What Quitters Want Consumers’ Views on Disparities Helen Lettlow, Dr PH December 7-8, 2005

1. What Quitters WantConsumers’ Views on Disparities Helen Lettlow, Dr PHDecember 7-8, 2005

2. Consumers Speak Out on Disparities in Health Care • In a study commissioned by the Commonwealth Fund, consumers were asked about their perceptions about disparities in health care. • The Harvard Forums on Health* conducted the national poll to explore the public’s knowledge about disparities and their opinions about various policies to remedy inequities in the health care system. *The Harvard Forums on Health commissioned Lake Snell Perry & Associates (LSPA) to conduct the study

3. Americans Speak Out on Disparities in Health Care • Americans of different races disagree about issues of disparities in health care • Americans differ as to the reason minorities may be treated differently in the health care arena • Hispanics point to cultural and language barriers • African Americans are especially likely to feel health care professionals treat minority patients different than whites

4. Poll Findings: perceived disparities by race

5. Access To Care Issues For Hispanics • Across all age groups, Hispanics are substantially more likely than non-Hispanic whites or African Americans to lack health insurances. • For more than a decade the uninsured rates for Hispanics adults and children have been two to three more times those for non-Hispanics whites. • Within the Hispanic population, adults who do not speak English fluently have greater difficulties communicating with and understanding their health care providers.

6. Cultural approaches to counseling and education • Use of community-based health advisors, or promotoras, peer-to-peer educators and advocates • Engaging community leaders as program planners, advisors, and evaluators • Hiring health care workers and other staff that reflect the ethnic/racial target population

7. Cultural approaches to counseling and education • Utilize community-based venues for conducting group counseling and informational sessions • Activate referral agreements with local health departments, clinics, social service providers, and neighborhood health centers • Cover transportation costs, and free access to NRT’s provide incentives, and other aids

8. Community approaches in tobacco control • Si Puedo (Yes, I Can) • 8-week program uses bi-weekly group meetings • Pathways to Freedom • Use church based venues for faith based cessation • Chicago Lung Association Cessation Program • Designed for whites; uses minority venues to advertise; ALA self-help techniques and cessation support groups

9. Provider approaches in tobacco control • Health care providers, primarily physicians and dentists, are often successful in informing patients about the urgency of quitting smoking • Providers are particularly effective with groups that exhibit high “power distance”: deference to authority figures (see Hofsted 1980) • The limitation is that large proportions of minorities lack access to primary care providers (see Aday et al 1993)

10. Cultural issues to consider • Rate of quit attempts vary by race/ethnicity • Level of public awareness about the effects of smoking vary by race/ethnicity • Degree of tobacco company marketing and sponsorships effect attitudes and behaviors • Availability of language-appropriate and low literacy written materials are limited • Communication styles and customs influence likelihood of seeking professional services

11. Cultural Awareness Tips to Consider • Advertise the service through local radio stations, print media, newsletters • Evaluate usefulness of printed self-help materials • Use evidence based counseling models, but add: cultural icons, local media outreach • Take time to become informed about the target population’s culture, values and attitudes • Invest in the process of building relationships to minimize mistrust, embrace another viewpoint

12. Cultural Awareness Tips to Consider • Avoid platitudes and quick fixes (e.g., Hispanics are family oriented.) • Take time to establish rapport with clients • Utilize trained interpreters and professionals who speak the language and represent the target population • Be prepared to address or refer for co-morbidities and social problems

13. Cultural Awareness Tips to Consider • Provide or refer to individual counseling vs. group counseling settings • Be prepared to provide more intensive follow-up via telephone, peer outreach or home visits • Observe the variety in communication styles across cultures (e.g. direct vs. indirect ) • Study demographic shifts in your local area that impact service delivery • Invite members of diverse groups to the table

14. Cultural Awareness Tips to Consider • Include diverse members to plan and develop new approaches that: • Reflect community values, attitudes and norms • Resonate with their cultural history • Have relevance to their social, economic and political realities • Use positive imagery • Use appropriate language and literacy levels • Empower participants to feel engaged

15. Contact Us American Legacy Foundation 2030 M Street, NW, 6th floor Washington, DC 20036 (202) 454-5555 www.americanlegacy.org hlettlow@americanlegacy.org