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Center for Immigrant Health (CIH)

NYU School of Medicine

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

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

Eight Intertwined CANIMP

ElementsCommunity Outreach and EducationProvider EducationFormative ResearchJunior Minority Scientist Mentorship ProgramPilot ProjectsCANIMP Internship ProgramTechnology Access ProgramCommunity Training Program: ResearchMethodology

PARTNERS

Community Cancer

Education and Linkages

Eunah Chung, M.P.H.

Community Cancer Education andLinkages

Programs Ever-Changing, Based onOngoing Focus GroupsVariety of Venues

English as Second Language ClassesSoccer ClubsCBO PartnersFaith-based Sites

Korean Community Focus GroupsFocus GroupMost participants visited doctors after they became sick andafter self-medication had failed (home-remedies, traditionalmedicine, over-the-counter medicine)Fear of receiving “bad-news”Language problems inhibited them from seeking medicalattention – even when sick, they forego medical attention ifinterpretation services unavailable or unable to find a friend orrelative to interpretTranslation services were “poor”Breast Cancer - Self breast exams as “hateful” and refused toperform themMammograms – inability to pay, difficulty taking time off, painassociated with mammograms, and fear of results

Focus Groups

Focus Groups Cervical Cancer - Lessknowledgeable about cervical cancer thanbreast cancerBelieved to be caused by frequent sex,abortions, having many children, uncleanhabits and untreated venereal diseaseProstate Cancer – several Korean men didnot know what the prostate was

Tracking Those Educated

825 community members wereeducated over 6 months

732 evaluations were received 80% were women 82% undocumented

Did they go for screening and follow-up?Now being tracked

Those reached

Ethnic Distribution

Other

1%

Haitian

39%

Korean

5%Caribbean

6%Chinese

15%

Latino

34%

Not Enough Men, Therefore…

Lay Health Worker Program for Men

Unique Focus for Lay Health WorkerPrograms

Program Success to be Tracked byUtilization of Screening and Follow-upServices

Health Education Materials:

THE HAITIAN EXAMPLERachel Andre

Printed materials

The Subcommittee for Materials Reviewand Development

Collected over 200 cancereducational materials from local,national, and international sources

Pamphlets, books, posters, showercards

Inadequate Materials

Cancer educational material in Creoleand/or French for the Haitiancommunity was almost entirely lackingExcept….

Cancer facts for men and women Taking Control (Nutrition facts) Breast Self-exam brochure

How Did These

Measure Up?

Cancer Facts for Men Brochure

Results

A literal translation of the EnglishHigh literacy levelOverloaded textThey were culturally inappropriate

Caucasian photos in old versionUnappealing visually

CANIMP Creates Its Own

These brochures were focus grouptested by the community and byproviders and scored well

However…video materials are sorelyneeded and are under development forprostate and colorectal

How Did We Do?

Developing Culturally Appropriate Education

Materials: Determining Effectiveness

Jennifer Lin, M.D.

SCCAN: Screening CTs in ChineseAmerican Newcomers

GoalsTo elucidate barriers and facilitators to Chineseimmigrant participation in cancer screening trialsTo develop strategies to enhance recruitment intothe NYU Early Detection Lung Cancer StudyTo develop recommendations for the facilitation ofrecruitment of Chinese immigrants in to cancerclinical trials

Methods- Part Ifocus groups with community members, keyinformants and physicians

OutlineKnowing your target audience

Partnering early with the community

Transcreating materials

Test marketing

Tracking Effectiveness of Materials

Knowing your audience

Know the languageTraditional Chinese versus Simplified Chinese

Know the level of literacyOnly 3% of newer immigrants from Fuzhou areelementary educates

Know who to include in your target audienceInclude the family

Partnering with the communityEARLY

Help identify target audience and familiarize withtheir cultural issues

Possible source of translators

Serve as advisory group for test marketing

Help disseminate educational materials

Transcreating Materials:Knowing culturally specific preferences

Tone and AttitudePositive reframing• i.e. superstition surrounding cancer, “keeping

healthy” instead of “cancer screening”

Soften tone• do not use “you must” or “you need”

Testimonials

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

Transcreating Materials continued…

AestheticsColor• red, pink, blue, green

Symbols• no bones / skeleton

Pictures• smiling Asian faces

Text• No big paragraphs

Test MarketingBack translation is NOTsufficient

Use the help of CBOs

Reviewers should besimilar to target audience

Should not be familiar withsubject matter ofeducational material

Tracking Effectiveness

�Controlled Study�2 Senior Centers 1 with specially developed materials

and intervention1 with usual and customary cancer

health education�Measure rates of clinical trials

enrollment

Summary

Chinese immigrants are an extremely diversepopulation

Cultural preferences specific to the Chinesepopulation can be addressed by partnering earlywith CBOs and test marketing translatedmaterials

Disseminate materials with CBOs and use amulti-faceted approach with written educationalmaterial

Technology Access Program

Jyotsna Changrani, M.D.,M.P.H.

Why Consider the Internet?The online population is more and more like the generalpopulation

Women, minorities, and those earning between $30,000and $50,000 are flocking online

62% of Internet users, or 73 million persons, have goneonline to search for health information

6 million persons go online for medical advice on atypical day – more than the number of people whoactually visit health professionals

Importantly,

62% of health seekers researched aspecific illness or condition. Informationon cancer was most popular amongdisease-researching health seekers

61% of health seekers say the Internethas improved the way they take care oftheir health either “a lot” or “some”

However, the Digital Divide Remains

LinguisticLimited non-English and bilingual sitesContent sparse and less accurate

Cultural“One Site Does Not Fit All”

CANIMPRecent Technology Projects

Caribbean CARES

Virtual Community for Immigrants withCancer

CaribbeanCancer Awareness Resources Education Services

To explore strategies that can be employed toimprove penetration and effectiveness of cancercommunication through the Internet inimmigrant communities

Methods included compiling and reviewingexisting online and offline materials; conductingwebsite review sessions with the targetpopulation; and, based on the above,developing a website prototype

The Divide

Of the 31 persons ‘extremely’ or ‘quite’confident in accessing the Internet, only 2 hadused the Internet in the past 6 months toaccess health/medical information

Compares unfavorably with the general U.S.population where 62% of all people on theInternet have used it to access health/medicalinformation

Virtual Community forImmigrants with Cancer(VCIC)

†• Lack of face-to-face support groups for limitedEnglish proficient population

• Where available, face-to-face groups not alwaysconvenient

• 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 non-immigrant English-speaking breast cancerpatients successfully reduced their depression,distress and negative reactions to pain

Spanish Online Support Groups: The Need

VCIC: Project Overview

VCIC provides information, and emotionaland social support to Spanish-speakingimmigrants with breast cancer, through anonline support groupThrough VCIC we will evaluate feasibility,acceptance, and effectiveness of onlinesupport groups within immigrantcommunities

VCIC:Scope of Effectiveness Tracking

The Intervention

Impact on Being a Cancer PatientPsychosocial Adaptation (Pre- and Post-Testing)

Project Implementation and Associated Costs

Whatever the outreach

materials or venue, a poor

reception will ruin the best

efforts

When a patient successfully reaches thehealth care system, what awaitshim/her?

CANIMP Cancer Education and

Services: Response to StatedBarriers

Language

Language

Culture

Finances