A Cardiovascular Health Intervention for Spanish Speakers: The Health Literacy and ESL Curriculum.

Spanish speakers in the United States are in need of effective interventions that address both cardiovascular disease (CVD) and health literacy. However, the literature lacks interventions that have used and evaluated a strategies that focus on both, particularly at the community level. The aim of this study was to explore the effect of a health literacy curriculum on cardiovascular health behavior among Spanish speaking adults. It used a randomized controlled pre-posttest design. Participants included Hispanic adults with a low-to-intermediate level of English proficiency. The intervention group received the health literacy and English as a second language (ESL) Curriculum with CVD specific content, while the control group received a conventional ESL curriculum. Tools included the Spanish Cardiovascular Health Questionnaire (CSC), the test of functional health literacy in adults (TOFHLA), and the Combined English Language Skills Assessment. Analysis of change scores included independent sample t test and multiple linear regression. A total of 155 participants completed the study. There was a significant greater improvement for the intervention group in change of CSC score from pretest to posttest (P = 0.049) compared to controls. The study also found significantly improved TOFHLA (P = 0.011), however it did not find a relationship between changes in CVD behavior and health literacy or English proficiency. The Health Literacy and ESL Curriculum constitutes a valuable resource for addressing the cardiovascular health, literacy, and language needs of Spanish-speaking adults. Interventions that take a multilevel education and health approach may be more effective in addressing the needs of immigrants. Research should further explore the interactions between CVD behavior, health literacy, and English proficiency.

Postapplication Advisement for U.S. Medical School Reapplicants: One School's Program.

PROBLEM: Reapplicants make up over one-quarter of U.S. medical school applicants. Postapplication advisement (PAA) can provide potential reapplicants with concrete strategies for improvement, a contextualized basis for their scores, and a realistic idea of their chances for success. However, more data showing the effectiveness of PAA and an analysis of best practices are needed for PAA programs to be more widely adopted. APPROACH: In 2010, the University of New Mexico School of Medicine (UNM SOM) created a PAA program that involves a postapplication seminar (PAS), mandatory self-assessment and action plan development, and an individual consult with an admissions dean to prepare participants for reapplication. OUTCOMES: From 2010 to 2016, 892 applicants who interviewed and were rejected at UNM SOM were eligible to participate in PAA. Of these, 478 (53.6%) chose to participate in PAA over the seven-year period. Males had a higher participation rate (246/430; 57.2%) compared with females (232/461; 50.3%; P = .04). African Americans had a higher participation rate (12/17; 70.6%) and American Indian/Alaska Natives had a lower participation rate (17/64; 26.6%) than any other race/ethnicity. Of reapplicants who were subsequently accepted, 140/178 (78.7%) attended PAS and a consult, and 7/178 (3.9%) attended PAS only, compared with 31/178 (17.4%) of subsequently accepted reapplicants who did not participate in any PAA (P < .001). NEXT STEPS: Additional research should focus on the best approach for assisting reapplicants with prioritizing areas for improvement in their application. Demographic data may be used to target outreach to specific populations.