Online Resources for Culturally and Linguistically Appropriate Services in Home Healthcare and Hospice: Resources for Spanish-Speaking Patients JUDITH S. YOUNG, MLS
Home healthcare and hospice clinicians are increasingly working with patients for whom English is not their primary language. Provision of culturally respectful and acceptable patient-centered care includes both an awareness of cultural beliefs that influence the patient’s health and also the ability to provide the patient with health information in the language with which he or she is most comfortable. This article identifies resources for understanding the cultural norms of different Spanish-speaking groups as well as materials appropriate for Spanishspeaking patients that healthcare professionals and government agencies from around the world have made available for others to use.
The United States Department of Health and Human Services (HHS) program “Healthy People 2020” (2011) noted that in 2008 the population was estimated to be 304 million. Approximately 33%, or more than 100 million persons, stated they belonged to an ethnic or racial minority population. The U.S. Census Bureau reported in 2008 that approximately 46.9 million people of Hispanic birth resided in the United States. This represents 15% of the total U.S. population. Twelve percent of the U.S. population speak Spanish in the home (Office of Minority Health [OMH], 2009). With demographics like this, providing patient education materials in Spanish is a mandate for home healthcare clinicians.
This article is the first in a series that introduces home healthcare and hospice clinicians to many online resources that will assist them in providing culturally competent, patient-centered care. This part will discuss Web sites for information about Hispanic cultures and Spanish-language patient education resources for clinicians. Future articles will focus on Asian, African, Middle Eastern, and European languages and ethnic groups. In the late 1990s, the OMH undertook the development of National Standards for Culturally and Linguistically Appropriate Health Care (CLAS) to address evidence that minority groups in the United States had significantly more morbidity and mortality than the majority
group had. OMH published their final report on the CLAS standards in March 2001, stating that “the aim of the [CLAS] standards is to contribute to the elimination of racial and ethnic health disparities” (OMH, 2001, p. ix). The standards encouraged culturally competent care and provide skilled interpreters for patients who had limited English proficiency (LEP). Standard 7 mandated that healthcare organizations receiving federal funds provide easily understood educational materials in the languages of the ethnic groups served in their communities. Culturally competent, patientcentered care includes both an awareness of cultural beliefs that influence the patient’s health and also the ability to provide the patient with health information in the language with which he or she is most comfortable. Cultural competency also means being aware of the “ethnic and religious beliefs, values, and practices” of one’s patients since these factors impact how a person perceives health and illness (Narayan, 2003, p. 612).
This article originally appeared in Home Healthcare Nurse 2012;30(1):E1–E7.
S12 Home Healthcare Nurse
www.homehealthcarenurseonline.com
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Most health sciences libraries offer a selection of books on the health practices of various cultural groups. However, the home care clinician without access to such a library is dependent on other outside resources. The Internet provides a multitude of Web sites offering this information. Perkins and Youdelman (2008) reported that U.S. state legislatures “are increasingly recognizing the need for linguistically-appropriate healthcare and have adopted measures that require or encourage health and social service providers to overcome language barriers” (p. 4). All 50 states now have laws about language access in healthcare institutions in addition to the federal CLAS standards. As the immigrant population grows, home healthcare clinicians are called on to care for patients whose primary language is not English and for whom health literacy may be an issue. At the time that the CLAS standards were developed, home healthcare clinicians expressed concern that implementing the language provisions would be an economic hardship (OMH, 2001). As organizations from all over the world have developed bilingual patient education materials and made them accessible on the Internet, providing linguistically appropriate material may no longer be a hardship. Most of these resources can be downloaded and freely distributed as long as the original source is cited. These sites have been developed by government agencies, healthcare organizations, nonprofit groups, and academic in-
vol. 32 • no. 5S • May 2014
stitutions, and present material that is objective, unbiased, and free. Finding this information is time consuming, however, which can be a problem for home healthcare clinicians, especially those in independent agencies with no relationship to a larger healthcare organization.
Spanish-Speaking Cultural Groups: Differences in Language Spanish-speaking patients come from a large number of culturally different countries located primarily in Central and South America, Europe (Spain), Cuba, the Caribbean, and others. Pronunciation of the kind of Spanish, and use of idioms varies from country to country. The culturally competent clinician should be aware of the patient’s country of origin.
Resources for Clinicians: A Listing • http://www.health.qld.gov .au/multicultural/health_ workers/latin_am.pdf The Centre for Cultural Diversity in Ageing in Australia has links to separate guides for Latin Americans and Spaniards on its Web site. Latin Americans: A Guide for Health Professionals (Queensland Health, n.d.) begins with information on patient interaction. It also discusses use of health services, health beliefs and practices, mental health, maternal and child health, and women’s health. • http://www.culturaldiver sity.com.au/practice-guides/ cultural-awareness
Cultural Briefing on the Spanish Community describes the people of Spain. It addresses religion, values, customs, greetings and gestures, dating and marriage, diet and eating, dress, approach to the health system, health status, and attitudes toward older people and those with a disability. • http://www.bu.edu/bhlp/ Resources/country_guides/ index.html The Boston University School of Medicine (n.d.) developed the Boston Healing Landscape Project, which is a program for the study of the cultural, therapeutic, and religious pluralism of the ethnic communities represented in the population served by the university. Their Web site includes extensive information for clinicians providing health services to patients from Puerto Rico and Guatemala. The site provides links to material giving an overview of each country and its cultural background. It reviews the immigrant experience and relevant healthcare issues. It also presents information on the healthcare systems in the individual countries. • http://depts.washington .edu/pfes/CultureClues.htm The University of Washington Medical Center offers a series of Culture CluesTM on its Web site. These are tip sheets for clinicians developed to promote awareness of the cultural influences on the various cultural groups served by the medical center. The series includes a two page guide
Home Healthcare Nurse S13
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“End-of-life care: The Latino culture” (University of Washington Medical Center, 2004). • http://www.healthcarechap laincy.org/userimages/ Cultural%20&%20Spiritual% 20Dictionary%2012-20-10.pdf The Health Care Chaplaincy in New York offers A Dictionary of Patients’ Spiritual & Cultural Values for Health Care Professionals. The first section of the document covers the world’s religions. The second section is devoted to individual cultures. The chapter on Hispanic American culture provides introductory information on decision making, family structure, food practices and beliefs, greetings, and nonverbal communication. Health, illness, and death issues discussed include consents, death and dying, illness beliefs, organ donation, pain, and terminal illness. A separate section covers pregnancy, birth, and postpartum. A separate chapter provides a small discussion of Cuban American beliefs relating to illness and the dying process. • http://www.nh.gov/oep/pro grams/refugee/documents/ ethnic_community_ profiles.pdf “Ethnic Community Profiles” from the New Hampshire Governor’s Office of Energy and Community Services (n.d.) is a detailed description of 16 ethnic groups that are prevalent in that state, including Cuban refugees. The six-page section on Cubans reviews communication, religion, social structure, health beliefs and practices, and pregnancy and childbirth.
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At the end is a list of health risks in refugees from Latin America as well as recommended laboratory and other tests for this population. • http://erc.msh.org/mainpage .cfm?file=1.0.htm&module= provider&language=English The “Provider’s Guide to Quality & Culture” Web site is designed to assist healthcare professionals in better serving the growing needs of ethnic communities in the United States. The Hispanics/Latinos section provides an introduction to the culture followed by a discussion of the strengths and protective factors in their families and communities. Challenges to their health and well-being are reviewed and principles for culturally competent health services are outlined. • http://cirrie.buffalo.edu/ culture/monographs/ index.php/?redirect=true The Center for International Rehabilitation Research Information has developed a monograph series on cultures of foreign-born persons in the United States. Cuba, Mexico, and El Salvador are among the countries of origin covered. The monographs provide general information about the culture and its values and recommends ways of interacting with those citizens. It particularly addresses how the cultures view disability and rehabilitation. The guides are available in .html and PDF format. • http://www.stanford.edu/ group/ethnoger/hispanicla tino.html
Health and Health Care of Hispanic/Latino American Elders is a curriculum module designed to educate healthcare providers on the important issues of caring for older Americans from Hispanic/Latino backgrounds. The demographics section includes morbidity and mortality data. The cultural traditions section addresses health beliefs and values, including treatment issues, end-of-life care, as well as complementary and alternative medicine practices. The document is a part of Ethno Med, the Stanford University School of Medicine Web site on ethnic specific geriatric care.
Resources for Patients: Patient Education Materials in Spanish • http://www.nlm.nih.gov/ medlineplus/spanish/) The U.S. National Library of Medicine maintains a Spanishlanguage version of MedlinePlus, its well-respected consumer health Web site (MedlinePlus información de salud para usted). • http://www.healthfinder .gov/espanol/ The U.S. Department of Health and Human Services has a Spanish-language site, Healthfinder.gov en español, which is similar to MedlinePlus. Although not as extensive in its links as MedlinePlus, the sources are of the same high quality. For example, under postpartum depression there are links to resources from the March of Dimes Birth Defects Foundation
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(http://www.marchofdimes.com/) and Postpartum Support International (http://www.postpar tum.net/). • http://nnlm.gov/outreach/ consumer/multi.html The consumer outreach librarians of the National Network of Libraries of Medicine (NN/LM) have collaborated on the Web site “Consumer Health Information in Many Languages Resources.” The site provides links to other sites with items in multiple languages including Spanish. • http://www.healthyroads media.org/index.htm Healthy Roads Media from the U.S. National Library of Medicine provides health information in 21 languages and a variety formats, including handouts, audio, and iPod video. New materials are highlighted on the main page and changed frequently. Material comes from sources such as Inova Fairfax Hospital, the U.S. National Cancer Institute, and the U.S. Committee on Refugees and Immigrants. Topics include diseases, dental health, immunizations, mental health, symptoms, medical tests, and medicines. In the medicine section, there are six entries in English and Spanish on Coumadin/warfarin with additional links to related information under other sections. Information on generic drugs is also available in Spanish. The injuries section includes information on both ankle sprains and bone fractures in Spanish. • http://www.ahrq.gov/ consumer/espanoix.htm
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The U.S. Agency for Healthcare Research and Quality (AHRQ) also offers a list of consumer materials in Spanish. Topics include surgery, specific conditions and diseases, prescriptions, clinical practice guidelines, cardiac rehabilitation, and smoking cessation. Many of the links are to videos. The specific conditions section includes a variety of resources related to diabetes. The prescriptions information includes a handout on using blood thinners safely. • http://www.cdc.gov/spanish/ enfermedades/ The Centers for Disease Control and Prevention (CDC) offers material in 22 foreign languages, including Spanish. The variety of topics primarily reflects the CDC’s focus, so it provides an extensive list of materials on infectious diseases. However, there is also information in Spanish on topics such as alcoholism, autism, cancer, diabetes, influenza, and birth defects. • http://hispanichealth.info .kramesonline.com/Spanish/ The National Hispanic Medical Association provides online access to Spanish translations of the Krames patient education materials. The homepage has three sections for browsing with alphabetical links to information on health, medicines, and health videos. There is also a search box in which you can enter a specific topic. A mirror site in English is available to guide healthcare providers who do not speak Spanish. The health sheets section includes
illnesses, surgical procedures, treatments, and diagnostic tools. The medications section has over 33,000 links to prescriptions, over-the-counter drugs, and nutraceuticals. The health videos cover diagnostics, procedures, and treatments. • http://mchlibrary.info/ KnowledgePaths/kp_ spanish.html Georgetown University’s Maternal and Child Health (MCH) Library offers the “SpanishLanguage Health Resources Knowledge Path” to provide patients with access to current information. The site has several sections, which are all on one page, so be sure to use the handy links in the boxed table of contents on the right side of the page. General resources are listed first and include information on health hotlines and helplines. There is also an A to Z annotated list of healthrelated Web sites ranging from AHRQ through womenshealth. gov. Following the Web site list is one for additional electronic publications and a selection of health-related databases that include Spanish-language materials. The final section of the site presents links to resources on specific maternal and child health topics ranging from adolescent violence prevention to sudden and other unexpected infant death. Again, the entries are annotated. In the case of help lines, phone numbers are provided. Whenever possible, the date of the publication is indicated. • http://www.noah-health.org/ Another extensive resource for Spanish-language information
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is New York Online Access to Health (NOAH). The site is a volunteer collaboration between librarians and healthcare professionals who select full-text, unbiased, and accurate consumer health information. The site is well organized and updated almost daily. The opening page is bilingual with two mirror columns listing its major sections. In the lower left hand corner of the bottom of the page is a link for new items that leads to a list of all the material added in the previous week. Above the columns is a standard search box. Searching on “home care” identified more than 400 items including medication information, and brochures on home-based pulmonary rehabilitation and home care following various surgical procedures. The health topics section opens a page with an outline of major subjects. Under “Disorders and conditions—body location systems” is an alphabetical list of both body parts and major health issues such as cancer, environmental health, mental health, and pregnancy and family. In true outline form, there are links to specific subtopics. For example, “Pregnancy and family” lists adoption, abortion, family planning/contraception, infertility, newborn and infant care (to 2 years), single parenthood, and surrogacy. The second link on the main page is to an A to Z index of all the conditions or health issues on the site. The list ranges from abdominal pain to Zollinger-Ellison syndrome. The individual topics contain links to material from authoritative sources such as the
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Mayo Clinic, the various National Institutes of Health, the Merck Manual, foundations, and various professional organizations. The hypertext links may make the site cumbersome to use. However, the quality and breadth of the information the links lead to makes the effort worthwhile. • http://www.infogen.org.mx/ Infogen1/servlet/CtrlHome Infogen is a Spanish-language site developed by volunteers and healthcare providers with a focus on birth defects. Sections of the Web site address prevention before, during, and after pregnancy; complications during pregnancy and postpartum, and specific birth defects. The defects section enables browsing by letter of the alphabet. Under the letter T were entries for Turner Syndrome, congenital muscular torticollis, congenital toxoplasmosis, and defects of trisomy 13, 18, and 21. The entries define the problem, discuss probable cause, identify diagnostic tests, review complications, and address the probability of the defect appearing in another pregnancy. • http://www.aacap.org/ page.ww?section=Facts+for+ Families&name=Facts+for+ Families The American Academy of Child & Adolescent Psychiatry provides an extensive collection of “Facts for Families” in English and Spanish. Topics covered include autism, grief, bedwetting, chronic physical illness, eating disorders, lead poisoning, and obesity.
• http://www.healthtransla tions.com/aspx/languages/ spanish.aspx The Missouri Hospital Association (MHA) sponsors HealthTranslations.com, which features “communication boards” with pictures of health-related procedures and descriptions of various conditions in English and seven languages including Spanish. There are links to more than 175 documents in Spanish that have been translated from MHA’s own publications as well as those from established agencies such as the Centers for Disease Control, the American Diabetes Association, and the U.S. National Heart, Blood, and Lung Institute. Topics covered range from abuse, domestic through West Nile virus. Under the resources tab is a link to additional agencies that offer Spanish-language materials. • http://www.healthinfotrans lations.org/language/spanish/ 524152/ Four central Ohio healthcare providers have developed Health Information Translations. Information is provided in 18 languages including Spanish. The material includes print as well as audio and video material. The list of Spanish titles is extensive and includes diagnostic tests, diseases and conditions, pregnancy and baby care, stress and coping, and surgeries. At the end of list of individual titles is a section for “other topics,” which includes home care. The home care section includes information on Foley catheters, drawing up insulin, incision care, and
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handling chemotherapy safely. The individual information sheets alternate English with the language selected. • http://www.wellzone.org/ contactUs.aspx The Humana Foundation has developed The Wellness Information Zone to provide public access to basic health information that is easily understood by those with low health literacy. Near the top of the homepage is a direct link to the Spanish-language information. The actual documents are from such reputable sources as the U.S. Food and Drug Administration, the American Academy of Family Physicians, and the Nemours Foundation. Topics covered range from acid reflux to vision problems. Mental health, heart diseases, and diabetes have the most available documents. • http://www.rhin.org/ Default.aspx The Refugee Health Information Network is a national collaborative partnership dedicated to providing multilingual patient education materials and information on refugee populations and cultures for U.S. healthcare providers. The search option enables you to search by language, topic, and format. The resources include audio and video materials in addition to print. A blanket search for all Spanish-language items identified a total of 663. A topical search for information on “heart disease” in Spanish resulted in 11 items that covered coronary artery disease, heart attacks, high
vol. 32 • no. 5S • May 2014
cholesterol, hypertension, diabetes, and stroke. • http://www.mhcs.health .nsw.gov.au/languages/ Spanish.html The New South Wales Multicultural Health Communication Service has resources in 64 languages including Spanish. Selecting Spanish brings up a list of the available documents arranged in alphabetical order by English title. Clicking on the title leads to the entry for the document that includes a brief explanation of the contents, the date of the most recent update, and a list of all of the languages available for that document. Next to each language is a link to the PDF file for the actual document. • http://www.rdns.com.au/ media_and_resources/ Documents/Translations/ Workplacewordsandphrases Spanish.pdf The Australian Royal District Nursing Service has bilingual information sheets of words and phrases for greetings, making appointments, medical problems, and farewells in English with Spanish. There is also an introduction to the Spanish alphabet with suggestions for pronouncing the letters in English. Sheets are also available for 13 other languages. • http://www.thewomens.org .au/SpanishFactSheets The Royal Women’s Hospital in Parkville, Australia, offers women’s health-related information in more than 25 community
languages including Spanish. The factsheets available in Spanish cover benign breast conditions, gynecology, pregnancy and childbirth, and contraception. There are links under each general category to the individual PDF files by factsheet title. There is also a link to a United Nations Children’s Fund Web site for information on breastfeeding.
Conclusion and Implications for Practice LEP patients are entitled to have “meaningful language services in healthcare settings” (Perkins & Youdelman, 2008, p. 6). Home healthcare clinicians in any size organization can fulfill this mandate using the wealth of multilingual patient education materials reviewed in this article. Judith S. Young, MLS, is the Librarian at the Dixon School of Nursing, Abington Memorial Hospital, Willow Grove, Pennsylvania. The author declares no conflicts of interest. Address correspondence to: Judith S. Young, MLS, Abington Memorial Hospital, Dixon School of Nursing, Suite 200, 2500 Maryland Rd., Willow Grove, PA 19090 ([email protected]). DOI:10.1097/NHH.0000000000000081 REFERENCES
Healthy People 2020. (2011). Disparities. Retrieved from http:// healthypeople.gov/2020/about/ disparitiesAbout.aspx Narayan, M. C. (2003). Cultural assessment and care planning. Home Healthcare Nurse, 21(9), 611-618. Office of Minority Health. (2001). National standards for culturally
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Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
and linguistically appropriate services in health care executive summar y. Retrieved from http://minorityhealth.hhs.gov/ assets/pdf/checked/executive .pdf Office of Minority Health. (2009). Hispanic/Latino profile. Retrieved
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from http://minorityhealth.hhs. gov/templates/browse.aspx? lvl=2&lvlID=54 Perkins, J., & Youdelman, M. (2008). Summary of state law requirements addressing language needs in health care. Retrieved from http://www.healthlaw.org/
images/pubs/nhelp_lep-statelaw-chart_12-28-07.pdf University of Washington Medical Center. (2004). End-of-life care: The Latino culture. Retrieved from http://depts.washington. edu/pfes/PDFs/End%20of%20 Life%20Care-Latino.pdf.
www.homehealthcarenurseonline.com
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Home healthcare and hospice clinicians are increasingly working with patients for whom English is not their primary language. Provision of culturally respectful and acceptable patient-centered care includes both an awareness of cultural beliefs that influence the patient’s health and also the ability to provide the patient with health information in the language with which he or she is most comfortable. This article identifies resources for understanding the cultural norms of different Spanish-speaking groups as well as materials appropriate for Spanishspeaking patients that healthcare professionals and government agencies from around the world have made available for others to use.
The United States Department of Health and Human Services (HHS) program “Healthy People 2020” (2011) noted that in 2008 the population was estimated to be 304 million. Approximately 33%, or more than 100 million persons, stated they belonged to an ethnic or racial minority population. The U.S. Census Bureau reported in 2008 that approximately 46.9 million people of Hispanic birth resided in the United States. This represents 15% of the total U.S. population. Twelve percent of the U.S. population speak Spanish in the home (Office of Minority Health [OMH], 2009). With demographics like this, providing patient education materials in Spanish is a mandate for home healthcare clinicians.
This article is the first in a series that introduces home healthcare and hospice clinicians to many online resources that will assist them in providing culturally competent, patient-centered care. This part will discuss Web sites for information about Hispanic cultures and Spanish-language patient education resources for clinicians. Future articles will focus on Asian, African, Middle Eastern, and European languages and ethnic groups. In the late 1990s, the OMH undertook the development of National Standards for Culturally and Linguistically Appropriate Health Care (CLAS) to address evidence that minority groups in the United States had significantly more morbidity and mortality than the majority
group had. OMH published their final report on the CLAS standards in March 2001, stating that “the aim of the [CLAS] standards is to contribute to the elimination of racial and ethnic health disparities” (OMH, 2001, p. ix). The standards encouraged culturally competent care and provide skilled interpreters for patients who had limited English proficiency (LEP). Standard 7 mandated that healthcare organizations receiving federal funds provide easily understood educational materials in the languages of the ethnic groups served in their communities. Culturally competent, patientcentered care includes both an awareness of cultural beliefs that influence the patient’s health and also the ability to provide the patient with health information in the language with which he or she is most comfortable. Cultural competency also means being aware of the “ethnic and religious beliefs, values, and practices” of one’s patients since these factors impact how a person perceives health and illness (Narayan, 2003, p. 612).
This article originally appeared in Home Healthcare Nurse 2012;30(1):E1–E7.
S12 Home Healthcare Nurse
www.homehealthcarenurseonline.com
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Most health sciences libraries offer a selection of books on the health practices of various cultural groups. However, the home care clinician without access to such a library is dependent on other outside resources. The Internet provides a multitude of Web sites offering this information. Perkins and Youdelman (2008) reported that U.S. state legislatures “are increasingly recognizing the need for linguistically-appropriate healthcare and have adopted measures that require or encourage health and social service providers to overcome language barriers” (p. 4). All 50 states now have laws about language access in healthcare institutions in addition to the federal CLAS standards. As the immigrant population grows, home healthcare clinicians are called on to care for patients whose primary language is not English and for whom health literacy may be an issue. At the time that the CLAS standards were developed, home healthcare clinicians expressed concern that implementing the language provisions would be an economic hardship (OMH, 2001). As organizations from all over the world have developed bilingual patient education materials and made them accessible on the Internet, providing linguistically appropriate material may no longer be a hardship. Most of these resources can be downloaded and freely distributed as long as the original source is cited. These sites have been developed by government agencies, healthcare organizations, nonprofit groups, and academic in-
vol. 32 • no. 5S • May 2014
stitutions, and present material that is objective, unbiased, and free. Finding this information is time consuming, however, which can be a problem for home healthcare clinicians, especially those in independent agencies with no relationship to a larger healthcare organization.
Spanish-Speaking Cultural Groups: Differences in Language Spanish-speaking patients come from a large number of culturally different countries located primarily in Central and South America, Europe (Spain), Cuba, the Caribbean, and others. Pronunciation of the kind of Spanish, and use of idioms varies from country to country. The culturally competent clinician should be aware of the patient’s country of origin.
Resources for Clinicians: A Listing • http://www.health.qld.gov .au/multicultural/health_ workers/latin_am.pdf The Centre for Cultural Diversity in Ageing in Australia has links to separate guides for Latin Americans and Spaniards on its Web site. Latin Americans: A Guide for Health Professionals (Queensland Health, n.d.) begins with information on patient interaction. It also discusses use of health services, health beliefs and practices, mental health, maternal and child health, and women’s health. • http://www.culturaldiver sity.com.au/practice-guides/ cultural-awareness
Cultural Briefing on the Spanish Community describes the people of Spain. It addresses religion, values, customs, greetings and gestures, dating and marriage, diet and eating, dress, approach to the health system, health status, and attitudes toward older people and those with a disability. • http://www.bu.edu/bhlp/ Resources/country_guides/ index.html The Boston University School of Medicine (n.d.) developed the Boston Healing Landscape Project, which is a program for the study of the cultural, therapeutic, and religious pluralism of the ethnic communities represented in the population served by the university. Their Web site includes extensive information for clinicians providing health services to patients from Puerto Rico and Guatemala. The site provides links to material giving an overview of each country and its cultural background. It reviews the immigrant experience and relevant healthcare issues. It also presents information on the healthcare systems in the individual countries. • http://depts.washington .edu/pfes/CultureClues.htm The University of Washington Medical Center offers a series of Culture CluesTM on its Web site. These are tip sheets for clinicians developed to promote awareness of the cultural influences on the various cultural groups served by the medical center. The series includes a two page guide
Home Healthcare Nurse S13
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
“End-of-life care: The Latino culture” (University of Washington Medical Center, 2004). • http://www.healthcarechap laincy.org/userimages/ Cultural%20&%20Spiritual% 20Dictionary%2012-20-10.pdf The Health Care Chaplaincy in New York offers A Dictionary of Patients’ Spiritual & Cultural Values for Health Care Professionals. The first section of the document covers the world’s religions. The second section is devoted to individual cultures. The chapter on Hispanic American culture provides introductory information on decision making, family structure, food practices and beliefs, greetings, and nonverbal communication. Health, illness, and death issues discussed include consents, death and dying, illness beliefs, organ donation, pain, and terminal illness. A separate section covers pregnancy, birth, and postpartum. A separate chapter provides a small discussion of Cuban American beliefs relating to illness and the dying process. • http://www.nh.gov/oep/pro grams/refugee/documents/ ethnic_community_ profiles.pdf “Ethnic Community Profiles” from the New Hampshire Governor’s Office of Energy and Community Services (n.d.) is a detailed description of 16 ethnic groups that are prevalent in that state, including Cuban refugees. The six-page section on Cubans reviews communication, religion, social structure, health beliefs and practices, and pregnancy and childbirth.
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At the end is a list of health risks in refugees from Latin America as well as recommended laboratory and other tests for this population. • http://erc.msh.org/mainpage .cfm?file=1.0.htm&module= provider&language=English The “Provider’s Guide to Quality & Culture” Web site is designed to assist healthcare professionals in better serving the growing needs of ethnic communities in the United States. The Hispanics/Latinos section provides an introduction to the culture followed by a discussion of the strengths and protective factors in their families and communities. Challenges to their health and well-being are reviewed and principles for culturally competent health services are outlined. • http://cirrie.buffalo.edu/ culture/monographs/ index.php/?redirect=true The Center for International Rehabilitation Research Information has developed a monograph series on cultures of foreign-born persons in the United States. Cuba, Mexico, and El Salvador are among the countries of origin covered. The monographs provide general information about the culture and its values and recommends ways of interacting with those citizens. It particularly addresses how the cultures view disability and rehabilitation. The guides are available in .html and PDF format. • http://www.stanford.edu/ group/ethnoger/hispanicla tino.html
Health and Health Care of Hispanic/Latino American Elders is a curriculum module designed to educate healthcare providers on the important issues of caring for older Americans from Hispanic/Latino backgrounds. The demographics section includes morbidity and mortality data. The cultural traditions section addresses health beliefs and values, including treatment issues, end-of-life care, as well as complementary and alternative medicine practices. The document is a part of Ethno Med, the Stanford University School of Medicine Web site on ethnic specific geriatric care.
Resources for Patients: Patient Education Materials in Spanish • http://www.nlm.nih.gov/ medlineplus/spanish/) The U.S. National Library of Medicine maintains a Spanishlanguage version of MedlinePlus, its well-respected consumer health Web site (MedlinePlus información de salud para usted). • http://www.healthfinder .gov/espanol/ The U.S. Department of Health and Human Services has a Spanish-language site, Healthfinder.gov en español, which is similar to MedlinePlus. Although not as extensive in its links as MedlinePlus, the sources are of the same high quality. For example, under postpartum depression there are links to resources from the March of Dimes Birth Defects Foundation
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Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
(http://www.marchofdimes.com/) and Postpartum Support International (http://www.postpar tum.net/). • http://nnlm.gov/outreach/ consumer/multi.html The consumer outreach librarians of the National Network of Libraries of Medicine (NN/LM) have collaborated on the Web site “Consumer Health Information in Many Languages Resources.” The site provides links to other sites with items in multiple languages including Spanish. • http://www.healthyroads media.org/index.htm Healthy Roads Media from the U.S. National Library of Medicine provides health information in 21 languages and a variety formats, including handouts, audio, and iPod video. New materials are highlighted on the main page and changed frequently. Material comes from sources such as Inova Fairfax Hospital, the U.S. National Cancer Institute, and the U.S. Committee on Refugees and Immigrants. Topics include diseases, dental health, immunizations, mental health, symptoms, medical tests, and medicines. In the medicine section, there are six entries in English and Spanish on Coumadin/warfarin with additional links to related information under other sections. Information on generic drugs is also available in Spanish. The injuries section includes information on both ankle sprains and bone fractures in Spanish. • http://www.ahrq.gov/ consumer/espanoix.htm
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The U.S. Agency for Healthcare Research and Quality (AHRQ) also offers a list of consumer materials in Spanish. Topics include surgery, specific conditions and diseases, prescriptions, clinical practice guidelines, cardiac rehabilitation, and smoking cessation. Many of the links are to videos. The specific conditions section includes a variety of resources related to diabetes. The prescriptions information includes a handout on using blood thinners safely. • http://www.cdc.gov/spanish/ enfermedades/ The Centers for Disease Control and Prevention (CDC) offers material in 22 foreign languages, including Spanish. The variety of topics primarily reflects the CDC’s focus, so it provides an extensive list of materials on infectious diseases. However, there is also information in Spanish on topics such as alcoholism, autism, cancer, diabetes, influenza, and birth defects. • http://hispanichealth.info .kramesonline.com/Spanish/ The National Hispanic Medical Association provides online access to Spanish translations of the Krames patient education materials. The homepage has three sections for browsing with alphabetical links to information on health, medicines, and health videos. There is also a search box in which you can enter a specific topic. A mirror site in English is available to guide healthcare providers who do not speak Spanish. The health sheets section includes
illnesses, surgical procedures, treatments, and diagnostic tools. The medications section has over 33,000 links to prescriptions, over-the-counter drugs, and nutraceuticals. The health videos cover diagnostics, procedures, and treatments. • http://mchlibrary.info/ KnowledgePaths/kp_ spanish.html Georgetown University’s Maternal and Child Health (MCH) Library offers the “SpanishLanguage Health Resources Knowledge Path” to provide patients with access to current information. The site has several sections, which are all on one page, so be sure to use the handy links in the boxed table of contents on the right side of the page. General resources are listed first and include information on health hotlines and helplines. There is also an A to Z annotated list of healthrelated Web sites ranging from AHRQ through womenshealth. gov. Following the Web site list is one for additional electronic publications and a selection of health-related databases that include Spanish-language materials. The final section of the site presents links to resources on specific maternal and child health topics ranging from adolescent violence prevention to sudden and other unexpected infant death. Again, the entries are annotated. In the case of help lines, phone numbers are provided. Whenever possible, the date of the publication is indicated. • http://www.noah-health.org/ Another extensive resource for Spanish-language information
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is New York Online Access to Health (NOAH). The site is a volunteer collaboration between librarians and healthcare professionals who select full-text, unbiased, and accurate consumer health information. The site is well organized and updated almost daily. The opening page is bilingual with two mirror columns listing its major sections. In the lower left hand corner of the bottom of the page is a link for new items that leads to a list of all the material added in the previous week. Above the columns is a standard search box. Searching on “home care” identified more than 400 items including medication information, and brochures on home-based pulmonary rehabilitation and home care following various surgical procedures. The health topics section opens a page with an outline of major subjects. Under “Disorders and conditions—body location systems” is an alphabetical list of both body parts and major health issues such as cancer, environmental health, mental health, and pregnancy and family. In true outline form, there are links to specific subtopics. For example, “Pregnancy and family” lists adoption, abortion, family planning/contraception, infertility, newborn and infant care (to 2 years), single parenthood, and surrogacy. The second link on the main page is to an A to Z index of all the conditions or health issues on the site. The list ranges from abdominal pain to Zollinger-Ellison syndrome. The individual topics contain links to material from authoritative sources such as the
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Mayo Clinic, the various National Institutes of Health, the Merck Manual, foundations, and various professional organizations. The hypertext links may make the site cumbersome to use. However, the quality and breadth of the information the links lead to makes the effort worthwhile. • http://www.infogen.org.mx/ Infogen1/servlet/CtrlHome Infogen is a Spanish-language site developed by volunteers and healthcare providers with a focus on birth defects. Sections of the Web site address prevention before, during, and after pregnancy; complications during pregnancy and postpartum, and specific birth defects. The defects section enables browsing by letter of the alphabet. Under the letter T were entries for Turner Syndrome, congenital muscular torticollis, congenital toxoplasmosis, and defects of trisomy 13, 18, and 21. The entries define the problem, discuss probable cause, identify diagnostic tests, review complications, and address the probability of the defect appearing in another pregnancy. • http://www.aacap.org/ page.ww?section=Facts+for+ Families&name=Facts+for+ Families The American Academy of Child & Adolescent Psychiatry provides an extensive collection of “Facts for Families” in English and Spanish. Topics covered include autism, grief, bedwetting, chronic physical illness, eating disorders, lead poisoning, and obesity.
• http://www.healthtransla tions.com/aspx/languages/ spanish.aspx The Missouri Hospital Association (MHA) sponsors HealthTranslations.com, which features “communication boards” with pictures of health-related procedures and descriptions of various conditions in English and seven languages including Spanish. There are links to more than 175 documents in Spanish that have been translated from MHA’s own publications as well as those from established agencies such as the Centers for Disease Control, the American Diabetes Association, and the U.S. National Heart, Blood, and Lung Institute. Topics covered range from abuse, domestic through West Nile virus. Under the resources tab is a link to additional agencies that offer Spanish-language materials. • http://www.healthinfotrans lations.org/language/spanish/ 524152/ Four central Ohio healthcare providers have developed Health Information Translations. Information is provided in 18 languages including Spanish. The material includes print as well as audio and video material. The list of Spanish titles is extensive and includes diagnostic tests, diseases and conditions, pregnancy and baby care, stress and coping, and surgeries. At the end of list of individual titles is a section for “other topics,” which includes home care. The home care section includes information on Foley catheters, drawing up insulin, incision care, and
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handling chemotherapy safely. The individual information sheets alternate English with the language selected. • http://www.wellzone.org/ contactUs.aspx The Humana Foundation has developed The Wellness Information Zone to provide public access to basic health information that is easily understood by those with low health literacy. Near the top of the homepage is a direct link to the Spanish-language information. The actual documents are from such reputable sources as the U.S. Food and Drug Administration, the American Academy of Family Physicians, and the Nemours Foundation. Topics covered range from acid reflux to vision problems. Mental health, heart diseases, and diabetes have the most available documents. • http://www.rhin.org/ Default.aspx The Refugee Health Information Network is a national collaborative partnership dedicated to providing multilingual patient education materials and information on refugee populations and cultures for U.S. healthcare providers. The search option enables you to search by language, topic, and format. The resources include audio and video materials in addition to print. A blanket search for all Spanish-language items identified a total of 663. A topical search for information on “heart disease” in Spanish resulted in 11 items that covered coronary artery disease, heart attacks, high
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cholesterol, hypertension, diabetes, and stroke. • http://www.mhcs.health .nsw.gov.au/languages/ Spanish.html The New South Wales Multicultural Health Communication Service has resources in 64 languages including Spanish. Selecting Spanish brings up a list of the available documents arranged in alphabetical order by English title. Clicking on the title leads to the entry for the document that includes a brief explanation of the contents, the date of the most recent update, and a list of all of the languages available for that document. Next to each language is a link to the PDF file for the actual document. • http://www.rdns.com.au/ media_and_resources/ Documents/Translations/ Workplacewordsandphrases Spanish.pdf The Australian Royal District Nursing Service has bilingual information sheets of words and phrases for greetings, making appointments, medical problems, and farewells in English with Spanish. There is also an introduction to the Spanish alphabet with suggestions for pronouncing the letters in English. Sheets are also available for 13 other languages. • http://www.thewomens.org .au/SpanishFactSheets The Royal Women’s Hospital in Parkville, Australia, offers women’s health-related information in more than 25 community
languages including Spanish. The factsheets available in Spanish cover benign breast conditions, gynecology, pregnancy and childbirth, and contraception. There are links under each general category to the individual PDF files by factsheet title. There is also a link to a United Nations Children’s Fund Web site for information on breastfeeding.
Conclusion and Implications for Practice LEP patients are entitled to have “meaningful language services in healthcare settings” (Perkins & Youdelman, 2008, p. 6). Home healthcare clinicians in any size organization can fulfill this mandate using the wealth of multilingual patient education materials reviewed in this article. Judith S. Young, MLS, is the Librarian at the Dixon School of Nursing, Abington Memorial Hospital, Willow Grove, Pennsylvania. The author declares no conflicts of interest. Address correspondence to: Judith S. Young, MLS, Abington Memorial Hospital, Dixon School of Nursing, Suite 200, 2500 Maryland Rd., Willow Grove, PA 19090 ([email protected]). DOI:10.1097/NHH.0000000000000081 REFERENCES
Healthy People 2020. (2011). Disparities. Retrieved from http:// healthypeople.gov/2020/about/ disparitiesAbout.aspx Narayan, M. C. (2003). Cultural assessment and care planning. Home Healthcare Nurse, 21(9), 611-618. Office of Minority Health. (2001). National standards for culturally
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and linguistically appropriate services in health care executive summar y. Retrieved from http://minorityhealth.hhs.gov/ assets/pdf/checked/executive .pdf Office of Minority Health. (2009). Hispanic/Latino profile. Retrieved
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from http://minorityhealth.hhs. gov/templates/browse.aspx? lvl=2&lvlID=54 Perkins, J., & Youdelman, M. (2008). Summary of state law requirements addressing language needs in health care. Retrieved from http://www.healthlaw.org/
images/pubs/nhelp_lep-statelaw-chart_12-28-07.pdf University of Washington Medical Center. (2004). End-of-life care: The Latino culture. Retrieved from http://depts.washington. edu/pfes/PDFs/End%20of%20 Life%20Care-Latino.pdf.
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