Diana Torres-Burgos, MD, MPH

Co-Chair, NHMA National Chapters

Co-Chair, NHMA NYC Chapter

VaccinateForAll.Org VacunasParaTodos.Info

Introducing NHMA'S Vaccinate For All Campaign

In March 2021, The National Hispanic Medical Association launched its Vaccinate For All campaign with support from the Centers for Disease Control and Prevention (CDC) and Johnson & Johnson to help reduce vaccine hesitancy, build vaccine confidence, and address structural and cultural barriers to vaccine access in Latino communities.

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Vaccinate For All works to achieve this by arming individual physicians, health professional associations, and other leaders with educational resources about the COVID-19 vaccines in order to increase vaccination accessibility and uptake among the Latino community.

Activating 'Champion' Network

Meeting Our Community where they are:

NHMA's Phoenix Chapter, led by member and Chapter Leader Dr. Ricardo Correa, volunteering and supporting local vaccination events alongside community leaders.

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VaccinateForAll.Org

IMPACT TO DATE

Monthly COVID-19 Virtual Briefing Series – 14 Sessions, 3,954 Registrations �(CME often offered)

177 Total Vaccinate For All Champions

• 133 Individuals
• 44 Organizations

10 NHMA Chapters Activated for localized outreach (CA, AZ, TX, LA, VA, NE, D.C. etc.)

NHMA’s V4A Champions Supported 27 community vaccination events (both one-time and recurring)

Media trained 15 physicians as trusted messengers and secured 37 placements in mainstream and local news (EN/SPAN)

Organic Social Media Traffic from NHMA-posted Vaccinate For All content:

• 670k+ Impressions
• 12.9k Engagements

(01/01-12/31, 2021)

English & Spanish Vaccinate For All Microsites

Through partnership with Telemundo as a Spanish-language media partner for NHMA’s Vaccinate For All Campaign and HispanicHealth.info resource hub, Telemundo will help NHMA increase access and awareness about the vaccination process and other health-related issues impacting the Latino community.�

“As a network that reaches millions of Hispanic households who rely on us for timely and accurate information, we are proud to partner with NHMA to provide our community additional information and resources to help them navigate the vaccination process,” said Christina Kolbjornsen, SVP, Corporate and External Affairs, NBCUniversal Telemundo Enterprises. “As part of our continued efforts under Planifica Tu Vacuna, we are committed to offering Spanish and English-language resources to support the Latino community during these unprecedented times.”

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HispanicHealth.info is a portal designed by NHMA and partners to share bilingual, Hispanic-focused health resources with providers, patients, and community members. These resources include information about COVID-19, Cardiovascular Disease, Obesity, Diabetes, HIV, Influenza, and more.

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Goal:

• Help fill in the gaps in healthcare resources for Hispanic people
• Raise awareness of the racial and ethnic disparities faced by Hispanics/Latinos in health and healthcare.

HispanicHealth.Info Resource Hub

Health Literacy, The Silent Epidemic�NHMA Annual Conference ��

Rebecca Vargas-Jackson, M.D.

March 26, 2022

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Health Literacy Basic Concepts

• Health Literacy is based primarily but not exclusively on the following topics:
1. Social determinants of Health
2. Equity and equitable communication, misinformation
3. Culture, language and acculturation, lack of understanding and trust
4. Cultural competence, cultural awareness, cultural humility, etc.
5. Racial and ethnic diversity, migratory status, work conditions
6. Bias and stigma
7. Messaging transcreation & culturally tailored communication

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Health Literacy Gaps

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• Translation on a Department of Health official website told Spanish readers they didn’t need the COVID-19 vaccine. Communication team lacked training on health literacy or messaging transcreation Jan 18, 2021

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• Misinformation targeting low Health literate Latinos has contributed to COVID-19 case and death health disparities, conspiracy theories, and hesitancy about vaccination  

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1.Social Determinants of Health & Health Literacy

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• Five key areas (determinants) include:
• Economic Stability
• Education
• Social and Community Context
• Health and Health Care
• Neighborhood and Built Environment

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Life is a combination of a genetic Lottery and a geographic accident ��All social determinates of health play a role in effective communication��Telehealth or telemedicine can not be used in geographically disadvantage areas without broadband, laptops or cell phones �

2. Equity & Health Literacy

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• Health equity is:
• the absence of systematic disparities in health between and within social groups that have different levels of underlying social advantages or disadvantages

3. Culture, the Challenge to Health Literacy

• Health is a cultural concept because culture frames and shapes how we perceive the world and our experiences
• Along with other determinants of health, culture defines:
• what patients & doctors believe about the causes of disease
• how life and health are perceived
• how health care information is received
• how rights and protections are exercised
• what is considered to be a health problem
• how people should interact with their neighbors
• who should provide advice & treatment for a health concern
• what type of paths should be followed (politics, beliefs, science, etc.)

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Health Literacy & How Does Culture Affect Health

The influence of culture in health is vast:

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• It affects perceptions of health, illness, and death

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• Beliefs about causes of disease (the ‘evil eye’, Voodoo)

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• Approaches to health promotion

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• How illness and pain are experienced and expressed

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• Where patients seek help (family, pharmacy, traditional healer)

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• The types of treatment patients prefer

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Cultural Beliefs & Health Literacy

• Superstitions, Fake news

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• Folk medicine

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• Beliefs, myths

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• Faith

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4. Health Literacy & Cultural Competence

• Cultural competence is a set of congruent behaviors, attitudes, and policies that come together in a system, agency or among professionals and enable that system, agency or those professions to work effectively in cross-cultural situations

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5. Health Literacy – Racial/Ethnic Disparities & COVID 19

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• Nationally, African-American deaths from COVID-19 are two times greater than expected based on their share of the population. In 4 states, the rate is three or more times greater 

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• In 42 states plus Washington D.C., Hispanics/Latinos make up a greater share of confirmed cases than their share of the population. In 8 states, it's more than 4 times greater

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December 2021

6. Health Literacy and Bias

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• Bias is a preference or an inclination, especially one that inhibits impartial judgment

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• Bias is a natural tendency among all humans; however, it becomes a concern when it interferes with how we make fair decisions

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• Bias is disproportionate weight in favor of or against an idea or persons, usually in a way that is closed-minded, prejudicial, or unfair 

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6. Health Literacy - Bias & Discrimination

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• Discrimination is differential behavior or conduct of one person or group toward another person/group based on individual prejudice or societal norms that have institutionalized prejudicial attitudes

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• Perceived racial/ethnic discrimination, is a perception of unfair treatment because of one's race or ethnicity with a range of adverse outcomes, from cardiovascular, to high rates of COVID19

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6. Health Literacy & Discrimination Types

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Health Literacy and Stigma

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• Stigma is a social opportunistic disease that attaches to many illnesses and increases morbidity and mortality rates (HU Stigma Conference)

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• Stigma is associated with a lack of knowledge about health: how COVID-19 spreads, a need to blame someone, fears about disease and death, and gossip that spreads rumors and myths

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Limited English Proficient and Health Literacy

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• Social determinants such as, language, and culture, can create barriers to communication, compliance and lead to health inequities
• There are validated tools to assess health literacy in English/Spanish

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• Interpreter is a person specially trained to convert oral messages from one language to another
• Translator is a person specially

trained to convert written text

from one language to another

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Health Literacy and Limited English Proficiency

• LEP patients are more likely to have low health literacy skills

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• A study on health literacy, & English proficiency published in the Journal of Health Communications reported:
• 45% of LEP patients reported having low health literacy
• 45.1% of LEP patients who reported low health literacy were found to be in poor health

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7. Messaging Transcreation

• The transfer of ideas from one language or culture to another

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• Transcreation is a technique used in the field of health communication, to adapt a message from one language or culture to another

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• Transcreation is the cultural process of adapting content from one language or culture to another while maintaining the existing tone, intent and style

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What is Health Literacy

• Health Literacy is a cultural, cognitive and social skill which determines the motivation & ability of individuals to gain access to, understand and use health related information

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www.hsph.harvard.edu/healthliteracy

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Health Literacy vs. Health Education

Do not confuse health literacy with Health Education

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• Health Education is a public health activity by which individuals and groups learn health related topics

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• Health Education does not address:
• Personal motivation
• Cultural background
• Social skills
• Providers’ and patient’s bias
• Learning disabilities
• Stigma, etc.

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Health Education Vs Health Literacy

Health HeEducation

The Health Literacy Challenge

Health Literacy�embodies the skills that each individual needs to develop and understand to maintain & improve their health�

9 out of 10 adults have difficulty using everyday health information

Health Literacy Facts

• People with low health literacy lack knowledge or have misinformation about the body and the nature or causes of diseases

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• Providers & communicators need to understand health literacy - “The system must become health literacy friendly” -

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Health Literacy�� by ��Race�and�Ethnicity

Improving Health Literacy

• The primary responsibility for improving health literacy lies with:
• Public health professionals
• Health care providers
• Education system

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• We must work together to ensure that health information and services can be understood and use by all

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health.gov/communication/literacy/quickguide/

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Providers Need to Remember

Barriers to Health Literacy - Facts

Health Literacy Challenges

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• Population changes
• Cultural values and understanding of health
• Technology gaps (telehealth)
• Inability to understand health information
• Limited English Proficiency (LEP)
• Difficulties navigating the health care environment

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Barriers to Health Literacy – “Poor Literacy”

Poor Literacy is one of the most critical barriers

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• According to the U.S. Department of Education, National Center for Education Statistics:
• 18% of U.S. adults performed at the lowest level of the PIAAC literacy scale (below level 1); international average is 16%

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• 20% of adults in the nation’s capital struggle with everyday literacy

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• 23% of adults in the U.S. demonstrated skills in the lowest level of prose, document, and quantitative proficiencies (level 1)

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LEP individuals did not participate in this study

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Critical Skills That Influence Health Literacy

• Communication (pronunciation, Verbalization, LEP)
• Comprehension (prose/reading, problem solving)
• Quantitative/numeracy
• System navigation (understanding the need for assistance)
• Health Information seeking
• Decision making/critical thinking
• Cultural background, beliefs, mistrust, bias

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Strategies to Improve Health Literacy of your Patients

• Increase your underrating of the importance of health literacy during any interaction with your patients

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• Learn how to assess health literacy skills of your patients

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• Use validated tools to assess health literacy in English & Spanish

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• Develop a strategy “ CDC Making health literacy Real”

Health Literacy & Covid 19 Vaccines

• Concerns and misconceptions reported by the Latino community include:
• Possible harmful effects of the vaccine
• Lack of culturally tailored communication in Spanish (I don't know what are they saying)
• Listing unfounded theories as DNA changes
• Religious beliefs based on social media misinformation
• Infertility misinformation disseminated in social media
• Cancer causing misinformation
• Use of tracking devices among others

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Health Literacy & Covid 19 Vaccines

• Some efforts dedicated to reduce hesitance, mistrust, & fear while increasing the levels of vaccination compliance in the Latino population
• Health campaigns supported by Latino institutions & medical societies
• Educational materials in Spanish
• Social media diffusion using influential Latino representatives
• Provide transparent, truthful, reliable, and tailored to the health literacy skills of target population information
• Messaging transcreation, information adapted to the language, health literacy, culture, and social background, of the Latino community

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Health Literacy, Some Recommendations

• Assess cultural values, misunderstandings, and fears
• Embrace an attitude of empathy and collaboration
• Ask permission to discuss vaccines
• Motivational interviewing
• Value traditional medicine
• Allow time for questions
• Be aware of your body language
• Be clear and direct with your answers – do not say the vaccine is 75% effective – say your possibilities to get infected if you are vaccinated are low

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Summary

• Remember health literacy is critical to positive health outcomes
• Health Literacy is the Silent epidemic

Living, Working, Dying

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Demographic Insights into COVID-19

Data

• COVID DATA Tracker

Deaths by Age and Race/Ethnicity

https://www.cdc.gov/coronavirus/2019-ncov/covid-data/investigations-discovery/hospitalization-death-by-race-ethnicity.html

COVID-19 and Economic Well-Being

Data

• Nationally representative study of older adults ages 50 and older in the United States.
• 2020 HRS COVID-19 Project Data V1 (Nov. 2020 Release).
• Administered to the 50% random subsample of households (3,266 respondents).
• Originally assigned to enhanced face-to-face interviewing (EFTF).
• Two random half groups; starting in June and September, respectively.

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HRS COVID-19 Module

HRS COVID Module

Structural Racism: The Root Cause of the Social Determinants of Health

• Access to health care
• Access to resources
• Education
• Employment
• Environment
• Income/Poverty

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• Insurance Coverage
• Housing
• Racism
• Discrimination
• Segregation
• Transportation

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Hesitancy to Vaccinate Themselves and Children

Adults’ Hesitancy to Vaccinate Themselves and Children by Select Demographic Characteristics

Adults’ Hesitancy to Vaccinate Themselves and Children by Select Demographic Characteristics - Education Level

Adults’ Hesitancy to Vaccinate Themselves and Children by Select Demographic Characteristics - Education Level - White vs Latino

Adults’ Hesitancy to Vaccinate Themselves and Children by Select Demographic Characteristics

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Many parents remain cautious about lifting mask mandate

Who's making the decisions?

Disinformation

Disinformation, or information that is shared with the intent to mislead people, is increasingly a global phenomenon. It has become more prevalent with the rise of social media and the digital economy and a lack of digital and media literacy among consumers of online media.¹

Malinformation is a deliberate publication of private information for personal or private interest, as well as the deliberate manipulation of genuine content. This is often done by moving private or revealing information about an individual, taken out of context, into the public sphere.

Disinformation, or information that is shared with the intent to mislead people, is increasingly a global phenomenon. It has become more prevalent with the rise of social media and the digital economy and a lack of digital and media literacy among consumers of online media.

Disinformation is often used as a catch-all term for all false information, but it is distinguished from misinformation by its purposeful intent to deceive.

Meet Them Where They Are

Social networks impact profoundly

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• motivation
• opportunity
• resources

The COVID-19 Digital Compañero Program

The smartphone (89%) is the most popular device for Latinos.

89%

Smartphones

70%

Latptops

51%

TV

Access To Resources

The most recent Pew Research Study found that 46% of Latinos said they were “very likely” to use WhatsApp compared to Black (23%) or White Americans (16%).

46%

Latino

23%

Black

16%

White

THANK YOU

Daniel Turner-Lloveras, MD

Ricardo Correa, M.D., EdD., F.A.C.P., F.A.C.E., F.A.P.C.R., F.A.C.M.Q.

Fellowship Director, Endocrinology, diabetes and Metabolism

Director, Diversity for Graduate Medical Education

University of Arizona College of Medicine

Staff Endocrinologist, Phoenix VAMC

Associate Professor of Medicine Creighton University SOM, Alix School of Medicine, Mayo Clinic

PACH Clinic, Medical Director (volunteer)

COVID19 and Latinx: a grassroot effort

THE PROBLEM: SPECIFIC PRESENTATIONS OF COVID-19 IN LATINX PATIENTS

Covid-19 provisional counts - health disparities. Centers for Disease Control and Prevention. https://www.cdc.gov/nchs/nvss/vsrr/covid19/health_disparities.htm. Published March 9, 2022. Accessed March 2, 2022.

Covid-19 provisional counts - health disparities. Centers for Disease Control and Prevention. https://www.cdc.gov/nchs/nvss/vsrr/covid19/health_disparities.htm. Published March 9, 2022. Accessed March 2, 2022.

Vaccine Acceptance in 2022

Solutions to Dissipate Health Disparities

Public Health Strageties

Educational Programs and Campaigns

Increased and Free Testing Centers

Universal Healthcare system

Accesible Medications and Increased Testing Sites

Vaccination for All

No Discrimination Based on Gender, Sexual Orientation or Immigration Status

Spanish-speaking Medical Professionals and Materials

Community resources such as Home-based deliveries of essential goods (food medications, PPE)

Solutions to Dissipate Health Disparities

TRUST IS VITAL!

Ending the Conversation

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1. Acknowledge agency and personal choice
2. Keep communication open
3. Offer to help find a vaccine

Key Messages

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1. The vaccine will keep you safe
2. Side effects are common
3. Vaccines are very effective
4. The vaccine is built on 20 years of research
5. Have questions? Please Ask.

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Starting the Conversation

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1. Ask questions and listen carefully
2. Create an alignment of safety
3. Find common goals

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3-5-3 Method for COVID-19 Vaccine Conversations

https://www.kevinmd.com/2022/03/health-care-and-the-latinx-experience-podcast.html

Thanks

riccorrea20@gmail.com @drricardocorrea

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Acknowledgments

Emma B Olivera, MD

Pediatrics

https://www.kevinmd.com/2022/03/health-care-and-the-latinx-experience-podcast.html