Disseminating H1N1 Information to Hard-to-Reach Minnesotans Lynn Bahta, R.N., P.H.N. Minnesota Department of Health April 2010 National Immunization Conference

Setting: Minnesota  Decentralized public health infrastructure:  87 counties  10 tribal health jurisdictions  Eight public health regions  Statewide videoconferencing capacity  Multi-cultural communication venue exists as the Emergency, Community & Health Outreach (ECHO)

Population Served  Growing diverse population  Minnesota 2008: 340,657 (6.5%) were foreign born  Increase of 5.3% since 2000 Source: Minnesota Demographic Center

Foreign-Born Population Minnesota, 2008  In 1960, more than 50% of foreign-born Minnesotans were from Europe.  In 2008, just 13.8% of foreign-born Minnesotans were from Europe. Source: 2008 American Communities Survey

 First assumption: certain populations may be at increase risk of morbidity and mortality due to:  Lack of health service access  Lack of information regarding health threat Background: Pre pandemic Planning

 Second assumption: that these certain populations would not seek traditional communication channels for information

Background: Spring H1N1 Outbreak  During the spring H1N1 outbreak a Special Populations section was designated within Operations Branch of MDH’s Incident Command structure

Background: Spring H1N1 Outbreak  Invitation to community leaders to attend an informational forum  Leaders identified and invited by Refugee Health Program, Office of Minority and Multicultural Health  Two forums held in metro area  150 community representatives attended

Background: Spring H1N1 Outbreak  Feedback:  Information directly from MDH is trustworthy and important to us  Tell us what the pandemic plan is  Give us the information and we will translate it for our communities  Limited English speaking groups aren’t the only disconnected communities – don’t forget African American, American Indian and homeless communities

Background: Spring H1N1 Outbreak  Debriefing and planning occurred during summer 2009  Based on debriefing, the communications plan was revised by a Core MDH team from:  Communications Office  Refugee Health program  Office of Minority and Multicultural Health  Office of Emergency Preparedness

Communication Plan Assumptions  Use a combination of methods  Get key messages to as many groups as possible  Focus on consistent public messages  Ability to keep information updated  Avoid duplicative effort  Use high quality translations

Communication Plan Assumptions  Populations to include:  Persons with limited English proficiency  Minorities  Persons with functional limitations related to communication, medical independence, supervision, and transportation concerns  Homeless persons  Persons in poverty

Proposed Activities  Develop data-driven list of top languages  Top 18  Top 10  Top 3  Translate relatively static key messages into all 18 identified languages

Proposed activities cont.  Translate weekly updates of evolving messages into top 3 or 10 – depending upon available resources  Translate certain materials such as screening forms or fact sheets into 3-10 top languages  Check quality of translations

Proposed activities cont.  Work with ECHO to provide mixed media messages in top languages  Coordinate ethnic media interviews  Conduct statewide community forum  Use ATT language line for public hotline calls

Proposed activities cont.  Keep partners informed  Local public health  Identified community leaders

Results & lessons learned: Fall 2009  Statewide interactive forum held: 230 participants  Three additional forums held in the Minneapolis-St. Paul area  Agenda included:  H1N1 disease update  Vaccination update  Pandemic planning guidance  How to work with local jurisdictions to meet the needs of special populations

Results & lessons learned: Fall 2009  Over 200 organizations were represented at the forums conducted and included:  Persons with limited English proficiency – both refugee and immigrant groups  Homeless shelters  Local Public Health  Community-based organizations (CBOs) serving the uninsured and underinsured

Results & lessons learned: Fall 2009  Communities represented cont.  Community Health Workers  Educators from the Commission on Deaf, Deaf-Blind, and Hard of Hearing Minnesotans, Deaf-Blind Services of MN  Minnesota State Council on Disabilities H1N1 educational session for Karen refugees from Burma

Results & lessons learned: Fall 2009  Media venues used  Somali radio  Hispanic radio  Hmong TV and web  ASL via DeafMD Spanish guest expert Dr. Cristina and host

Our website:

ECHO Emergency, Community & Health Outreach

Results & lessons learned: Fall 2009  Vaccination by community-based organizations and neighborhood clinics  Churches  Temples  Community Centers  Schools  Public housing sites  Neighborhood celebrations  Groups served:  Persons of color  Persons with limited English proficiency  Homeless persons  Homebound persons

2009 H1N1 Vaccination Coverage Estimates as of January 2010 Source: BRFSS and NHFS

Ongoing activities  Assist CBOs in developing Continuity of Operations plans  Establish ongoing contact list of community leaders  Identify gaps in communication  Identify more efficient methods for updating communities  Continue to work with local health jurisdictions to meet special population needs

Acknowledgements  Sara Chute, MPP, Refugee Health Consultant Immunizations, Tuberculosis, International Health  Don Sheldrew, MSW, LicSW, NREMT-P, Planner Office of Emergency Preparedness  Susan Ersted, MEd, Communications Manager Immunizations, Tuberculosis, International Health