Ensure the competence of individuals providing language assistance, recognizing that the use of untrained individuals to diverse cultural health and/or minors as interpreters should be avoided. 8. Provide easy-to-understand print and multimedia materials and signage in the languages commonly used by the populations in the service area. Engagement, Continuous Improvement, and Accountability: beliefs beliefs and practices , practices 9. Establish culturally and linguistically appropriate goals, policies, and management accountability, and infuse them throughout the organization’s planning and operations. 10. Conduct ongoing assessments of the organization’s CLAS-related activities and integrate CLAS-related measures into measurement and continuous quality improvement activities. preferred languages, 11. Collect and maintain accurate and reliable demographic data to monitor and evaluate the impact of CLAS on health equity and outcomes and to inform service delivery. 12. Conduct regular assessments of community health assets and needs and use the results to plan and implement health literacy health literacy , and other services that respond to the cultural and linguistic diversity of populations in the service area. 13. Partner with the community to design, implement, and evaluate policies, practices, and services to ensure cultural and linguistic appropriateness. 14. Create conflict and grievance resolution processes that are culturally and linguistically appropriate to identify, prevent, communication needs” and resolve conflicts or complaints. 15. Communicate the organization’s progress in implementing and sustaining CLAS to all stakeholders, constituents, and the general public. Office of Minority Health, U.S. Department of Health & Human Services.

Complexity & Culture & Norms Difficulty Individual Capacity Barriers to change health-related PRINT Reading Fluency • Prose LITERACY • Quantitative • Document ability to understand Knowledge written health info IMPROVED Attitudes HEALTH Self-efficacy health-related Behavior Change ORAL Prior Knowledge • Vocabulary LITERACY • Conceptual knowledge of heath & healthcare ability to orally communicate about health Complexity & Difficulty Baker DW. J Gen Intern Med . 2006;21: 878–883

Surface Structure Deep Structure A C C E P TA N C E S A L I E N C E Prerequisite for feasibility Determines effectiveness (i.e., face validity) Underlying conceptions & values informing people’s Apparent characteristics perception of the world E.g., traditional foods in materials and examples, Cultural values, moral, deliver program in Spanish beliefs, stressors and in familiar locations E.g., familismo , personalismo , fatalism, simpatía Demands empathy & rapport Resnicow K, et al. Ethn Dis . 1999;9(1):10-21 Ojeda L, et al. Hisp J Behav Sci . 2011;33(2):184-203

H. Gibbs, et al M. Townsend, et al

Examination by subject- matter experts for conceptual integrity assurance. Involves back-translation Forward Equivalence Translation Verification Native speakers, bilingual, bicultural researchers Appraisal of respondents’ Cognitive comprehension & congruence with Interviewing intended meaning Tran TV. Developing Cross Cultural Measurement. Oxford University Press; 2009 Townsend MS, et al. J Nutr Educ Behav . 2008;40(3):181-186

Cognitive Domains of Cognitive Interview Questions Interviewing Are there any Can you words that you please read would change? Does the the question Spanish aloud? COMPREHENSION APPROPRIATENESS version ask the same as the English version? CLARITY RELEVANCE How would you respond to this VISUALS BILINGUAL question? What does this scenario Does the photo look like represent the in your question asked? household? Tran TV. Developing Cross Cultural Measurement. Oxford University Press; 2009 Townsend MS, et al. J Nutr Educ Behav . 2008;40(3):181-186

Examination by subject- matter experts for conceptual integrity assurance. Involves back-translation Pre-Final Forward Equivalence Version Translation Verification Native speakers, bilingual, bicultural researchers Appraisal of respondents’ Cognitive comprehension & congruence with Interviewing intended meaning Tran TV. Developing Cross Cultural Measurement. Oxford University Press; 2009 Townsend MS, et al. J Nutr Educ Behav . 2008;40(3):181-186

Culturally Sensitive Nutrition Education ¡SALUD! Comiendo en Familia Latino parents with young children Social Cognitive Theory Healthy eating Knowledge Self-efficacy Outcome expectancies Barriers Goal Setting Diaz-Rios LK, et al. J Nutr Educ Behav . 2016;48:425-429 Bandura A, et al. J Pers Soc Psychol . 1977;35(3):125-139.

Culturally Sensitive NE Approach for Latino Parents with Young Children TALK HEART HANDS Facilitated group Emotion-based Skill-building discussions, materials activities round-table style Storytelling Goal-setting Information Touching Hearts, Self-efficacy Touching Minds Barriers Abusabha R, et al. J Am Diet Assoc . 1999;99(1):72-76 Colchamiro R, et al. J Nutr Educ Behav . 2010;42(3S):S59-S65

Improving eating My Childhood Meals EBM: Follow the practices learned Welcome Cobwebs & Cables: Leader (Role Magic Word (Goals) from family when Shaping Habits Modeling) a child Foods in their Groups Incorporate Florence’s Story: The Superfood EBM: Tasteful Gifts Superfoods Superfoods in Failure & Success Tomorrow's (Superfoods) the diet Today's Breakfast Breakfast My Family’s Plate & Discovering Portion Create nutritious The Son’s Letter: My Plate Health, Today & Sizes meal plates Gifts from Parents Tomorrow Creating Meals Make healthier Stone-Breaking Men, Food Label Inspector Reading "Not all that shines is choices using Moms Cooking: A Finding the Healthiest Labels gold" food labels Wellness Vision Choice Establish a meal schedule and a The Fly in the Wall: EBM: Set the Table Experiment Recipe Let’s Eat healthy meal Family meals (Family Meals) My Breakfast Plate environment Diaz-Rios LK, et al. J Nutr Educ Behav . 2016;48:425-429 Colchamiro R, et al. J Nutr Educ Behav . 2010;42(3S):S59-S65