Spanish Language Speakers Research Articles

“It was just right:” Patient experience, acceptability, and perceived utility of a novel financial navigation program in oncology.

279 Background: Cancer-related financial hardship is prevalent and associated with poor health outcomes. CAFÉ is a multi-site randomized control trial (RCT) testing a financial navigation intervention to reduce financial hardship for people newly diagnosed with cancer. Methods: The CAFÉ trial randomized participants (n=371) to usual care or one of two intervention arms. Participants randomized to the intervention arms received either brief (one proactive outreach) or extended (three proactive outreaches) contact from a navigator along with access to navigation services for 6 months. At the final outreach call, we asked participants to answer open-ended questions about the perceived acceptability and helpfulness of the program. Navigators recorded verbatim notes, and a trained qualitative methodologist conducted content analysis. Results: Among 69 participants (35 extended; 34 brief) who completed final outreach calls, to date, 65% were female, average age was 63 years, and 3 were Spanish-language speakers. Cancer diagnoses included: breast (35%), prostate (16%), colorectal (7%), lung (4%), and other (38%). Almost all (99%; 68) expressed high satisfaction with the navigation program. Most (83%; 57) reported easy rapport-building (e.g., sharing needs; feeling listened to). Most (81%; 56) found the frequency of outreach appropriate to their needs and reported navigators were accessible when needed (72%: 50). Most participants (84%; 58) found their experience helpful, including the proactive outreach and advocacy provided by the navigators. Useful program components included answering patients cost-related questions and identifying financial resources (74%; 41); satisfaction about the navigator’s expertise (72%; 50); and ongoing reminders about patient actions (e.g. applying for medical financial assistance) (48%; 33). Areas for improvement included offering more personalized financial resources; more support applying for such resources; extending the service beyond 6 months; and starting outreach closer to cancer diagnosis date. Brief arm participants less often endorsed appropriate frequency (74% vs 86%) and ease of contact (68% vs 77%) than those in the extended arm. Conclusions: Components of the CAFÉ financial navigation program found to be highly acceptable included proactive outreach, ongoing support and navigator knowledge; ease of rapport-building; and accessibility. Future analyses will determine the effectiveness of the CAFÉ program on financial, health and healthcare outcomes. Clinical trial information: NCT05018000 .

Advance Care Planning for Spanish-Language Speakers: Patient, Family, and Interpreter Perspectives.

Language access barriers for individuals with limited-English proficiency are a challenge to advance care planning (ACP). Whether Spanish-language translations of ACP resources are broadly acceptable by US Spanish-language speakers from diverse countries is unclear. This ethnographic qualitative study ascertained challenges and facilitators to ACP with respect to Spanish-language translation of ACP resources. We conducted focus groups with a heterogeneous sample of 29 Spanish-speaking persons who had experience with ACP as a patient, family member, and/or medical interpreter. We conducted thematic analysis with axial coding. Themes include: (1). ACP translations are confusing; (2). ACP understanding is affected by country of origin; (3). ACP understanding is affected by local healthcare provider culture and practice; and (4). ACP needs to be normalized into local communities. ACP is both a cultural and clinical practice. Recommendations for increasing ACP uptake extend beyond language translation to acknowledging users' culture of origin and local healthcare culture.

ADVANCE CARE PLANNING FOR SPANISH-LANGUAGE SPEAKERS: PATIENT, FAMILY, AND INTERPRETER PERSPECTIVES

Abstract Language access is a challenge to advance care planning (ACP). Spanish-language speakers are the largest non-English speaking population in the US. While ACP tools have been translated into Spanish, it is unclear how heterogeneity in country of origin may affect the generalizability of translations across diverse US Spanish-speaking populations. The study objective is to describe challenges and facilitators to ACP for diverse populations of Spanish-language speakers. We conducted 3 focus groups with a total of 29 participants from members of Spanish-language speaking communities whose countries of origin were predominantly from the Caribbean, Central, and South America. Eligibility included being 18 years or older, being a native Spanish-speaker, and having direct experience with ACP as a patient, caregiver, or medical interpreter. We conducted thematic analysis with axial coding. Themes include: 1. Linguistic Challenges with Current ACP Translations; 2. Effect of Country of Origin and Culture on ACP Understanding; 3. Impact of Local Healthcare System Cultural on ACP; and 4. Need for ACP to be Normalized into the Local Community. ACP is both a cultural practice and a clinical practice. Recommendations for improving ACP completion for non-English speakers extend far beyond translation, since simply translating ACP tools without a cultural context is neither equitable nor inclusive. A key step is normalizing ACP into the local community. Understanding the intersection of local healthcare systems of ACP practice with the patient’s and family’s cultures of origin will facilitate introducing ACP in a culturally sensitive manner.

Testing the impact of culturally-relevant communication style on engagement with Hispanic and Latinx adults

Effective science communication for a multilingual population requires more than language translation, it also requires being mindful of cultural communication styles. This study tested the impact that communication style has on feelings of inclusion, learning, and engagement in the Earth sciences for Hispanic and Latinx adults. An online survey with open and closed questions was used to evaluate two science videos (in both Spanish and English) with different communication styles: 1) a traditional, interview-based style, where experts present a science concept, and 2) an informal conversational style, where a scientific message is shared through a casual conversation. Seventy-four participants self-identified as Hispanic and Latinx and were the focus of the data analysis. Both video styles were positively received, with participant feedback emphasizing feelings of inclusion in seeing Latina scientists, easy to understand science concepts, and accessible language. Hispanic and Latinx adults preferred the traditional video, but the conversational video ranked higher in other aspects, which varied based on participants’ primary spoken language at home. For example, the conversational video had a positive impact on the ability to relate information to their own life and increase awareness of Earth science careers for Spanish-language speakers. Findings suggest the use of both video styles could improve feelings of inclusion and engagement for Hispanic and Latinx adults. Additional aspects of culture and demographics may explain some of the language-based results. Future science videos are encouraged to be co-designed by, for, and with Hispanic and Latinx communities to emphasize cultural values while avoiding stereotyping and cultural appropriation.

Consent for Use of Genetic Data among US Hispanics/Latinos: Results from the Hispanic Community Health Study/ Study of Latinos.

Inclusion of historically underrepresented populations in biomedical research is critical for large precision medicine research initiatives. Among 13,721 Hispanic Community Health Study/Study of Latinos (HCHS/SOL) enrollees, we used multivariable-adjusted prevalence ratios to describe characteristics associated with participants' willingness to consent to different levels of biospecimen and genetic data analysis and sharing. At baseline (2008-2011), HCHS/SOL participants almost universally consented to the use of biospecimens and genetic data by study investigators and their collaborators (97.6%; 95%CI: 97.1, 98.0). Fewer consented to biospecimen and genetic data sharing with investigators not affiliated with the HCHS/SOL research team (81%, 95%CI: 80, 82) or any data sharing with commercial/for-profit entities (75%, 95%CI: 74, 76). Those refusing to share their data beyond the study investigators group were more often females, Spanish language-speakers and non-US born individuals. As expected, participants who were retained and reconsented at the six-year follow up visit tended to embrace broader data sharing, although this varied by group. Over time, Puerto Ricans and Dominicans were more likely to convert to broader data sharing than individuals of a Mexican background. Our analysis suggests that acculturation and immigration status of specific Hispanic/Latino communities may influence decisions about participation in genomic research projects and biobanks.

Structural-Semantic Components of the Concept IDENTIDAD in Spanish Language

The concept IDENTIDAD is of great importance in the daily life and activities of Spanish language speakers and plays an important role in shaping the conceptual and linguistic pictures of the world. The present article is dedicated to study the structural-cognitive approach, the concept and the structural-semantic features of the word IDENTIDAD. The models of the construction of the concept (field, frame) were determined, while the principles of the organization of the components in the semantic structure of the concepts were revealed as well. The present publication presents the structure of the concept IDENTIDAD on the material of Hispanic lexicographic sources. The language tools used to represent the concept IDENTIDAD were also considered.Spanish nouns, verbs and adjectives that state the features of the concept IDENTIDAD were defined and analyzed. To identify both the conceptual characteristics and content of the concept, a comparison of linguistic units, vocabulary definitions and language contexts were performed. Conceptual peculiarities manifested the value of the linguistic units used to express this concept, vocabulary and linguistic contexts. This is the reason why the linguistic means were analyzed in speech to express the concept IDENTIDAD. The material of the study of the conceptual component consisted in articles of encyclopedic, synonymous and explanatory dictionaries containing the key token IDENTIDAD. The structure of the concept IDENTIDAD was represented by the synthesis of the core and the periphery, which distinguished the conceptual, figurative and value components. The construction of the concept under study was possible by modeling the hierarchical structure to analyze the distribution of linguistic material by terminals, slots and subplots.

A matched-guise study on L2, heritage, and native Spanish speakers’ attitudes to Spanish in the State of Washington

By means of a matched-guise study, this paper examines the attitudes of L2, heritage, and native Spanish speakers in the state of Washington toward Mexican-accented and English-accented Spanish. We interpret our findings in the wake of previous research on language attitudes and ideologies related to Spanish in the United States which shows that Spanish and those who speak it as a first or heritage language are thought to have a lower socioeconomic status than English and Anglophones. 97 Spanish-speaking participants residing in Washington (N=95) and the Pacific Northwest (N=2) rated 4 voices along six-point semantic differential scales falling into the dimensions of superiority, solidarity, language competence, and physical characteristics. We submitted mean scores to a linear mixed-effects model. Contrary to our expectations, all groups rated the Mexican-accented guises higher than the English-accented guises in the dimension of superiority. Also unforeseen, the L2 speakers rated the Mexican-accented voices higher in the dimension of solidarity. We consider the high level of education of the respondents and, for the L2 subjects, their experience as advanced Spanish language speakers, as likely explanations for the observed attenuation of well-documented prevailing stereotypes directed at Latinos from the monolingual community at large.

Nahuatl as a Classical, Foreign, and Additional Language: A Phenomenological Study

In this study, participants learning an endangered language variety shared their experiences, thoughts, and feelings about the often complex and diverse language-learning process. I used phenomenological interviews in order to learn more about these English or Spanish language speakers’ journey with the Nahuatl language. From first encounter to their current state in their journey, participants described their challenges with gaining access to the language through courses, materials and institutions, their language observations and their sustaining motivations. In addition to those descriptions, my analysis showed many participants shared two underlying motivations for studying this language: (a) using the Nahuatl language for specific purposes, and (b) using Nahuatl as a connection to an historical or cultural past. Both of these motivations were driven by a higher purpose in ensuring the survival of speakers of this language group.

Feasibility and Effectiveness of an Automated Bilingual Text Message Intervention for Weight Loss: Pilot Study

BackgroundLittle is known about the feasibility and acceptability of tailored text message based weight loss programs for English and Spanish-language speakers.ObjectiveThis pilot study evaluated the feasibility, acceptability, and estimated impact of a tailored text message based weight loss program for English and Spanish-language speakers. The purpose of this pilot study was to inform the development of a full-scale randomized trial.MethodsThere were 20 overweight or obese participants (mean age 40.10, SD 8.05; 8/20, 40% male; 9/20, 45% Spanish-speakers) that were recruited in San Diego, California, from March to May 2011 and evaluated in a one-group pre/post clinical trial. For 8 weeks, participants received and responded to 3-5 text messages daily sent from a fully automated text messaging system. They also received printed weight loss materials and brief 10-15 minute weekly counseling calls. To estimate the impact of the program, the primary outcome was weight (kg) measured during face-to-face measurement visits by trained research staff. Pre and post differences in weight were analyzed with a one-way repeated measures analysis of variance. Differences by language preference at both time points were analyzed with t tests. Body mass index and weight management behaviors also were examined. Feasibility and acceptability were determined by recruitment success, adherence (ie, percentage of replies to interactive text messages and attrition), and participant satisfaction.ResultsParticipants who completed the final assessment (N=18) decreased body weight by 1.85 kg (F 1,17=10.80, P=.004, CI∆ 0.66-3.03, η2=0.39). At both time points, there were no differences in weight by language preference. Participants responded to 88.04% (986/1120) of interactive text messages, attrition rate was 10% (2/20), and 94% (19/20) of participants reported satisfaction with the program.ConclusionsThis fully automated text message based weight program was feasible with English and Spanish-speakers and may have promoted modest weight loss over an 8-week period.Trial RegistrationClinicaltrials.gov NCT01171586; http://clinicaltrials.gov/ct2/show/NCT01171586 (Archived by WebCite at http://www.webcitation.org/6Ksr6dl7n).

Providing cancer survivorship care plans for Spanish language speakers: Overall use and satisfaction patterns.

e20671 Background: Cancer survivorship care plans may be communication aides to assist healthcare providers and empower survivors. A paucity of information exists regarding the provision of survivorship care plans to the Spanish speaking population. Methods: The LIVESTRONG Care Plan is an Internet-based tool for creation of survivorship care plans, originally launched in 5/07. It is available at www.livestrongcareplan.org, and via OncoLink, a cancer information website based at the University of Pennsylvania, serving over 3.9 million pages/ month to 185,000 unique IP addresses. A direct link on the homepage directs users to the Spanish version. All information is provided and translated by oncology nurses and physicians. Results: Since launch of the tool, 293 Spanish care plans have been created (1% of total care plans). Care plans in Spanish have been created by survivors in 78% of cases, and healthcare providers in 22%. This differs from the entire user population, in which use by HCP approaches 50% (p=< 0.001). Spanish-speaking users are 52% female, and 82% Latino/a, and less likely from the US (60% vs 87% , p=0.02), also being from Mexico (15%), Spain (10%), Chile (9%), Puerto Rico (5%) and Venezuela (3%). Spanish users were most often survivors of breast (20%) GU (33%) and GI (20%) cancers (vs general population 50%, p = 0.03; 10%, p = 0.04; 11%, p = 0.03, respectively). Only 8% of Spanish-speaking users report having received previous survivorship information vs 13% in the overall group (p=0.07). All users (100%) of the Spanish version rate experience and satisfaction with the care plan as “very good” or “excellent.” Average time for completion of Spanish plans was 9:28 min. Conclusions: Most users of the Spanish plan are survivors who have not received this information before, from the US and several Central/South American countries. They are highly satisfied with the information provided. Healthcare providers are proportionally less likely to use the Spanish version of the plan than survivors are.

Seeing in 3-D: Examining the Reach of Diabetes Self-Management Support Strategies in a Public Health Care System

The authors examined whether tailored self-management support (SMS) strategies reach patients in a safety net system and explored variation by language, literacy, and insurance. English-, Spanish-, and Cantonese-speaking diabetes patients were randomized to weekly automated telephone disease management (ATDM) or monthly group medical visits. The SMS programs employ distinct communication methods but share common objectives, including behavioral "action plans." Reach was measured using three complementary dimensions: (a) participation among clinics, clinicians, and patients; (b) patient representativeness; and (c) patient engagement with SMS. Participation rates were high across all levels and preferentially attracted Spanish-language speakers, uninsured, and Medicaid recipients. Although both programs engaged a significant proportion in action planning, ATDM yielded higher engagement, especially among those with limited English proficiency and limited literacy. These results provide important insights for health communication and translational research with respect to realizing the public health benefits of SMS and can inform system-level planning to reduce health disparities.

Inequalities in Mexican Children’s Schooling

In this article we measure the evolution of inequalities in basic school attendance and educational attainment of Mexican children from 1960 to 2000. During this time, the Mexican government made great efforts to extend education to the most disadvantaged sectors of society, particularly rural communities. Nevertheless, differences in educational attainment persist. We focus on three types of inequality in education: urban/rural, gender, and ethnic inequality as indicated by speaking an indigenous language. The structure and economic resources of families also mediate the amount of education that children receive. To this end, we examine the determinants of primary completion and secondary school enrollment in rural communities in ten of the poorest states in Mexico, paying particular attention to differences between boys and girls and indigenous language and Spanish-language speakers.

The Participation of National Minorities in Pre-Modern Educational Systems

This article presents the results of research carried out on the linguistic and educational needs of Guatemala's national minorities and the responses given to those needs by Guatemala's central government. Specifically, the case of the Garífuna population on the Atlantic Coast is studied with a view to understanding the educational policy dynamics underlying Pre-Modern States towards the multicultural groups' lack of participation and incorporation into the national polity. Lastly, the specific educational claims of the Garífunas are studied, particularly in relation to Guatemala's other linguistic blocks, namely, Mayan and Spanish language speakers.