2. Tips and Tactics to Overcome Literacy and Cultural Barriers
Friday, August 9 3:45 – 4:15 PM George R. Brown Convention Center
Houston, TX

3. Sandra Arévalo MPH, RDN, CDE, CLC, FADA
Director of Nutrition and Outreach
Montefiore
South Bronx Health Center
Bronx, NY

4. Disclosure to Participants
Notice of Requirements For Successful Completion
Please refer to learning goals and objectives
Learners must attend the full activity and complete the evaluation in order to claim continuing education credit/hours
Conflict of Interest (COI) and Financial Relationship Disclosures:
No COI/Financial Relationship to disclose
Non-Endorsement of Products:
No endorsements to disclose
Off-Label Use:
Nothing to disclose

5. Objectives
At the completion of this presentation, the participant will be able to:
Explain the influx of literacy and culture in health choices and outcomes
Identify practices of patients with low literacy and cultural barriers to diabetes self-care
Practice innovative methods that help to break literacy and cultural barriers to enhance adherence to recommendations

6. What is literacy?

7. What is literate?

8. 43% of people in the US have limited reading ability
Are we literate?
43% of people in the US have limited reading ability

9. “Functional” Literacy
“ An individual’s ability to read, write, and speak in English, and compute and solve problems at levels of proficiency necessary to function on the job and in society, to achieve one’s goals, and develop one’s knowledge and potential.” National Literacy Act of 1991

10. What is culture?
Culture is not only about race or country of origin, but about the experiences that shape our personality and the way we live our lives.

11. One Size Doesn’t Fit All
Individuals from the same territory might be united by broad cultural similarities, but each segment might have its own habits and traditions
Again, very important point! I am thinking this would be a nice slide to have before talking about food differences, slide 9. Do you like chile, pique or whatever it is called ? Or eat tortillas at most meals like I do? We could play off of each other’s differences with this one to show the audience that we are very different although we share a common language.Like it… I agree – we can compare our own experience throughout the presentation as well as those of our family members and friends.

12. Immigrant Cultures in The US
Origin Dominant
Emphasize traditional health choices
U.S. Dominant
Emphasize American health choices
Bi-cultural
Emphasize positive behaviors of both cultures 12 12

13. Latinos are all different
Different culinary habits and traditions
Many variations in the language
Again, very important point! I am thinking this would be a nice slide to have before talking about food differences, slide 9. Do you like chile, pique or whatever it is called ? Or eat tortillas at most meals like I do? We could play off of each other’s differences with this one to show the audience that we are very different although we share a common language.Like it… I agree – we can compare our own experience throughout the presentation as well as those of our family members and friends.

14. One Language Many Variables
USA
Mexico Central America
Caribbean
South America
Beans
Frijoles
Habichuelas/ Judias
Fríjoles/Habas
Squash
Calabaza
Calabaza/ Ahuyama
Ahuyama/ Zapallo
Corn on the cob
Elote
Maiz asado
Mazorca
Peanuts
Cacahuates
Maní
Rice stuck to the pot
Pegado de arroz
Concón
Pega/concolón
Comida – Food – Implication for insulin administration or medication
Vegetables or Verduras?
Pictorials are important

15. Health Literacy and Acculturation
Level of acculturation can further compound to our challenges

16. Illness, Poverty & Literacy
Low literacy costs $73 million or more per year in terms of direct health care costs
43% of adults at level 1 literacy skills live in poverty vs 4% of those at level 5
90% of welfare recipients are high school dropouts
05/31/2019

17. Illness, Poverty & Literacy

18. Low health literacy is associated with:
Less knowledge of disease and self-care
Worse self-management skills
Lower medication compliance rates
Higher hospitalization rates
Worse health outcomes
Higher rates of depression

19. Am I doing a good job?

20. Let’s put ourselves in their shoes…

21. Exercise #1
Hint: The first word is “CLEANING.”
GNINAELC = ot erussa high ecnanrofrep, yllacidoirep naelc eht epat sdaeh dna nalspac revenehw uoy eciton na noitaiurnicca fo tsud dna nworb-red edixo selcitrap. Esu a notton baws denelsiom htiw iyporposi lohocla. Eb erus on lohocla sehcuot eht rebbur strap, sa ti sdnet: ot yrd dna yllautneve kcarc eht rebbur. Esu a pmad thole ro egnops ot naelc eht tenibac. A dlim paos, ekil gnihsawhsid tnegreted, lliw pleh evomer esaerg ro lio.
Read the entire passage below out loud to yourself. You have 1 minute to read.
Hint: The words are written backwards and the first word is “CLEANING.”

22. Exercise #2
Select a partner and after reading the information below, use the “teach back” technique to demonstrate understanding of the information.
“Mrs. B., your doctor would like you to take two tablets, twice a day, on an empty stomach. He wants you to make an appointment to see him again in two weeks and then he will give you a referral to the Gastroenterologist”.

23. Exercise #3
Global Financial Group Inc. (GFG-TSX Venture) announces that the non-brokered private placement previously announced December 16, 2003 has been over subscribed. The Company has increased the non-brokered private placement, subject to the approval of the TSX Venture Exchange, up to 703,800 units of the Company at a price of $0.25 per unit. Each unit will consist of one common share and one non-transferable share purchase warrant entitling the holder to purchase one additional common share of the Company for a period of one year at a price of $0.30 per share. The proceeds of the private placement will be used for the development of the e-globe x-change and general working capital.

24. Tips and Tactics to Overcome Literacy and Cultural Barriers

25. 1. Identify patients with low literacy
High risk group:
- did not complete high school, minority, elderly.
Does not know names of medicines
Frequent missed appointments
“I forgot my glasses”
Always comes with someone else:
“surrogate reader”

26. 2. Identify literacy levels
Use “social history” to ask about education, literacy, etc.
“How far did you go in school?”
Do you enjoy reading?
What do you like to read?
“A lot of people have trouble reading things they get from the doctor because of all the medical words. Is it hard for you to read the things you get here?”

27. 3. Assess Acculturation Ask about: country of origin
length of permanency in the US
roots, family values, holidays, celebrations
home remedies and health believes
activities patient loved to do at original country
markets, cultural foods, ingredients, and recipes
Discuss advice for medical professional Vs Advice for patient/caregiver
Key questions:
How long they’ve been living in the US
Where are they from
Suggest Lorena’s book
For both providers and patients: get personal – work as a team, know each other

28. 4. Help patients improve comprehension
Ask patient to read and explain
Prescription labels.
“If you were going to eat lunch at noon, what time should you take the medicine before lunch?”

29. Ask patient to read and explain Appointment slips
“When is your next
Appointment?
Where?”
Endocrinology

30. Ask patient to read and explain Glycemia readings
“Is your blood sugar
normal today?”

31. Ask patient to read and explain Handouts “Which of these symptoms do
you feel when your sugars are low?”

32. Ask patient to read and explain Food labels
“How much sugar is in this bottle?”

33. 5. Use Friendly-Educational Materials
Simple wording
Short sentences
Picture based
Focus on key points
Use cultural appropriate examples

34. 6. Inspect your community
Attend ethnic events
Enjoy ethnic festivals
Visit ethnic stores
Join cultural groups
Read books about other countries
Join list-serves
Share with people from other countries

35. 7. Use Other Tips & Tactics
Define new words and concepts
Slow down the pace of your speech
Do not raise the tone of your voice
Use analogies
Use lots of visuals
Focus on key messages and repeat often
Use demonstrations followed by “teach back”
Use good translations
Both providers and patients can learn from each other and need to follow this tips to enhance communication

36. Am I doing a good job?
Yes, we are!
It just isn’t easy!