Center for Immigrant Health (CIH) NYU School of Medicine

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Roger Lewis
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1 Cancer Awareness Network for Immigrant Minority Populations Tracking the Innovations Center for Immigrant Health (CIH) NYU School of Medicine

2 How Effective Are They? Focus on Three Project Areas Community Cancer Education and Outreach Materials Development Technology Access Provider Practices and Education and Language Access

3 CANIMP Mission Builds bridges between immigrant communities and cancer health service providers and researchers in the areas of lung, prostate, breast, cervical, oral, and colorectal cancers Latino, Haitian, English-speaking Caribbean, Chinese, Korean, South Asian immigrant communities

4 Eight Intertwined CANIMP Elements Community Outreach and Education Provider Education Formative Research Junior Minority Scientist Mentorship Program Pilot Projects CANIMP Internship Program Technology Access Program Community Training Program: Research Methodology

5 PARTNERS

6 Community Cancer Education and Linkages Eunah Chung, M.P.H.

7 Community Cancer Education and Linkages Programs Ever-Changing, Based on Ongoing Focus Groups Variety of Venues English as Second Language Classes Soccer Clubs CBO Partners Faith-based Sites

8 Korean Community Focus Groups Focus Group Most participants visited doctors after they became sick and after self-medication had failed (home-remedies, traditional medicine, over-the-counter medicine) Fear of receiving bad-news Language problems inhibited them from seeking medical attention even when sick, they forego medical attention if interpretation services unavailable or unable to find a friend or relative to interpret Translation services were poor Breast Cancer - Self breast exams as hateful and refused to perform them Mammograms inability to pay, difficulty taking time off, pain associated with mammograms, and fear of results

9 Focus Groups Focus Groups Cervical Cancer - Less knowledgeable about cervical cancer than breast cancer Believed to be caused by frequent sex, abortions, having many children, unclean habits and untreated venereal disease Prostate Cancer several Korean men did not know what the prostate was

10 Tracking Those Educated 825 community members were educated over 6 months 732 evaluations were received 80% were women 82% undocumented Did they go for screening and follow-up? Now being tracked

11 Those reached Ethnic Distribution Korean Caribbean 5% 6% Chinese 15% Other 1% Haitian 39% Latino 34%

12 Not Enough Men, Therefore Lay Health Worker Program for Men Unique Focus for Lay Health Worker Programs Program Success to be Tracked by Utilization of Screening and Follow-up Services

13 Health Education Materials: THE HAITIAN EXAMPLE Rachel Andre

14 Printed materials The Subcommittee for Materials Review and Development Collected over 200 cancer educational materials from local, national, and international sources Pamphlets, books, posters, shower cards

15 Inadequate Materials Cancer educational material in Creole and/or French for the Haitian community was almost entirely lacking Except. Cancer facts for men and women Taking Control (Nutrition facts) Breast Self-exam brochure

16 How Did These Measure Up?

19 Cancer Facts for Men Brochure

20 Results A literal translation of the English High literacy level Overloaded text They were culturally inappropriate Caucasian photos in old version Unappealing visually

21 CANIMP Creates Its Own

22 How Did We Do? These brochures were focus group tested by the community and by providers and scored well However video materials are sorely needed and are under development for prostate and colorectal

23 Developing Culturally Appropriate Education Materials: Determining Effectiveness Jennifer Lin, M.D.

24 SCCAN: Screening CTs in Chinese American Newcomers Goals To elucidate barriers and facilitators to Chinese immigrant participation in cancer screening trials To develop strategies to enhance recruitment into the NYU Early Detection Lung Cancer Study To develop recommendations for the facilitation of recruitment of Chinese immigrants in to cancer clinical trials Methods- Part I focus groups with community members, key informants and physicians

25 Outline Knowing your target audience Partnering early with the community Transcreating materials Test marketing Tracking Effectiveness of Materials

26 Knowing your audience Know the language Traditional Chinese versus Simplified Chinese Know the level of literacy Only 3% of newer immigrants from Fuzhou are elementary educates Know who to include in your target audience Include the family

27 Partnering with the community EARLY Help identify target audience and familiarize with their cultural issues Possible source of translators Serve as advisory group for test marketing Help disseminate educational materials

28 Transcreating Materials: Knowing culturally specific preferences Tone and Attitude Positive reframing i.e. superstition surrounding cancer, keeping healthy instead of cancer screening Soften tone do not use you must or you need Testimonials

29 Transcreating Materials continued Clarity of Content Transcreation Literal translation is difficult to understand like [a] textbook from [a] doctor s office Explain difficult or foreign concepts Be explicit about certain content areas FREE painless No medications involved No documentation necessary

30 Transcreating Materials continued Aesthetics Color red, pink, blue, green Symbols no bones / skeleton Pictures smiling Asian faces Text No big paragraphs

31 Test Marketing Back translation is NOT sufficient Use the help of CBOs Reviewers should be similar to target audience Should not be familiar with subject matter of educational material

32 Tracking Effectiveness Controlled Study 2 Senior Centers 1 with specially developed materials and intervention 1 with usual and customary cancer health education Measure rates of clinical trials enrollment

33 Summary Chinese immigrants are an extremely diverse population Cultural preferences specific to the Chinese population can be addressed by partnering early with CBOs and test marketing translated materials Disseminate materials with CBOs and use a multi-faceted approach with written educational material

34 Technology Access Program Jyotsna Changrani, M.D., M.P.H.

35 Why Consider the Internet? The online population is more and more like the general population Women, minorities, and those earning between $30,000 and $50,000 are flocking online 62% of Internet users, or 73 million persons, have gone online to search for health information 6 million persons go online for medical advice on a typical day more than the number of people who actually visit health professionals

36 Importantly, 62% of health seekers researched a specific illness or condition. Information on cancer was most popular among disease-researching health seekers 61% of health seekers say the Internet has improved the way they take care of their health either a lot or some

37 However, the Digital Divide Remains Linguistic Limited non-english and bilingual sites Content sparse and less accurate Cultural One Site Does Not Fit All

38 CANIMP Recent Technology Projects Caribbean CARES Virtual Community for Immigrants with Cancer

39 Caribbean Cancer Awareness Resources Education Services To explore strategies that can be employed to improve penetration and effectiveness of cancer communication through the Internet in immigrant communities Methods included compiling and reviewing existing online and offline materials; conducting website review sessions with the target population; and, based on the above, developing a website prototype

40 The Divide Of the 31 persons extremely or quite confident in accessing the Internet, only 2 had used the Internet in the past 6 months to access health/medical information Compares unfavorably with the general U.S. population where 62% of all people on the Internet have used it to access health/medical information

41 Virtual Community for Immigrants with Cancer (VCIC)

42 Spanish Online Support Groups: The Need Lack of face-to-face support groups for limited English proficient population Where available, face-to-face groups not always convenient feeling too weak or sick to go outside their homes feeling depressed and ugly did not want to leave home Professionally facilitated online support for nonimmigrant English-speaking breast cancer patients successfully reduced their depression, distress and negative reactions to pain

43 VCIC: Project Overview VCIC provides information, and emotional and social support to Spanish-speaking immigrants with breast cancer, through an online support group Through VCIC we will evaluate feasibility, acceptance, and effectiveness of online support groups within immigrant communities

44 VCIC: Scope of Effectiveness Tracking The Intervention Impact on Being a Cancer Patient Psychosocial Adaptation (Pre- and Post-Testing) Project Implementation and Associated Costs

45 Whatever the outreach materials or venue, a poor reception will ruin the best efforts When a patient successfully reaches the health care system, what awaits him/her?

46 CANIMP Cancer Education and Services: Response to Stated Barriers Language Language Culture Finances

LANGUAGE ACCESS POLICY and IMPLEMENTATION PLAN NEW YORK CITY CHILDREN S SERVICES

LANGUAGE ACCESS POLICY and IMPLEMENTATION PLAN NEW YORK CITY CHILDREN S SERVICES 1. Purpose and Goals The purpose of this language access policy and implementation plan is to ensure that children and families