calpact webinar: putting culture into context: communicating with diverse latino communities

Welcome to the Webinar

Health Communica/on Ma1ers! Pu$ng Culture Into Prac0ce:

Communica0ng with Diverse La0no Communi0es

We will begin shortly…

Today you’ll be hearing from. . .

Holley Wilkin, PhD Georgia State University

Sonya Suarez-Hammond Univision Communications, Inc.

Carmen Gonzalez, PhD University of Southern California

I will be your moderator. . .

Nancy Murphy, MSHC Metropolitan Group,

Moderator

Agenda

1.  Review of session objec0ves 2.  Introduc0on of today’s speakers 3.  The New American Reality: Hispanics and Healthcare 4.  Q & A 5.  Crea0ng a Communica0on Ecology 6.  Q & A 7.  Specific ac0ons and resources

Objectives •  Iden0fy diversity among La0no popula0ons and take

appropriate steps to build a communica0on ecology rela0ve to that diversity

•  List at least two healthcare myths about La0nos •  Describe the role that media, community and family

influences play in healthcare decisions •  Describe how to reach La0nos more effec0vely through

culturally relevant communica0on and outreach

Health Literacy: Undervalued by Public Health? A tool for public health professionals. Prepared for the American Public Health Associa0on Community Health Planning & Policy Development Sec0on

Tammy Pilisuk, MPH AUG 2011

Who is speaking today: Sonya Suarez-Hammond

Sonya Suarez-Hammond Senior Director, Strategy & Insights Univision Communications, Inc. Email: [email protected] Website: http://univision.net

Who is speaking today: Carmen Gonzalez and Holley Wilkin


Email: [email protected]

Holley Wilkin, PhD Georgia State University Email: [email protected]

Who is moderating our discussion today:

Nancy Murphy, MSHC Nancy Murphy, MSHC Executive Vice President, Metropolitan Group Email: [email protected] Website: www.metgroup.com

Introducing Sonya Suarez-Hammond

Sonya Suarez-Hammond Senior Director, Strategy & Insights Univision Communications, Inc. Email: [email protected] Website: http://univision.net

Pu@ng Culture Into Context: Communica/ng with Diverse

La/no Communi/es

Presented by: Sonya Suarez-‐Hammond

Senior Director, Strategy & Insights Healthcare Team

Univision CommunicaAons April 8, 2014

Agenda

ü U.S. Hispanics: The New American Reality

ü Hispanic Healthcare Landscape ü Engaging Hispanic Pa/ents ü Key Takeaways

U.S. Hispanics: The New American Reality

The New American Reality 55.7M Hispanics in the U.S. Today!

In 2014 Hispanics represent:

•  17.5% of Total U.S.

Source: U.S. Census Bureau, 2014 National Population Projections July 1, 2012 to July 1, 2060. Released December 2012.




•  24.6% of Children 0-17


The Changing Face of The Na/on’s Youngest Popula/on

Source: National Statistics Reports Volume 62 Number 1. Births Final Data for 2011 Released June 28, 2013

1 in 4 Babies born in the U.S.

is Hispanic

1 in 2 Babies born in CA and TX

is Hispanic





•  19.9% of Adults 18-49






•  19.9% of Adults 18-49

•  9.6% of Adults 50+


Hispanic Popula/on Expected To Double

31% of the U.S. Popula/on Will Be Hispanic By 2060

% of Total

Total

14.622.4

35.3

50.5

63.7

78.6

94.8

111.7

128.7

6.4%9.0%

12.5%

16.3%

19.1%

21.9%

25.0%

27.9%

30.6%

1980 1990 2000 2010 2020 2030 2040 2050 2060

Today: 17.5%

Actual Forecast Source: U.S. Census Decennial Census 1980, 1990, 2000, 2010. 2012 National Projections Released

December 2012.

A ques0on for Sonya

You’ve just shared some great statistics to help clarify myths and misunderstandings about the presence of Hispanics in the U.S. now and in the future. What about some of the myths specifically related to healthcare? What are some of the biggest misunderstandings there?

$40B spent by Hispanics on out-of-pocket

healthcare expenditures in

20124

$19B

42% of Hispanics covered by private insurance3

34% of Hispanics covered by

government insurance3

vs.

71% of all Hispanics currently

have health insurance vs. 88% of Non-Hispanics1

10.2 Million uninsured Hispanics are ACA eligible for

insurance2

Source: 1. U.S. Census Bureau, 2012 American Community Survey (1-Year Estimate); 2. Center for Medicaid and Medicare Services 2011 Analysis of uninsured and eligible population; 3. Census Bureau, Current Population Survey, 2012 Annual Social and Economic Supplement.; 4. Global Insight

2013 Hispanic Market Monitor Forecast ; 5. Symphony Health TRx Retail Dollars MAT Ending September 2013, Based on Adults 18+.

Dispelling Hispanic Healthcare Myths Health

Expenditures Health Insurance

U.S. Hispanics Healthcare Landscape

Percep/on is Not Reality

47% of Hispanics rate their health as very good/excellent vs. 38% of Non-‐Hispanics

Source: 2012 UCI Pa0ent Journey Proprietary Research Note: Survey respondents reflect symptoma0c or diagnosed pa0ents suffering from at least one of 9 diseases measured in the study.

Even though Hispanics have high prevalence of many disease states,

their health perceptions are still more positive…

Source: 2010 Yankelovich MONITOR Multicultural Marketing Study, Based on P16+. Top 2 Box Summary of Amount of Worry or Stress Caused by Each of the Following

In Healthcare It’s All About the Family

62% of Hispanics vs. 47% of Non-Hispanic Whites

The Health of Other Family Members

“I worry about….”

Source: 2010 Yankelovich MONITOR Multicultural Marketing Study, Based on P16+. Top 2 Box Summary of Amount of Worry or Stress Caused by Each of the Following

In Healthcare It’s All About the Family

62% of Hispanics vs. 47% of Non-Hispanic Whites

The Health of Other Family Members

“I worry about….”

42% of Hispanics vs. 23% of NH Whites

Taking Care of Elderly Family Members

Family Dynamics and Cultural Values Impact Healthcare Behavior

Multi-Generational Household Structure


Familialismo & Collectivism



A Holistic Approach

to Healing

Familialismo &

Collectivism



A Holistic Approach

to Healing

Power Distance


Familialismo &

Collectivism


Power Distance

Spiritualism & Religion

Familialismo &

Collectivism

A Holistic Approach

to Healing



Power Distance


Familialismo &

Collectivism

A Holistic Approach

to Healing

Fatalism



Power Distance


Familialismo &

Collectivism

A Holistic Approach

to Healing

Fatalism

Machismo & Marianismo


Hispanics Rely on Family and Friends

57% of Hispanics cite “friends/family” as a source of health and nutrition info vs. 41% of Non-Hispanics

Source: UCI Patient Journey Proprietary Research 2012; Based on Hispanics who visited a doctor and have a positive relationship. Note: Survey respondents reflect symptomatic or diagnosed patients suffering from at least one of 9 diseases measured in the study.

25% 32%

45% 46%

57%

67%

5% 11%

52%

61%

39%

58%

Health Insurance Companies

Pharmaceu/cal Manufacturers

Nurses Pharmacists Hospitals Doctors

Hispanic Non-‐Hispanic

Hispanics Are More Trus/ng in their Sources of Healthcare Informa/on

Source: Univision / Experian Simmons/ Pharmaceuticals Advertising Awareness Study Base: Total Respondents Q9. Using a scale of “1” to “5” where “1” is “not at all trustworthy”

and “5” is “extremely trustworthy”, please indicate how much you trust in each of the following.

Cultural differences appear in varying levels of trust in health care professionals

A ques0on for Sonya

Wow! That’s a great picture you’ve just painted for us about the influences in health and healthcare decisions. So what should we do with that information? How can we apply that information to improve communication and engagement with Hispanics in healthcare settings?

Understanding and Engaging Hispanic Pa/ents

Internal Tug-‐of-‐War

Source: Univision Patient Journey primary research Source: 2012 UCI Pa0ent Journey Proprietary Research -‐ Focus Groups

Among Hispanics

Top 3 Challenges to Seeking Medical Care

Among Non-‐Hispanics

1st Prefer to use a healthy diet and exercise


Source: 2012 UCI Pa0ent Journey Proprietary Research; Note: Survey respondents reflect symptoma0c or diagnosed pa0ents suffering from at least one of 9 diseases measured in the study.

Among respondents who saw a Dr/Specialist for their Primary Condi0on & waited more than a month to make an appointment from the 0me their symptoms started OR they did not see a Dr/Specialist for their Primary Condi0on.

Among Hispanics




2nd Feel I am in good health overall so I don’t need to seek medical care


2nd Afraid of worrying my

family if I am found ill



Among Hispanics




2nd Feel I am in good health overall so I don’t need to seek medical care

3rd Afraid of the possibility of needing surgery


2nd Afraid of worrying my

family if I am found ill 3rd Difficult for me to leave

home due to family care responsibili/es



Key Drivers Offer Mo/va/on

Top INFLUENCERS among Hispanics to seeking medical care: “I want to be healthier than I am now” “I want to prevent any limita/ons to my ac/vi/es “ “I’m afraid I won’t get be1er without medical care “ “I don’t want my illness to prevent me from enjoying family /me or celebra/ons “

Source: 2012 UCI Pa0ent Journey Proprietary Research; Based on Hispanics who visited a doctor and have a positive relationship. Note: Survey respondents reflect symptoma0c or diagnosed pa0ents suffering from at least one of 9 diseases measured in the study.

The Doctor-‐Pa/ent Rela/onship Needs A1en/on

Characterizing Rela/onship with their Primary Care Doctor:

Makes me feel at ease Only 42% of Hispanics vs. 56% of Non-Hispanics




Makes me feel at ease Only 42% of Hispanics vs. 56% of Non-Hispanics Understands my needs Only 40% of Hispanics vs. 55% of NHs




Makes me feel at ease Only 42% of Hispanics vs. 56% of Non-Hispanics Understands my needs Only 40% of Hispanics vs. 55% of NHs Respects my opinion Only 36% of Hispanics vs. 49% of NHs




Makes me feel at ease Only 42% of Hispanics vs. 56% of Non-Hispanics Understands my needs Only 40% of Hispanics vs. 55% of NHs Respects my opinion Only 36% of Hispanics vs. 49% of NHs Understands my fears Only 31% of Hispanics vs. 39% of NHs


A Holis/c Approach to Disease Awareness and Educa/on

Family & Friends

Healthcare Professionals

Pharmacists Clinics & Health Fairs

Media (Tradi/onal, Digital, Social)

Community & Cultural Events

Media Plays a Cri/cal Healthcare Role and Helps Hispanics Take Ac/on

83% of Hispanics received health

information from the media, and

79% took action from the media.

Source: 2008 PEW Research http://pewresearch.org/pubs/923/hispanics-health

79% Took Action from Media

IMPACT of MEDIA

83% 71% 63% 31%

From the Media: TV, Radio, Print, Internet

From Doctors & Other Health Professionals

From Family & Friends

Church or Community Groups From the Media:

TV, Radio, Print, Internet

41% 57% 64%

Affected decision on how to treat an illness or medical condi/on

Lead to ask a doctor or other medical professional new

ques/ons

Changed their way of thinking about diet & exercise

Key Takeaways ü Today’s U.S. Hispanic market is a growing, dynamic and

evolving population group reflecting a new American reality.



ü Hispanic culture and family dynamics impact healthcare decisions and behaviors. Hispanic cultural insights should be leveraged in Hispanic communications for optimal patient engagement.




ü Cultural communication gap must be closed. Reach the Hispanic patient through culturally relevant communication outreach.




ü There is a cultural communication gap that must be closed. Reach the Hispanic patient through culturally relevant communication outreach.

ü Understanding cultural factors can lead to better Hispanic patient engagement and improved health outcomes.

Thank You. Gracias.

Discussion/Q&A

Ask Sonya! Share with Sonya!

Introducing Carmen Gonzalez and Holley Wilkin



A Communication Ecology Approach to Studying Latina Health

Holley Wilkin, Ph.D. & Carmen Gonzalez, Ph.D. University of Southern California Georgia State University

Goals/Preview

¨  Introduce communication infrastructure theory

¨ Present a community-level case study of Latina health

“85 or 90 percent of the time they’re super full. They people are sleeping from waiting so long. If only it were easier, if they had more clinics, perhaps they’d have better service.…A mother of a 5-year old girl in Pico Union

Our focus group participants say…

“There are insurances that they do not accepts in all the clinics,…and some of the nurses are really mean. We’re not asking for anything for free…it’s even less [welcoming] if one doesn’t speak English well and doesn’t understand”

A mother of two kids in South Gate

Communication Infrastructure Theory

Neighborhood Storytelling

Network

RESIDENTS & FAMILIES

LOCAL MEDIA

COMMUNITY ORGS


“85 or 90 percent of the time they’re super full. They people are sleeping from waiting so long. If only it were easier, if they had more clinics, perhaps they’d have better service.…A mother of a 5-year old girl in Pico Union

Our focus group participants say…

“There are insurances that they do not accepts in all the clinics,…and some of the nurses are really mean. We’re not asking for anything for free…it’s even less [welcoming] if one doesn’t speak English well and doesn’t understand”

A mother of two kids in South Gate

Communication Environment

Neighborhood Storytelling

Network

RESIDENTS & FAMILIES

Ethnic Diversity

Public Spaces (Libraries, parks,

etc.)

Street Safety

Transportation

Goods & Services

Work Conditions

Area Appearance

Schools

Health Care Resources

Law Enforcement

LOCAL MEDIA

COMMUNITY ORGS


Storytelling Network & Health

Local/ Ethnic Media

Community & Non-Profit

Organizations

Residents/ Families

The storytelling network

+


Local/ Ethnic Media


Organizations

Residents/ Families


+

Breast cancer & diabetes knowledge (Kim et al., 2011)


Local/ Ethnic Media


Organizations

Residents/ Families


+


Perceived ease of receiving medical care (Wilkin & Ball-Rokeach, 2011)


Local/ Ethnic Media


Organizations

Residents/ Families


+


Perceived ease of receiving medical care (Wilkin & Ball-Rokeach, 2011)

Exercise (Wilkin et al., 2012)

Inconsistent & Additional Findings

¨ No relationship: ¤ Prostate cancer knowledge (Kim et al., 2011)

¤ Fruit and vegetable intake (Wilkin et al., 2012)

A ques/on for Carmen/Holley

So if your research shows that the storytelling network can have some real positive outcomes for health, how do we use it? What does that look like?

Implications

¨ Strengthen STN connections

¨ Turn to the STN to tell stories about health issues

¨  Identify communication ecologies

COMMUNICATION ECOLOGIES IN LOS ANGELES | GLENDALE


Anglos in Glendale

26%

38% 32%

Mainstream TV

M. Newspapers

Interpersonal

13% Internet


Anglos in Glendale

26%

38% 32%

Mainstream TV

M. Newspapers

Interpersonal

13% Internet

Armenians in Glendale

30% 30%

12% 19%

Mainstream TV

Geo-‐Ethnic TV

M. Newspapers

Interpersonal


Anglos in Glendale

26%

38% 32%

Mainstream TV

M. Newspapers

Interpersonal

13% Internet

Armenians in Glendale

30% 30%

12% 19%

Mainstream TV

Geo-‐Ethnic TV

M. Newspapers

Interpersonal

La/nos in Glendale 31% 27% 25% 25%

Mainstream TV

Geo-‐Ethnic TV

M. Newspapers

Interpersonal



Mainstream TV

Geo-‐Ethnic TV

M. Newspapers

Interpersonal



Mainstream TV

Geo-‐Ethnic TV

M. Newspapers

Interpersonal

La/nos in Pico Union

19%

45%

17%

33% Mainstream TV

Geo-‐Ethnic TV

G-‐E Newspapers

Interpersonal

USC’s Multilevel Study

The Multilevel Study identifies individual, interpersonal, and community-level barriers to cervical cancer prevention

among Latinas.

Cervical Cancer in LA County by Ethnicity

9.3

7.6

14.3

7.5

0

2

4

6

8

10

12

14

16

Asian Black Latina White Incidence rates per 100,000. Source: LA County Department of Public Health, Office of Women’s Health. Health Indicators for Women in Los Angeles County, February 2010.

Multilevel Study Design

1,655 in-person surveys of Latinas in LA County

identification of 25 neighborhood clusters

focus groups with survey respondents from 6 unique neighborhoods

health communication asset mapping

systematic social observation in 6 unique neighborhoods

Theoretical Framework

sister

mom

home remedy

internet

doctor

neighbor

otc

magazine

home remedy

clinic

“A communication ecology is a network of communication resources constructed by an individual in pursuit of a goal and in context of their communication environment” (Metamorphosis Project, 2011)

Transnational Health

Transnational Health Findings

¨  54% use products from a botanica

¨  52% use home remedies regularly

¨  37% use non-prescription medicine from their home country

¨  30% use prescription medicine from their home country


ü  Women who report higher levels of transnational health experience higher disregard of their feelings or emotions on behalf of medical professionals.


ü  Women who report higher levels of transnational health experience higher disregard of their feelings or emotions on behalf of medical professionals.

ü  Women who report higher levels of transnational health are more likely to be non-compliant with cervical cancer screening guidelines (having a Pap test every 3 years).

A ques/on for Carmen/Holley

Wow! More great insight to help us understand the Hispanic healthcare consumer. Can you share with us some specific tools or techniques for improving communication?

Health Communication Asset Mapping (HCAM)

Concepts & Definitions

•  Communication Assets: physical components of the urban environment that residents consider positive spaces of social and community interaction

•  Health Communication Assets: spaces where residents feel comfortable talking about health or where health information can be shared with the community

Concepts & Definitions

•  Communication Assets: physical components of the urban environment that residents consider positive spaces of social and community interaction

•  Health Communication Assets: spaces where residents feel comfortable talking about health or where health information can be shared with the community

Communication assets can be used as capacity-building blocks to promote healthier

communities and strengthen neighborhood storytelling networks.

Boyle Heights

HCAM Workshop

HCAM Curriculum

Collaborative Map

Collaborative Map

1. LAC+USC Medical CenterAlso known as County/USC, this is the largest healthcare provider in Los Angeles County. LAC+USC is one of the few medical centers in LA that provides low-cost or free health services, including emergency, gynecological and pediatric care.

2. East Los Angeles Occupational Center ELAOC provides technical training and job placement for adults and high school students. It was chosen as a health communication asset because it is a space where health fairs or workshops with residents can be held.

3. Proyecto PastoralThis community building organization provides training, education and social services for the Boyle Heights community. It is a space that can promote health by organizing change from within the community.

4. Self Help GraphicsThis is a non-profit visual arts center that hosts many art events and workshops for residents of all ages. They are a vital community resource that can incorporate health topics in their arts and culture programs.

5. White Memorial Medical CenterWhite Memorial is a not-for-profit, faith-based, teaching hospital. It provides inpatient, outpatient and emergency services to the community, including general medical care and women’s and children’s services.

6. Mariachi PlazaThis historic square includes restaurants, a Metro Gold Line station, and shops such as the bookstore Libros Schmibros. It has traditionally served as a gathering place for the community and would be a good place to share information with residents.

7. Mendez Learning CenterThe Center is a small public high school that prepares students for success while maintaining a focus on family and community. Health can be promoted here through educational activities that are already in place.

8. Boyle Heights Technology Youth CenterThis community resource center is part of the LA Youth Opportunity Movement and includes an alternative high school, recording studio and computer lab. It is a good space to `share health information with young residents.

9. Hollenbeck ParkThis park is very well known in the community as a space where many events occur, including large health fairs. Hollenbeck park is a place where families go to relax and spend time interacting with other residents.

10. Stevenson Parents CenterAs part of Stevenson Middle School, the Center was created to promote the involvement of parents in youth education. The center can be a good place to promote community health through educational activities.

GET INVOLVED! A healthy Boyle Heights depends on residents, community organizations, and health workers sharing health information. Here are some examples of resources to share:

This work was supported by the National Cancer Institute for Barriers to Cervical Cancer Prevention in Hispanic Women: A Multilevel Approach, which was an award to the University of Southern California (R01CA155326 - Murphy/ Ball-Rokeach). The content is solely the responsibility of the authors and does not represent official views of the NCI or of the National Institutes of Health.

There are many spaces in the community where people gather or feel comfortable talking about health. Below we highlight some of the health communication assets in Boyle Heights.

ENVIRONMENTAL JUSTICE & AIR POLLUTION: Air Quality Management District (AQMD): report pollution in your neighborhood (noise, smells, & smoke from local industry; pollut-ing vehicles) – 1-800-CUT-SMOG Clean Up Green Up: Find out how to get involved in local environ-mental justice work. Visit www.CLEANUPGREENUPLA.org

CLINICA ROMERO: For information about pap tests, mammograms, and pre-natal care 213-989-7700 FOR NEW PATIENTS

BUILDING HEALTHY COMMUNITIES BOYLE HEIGHTS COLLABORATIVE: A collaborative of nonprofit groups working to make Boyle Heights a healthier community by improving employment, education, housing, safety, environmental conditions, healthy food access and more. For information, please contact Joel Perez at [email protected].

EAST LOS ANGELES WOMEN’S CENTER: Ensures that all women, girls, and their families live in a place of safety, health, and personal well-being, free from violence and abuse, with equal access to necessary health services and social support. DIRECT LINE: 323-526-5819, BILINGUAL RAPE & BATTERING HOTLINE: 800-585-6231, AIDS HOTLINE: 800-400-7432

211: A countywide human services crisis intervention, information and referral assistance hotline. 311: A citywide toll-free number that provides immediate access to information and more than 1,500 non-emergency city services

BOYLE HEIGHTS BEAT: A bilingual community newspaper produced by youth. Adult con-tributors also share their stories on BOYLEHEIGHTSBEAT.COM/PULSODEBOYLEHEIGHTS.COM. Find out how to be a community contributor by visiting the site or calling 323-834-975.

Corra La Voz Spread The Word

“We chose Hollenbeck Park because it is very well known among the community, and

in fact there was a health fair when we stopped there.”

HOW WE MADE THIS MAP: Promotoras de Salud, community organizers, and researchers walked the neighborhood and mapped good spaces where health communication can occur.

For more information on this map go to www.metaconnects.org.

GIS MAP

Key Takeaways

No “one size fits all” for outreach

Include the perspective of residents and community leaders

Use the indigenous storytelling network in your outreach

Figure out what health storytellers are most important to your audience

Identify local communication assets and resources

THANK YOU

Questions for our speakers


Sonya Suarez-Hammond Univision Communications, Inc.

Carmen Gonzalez, PhD University of Southern

California

Evalua/on & Ques/ons

•  An evaluation will pop up following today’s webinar ─ please share your feedback that will help us improve future webinars

•  Let us know if you’d like to follow-up on anything we touched on today

•  Additional questions? Contact our presenters or moderator

Resources •  hep://www.univision.net/healthcare

•  hep://www.metamorph.org

•  hep://www.metaconnects.org

97

Speaker Contact Informa/on

Sonya Suarez-‐Hammond ssuarez-‐[email protected]

Carmen Gonzalez, PhD [email protected]

Holley Wilkin, PhD [email protected]

Thank you to our Sponsors

Community Health Planning and Policy Development Section, APHA

Thank you to our planning commi1ee

•  Tammy Pilisuk, MPH, APHA-‐CHPPD •  Erin Brigham, MPH, CareSource, APHA-‐CHPPD •  Meghan Bridgid Moran, PhD, San Diego State University, School of Communica0ons

•  Lisa Peterson, MPH, CALPACT at UC Berkeley •  Nancy Murphy, MSHC, Metropolitan Group •  Stefanie Smithey, Metropolitan Group

About This Series •  The Health Communica<on Ma=ers series will help par0cipants in all

walks of public health to apply health literacy principles to their everyday communica0ons.

•  What audiences do you communicate with—consumers, health

professionals, disenfranchised communi0es, your public health peers? Whatever your role in public health, it’s likely that you need to communicate effec0vely. But how do you know your communica0on is effec0ve?

•  Only about 10 percent of the general popula0on is considered “health

literate.” That leaves the vast majority of us with barriers to understanding the health-‐related informa0on we read.

Conclusion

Thank you!

www.calpact.org

calpact webinar: putting culture into context: communicating with diverse latino communities

Education