What Quitters Want Consumers

1
What Quitters Want Consumers Views on
Disparities Helen Lettlow, Dr PH December
7-8, 2005
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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 publics 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
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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
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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

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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
  NRTs 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)

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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

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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
  populations culture, values and attitudes
• Invest in the process of building relationships
  to minimize mistrust, embrace another viewpoint

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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

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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

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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

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