Reaching Latinas with Information on Folic Acid: How to Use the NCFA Hispanic Outreach Tool Kit Liany Elba Arroyo, MPH, CPH Institute for Hispanic Health National 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 Overview NCLR is the largest national Latino civil rights and advocacy organization in the 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 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 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; 1 st, 2 nd, or 3 rd 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 tool they can use to guide them in partnering with the 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 tool to plan targeted outreach campaigns for the Hispanic community and increase partnerships with 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, s, and greeting cards Community 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 July February August March September April October May November JuneDecember

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 Points These 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, CPH Director, Institute for Hispanic Health National Council of La Raza th Street, NW Washington, DC