Latino patients' preferences for medication information and pharmacy services.

OBJECTIVES: To examine (1) Latino patients' language preferences for receiving verbal and written medication information in community pharmacies, (2) the types of problems and concerns Latino patients report about using their medications, and (3) the factors that Latino patients believe are important when choosing a community pharmacy. METHODS: Individuals were eligible to participate if they were 18 years of age or older, if they self-identified as being Latino, and if they or their children were currently taking prescription medications. All 93 participating individuals were interviewed in Spanish. RESULTS: The majority of patients did not always receive their prescription labels or written medication information in Spanish. Approximately 52% of the respondents preferred to receive verbal information in Spanish without an interpreter, and 21.5% preferred to receive it in Spanish with an interpreter. Most respondents (70%) preferred written information in Spanish, and 21.5% preferred written information in both Spanish and English. The most commonly reported problems were difficulty paying for medications, difficulty reading the English on the prescription labels, and adverse effects. Participants valued pharmacies with friendly and respectful employees. CONCLUSION: Study participants reported many problems or concerns in using their medications, and the majority preferred receiving written and verbal information about their medication in Spanish. Pharmacies need to find better ways of providing services to the rapidly growing Latino population.

Social support and dental utilization among children of Latina immigrants.

Latino children use fewer professional dental services and experience more dental decay than non-Hispanic White and non-Hispanic Black children. This study tested the association between four types of social support (information, influence, material aid, emotional aid) and dental use among children of Latina immigrants in North Carolina. Latina mothers age 15-44 years (N=174) were sampled from four counties using a multistage church-based sampling design. Each mother reported dental care use for her oldest child younger than 11 years of age. Instrumental aid (information) alone was not associated with dental care use, but receiving any of the other types of social support was associated with dental care use at the bivariate level (p<.01) and at the multivariate level (OR=3.13; 95% CI=1.67-5.87). Over half of the women (65.2%) received at least one of these forms of social support. Interventions expanding dental-related social support could help Latina immigrant mothers overcome barriers to dental care for their children.

Perceptions of quality of reproductive care services in Bolivia: use of photo prompts and surveys as an impetus for change.

Surveys are sometimes used to assess women's perceptions of the quality of reproductive health care, but less empowered women may feel uncomfortable expressing their views in this method. We demonstrate the use of a participatory approach, combining a standard survey with an innovative photonarrative method. Women in Cochabamba, Bolivia, were asked to participate in exit surveys (n = 108). A subsample did photonarratives (n = 20). The survey showed rural women had less access to care, but photonarratives revealed the cause - fear. Women asserted quality of care was high, but photonarratives contradicted survey results. Staff used photonarratives to select action items for quality improvement.

Development of an easy-to-use Spanish Health Literacy test.

OBJECTIVE: The study was intended to develop and validate a health literacy test, termed the Short Assessment of Health Literacy for Spanish-speaking Adults (SAHLSA), for the Spanish-speaking population. STUDY DESIGN: The design of SAHLSA was based on the Rapid Estimate of Adult Literacy in Medicine (REALM), known as the most easily administered tool for assessing health literacy in English. In addition to the word recognition test in REALM, SAHLSA incorporates a comprehension test using multiple-choice questions designed by an expert panel. DATA COLLECTION: Validation of SAHLSA involved testing and comparing the tool with other health literacy instruments in a sample of 201 Spanish-speaking and 202 English-speaking subjects recruited from the Ambulatory Care Center at UNC Health Care. PRINCIPAL FINDINGS: With only the word recognition test, REALM could not differentiate the level of health literacy in Spanish. The SAHLSA significantly improved the differentiation. Item response theory analysis was performed to calibrate the SAHLSA and reduce the instrument to 50 items. The resulting instrument, SAHLSA-50, was correlated with the Test of Functional Health Literacy in Adults, another health literacy instrument, at r=0.65. The SAHLSA-50 score was significantly and positively associated with the physical health status of Spanish-speaking subjects (p<.05), holding constant age and years of education. The instrument displayed good internal reliability (Cronbach's alpha=0.92) and test-retest reliability (Pearson's r=0.86). CONCLUSIONS: The new instrument, SAHLSA-50, has good reliability and validity. It could be used in the clinical or community setting to screen for low health literacy among Spanish speakers.

The Americans With Disabilities Act: explaining legislative intent through experiential learning.

Imparting the requirements of healthcare workforce legislation to students is only one aspect of preparing undergraduate healthcare management students to be effective managers. On first review, the Americans with Disabilities Act (ADA) appears quite straightforward. The Act applies to any employer with 15 or more employees and covers a full range of employment practices. What the law does not address are the skills in empathy and decision-making that are needed for effective implementation of the law. In this article, the authors describe an experiential learning model that was designed to teach healthcare management majors, (soon-to-be healthcare managers), not only the provisions of the ADA law but also skills in empathy and critical decision-making. Reflections from student participants are included. These reflections are examples of changes in students' empathy occurring as a result of participation in the ADA Experience. The authors also present actual case requests for "reasonable accommodation" made by persons employed in a healthcare setting.

Short Assessment of Health Literacy-Spanish and English: a comparable test of health literacy for Spanish and English speakers.

OBJECTIVE: The intent of the study was to develop and validate a comparable health literacy test for Spanish-speaking and English-speaking populations. STUDY DESIGN: The design of the instrument, named the Short Assessment of Health Literacy-Spanish and English (SAHL-S&E), combined a word recognition test, as appearing in the Rapid Estimate of Adult Literacy in Medicine (REALM), and a comprehension test using multiple-choice questions designed by an expert panel. We used the item response theory (IRT) in developing and validating the instrument. DATA COLLECTION: Validation of SAHL-S&E involved testing and comparing the instrument with other health literacy instruments in a sample of 201 Spanish-speaking and 202 English-speaking subjects recruited from the Ambulatory Care Center at the University of North Carolina Healthcare System. PRINCIPAL FINDINGS: Based on IRT analysis, 18 items were retained in the comparable test. The Spanish version of the test, SAHL-S, was highly correlated with other Spanish health literacy instruments, Short Assessment of Health Literacy for Spanish-Speaking Adults (r=0.88, p<.05) and the Spanish Test of Functional Health Literacy in Adults (TOFHLA) (r=0.62, p<.05). The English version, SAHL-E, had high correlations with REALM (r=0.94, p<.05) and the English TOFHLA (r=0.68, p<.05). Significant correlations were found between SAHL-S&E and years of schooling in both Spanish- and English-speaking samples (r=0.15 and 0.39, respectively). SAHL-S&E displayed satisfactory reliability of 0.80 and 0.89 in the Spanish- and English-speaking samples, respectively. IRT analysis indicated that the SAHL-S&E score was highly reliable for individuals with a low level of health literacy. CONCLUSIONS: The new instrument, SAHL-S&E, has good reliability and validity. It is particularly useful for identifying individuals with low health literacy and could be used to screen for low health literacy among Spanish and English speakers.

Perceived insufficient milk as a barrier to optimal infant feeding: examples from Bolivia.

In its recently adopted Global Strategy on Infant and Young Child Feeding, the World Health Assembly called for urgent action in addressing the barriers to optimal feeding practices. This paper examines mothers' concerns about milk insufficiency as a major contributor to suboptimal infant feeding decisions, using survey data from peri-urban areas of two Bolivian cities. Mothers in the lowland modernizing city of Santa Cruz were more likely than mothers in the highland traditional city of Cochabamba to express concern about insufficient milk, and also less likely to feed their infants according to international recommendations. Furthermore, perceived milk insufficiency was particularly common among mothers of infants younger than 6 months of age -- an age at which infants are particularly vulnerable to the adverse effects of breast-feeding cessation and complementary feeding initiation. The paper concludes with policy, programme and research recommendations to address the critical problem of perceived insufficient breast milk.

Social support among Latina immigrant women: bridge persons as mediators of cervical cancer screening.

New Latina immigrants face numerous linguistic, cultural, logistical, and material barriers to cervical cancer screenings. Promotoras (lay health advisors) are a proven strategy to promote utilization of care. Since the mid-1990s, interventions in North Carolina have aimed to connect Latina immigrants to a broader range of bridge persons. This study assessed the effect of bridge persons on utilization of cervical cancer screening by Latina immigrants in North Carolina. Women were recruited in Spanish-language churches in four counties (N = 223). Logistic regression results show that persons known through advocacy organizations appeared to increase probability of recent Pap screening by an average of 10.4 percentage points (p < 0.05). Promotoras remain more effective, increasing probability of screening by 12.9 percentage points (p < 0.05) but few women (14%) knew one. No association was found with other bridge person profiles. Interventions are needed to better engage all bridge persons in linking immigrants to preventive health services.

Improving access for Latino immigrants: evaluation of language training adapted to the needs of health professionals.

The number of Latinos in North Carolina grew by almost 400% between 1990 and 2000. The rapid change in demographics in this state and other southeastern states has caught healthcare providers unprepared. Lack of ability to communicate with Latino patients may result in errors in diagnosis or reduced compliance with recommended treatments. The Culturally and Linguistically Appropriate Services (CLAS) Standards, published in 2001, mandate culturally and linguistically appropriate services for persons with limited English proficiency. This paper describes an innovative strategy to promote Spanish and culture-learning skills of healthcare providers and presents results of the evaluation conducted to determine its impact on access to quality care. The evaluation used a 360 degrees case study design, at 1-year follow-up. Use of Spanish language health-related materials is key to the training's success. The authors make recommendations for replication of the integrated language and culture-training model in other new settlement areas, especially those in the southeast of the United States.

Los sistemas cosmopolitas y tradicionales de salud: la mujer como nexo / Cosmopolitan and traditional health systems: woman as the nexus

The cost of extending health care to rural areas in developing countries has hindered efforts to bring cosmopolitan or «western» medicine into those areas. As a cost-effective and realistic strategy for expanding the services needed in the countryside-in a context of finite resources-the writer proposes making women agents of health care in the rural care system and giving them training that includes both formal and traditional practices. The process offers the woman, as a mother, the opportunity to play a leading part in evaluating the health status of her children and other members of her family. Based on the experience acquired in a rural health project carried out in the Altiplano of Bolivia, specific recommendations are made for application of this approach, which is based in the community itself, and the difficulties encountered in its practical application are cited (Au)

Maternal and infant feeding practices in rural Bolivia

Published in spanish in Bol. Oficina Sanit. Panam 114(1), 1993