Spanish-speaking Members Research Articles

Attitudes Toward COVID-19 Vaccines Among Pregnant and Recently Pregnant Individuals

Pregnant people and infants are at high risk of severe COVID-19 outcomes. Understanding changes in attitudes toward COVID-19 vaccines among pregnant and recently pregnant people is important for public health messaging. To assess attitudinal trends regarding COVID-19 vaccines by (1) vaccination status and (2) race, ethnicity, and language among samples of pregnant and recently pregnant Vaccine Safety Datalink (VSD) members from 2021 to 2023. This cross-sectional surveye study included pregnant or recently pregnant members of the VSD, a collaboration of 13 health care systems and the US Centers for Disease Control and Prevention. Unvaccinated, non-Hispanic Black, and Spanish-speaking members were oversampled. Wave 1 took place from October 2021 to February 2022, and wave 2 took place from November 2022 to February 2023. Data were analyzed from May 2022 to September 2023. Self-reported or electronic health record (EHR)-derived race, ethnicity, and preferred language. Self-reported vaccination status and attitudes toward monovalent (wave 1) or bivalent Omicron booster (wave 2) COVID-19 vaccines. Sample- and response-weighted analyses assessed attitudes by vaccination status and 3 race, ethnicity, and language groupings of interest. There were 1227 respondents; all identified as female, the mean (SD) age was 31.7 (5.6) years, 356 (29.0%) identified as Black race, 555 (45.2%) identified as Hispanic ethnicity, and 445 (36.3%) preferred the Spanish language. Response rates were 43.5% for wave 1 (652 of 1500 individuals sampled) and 39.5% for wave 2 (575 of 1456 individuals sampled). Respondents were more likely than nonrespondents to be White, non-Hispanic, and vaccinated per EHR. Overall, 76.8% (95% CI, 71.5%-82.2%) reported 1 or more COVID-19 vaccinations; Spanish-speaking Hispanic respondents had the highest weighted proportion of respondents with 1 or more vaccination. Weighted estimates of somewhat or strongly agreeing that COVID-19 vaccines are safe decreased from wave 1 to 2 for respondents who reported 1 or more vaccinations (76% vs 50%; χ21 = 7.8; P < .001), non-Hispanic White respondents (72% vs 43%; χ21 = 5.4; P = .02), and Spanish-speaking Hispanic respondents (76% vs 53%; χ21 = 22.8; P = .002). Decreasing confidence in COVID-19 vaccine safety in a large, diverse pregnant and recently pregnant insured population is a public health concern.

Assessing the association between antibody status and symptoms of long COVID: A multisite study.

The association between SARS-CoV-2 humoral immunity and post-acute sequelae of COVID-19 (long COVID) remains uncertain. The objective of this population-based cohort study was to assess the association between SARS-CoV-2 seropositivity and symptoms consistent with long COVID. English and Spanish-speaking members ≥ 18 years old with SARS-CoV-2 serologic testing conducted prior to August 2021 were recruited from Kaiser Permanente Southern California and Kaiser Permanente Colorado. Between November 2021 and April 2022, participants completed a survey assessing symptoms, physical health, mental health, and cognitive function consistent with long COVID. Survey results were linked to SARS-CoV-2 antibody (Ab) and viral (RNA) lab results in electronic health records. Weighted descriptive analyses were generated for five mutually exclusive patient groups: (1) +Ab/+RNA; (2) +Ab/- or missing RNA; (3) -Ab/+RNA; (4a) -Ab/-RNA reporting no prior infection; and (4b) -Ab/-RNA reporting prior infection. The proportions reporting symptoms between the +Ab/+RNA and -Ab/+RNA groups were compared, adjusted for covariates. Among 3,946 participants, the mean age was 52.1 years old (SD 15.6), 68.3% were female, 28.4% were Hispanic, and the serologic testing occurred a median of 15 months prior (IQR = 12-18). Three quarters (74.5%) reported having had COVID-19. Among people with laboratory-confirmed COVID-19, there was no association between antibody positivity (+Ab/+RNA vs. -Ab/+RNA) and any symptoms, physical health, mental health, or cognitive function. As expected, physical health, cognitive function, and fatigue were worse, and palpitations and headaches limiting the ability to work were more prevalent among people with laboratory-confirmed prior infection and positive serology (+Ab/+RNA) compared to those without reported or confirmed prior infection and negative serology (-Ab/-RNA/no reported COVID-19). Among people with laboratory-confirmed COVID-19, SARS-CoV-2 serology from practice settings were not associated with long COVID symptoms and health status suggesting limited utility of serology testing for long COVID.

Assessing Public Interpretation of Original and Linguist-Suggested SPC Risk Categories in Spanish

Abstract Recent work has shown that the words used in the Storm Prediction Center’s convective outlook are not easily understood by members of the public. Furthermore, Spanish translations of the outlook information have also been shown to have interpretation challenges. This study uses survey data collected from the Severe Weather and Society Spanish Survey, a survey of Spanish speakers across the United States, to evaluate how U.S. residents receive, understand, and respond to weather forecasts and warnings. For this experiment, respondents were tasked with ranking the words and colors used in the SPC’s convective outlook. They were randomly assigned either 1) the words originally used by the SPC for Spanish translations or 2) a set of words suggested by linguistic experts familiar with Spanish dialects in the United States. We find Spanish speakers have similar challenges to English speakers when ordering the words the SPC uses. When using the translations proposed by the linguistic experts, we find the majority of Spanish speakers ranked the words in the intended order of associated risk. Spanish speakers also displayed similar ranking distributions for the colors in the outlook as English speakers, where both groups ranked red as the highest level of risk. These findings suggest the original translations used by the SPC convective outlook create barriers for Spanish speakers and that the expert translations more effectively communicate severe weather hazards to Spanish-speaking members of the public. Significance Statement The SPC’s convective outlook provides important information about the risk posed by severe storms to members of the public. While the SPC had official Spanish translations for the categorical labels used in the outlook, it was believed anecdotally that there was a disconnect between the words the SPC was using and the way the translated outlook was being interpreted by Spanish-speaking members of the public. This work verifies previous beliefs about the original translation set and confirms the reliability of a new set of translations developed by linguistic experts among Spanish-speaking members of the public.

Abstract 48: An Updated Early Stroke Recognition Tool for the Inclusivity of Spanish-Speakers: RAPIDO

Background and Issues: Hispanics have higher stroke incidence and recurrence and are less likely to know the signs and symptoms of stroke compared to non-Hispanic Whites. Stroke awareness education promotes the recognition of the common signs and symptoms of stroke and subsequent treatment-seeking behaviors resulting in improved outcomes. Acronyms have been created to bring awareness to key stroke sign and symptom indicators; however, there are discrepancies when translating existing acronyms for Spanish-speakers. Purpose: The purpose of this project was to create and update a stroke awareness acronym for the inclusivity of Spanish-speakers. Methods: We searched the literature and were unable to identify translations of the commonly publicized FAST or BE-FAST acronyms into recognizable and relatable Spanish words across various dialects. Led by a Spanish-speaking nurse with experience working with stroke patients, our research team identified Spanish words that are used across various dialects for the translation of the BE-FAST acronym (balance, eyes, face, arm, speed, and time). Diverse Spanish-speaking members of our research team incorporated relatable images and reviewed the translated acronym for content and clarity. Results: We created the acronym RAPIDO for Spanish-speakers. Similar to FAST and BE-FAST, RAPIDO illustrates warning signs and symptoms of stroke and the need to seek treatment quickly. Conclusions: The creation of the RAPIDO acronym constitutes an important step in providing stroke awareness education to Spanish-speakers. If validated with the broader healthcare professional and lay community, adding the RAPIDO acronym to public stroke educational programs may be warranted.

Abstract PO-015: The Metastatic Breast Cancer Project in Spanish: Developing a Spanish language patient-partnered research project with the Latinx community through culturally appropriate materials

Abstract Breast cancer is the leading cause of cancer-related mortality for Latinx women in the US. Compounding this challenge is low representation of Latinx patients (pts) in cancer research studies. Neglecting Latinx participation limits scientific understanding and the development of effective therapies for all pts. To address this disparity and increase research accessibility, we collaborated with Latinx community (comm) members and translated all aspects of an existing patient-partnered research project, The Metastatic Breast Cancer Project (MBCproject), into Spanish. The MBCproject (MBCproject.org) is a research study that directly engages pts through social media and advocacy groups, empowering pts to share their samples, clinical information, and experiences. Despite having 3,300 consented participants, only 3.7% (123) identify as Hispanic, Latinx, or Spanish. With the Latinx population increasing in the US and cancer’s impact on the comm, it is imperative that Latinx individuals participate in cancer research. Native Spanish speaking members on the MBCproject team leveraged the existing MBCproject model of direct collaboration with pt communities to translate pt-facing materials. Pts and pt advocates provided feedback on site content, project name, surveys, and biospecimen kit instructions through video calls with team staff. Over 17 months, 6 focus groups were held with 9 members of the comm, assessing 6 different material items. Iterations of the materials discussed were shared via email to complete the process. Proposed Spanish language dialect, pronoun formality, and transparency in project content were also reviewed to ensure messaging resonated with the broader Latinx comm. Following comm review, modifications were integrated into materials. A Mexican- Spanish dialect and formal pronouns were chosen to be used across all materials. The project name remained to maintain continuity across languages. Distinct feedback included simplified terminology and materials that could be shared with their health care provider. Clarity in tissue acquisition, privacy of data collected, and participation requirements was also requested. Attendance of study staff at Latinx cancer disparities research conferences revealed interest amongst investigators for more comprehensive demographic data collection of Latinx pts in studies, leading to the development of more detailed race and ethnicity questions in our intake survey. Finalized project materials have been submitted for IRB approval and expected to be launched at mbcprojectenespanol.org in Fall 2020. This partnered approach has led to an inclusive set of materials embraced by the Latinx pts and pt advocates who have helped us develop the MBCproject in Spanish. This is a foundational pilot that will allow Spanish speaking participants to engage in cancer research without a language barrier and contribute to the acceleration of scientific discoveries that impacts their community. Citation Format: Tania G. Hernandez, Sara Balch, Jorge Buendia- Buendia, Jorge Gomez Tejeda Zanudo, Mary McGillicuddy, Colleen M. Nguyen, Foxy Robinson, Corrie Painter, Elana Anastasio, Michael Dunphy, Nikhil Wagle. The Metastatic Breast Cancer Project in Spanish: Developing a Spanish language patient-partnered research project with the Latinx community through culturally appropriate materials [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-015.

A live community growing together: Communal occupation of a senior center welcoming Spanish-speaking elders

ABSTRACT The percentage of Latinx immigrants over the age of 65 in the United States is expected to more than double within the next 30 years. These elders face particular health and occupational disparities emerging from a transaction of individual and sociocultural factors that warrants attention by both service providers and researchers. This study employed an ethnographic approach including interviews, observations, document review, and group mapping activities. It sought to explore a county senior center as it evolves toward greater inclusion of Spanish-speaking members who are increasingly agentic in their community occupations despite facing initial constraints. John Dewey’s philosophy is employed alongside critical theoretical perspectives to illuminate the juxtaposition of individual vulnerability and agency interwoven with structural elements. The communal growth experienced by the senior center and the Spanish-speaking elders is characterized by social relationships that transform, and are transformed by, shared occupation. For occupational scientists, the results offer an expanded understanding of communal occupation and its influence on community change, in this case focused on a marginalized population integrating into dominant cultural spaces and practices.

Uptake and use of a diabetes management program with a mobile glucometer

ObjectiveInnovative mobile health technologies (mHealth) may facilitate self-management of blood glucose. This study evaluates uptake, use, and predictors of uptake and long-term use of a diabetes mHealth intervention, which comprises an FDA-approved mobile glucometer and nurse coaching, in a real-world setting. Methodsn = 4438 commercially-insured adults with diabetes were recruited from 2014 to 2015 via an opt-in, phone-based process. In this post-only study, we obtained data on recruitment, glucometer use, demographics, and insurance and employer characteristics. We calculated percent uptake and reasons for unsuccessful recruitment. We used logistic regression to model predictors of uptake and survival analysis to examine duration of testing and predictors of discontinuation. ResultsOf the recruited members, 556 (12.5%) signed up for the mHealth program and 324 (7.3%) began testing. Of those who did not sign up, the majority (70.6%) were unable to be reached by phone. Male (OR = 1.60, 95% CI: 1.25, 2.03) and Spanish-speaking (OR = 8.34, 95% CI: 5.40, 12.88) members were more likely to start testing. Two-thirds (66.2%) of those who started testing had a first test value that indicated hyperglycemia; 97% tested more than once and the median time between first and last test was 407 days. Older age was the only significant predictor of long-term use. ConclusionsAlthough uptake of the mHealth program was low, most members who started testing had initial glucose values that indicated a need for better glucose management and the majority of patients engaged with the program for over a year. Male and Spanish-speaking members were more likely to initiate the program.

Reach and Validity of an Objective Medication Adherence Measure Among Safety Net Health Plan Members with Diabetes: A Cross-Sectional Study.

With the expansion of Medicaid and low-cost health insurance plans among diverse patient populations, objective measures of medication adherence using pharmacy claims could advance clinical care and translational research for safety net care. However, safety net patients may experience fluctuating prescription drug coverage, affecting the performance of adherence measures. To evaluate the performance of continuous medication gap (CMG) for diverse, low-income managed care members with diabetes. We conducted this cross-sectional analysis using administrative and clinical data for 680 members eligible for a self-management support trial at a nonprofit, government-sponsored managed care plan. We applied CMG methodology to cardiometabolic medication claims for English- , Cantonese- , or Spanish-speaking members with diabetes. We examined inclusiveness (the proportion with calculable CMG) and selectivity (sociodemographic and medical differences from members without CMG). For validity, we examined unadjusted associations of suboptimal adherence (CMG > 20%) with suboptimal cardiometabolic control. 429 members (63%) had calculable CMG. Compared with members without CMG, members with CMG were younger, more likely employed, and had poorer glycemic control but had better blood pressure and lipid control. Suboptimal adherence occurred more frequently among members with poor cardiometabolic control than among members with optimal control (28% vs. 12%, P = 0.02). CMG demonstrated acceptable inclusiveness and validity in a diverse, low-income safety net population, comparable with its performance in studies among other insured populations. CMG may provide a useful tool to measure adherence among increasingly diverse Medicaid populations, complemented by other strategies to reach those not captured by CMG.

Dimensions of Religiousness and Cancer Screening Behaviors Among Church-Going Latinas

Churches are a promising setting through which to reach Latinas with cancer control efforts. A better understanding of the dimensions of religiousness that impact health behaviors could inform efforts to tailor cancer control programs for this setting. The purpose of this study was to explore relationships between dimensions of religiousness with adherence to cancer screening recommendations among church-going Latinas. Female Spanish-speaking members, aged 18 and older from a Baptist church in Boston, Massachusetts (N = 78), were interviewed about cancer screening behaviors and dimensions of religiousness. We examined adherence to individual cancer screening tests (mammography, Pap test, and colonoscopy), as well as adherence to all screening tests for which participants were age-eligible. Dimensions of religiousness assessed included church participation, religious support, active and passive spiritual health locus of control, and positive and negative religious coping. Results showed that roughly half (46 %) of the sample had not received all of the cancer screening tests for which they were age-eligible. In multivariate analyses, positive religious coping was significantly associated with adherence to all age-appropriate screening (OR = 5.30, p < .01). Additional research is warranted to replicate these results in larger, more representative samples and to examine the extent to which enhancement of religious coping could increase the impact of cancer control interventions for Latinas.

Survey on Clinical Practice Guidelines Use among Latin American Cardiologists.

Background There is a broad consensus about the benefits of applying Clinical Practice Guidelines (CPGs) as a standard of care and most countries, even in Latin America; however, the applicability of CPGs to medical practice is lower than expected. The failure in the implementation of CPGs is due to several factors, including physicians’ lack of adherence. Objectives To estimate the utilization rate of CPGs and to know the objections of Latin American cardiologists against them. Material and Methods We conducted an anonymous email survey among 10% of the Spanish-speaking members of the Interamerican Society of Cardiology that were randomly selected. The questions included demographic data, use of CPGs and objections to use them. We assumed that most of the respondents would make a positive answer when asked about the use CPGs; yet, we also assumed that they would criticize and comment the limitations of CPGs if they were induced to do so. Results The survey was responded by 952 of the 1197 cardiologists selected. The utilization rate of CPGs was 91.5%; 75.8% (660/871) used foreign and local guidelines, while 24.2% only used local CPGs. 58.2% of survey respondents had at least one objection to the quality or usefulness of CPGs. The most common complaints were that the guidelines proposed the use of resources that were not always available (11.5%), recommended impractical strategies due to lack of medical coverage (9.2%) and did not represent the patients in real practice (7.7%). Among those who did not use CPGs, 22.2% did not know the last guidelines published. Conclusions Although the utilization of CPGs is high, the objections about their usefulness constitute a barrier to improve the adherence of cardiologists to use them. These data should be considered to improve the production, diffusion and implementation of CPGs in Latin America.

Some antecedents and effects of participation in Spanish virtual brand communities

Virtual brand communities are increasing their importance day by day due to the fact that many consumers are using several online tools to share ideas and contact fellow consumers. For this reason, this work explores some antecedents and outcomes of consumer participation in virtual brand communities. The data, obtained through a web survey using Spanish-speaking members of several virtual communities, show that propensity to trust, familiarity with the community, satisfaction in previous interactions with other community members and communication in the community are the main precursors of consumers intentions to participate in a virtual community. Additionally, consumer participation in the activities carried out in a virtual brand community may enhance consumer loyalty to the brand around which the community is centred.

Patient-Physician Language Concordance: A Strategy for Meeting the Needs of Spanish-Speaking Patients in Primary Care

The Hispanic/Latino community increased by 58% in the last decade (1990-2000) and it is estimated that Hispanics/Latinos will be 30% of the population by 2050. Many of the Hispanic/Latino households (40%) surveyed by the census bureau in 2000 spoke Spanish. Because of its location, the Southern California Permanente Medical Group, which provides the medical services for Kaiser Permanente Southern California (KPSC) serves a large and growing Hispanic/Latino community. It is estimated that by 2010, the KPSC region will be between 30-50% Hispanic/Latino. A Spanish language task force (the task force) was created in 2006 to address the needs of the KPSC Spanish-speaking membership using primary care services. This task force examined data from a variety of sources including electronic medical databases and focus group reports from Spanish-speaking members. Using the task force findings and the literature in this area, we make recommendations to increase patient-physician language concordance in other health care settings so that organizations can effectively serve a growing Hispanic/Latino, Spanish-speaking patient population.

Responding to the Language Challenge: Kaiser Permanente's Approach

To inform current debates on improving health care quality for patients with limited English proficiency by identifying the drivers and processes for one large health care delivery system's implementation of particular models, key success factors, and remaining challenges for the field. A qualitative case study of the Kaiser Permanente (KP) San Francisco Medical Center's approach to developing linguistic access services and subsequent organizationwide initiatives. We conducted semistructured interviews with eight current and former clinical and administrative leaders from the KP San Francisco Medical Center and national headquarters. Interviews were analyzed for key themes. KP San Francisco Medical Center developed linguistic and cultural services in response to a confluence of external and internal factors, including changing demographics, care quality challenges, and patient and clinician satisfaction issues. Early strategies included development of language-specific care modules focused on Chinese- and Spanish-speaking members while meeting broader linguistic access and cultural-competency needs through a centralized Multicultural Services Center. Additional approaches across KP regions have focused on improving interpreter services, optimizing use of bilingual staff, and creating a translation infrastructure to improve quality and reduce redundancy in written translation efforts. KP's experiences developing linguistic and cultural care and services since the 1990s provide lessons about decision-making processes and approaches that may guide other health systems, insurers, and policy makers striving to improve care quality and safety for patients with limited English proficiency.

Booster Seat Use in an Inner-City Day Care Center Population

Objective. To determine use and knowledge of belt positioning booster seats by drivers transporting children from day care centers in the central city of Milwaukee, Wisconsin. Methods. A prospective, direct observational, community-based, exploratory study was undertaken in May 2005. Eighteen day care centers in urban Milwaukee that met the predetermined criteria, including > 10 children ages 4–8 enrolled, were invited to participate. Volunteer observers, including Spanish-speaking members, from community organizations were trained in proper placement by certified car seat technicians. Teams visited sites, completed a standardized survey form with drivers who agreed to participate, and observed the type and placement of restraint in which each child was placed. Results. Of 841 children observed, 283 were determined to be booster-seat eligible. Only 21% were in the appropriate restraint. Latino, African American, and older children were significantly less likely than white and younger children to be appropriately restrained. Appropriate restraint use was more frequent among those living in the proper ZIP codes with higher median incomes. Conclusions. This is the first observational study of booster seat use in this Milwaukee population with appropriate restraint use varying widely from reported state and national data. The low rates of appropriate booster seat use, particularly by Latino and African American caregivers and those living in low-income neighborhoods, in this large metropolitan center supports the need for further study and targeted interventions.

An English/Spanish safety climate scale for construction workers

Workers in the construction trades experience high rates of traumatic injury. An increasing number of workers in this industry speak only Spanish, including members of construction trade unions. This brief communication reports a dual language safety climate scale developed during a larger training intervention study. Construction workers in two unions self-completed a previously validated 6-item safety climate scale modified for the construction trades. A seventh item was developed midway through the study and incorporated into the version completed by half of the respondents. For one union with a sizeable number of Spanish-speaking members, a dual-language (Spanish/English) version was administered. Follow-up telephone interviews conducted 3 months after the self-completed survey also included the safety climate scale. Cronbach's coefficient alpha was 0.85 for the 6-item scale and 0.85 for the 7-item scale. Similar coefficient alpha scores were found for the subgroup of Spanish-speakers on the 6- and 7-item scales. Spanish speakers with low education were less likely to respond to the scale when self-completing but not when it was administered by telephone in Spanish. This safety climate scale elicits consistent and reliable response from unionized construction workers when administered in English or in Spanish. Spanish literacy may be a consideration for the use of this scale among foreign-born Hispanic workers.

Methodological concerns for non-Hispanic investigators conducting research with Hispanic Americans.

The fastest-growing ethnic population in the United States, Hispanic Americans are underrepresented in health care research because of an insufficient number of Hispanic American researchers, study teams without Spanish-speaking members, a lack of Spanish-language instruments, and investigator ignorance about cultural differences. Culturally insensitive research produces biased results that can inaccurately represent Hispanic Americans. The purpose of this article is to discuss methodological concerns when conducting research with Hispanic Americans including: instrument response format, translation issues, population-related extraneous variables, and response tendencies that can influence results.