Reaching Latinas with Information on Folic Acid:

How to Use the NCFA Hispanic Outreach Tool Kit

Liany Elba Arroyo, MPH, CPHInstitute for Hispanic HealthNational Council of La Raza

Presentation Overview• NCLR Overview• Snapshot of the Latino Community

– Activity 1

• Barriers Faced By Latinos• Review Tool Kit & Marketing Plan

– Activities 2 and 3

• Strategies to Engage the Latino Community• Questions/Comments

NCLR OverviewNCLR is the largest national Latino civil rights and advocacy organization inthe U.S. It was founded in 1968 to improve opportunities for Hispanic Americans.

NCLR’s headquarters is in Washington, DC, and it has offices in AZ, CA, GA,IL, NY, TX, and Puerto Rico.

Three major functions: • Strategic, capacity-building assistance to community-based

organizations• Applied research, policy analysis, and advocacy• Public information efforts and other events

NCLR has nearly 300 Affiliate partners in 41 states and Puerto Rico.the District of Columbia

IHH Overview

In 2002, Institute for Hispanic Health (IHH) was established to:

• Promote science-based, quality, culturally competent interventions to improve access to and use of health promotion and disease prevention programs.

• Reduce the incidence, burden, and impact of health problems among Hispanics and promote well-being.

• Partner with NCLR Affiliates, government agencies, private funders, and other Hispanic-serving organizations to address disparities.

• 46.9 million (not including the approximately four million residents of Puerto Rico); Hispanics in U.S. compose roughly 15.4% of U.S. population.

• 64% of Latinos are of Mexican origin.• 40% are foreign-born (excluding Puerto Ricans).• Median age is 27.7, compared to 36.8 for the U.S. population

as a whole.• 25% of children under five are Hispanic.• 22% of children under 18 are Hispanic.

Demographics of U.S. Latino Population

Source: U.S. Census Bureau 2008

Demographics of U.S. Latino Population

• One-third of population has no health insurance.• 11% of college students are Hispanic.• 24% do not speak English well.• 21.5% live below poverty level.• Median household income is about $37,800.• Almost 40% have not graduated from high school.• States with the largest Latino populations:

– California, Texas, Florida, New York, Illinois, Arizona, New Jersey, Colorado, New Mexico, and Georgia

Source: NCLR calculations using U.S. Census Bureau, 2007 American Community Survey.

Hispanic Women in the U.S.

• Hispanic women have a higher fertility rate than non-Hispanic White women (97.7 vs. 58.5 per 1,000).

• 54% of pregnancies among Latinas are unplanned.• 53% of Latina teens get pregnant at least once

before the age 20.• Complications such as diabetes, obesity, and

uninsurance affect Hispanic women at higher rates then the general population.

Latina and Prenatal Care

More than 20% of Latina immigrant women do not begin prenatal care in the first trimester.*

Multiple barriers inhibit access to prenatal care (e.g., uninsurance, poverty, language, low levels of education, low socioeconomic status, lack of information, and immigration status).

*National Latina Institute for Reproductive Health (NLIRH), Prenatal Care Access Among Immigrant Latinas (New York: NLIRH, 2006)

Latinas and Prenatal Care (cont’d)

U.S.-born Latinas have higher rates of pregnancy complications than foreign-born Latinas (90.5 vs. 71.8 per 1,000 live births).*

Latinas are 1.5 to 2 times more likely to have babies with neural tube defects than other groups.

*David Hayes-Bautista et al., Timely Access to Prenatal Care: Prime Necessity for Latina Mothers, (Los Angeles: Center for the Study of Latino Health and Culture, UCLA, 2003).

Activity 1: Your Latino Community

• In groups of three, think about the community you are attempting to reach with information on folic acid.

• List the characteristics of that community. Include the following: – National origin (e.g., Mexican, Puerto Rican, Central American)– Generational status (e.g., immigrant; 1st, 2nd, or 3rd gen.)– Socioeconomic status (e.g., working poor, middle class)– Family unit (e.g., large extended families, small family unit)– Rural vs. urban (geographically dispersed)

• If you do not have all of this information or are not familiar with the Latino population you are trying to reach, where could you find out this information?

• You have five minutes to discuss this in your group. • Save this information for an activity later on.

Barriers to Health Care Access• Access

• Language • Lack of insurance• Literacy levels• Information

• Sociocultural Factors• Lack of knowledge about U.S. health care system• Fear of deportation or jeopardizing future legal status• Familial orientation• Mixed-status families• Generational status• Education

• Structural Factors• Long waits• Inconvenient hours• Lack of transportation• High cost of services• Lack of Spanish-speaking providers• Legal permanent residents who enter after 08/1996 barred

from accessing Medicaid (CHIP reauthorization allows pregnant women and children to access Medicaid and CHIP)

Barriers to Health Care Access

What can we do?• We need to develop culturally and linguistically appropriate

strategies to reach Latinas most at risk and in need of information.• Two-pronged approach:

• Media• Community outreach

• NCLR and NCFA developed two tools in response to this need:◦Hispanic Media and Community Outreach Tool Kit◦Hispanic Communications and Marketing Plan

Hispanic Media & Community Outreach Tool Kit

Purpose: To provide organizations with a toolthey can use to guide them in partnering withthe Hispanic media on folic acid promotion. It contains:

A profile of the Latino community An overview of how to work with the media An explanation of how the Hispanic media differs from

mainstream media Suggested talking points Templates for related press materials Information on resources

Hispanic Media & Community Outreach Tool Kit (cont’d)

Is it important to work with Spanish-language media because they:

Seek to provide information to the community that is relevant and culturally sensitive

Like a human angle -- personal stories, statistics, and data on the Latino community

Reach a segment of the population that may not be familiar with mainstream U.S. institutions or the political system

Enjoy cultivating relationships and will continue to seek you out as a source of additional information

Have bilingual staff and will work with all groups to fulfill their mission

Activity 2: Practicing Your Elevator Speech

• Divide into groups of three. One person in the group will be the reporter, one will be an organizational spokesperson, and one will be timekeeper.

• Reporter should ask spokesperson three questions:– Why is this issue important?– Why should it matter to Latinos?– What can Latinos do to address the issue?• Spokesperson answer questions in a 30 second sound bite, then a

15 second sound bite. Each person in the group should take a turn in each role.

• Each team should pick one person to share their answers with the group.

Hispanic Communications and Marketing Plan

Purpose: To provide organizations with a toolto plan targeted outreach campaigns for theHispanic community and increase partnershipswith local Latino organizations. It contains: ◦A planning tool for increasing outreach, partnerships,

and contacts with Latino organizations and women◦A timeline of possible monthly activities organized by

key dates◦A budget template

Hispanic Communications and Marketing Plan (cont’d)

Possible activities include:Media Outreach◦Radio, TV, newspapers/print, internet, emails, and greeting

cardsCommunity Partnerships◦Get involved with Latino community organizations! ◦Be a resource for local organizations. Know about and

attend their events.Community Outreach◦Give talks in the community, advertise in local

establishments, and attend popular local events.

Hispanic Communications and Marketing Plan (cont’d)

Key months for activities include:– January -- National Birth Defects Prevention Month

and Folic Acid Awareness Week– May -- Mother’s Day; National Teen Pregnancy

Prevention Month; National Women’s Health Week; National Women’s Check-up Day

– September -- Hispanic Heritage Month (September 15 – October 15)

– October -- National Spina Bifida Awareness Month

Hispanic Communications and Marketing Plan (cont’d)

Budget Template: This allows organizations to plan their outreach

budget according to their activities and to think about the various costs that may be involved.

Always take advantage of opportunities that might be free or low-cost but still pervasive and effective. Building and cultivating relationships can create these opportunities.

Marketing and Communications Plan Template

Goals: (What do you want to accomplish? Be sure whenever possible that these are measurable; it is best to include a target figure.)

Plan: (How specifically do you plan on reaching your goals? What are you going to do differently this year than last year? Who are your partners?)

Timeline: (Map out your plan for the year. Include all of the “little” steps so you don’t forget. Use this timeline as a checklist each month to see what needs to be done.)January JulyFebruary AugustMarch SeptemberApril OctoberMay NovemberJune December

Activity 3: Using What You Learned

• Divide into groups of four.• As a group, use the template as a guide to develop a media and

community outreach activity for a specific month. Use the information from Activity 1 to help you decide what types of activities you are going to engage in.

• As you fill in the template, think about the following questions:– Why did you pick this month?– Why do you think these activities will be effective in reaching

the Latino community?– Who are your partners and why? What benefit(s) do they get?– How will you measure success?

How Can We Effectively Reach the Latino Community?

• Identify and understand the needs of the community you are serving.

• Tailor programs to address those needs.• Work in collaboration with the community.

– They determine their needs.– They are partners in decision making.

• Community should benefit from the collaboration.• Knowledge and capacity should be transferred/left in

community.

Strategies for Engagement

– Employing promotores de salud– Viewing family as the basis for intervention– Using social marketing and grassroots approaches

simultaneously– Working with community-based organizations– Providing tools to act upon information received– Maintaining ongoing interventions

Who are Promotores de Salud?• Promotores de salud are lay health

educators trained in health topics of interest to the community.

• The concept evolved from the Russian feldshers in the 1600s to China’s “barefoot doctors” in the 1950s and then to promotores de salud in the 1960s as liberation theology was taking hold in Latin America.

Promotores de salud may function as: ♦ Patient navigators who assist the

community in navigating the health care system to access health services

♦ Community representatives who take a lead role in leading local health advocacy efforts

Final PointsThese tools do not detail all effective methods of

reaching the Latino population – organizations still may need to tailor messages/strategies to their community.

Media is important BUT more successful when the grassroots (i.e. community) activities compliment the air media message to truly hit home on a personal level.

Do not limit yourself by simply translating English materials. Develop messages for Latinos.

Don’t forget English-speaking Hispanics!

Questions?

Liany Elba Arroyo, MPH, CPHDirector, Institute for Hispanic Health

National Council of La Raza1126 16th Street, NW

Washington, DC 20036larroyo@nclr.org