Reaching out to the Latino Community

This month we are presenting the results of our recently conducted survey on how to better provide health information to the Latina community. Since 1990 the Latino population in North Carolina has more than quadrupled. The North Carolina Healthy Start Foundation is committed to reaching this population by developing culturally and linguistically appropriate health information campaigns and materials. Starting in 1998, with its Marta Campaign, the Foundation promoted the services of a 1-800 resource line (now called the NC Family Health Resource Line) and two publicly funded health insurance programs for children. In 2000, the face of the campaign changed to Ana María.

To ensure that our campaign continues to meet the needs of the Latina community, in May 2009, we conducted an online survey of service providers who have ordered our Spanish-language materials in the last two years. We also conducted in-person interviews with Latinas who are the intended target of our materials. The information will help us make any needed changes to our materials and campaign. In the meantime, we hope that some of the information we gathered will be useful to you as you work with your Latina clients.

Profile of survey respondents

Online Survey
Our survey went out to 818 service providers and we had a response rate of 35%. Respondents to our online survey represented 82 of the 100 N.C. counties. More than 40% were from health departments and another 15% worked for a nonprofit or community-based organization. The most common occupation among respondents was nursing (20%) followed by supervisor/managers of an organization and Health Check coordinators (11% each). About 75% of respondents described themselves as not having the ability to speak Spanish or having only basic Spanish skills. More than 50% of respondents said they would attend a regional training to help them better understand Latino culture and how to use the Spanish-language materials.

Latina community interviews
The 54 Latinas who were interviewed in Spanish were from 10 counties (Chatham, Duplin, Harnett, Johnston, Nash, Sampson, Wake, Watauga, Wayne and Yadkin). The majority (35%) lived in Wake County, followed by 18% from Watauga County and 16% from Chatham County. About 66% of respondents were born in Mexico, followed by 20% born in Honduras. The remaining respondents were from El Salvador, Venezuela, Uruguay, Argentina and Colombia. Their time living in North Carolina ranged from 3 months to 23 years. The women were between the ages of 18 and 56 and most of them had children (from 1 to 7 each). About 10% of the women did not have any children.

These participants were asked to rate their ability to speak, understand, read and write English and Spanish. More than 50% stated they could speak "a little" English. About 40% said they could understand "a little" English. In terms of reading skills, more than 80% reported their ability to read in Spanish as "very good" and almost 40% said they had no ability to read in English. About 27% of the women interviewed said they had completed nine years of education, while 38% said they had completed high school.

Our written materials

We aim to write our Spanish-language materials at a low reading level and we focus test our materials with the intended audience to make sure that the content is understandable. About 10% of respondents from our online survey felt that the reading level of our materials is too high. Given the diversity of the population that we try to reach, we aim for a balance between reading level and sufficient content. We asked in both surveys about different formats we have used in our publications.

Fotonovela (picture story)
We have used the fotonovela format in publications covering the topics of folic acid, Sudden Infant Death Syndrome and children’s health insurance. This format presents the information as part of an individual’s story, with pictures of people the reader can relate to and with few words. This format reflects a cultural tradition of reading comic books which has been adapted as a tool for health literacy.

More than 40% of online survey respondents felt that an individual’s story is the most effective way to convey health messages to Latinos and about 25% picked fotonovelas as one of the ways their clients like to receive health information. Based on the community interviews, we found that 78% of respondents felt they could identify with the main character, Ana María, featured in the fotonovelas. More than 90% felt that the fotonovela format provided information in a way that was easy and useful to understand.

Magazine style
Mujer Total (published in 2007) uses a magazine-style format to cover a variety of topics. This format has more text, but encompasses one topic per page. Since its publication, we’ve received positive feedback from health educators who use it to address specific topics with their clients. We find that it is also a popular piece when we exhibit our materials in the community.

About 30% of online survey respondents stated that their clients prefer this format to receive health information. Interestingly, when given the choice, more than 70% of the Latinas we interviewed picked Mujer Total over the fotonovela, citing the varied topic content, colors and size as reasons for their preference.

Other ways to reach Latinas

We also started to explore other formats, including audio, to get health messages to Latinas. We currently have an audio version of Healthy Mom, Healthy Baby/ Mamá Saludable, Bebé Saludable on our Web site both in English and Spanish. Women can listen to the recording on the Web site and follow along with the electronic file on the site or with a hardcopy of the book. We also developed three one-minute videos on the topic of safe fish consumption which are also available on our Web site www.mamasana.org. These videos were developed as a television news brief, based on a different survey we conducted which found that Latinos frequently get their health information from television. In the current community interviews 25% of respondents said that the most common way they obtain health information was from television, followed by about 21% from staff at their health clinics.

The Internet

Is the Web a good way to reach Latinas? Less than 1% of service providers thought that Latinas prefer the Internet as a way to receive health information. In our community interviews, we asked about the use of the Internet in two ways, first as part of a list of options of how they currently receive health information and then directly "do you use the Internet to find health information?" About 5% included the Internet as one of the ways they currently get information. When asked directly, about 37% responded that they use the Internet. Respondents with the highest levels of formal education (high school and college) and who rated themselves as "good" or "very good" in English were more likely to report using the Internet. This trend is similar to a national study done in 2008 by the Pew Hispanic Center.

In our community interviews, about 40% of the respondents use Google to search for health information and 13% use the Web site of Univision, the Spanish language television channel, to find health information. While we did not specifically survey young people, we predict that more and more young Latino immigrants being raised in the U.S. will be using the Internet; making our information available on the Web is a good way to serve them.