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Reaching out to the Latino Community

Two friends viewing Mujer TotalThis 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 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.Couple looking at laptop

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.

What about bilingual materials?

Should all our materials be bilingual? We asked service providers who request our materials what would help them distribute Spanish-language health education materials and more than 60% said they would like materials to be bilingual. We also asked Latinas how they prefer to receive written materials. More than 50% preferred materials in Spanish and almost 45% preferred bilingual materials. In both surveys we asked what the respondents thought would be the preference of young Latinos (none of the respondents were under 18). More than 50% of service providers and more than 60% of community members felt that materials for Latino youth should be bilingual. We will explore the bilingual format for future publications.

What health topics do Latinas want to know about?

We asked respondents in both surveys to identify the top three health topics of interest for Latinas. Although we cannot really compare responses because the service providers responded in terms of the clients they serve and the community respondents may or may not be representative of those clients, it is interesting to see that the topics selected do not match. Based on the service provider survey, Latinas most often ask about pregnancy or prenatal care (58%), infant health or development (44%) and family planning or birth control (33%). According to community participants, the topics of most interest to them are nutrition/weight control (15%), dental health (15%) and low-cost medical insurance (12%). The difference could be explained by who is seeking health services (young Latinas who are pregnant or recently pregnant) from the service providers who answered the survey. A closer look at our community responses showed that those who were 18-25 were more interested in information on pregnancy and prenatal care than older respondents; and women 18-35 were more interested in infant health topics than women older than 35 years.


Based on the survey and community interviews, we have the following recommendations for reaching out to your Latina clients:

  1. Ask you clients what other health topics they would like information on.
  2. Provide clients with written materials that reinforce the topic you have addressed with them.
  3. Ask clients if they have access to the Internet and if so, direct them to Web sites that have credible health information.
  4. Provide clients with the phone number of the bilingual NC Family Health Resource Line 1-800-367-2229.
  5. Make Internet access an option at health departments or community organizations.

Here at the Foundation we plan to:

Latinos At-A-Glance
  • Latinos account for 6% of North Carolina’s population or about 500,000 people1
  • 17% of North Carolina babies born in 2007 were Latino2

Among Latinas surveyed in 10 counties in North Carolina:

  • 65% seek out health professionals for health information
  • 35% prefer to get written health information
  • 37% use the Internet to get health information

According to service providers who answered our online survey:

  • 12% of service providers reported that their clients speak an indigenous language (a language native to their home country other than Spanish)
  • 84% reported having clients from Mexico
  • 45% reported having clients from Guatemala

  1. North Carolina Minority Health Facts: Hispanic/Latinos. December 2006.
  2. 2007 North Carolina Infant Mortality Report, Table 12. North Carolina Residents Live Births: Percent by Race /Ethnicity, 2005/2007. NC State Center for Health Statistics.

Health Resources en Español

  1. The NC Family Health Resource Line (1-800-367-2229) Provides information in English and Spanish to callers on a variety of health topics. Caller can be given information about services in her county and receive a packet of information.
  2. This Web site created by the North Carolina Healthy Start Foundation provides information to the public in Spanish. Includes a section Vea y escuche (Watch and listen) with a variety of radio and television spots, interviews and videos in Spanish.
  3. Mama Sana, Bebé Sano This is the combined audio/pdf version of Healthy Mom, Healthy Baby in Spanish.
  4. Safe Fish Consumption videos. Three one-minute videos explain the importance of eating fish, the problem with mercury and which fish to avoid, and describe correct portion sizes.  Accompanying brochure on the topic also available on the Web site.

5 Useful Spanish Phrases

  1. ¿Le gustaría más información sobre el tema que hablamos hoy? (Would you like more information about the topic we discussed today?)
  2. Este folleto le da más información sobre el tema que platicamos hoy. (This brochure gives you more information about the topic we discussed today.)
  3. ¿De qué otros temas de salud le gustaría recibir información? (What other health topics are you interested in?)
  4. Puede hablar a la Línea de Recursos de Salud Familiar de Carolina del Norte para obtener más información. (You can call the NC Family Health Resource Line to obtain more information.)
  5. ¿Usted usa el Internet para buscar información de salud? (Do you use the Internet to look for health information?)

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