Optim timizing Health lth Lit iteracy Pro rograms: : In Innovativ tive St Stra rategies Fro rom th the Fie ield (P (Part rt 2) Ap April il 9, 9, 201 2019
The importance of health literacy Prevalence of low health literacy In 2003, only 12% of American adults had proficient health literacy. 1 Rates were lower for racial and ethnic minorities, nonnative English speakers, and those with a low socio-economic status. 1 Kutner, Greenburg, Jin, & Paulsen, 2006
The importance of health literacy Impact of low health literacy • Low health literacy is linked to variety of poor health outcomes, including higher morbidity rates. 2 • Low health literacy contributes to racial and ethnic health disparities. 3 2 Berkman, Sheridan, Donahue, Halpern, & Crotty, 2011; DeWalt, Berkman, Sheridan, Lohr, & Pignone, 2004; Paasche-Orlow & Wolf, 2007 3 Chaudhry et. al, 2011; Howard, Sentell, & Gazmararian, 2006; Osborn et.al, 2011; Osborn, Paasche-Orlow, Davis, & Wolf, 2007
PRESENTERS FOR TODAY’S WEBINAR Neissly Tapia, Outreach Worker, North Carolina Farmworkers Project. Ms. Tapia uses the Popular Education Insurance Utilization Training Program , which helps seasonal farmworkers learn about how to access needed health care and stay healthy. The program delivers procedures and protocols via song- and video-based activities. Everly Macario, Public Health Research and Communications Consultant . Dr. Macario is a behavioral scientist with expertise in health communications and social marketing. Dr. Macario developed a series of English/Spanish fototabloids that were published in community newspapers, reaching predominantly Hispanic/Latino populations with varying levels of English proficiency and health literacy about diabetes prevention in rural New Mexico. Oscar J. Espinosa, Senior Associate at Community Science. He has led multiple projects in underserved communities around the country that assessed the effectiveness of outreach and education strategies designed to improve access to health care services for difficult-to-reach populations.
USING SONGS AND GAMES TO REACH RURAL FARM WORKERS North Carolina Farmworkers Project Ms. Neissly Tapia
NORTH CAROLINA FARMWORKERS PROJECT Founded in 1994 to promote the organization of farmworkers, help them find o solutions to their problems and give them the tools to better their work conditions, living conditions, and health. Located in Benson, NC o Current programs: o Health education Promotores Project of healthy foods for diabetics Research partnership with Wake Forest University Affordable Care Act outreach and enrollment
OUR PURPOSE o Identify problems o Find solutions o Empower
CHALLENGES Schedule flexibility o Low education levels/reading o proficiency Engage audience in dynamic and o culturally competent way: “De Colores ” song o “El Repollo ” game o Gain audience’s trust and engage them in a conversation o about their health
DEVELOPING THE INNOVATION Popular Education trainings o Team Work o Brainstorming process o Cultural and linguistic o competence El tabaco (The Tobacco) song o (music of De Colores) El Repollo (the cabbage) game o Knowledge gain in an o interactive way Meetings (outreach visits) o Impact (behavior change) o
EL TABACO “THE TOBACCO” SONG Versión en español English version The tobacco, the tobacco has El tabaco, el tabaco tiene nicotine nicotina That comes through your pores. que entra por los poros. The Tobacco, the tobacco is very El tabaco, el tabaco es muy bad, very bad malo, muy malo, Even for the bulls. hasta para los toros. Si se moja, si se moja les puede If it gets wet, if it gets wet you can dar náuseas have nauseas Y también vomitar. And also throw up. // Y es por eso debes cubrirte //And that’s why you should cover con las mangas largas y botas With long sleeves and your boots también. // too. //
EL REPOLLO (THE CABBAGE) GAME Q & A Game o Audience participation o Learn from each other o Changes in behavior o Increase in use of preventive practices o Reduction of allergies and tobacco related o illness
TIPS/ LESSONS LEARNED Flexibility o o Schedules o Needs o Environment o Resources Empathy o o Cultural and linguistic competence o Social and economic issues o Making information useful and accessible Creativity o o Use existing material in a dynamic way Teamwork o o Brainstorm process Community Connection o Partnerships with local clinics and transportation services o Relationships with Farmworkers o
CONTACT INFORMATION Neissly Tapia Janeth Tapia CAC O&E Program Outreach coordinator neissly@ncfwp.org Janeth@ncfwp.org 919-820-7381 919-915-2220 Ana Beltran Anna Jensen CAC O&E Program Executive Director anab@ncfwp.org annaj@ncfwp.org 910-891-8254 919-915-9990
BILINGUAL FOTO-TABLOIDS IN COMMUNITY NEWSPAPERS Dr. Everly Macario Public Health Research and Communications Consultant
MINI-HISTORY OF FOTONOVELAS “ Fotonovela: ” Story using posed photographs (not illustrations), text o bubbles with simple text, dramatic narrative with characters in common everyday situations. Fotonovelas started post-WWII — photo-booklets 1 st produced in Italy as a o by-product of film industry — pictorial summaries of Hollywood films; evolved into their own/unique mediums. 1979: Mexico publishing 70 million copies PER MONTH of fotonovelas / o “ historietas ” (graphic novels with illustrations). 1970s-1980s — fotonovelas became a popular cultural communication / o entertainment medium within U.S. Latino communities. Fotonovelas served as a cultural bridge between an often impersonal, o unfamiliar, and often alienating environment and the more familiar heritage of readers.
SAMPLE 1986 FOTONOVELA
SAMPLE 1986 FOTONOVELA
FOTONOVELAS TODAY Today, fotonovelas read/discussed/loaned/rented/resold among family o members and neighbors. This is important because : 7 in 10 Latinos report obtaining health o information through their social networks (family, friends, churches, community groups). Public Health uses fotonovelas as an educational tool — educational o messages are incorporated into popular entertainment narratives (consciousness raising, dramatic relief) (“edutainment”). Motivation to learn increases when education content relates to personal o beliefs and experiences through open-ended stories, socio-dramas, and pictures depicting typical health-related situations.
SAMPLE BILINGUAL FOTONOVELA (2013 — DATE)
LATINOS IN THE UNITED STATES Latino population in the U.S.: 56.6 million. o 17.6% of total U.S. population. o CHALLENGE: Latinos suffer disproportionately from diabetes and o pre-diabetes. 17% of adult Latinos in the U.S. have diagnosed diabetes, compared o with 8% of non-Hispanic white adults. o For Mexican Americans, who comprise 63.3% of the U.S. Latino population, the rate of diagnosed diabetes is 18.3%.
HISPANICS/LATINOS & HEALTH LITERACY: CHALLENGES Latinos are more likely than non-Hispanic whites to experience o difficulty communicating with their physicians. Spanish-speaking Latinos have more difficulty than whites and African o Americans understanding prescription bottle instructions and written health information obtained from a doctor’s office. Health literacy is an issue for the general population, but for Latinos, o the issue is magnified because: Lack of English language proficiency. o Inadequately translated materials that go from high literacy English to even o higher literacy Spanish. Trouble accessing health care. o Other socio-cultural barriers. o
HISPANICS/LATINOS & RURAL U.S. Latinos are one of the fastest growing RURAL populations in the U.S. o 3.2 million Latinos live in rural areas, comprising 6.3% of the nation’s o non-metro inhabitants. New Mexico is in top 7 states in U.S. with highest concentration of o Latinos living in non-metro areas. CHALLENGE: Meeting rural Latinos’ health information and health o care needs.
PRINT VS. ONLINE HEALTH INFORMATION: CHALLENGES A majority of seniors prefer information in PRINT form to learn about o health. A 2016 study found that only 5%-8% of thousands of Medicare o patients were going online to fill prescriptions, deal with health insurance, or communicate with their doctors. Only 16% were searching for health information online. o
HEALTH LITERACY INNOVATION: FOTOTABLOIDS CHALLENGE : How to address Latino diabetes health disparities in rural o areas? KEY DECISIONS : We combined 3 proven, popular, and credible o communication vehicles for addressing Latino diabetes health disparities in rural areas: Bilingual-- Community newspapers o Health-related fotonovelas in fototabloid format. o Community health promoters/workers (“ promotores ”) . o
FOTOTABLOID CONTENT Fototabloid content was based on CDC National Diabetes Prevention o Program (NDPP) — a program proven to prevent or delay type 2 diabetes. Goal of fototabloids: To motivate Latinos with prediabetes to call for o more information on diabetes prevention or enroll in local NDPP class (sponsored by New Mexico Department of Health). We tested this intervention in Albuquerque (intervention-plus: o fototabloids+promotores), Española (intervention: fototabloids only/no promotores), and Sunland Park in New Mexico (control: posters/pamphlets only [no foto-tabloids/no promotores]).
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