In addition to the deaf, hard-of-hearing and visually-impaired, MMW coalition advocates say it is important to reach seniors with limited English proficiency (LEP) with healthcare information using “unique outreach methods” and “effective strategies.”
During her own panel, “Reaching Limited English Proficiency (LEP) Older Adults with Health Care Outreach,” Erin Weir, MSW, manager of healthcare access of Age Options, said individuals with limited English, especially seniors, are less like to seek medical care, even if they are insured.
Weir said, according to a research report by the Kaiser Family Foundation in August 2012 titled “Overview of Health Coverage for Individuals with Limited English Proficiency,” they are more likely to report negative health care experiences. The report can be accessed at the foundation’s website at http://www.kff.org/uninsured/upload/8343.pdf.
“[They are] more likely to be uninsured and [have] negative experiences,” she said. “They need health literacy, [especially with] the Affordable Care Act. A lot of health information is difficult for even people with degrees.”
The foundation reports further that individuals, especially seniors, with limited English are more likely to be uninsured than adults who speak standard American English. About 50 percent of limited English adults are uninsured, which is three times the rate of uninsured English speakers. These adults are more likely to have less high school education than English-proficient adults, it states. Children who have limited English proficiency or have a parent suffering likewise are twice as likely to be uninsured, the foundation reveals in its research.
Additionally, according to a report by the Coalition of Limited English-Speaking Elderly in June 2012 titled “A Profile of Limited English Speaking Older Adults in metropolitan Chicago,” one-third of limited-English seniors in Chicago have a disability, Weir added. The coalition also demonstrates that more than half of limited English adults in Chicago have not completed high school.
A September 2005 article in the Journal of General Internal Medicine found that limited-English adults are more likely to report difficulties understanding medical situations. The article can be accessed at the National Library of Medicine website at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1490205.
“[Seniors with] LEP have it hard,” she said. “You can imagine how hard it is. A person goes to a hospital and is told that an interpreter will be there and they don’t [show up]. That’s devastating. They may never go to [that] hospital again.”
Healthcare materials, Weir explained, can be hard to understand even for native English speakers. Those who do not read or understand English may have more difficulty and need more help navigating healthcare applications and systems.
She said limited-English demographics need unique outreach methods because of their challenges to health literacy must be overcome, there is a possibility that their negative experiences may block access to care, their culture, beliefs, values, roles of families, communities and individuals and the prioritization of their needs must be examined and their trust in health institutions must be restored.
“Trust is a major factor,” Weir said. “Many LEP [adults] have a lot of negative experiences. [The] blind have reason to distrust government and associations. We need to win their trust back again.”
To regain the trust of the disabled and those speaking limited English, coalition advocates must listen to the needs, fears and perceived barriers of the members of their communities whether by creating or participating in forums that enable this, she said. Weir explained that responding to identified needs ensures that the message of advocates is received as important and valuable. This leads to trust on the part of the underserved.
Weir said that advocates must work with key stakeholders already trusted in their communities. She pointed to a partnership formed between the MMW coalition and the Coalition of Limited English Speaking Elderly in Chicago. She advised that advocates must reach out to highly utilized locations such as community centers or churches and partner with them rather than using them as a site for field work.
“We tried to listen,” Weir said of AgeOptions and its efforts to reach out to adults with limited English and their communities. “You will never get [their] trust if you talk first. What are they afraid of? What don’t they trust? What do they need?”
She added that building trust takes time. Partnerships must benefit both parties — the advocates and key stakeholding groups in the communities, Weir said. Advocates must also be prepared to hold up their end of the bargain when entering with and executing relationships with such community groups, she said.
“We have great partnerships,” she said of AgeOptions. “You may have community centers. Don’t call them to ask to use their site. You may have a partnership [with them]. When you [have] materials, talk to [your] partners. Use them as stakeholders.”
Weir counsels advocacy groups to be honest and accurate when conducting outreach to limited English and disabled communities. She said “deceptive/incorrect information” will breach any trust sought for.
“You focus on teaching them that issue [that’s most important to them],” Weir said. [You] not only give information out [but you also] take back trust.”
She added that it is important to learn what is and what is not culturally appropriate in both oral and written communication. The most knowledgeable stakeholders, she said, use methods and tools that work and learn how to avoid offending those they serve.
They use plain English language in all of their communication materials, she said. They translate all written materials and know when to perform an appropriate translation of language and when to conduct a literal translation.
“Don’t be offensive or [your message] won’t be received,” she said. “[Make sure that it is] simple and plainly done [when addressing key] health issues. Make it easy to comprehend.”
Weir held up as an example an initiative by the Coalition of Limited English Speaking Elderly to reach out to 50 ethnic groups and to produce and distribute materials in Korean, Arabic, Indian and Spanish languages. AgeOptions itself worked with 13 agencies in 13 different languages to spread Medicare materials.
The MMW coalition, she said, prides itself on distinguishing between providing culturally appropriate translations and translating word for word in delivering its content.
Advocacy groups should also designate and identify individuals that their limited-English and disabled clients must contact to follow up with questions or obtain further assistance, Weir said. This must be done before engaging in outreach, she added.
They should also determine what methods will be used to assist limited-English clients and reveal these in their materials, she said. Advocates must also decide whether they will use bilingual staff or in-person or telephone interpretation services for their clients.
“Use community stakeholding groups that use language to rewrite in their languages of origin,” Weir said. “Know who you will tell to call. It is dangerous to offer things [that are] not there. Decide [if you will use bilingual staff or an interpretation service].”
This article was originally published Feb. 8, 2014 on the website of PharmPsych.com, one of seven websites that comprise The Pharm Psych Network, a medical communications and education company.