Spanish-speaking Population Research Articles

The Latino Integrative Medical Group Visit as a Model for Pain Reduction in Underserved Spanish Speakers.

Chronic pain is a common problem in the United States, one for which there is a dearth of effective treatments. Nonpharmacological options are a promising alternative, especially for Spanish-speaking Latinos. This pilot study would like to assess the feasibility of an adapted Integrative Medical Group Visit (IMGV) curriculum for a Spanish-speaking Latino chronic pain population. We translated and adapted the curriculum of the IMGV for a Spanish-speaking Latino chronic pain population. We then tested the feasibility of using this model with two pilot groups (N = 19) using a pre-postdesign. This intervention was targeted for underserved Spanish-speaking Latino patients with chronic pain. This study took place at a safety net academic teaching hospital, the Boston Medical Center, and at a community health center located in a majority Latino neighborhood, the East Boston Neighborhood Health Clinic. We used the validated Spanish translations of the Patient-Reported Outcomes Measurement Information System (PROMIS-29) (short version), Personal Health Questionnaire (PHQ-8), and Perceived Stress Scale (PSS-10). We also gathered qualitative information through focus groups and in-depth interviews. Using PROMIS measures, there was a statistically significant reduction in pain interference (p = 0.01), fatigue (p = 0.01), and depression (p = 0.01). Qualitative data also indicated the participants felt they benefited from the visits and having care in Spanish was unique. This model offers a promising nonpharmacological option for Spanish-speaking patients with chronic pain and could offer an alternative for addressing disparities for this population.

C-71Sensitivity and Specificity of The Trail Making Test in a Spanish-speaking Population with Mild Cognitive Impairment

C-71Sensitivity and Specificity of The Trail Making Test in a Spanish-speaking Population with Mild Cognitive Impairment

Adaptación al español de la Escala de Espiritualidad y Sentimientos Religiosos (ASPIRES)

Uno de los problemas que han presentado las técnicas de evaluación de la religiosidad y la espiritualidad en Psicología radica en que la mayoría solamente reflejan las orientaciones cristianas y occidentales. El objetivo de este estudio consiste en adaptar al español la Escala de Evaluación de Espiritualidad y Sentimientos Religiosos (Assessment of Spirituality and Religious Sentiments scale [ASPIRES]), desarrollada por Piedmont (2004) para responder a estos inconvenientes, en una muestra no probabilística incidental compuesta por estudiantes universitarios de la Ciudad Autónoma de Buenos Aires (N=336). El análisis factorial confirmatorio indica un buen ajuste a los datos del modelo propuesto por el autor, por lo que se recomienda su empleo en el contexto local. Se sugiere que futuros estudios exploren las propiedades de ASPIRES en poblaciones diferentes (e.g. religiosas), de modo de contribuir con la generalización y la representatividad de los resultados del presente estudio.

Psychometric Properties of the Castilian Spanish Version of the Client Satisfaction Questionnaire (CSQ-8)

Although there are data on the psychometric properties of the Client Satisfaction Questionnaire (CSQ-8) in the United States Hispanic population, there are no data about the suitability of the questionnaire in Spanish-speaking populations in Spain. Trained and independent interviewers administered a Castilian Spanish translation of the CSQ-8 to 205 subjects (86.3% women, mean age 55.6 years) with subclinical depressive symptoms who participated in brief cognitive-behavioral group therapy interventions in Spain to treat subclinical depression. The internal consistency of the scale was satisfactory (α = .80). A single factor was identified that aggregated all eight items with high loadings in this global factor, which accounted for 43.5% of total variance. Differences in satisfaction were found based on the patients’ education level (p = .038) and post-treatment depressive symptoms (p = .021). There were no differences in level of satisfaction based on sex, age, marital status, social class, pre-treatment depressive symptoms or the number of sessions attended. The results indicate that the Castilian Spanish CSQ-8 has adequate psychometric properties and maintains those of the original questionnaire; therefore, it is suitable for use in Spain for assessment of satisfaction with services received.

Assessing Cancer Health Literacy among Spanish-Speaking Latinos.

Health literacy is a dynamic construct that changes with specific health conditions; thus, new disease-specific health literacy tools are needed. Since cancer is the leading cause of death among Latinos, the largest and fastest-growing minority population in the nation, there is a need to develop tools to assess cancer health literacy (CHL) among the Spanish-speaking population. The Cancer Health Literacy Test, Spanish version (CHLT-30-DKspa) was applied to identify Spanish-speaking individuals with low CHL and ascertain which items in the tool best discriminate between CHL level groups. Cross-sectional field test of the CHLT-30-DKspa among Spanish-speaking Latinos. Latent class analysis (LCA) identified participants with varying CHL levels. Probability of correct answers, odds ratios, and standardized errors were used to identify the items that allow the classification of individuals among the latent classes. LCA resulted in a three-latent-class model predicting 39.4% of participants to be in the HIGH class, 43.3% in the MEDIUM class, and 17.3% in the LOW class. Eleven items (the CHLT-11-DKspa) meet the criteria to clearly separate participants with HIGH and LOW classes of CHL. Although the best model fit was a three-class solution, results showed a clear separation of individuals from HIGH versus LOW levels of CHL, but separation of those in the MEDIUM level was not as clear. The CHLT-11-DKspa is a shorter measure that may be relatively easy to use in a clinical encounter to identify Spanish-speaking patients with the poorest levels of CHL who may require additional support to understand medical instructions and care plans.

The Brief-ACRA Scale on Learning Strategies for University Students

The examination and promotion of learning strategies in higher education has become a hot topic, not only for academic success, but also for professional and personal development. Among the tools available for evaluating learning strategies, the ACRA adapted for university students stands out as one of the most popular in studies with Spanish-speaking populations. However, there have been no attempts at validation using confirmatory factor techniques and there are no cut-off points available for training purposes. In this paper, the factor structure of the ACRA scale is examined. A cross-validation strategy (combining exploratory and confirmatory factor analyses) was used on a sample of 809 university students. A 17-item version is proposed, showing evidence for structural invariance across genders. The resulting three-factor structure is discussed (micro-strategies, memorizing-keys and metacognition, and emotional-social support), together with its association with other dimensions. Moreover, criteria by gender are provided.

Affordances in the Home Environment for Motor Development-Infant Scale, Spanish Translation

ABSTRACTThe home environment has a critical influence on an infant’s development and well-being. The Affordances in the Home Environment for Motor Development-Infant Scale (AHEMD-IS) is an instrument that has been developed to assess the home environment. This article illustrates the translation, validation, and cultural adaptation process of the AHEMD-IS from English to Spanish. The AHEMD-IS underwent a comprehensive process involving a four-phase translation process: (1) Forward translation, (2) Semantic equivalence, (3) Content equivalence testing, and (4) Final version development. Steps 1 and 2 resulted in linguistic alterations from the initial translation to enhance clarity for general public understanding. In step 3, mothers reported that the instrument was clear and easy to complete. Step 4 involved a final review of the instrument. The final outcome is a validated instrument that may prove beneficial when evaluating the home environment with Spanish-speaking populations, particularly those of Mexican descent.

From plantation to proletariat: Raizals in San Andrés, Providencia and Santa Catalina

The authors examine the implications of both a recent international ruling at The Hague curtailing fishing rights and the encroaching Colombian-based tourist industry for Raizals – descendants of African slaves brought by the British to the islands of San Andrés, Providencia and Santa Catalina in the Caribbean Sea. There they developed an autonomous way of life, in a subsistence economy based on fishing after the British abandoned the islands. While nominally under the control of the Spanish empire and afterwards the Colombian state, Raizals differ in many ways from the dominant Spanish-speaking, Creole and Catholic mainland population – being English-speaking, Afro and Protestant. Until the mid-twentieth century, they enjoyed substantial autonomy, now undermined by the Colombian nation-building project and a judgment of the international court at The Hague giving nearby Nicaragua rights over the waters of the Colombian islands, consequently precluding Raizals from accessing their traditional fishing resources. As a result, the islanders, with their culture recast as ‘heritage’, have become proletarians subordinated to tourist industries owned by mainland Colombians.

Evaluación de estrategias de aprendizaje mediante la escala ACRA abreviada para estudiantes universitarios

The examination and promotion of learning strategies in higher education has become a hot topic, not only for academic success, but also for professional and personal development. Among the tools available for evaluating learning strategies, the ACRA adapted for university students stands out as one of the most popular in studies with Spanish-speaking populations. However, there have been no attempts at validation using confirmatory factor techniques and there are no cut-off points available for training purposes. In this paper, the factor structure of the ACRA scale is examined. A cross-validation strategy (combining exploratory and confirmatory factor analyses) was used on a sample of 809 university students. A 17-item version is proposed, showing evidence for structural invariance across genders. The resulting three-factor structure is discussed (micro-strategies, memorising-keys and metacognition, and emotional-social support), together with its association with other dimensions. Moreover, criteria by gender are provided.

Traducción y validación de la versión abreviada del Freiburg Mindfulness Inventory (FMI-14)

<p>Recientemente se ha incrementado el interés de la psicología y otras ciencias de la salud por el concepto de Mindfulness. La evaluación de este constructo es cada vez más frecuente en el ámbito clínico para diseñar intervenciones enfocadas en mejorar la salud física y/o psicológica. En este trabajo se ha traducido y validado el Freiburg Mindfulness Inventory, en su versión breve (FMI-14). La muestra estuvo conformada por 200 personas de nacionalidad mexicana pertenecientes tanto a población universitaria como no universitaria. El instrumento se analizó a través de varias técnicas estadísticas, entre ellas un análisis factorial exploratorio (AFE) por medio del cual se identificaron cuatro componentes del Mindfulness, aquí denominados: atención, autocontrol, aceptación y autopercepción. Posteriormente, mediante un análisis factorial confirmatorio (AFC) se encontró que este modelo presenta un buen ajuste a los datos (CFI = .93; GFI = .93; AFGI = .89; SRMR = .05; RMSEA = .04). Los resultados también indicaron que la versión en español del FMI-14 es confiable (? = .80) y válida para evaluar Mindfulness.</p>

Student-led co-curricular medical Spanish training in a pharmacy professional program

Background and purposeThis paper describes a student-led co-curricular training program to increase pharmacy student proficiency with medical Spanish terminology. Western University of Health Sciences (WesternU) pharmacy students frequently can interact with Spanish-speaking patients in experiential rotations. Moreover, the clear majority of program graduates remain in California, a state with a high Spanish-speaking population. Developing foundational knowledge of medical Spanish terminology can enhance communication with Spanish-speaking patients, who may have limited English proficiency and experience a lack of language concordance when interacting with the healthcare system. Providing training in medical terminology in another language is important because communication barriers have been associated with adverse medical outcomes, such as poor medication adherence. Educational activity and settingThe development of the training logistics and materials are described for replication of the process, whether with medical Spanish or other languages. Students in the pharmacy program developed the medical Spanish training that is now a robust co-curricular activity with over 100 students participating in the training each semester. An important aspect of the WesternU co-curricular activity is that students develop materials, create learning activities, and facilitate training.

Impact of language on distress screening in cancer patients at an NCI-Designated Comprehensive Cancer Center.

e18070 Background: Psychological distress has been linked to poor outcomes among cancer patients. In 2007, the Institute of Medicine reported that distress is often unrecognized. While much is known about distress screening in English speaking populations, little is known about the provision of screening in Spanish. Methods: From 2009-2016, over 9000 solid tumor and lymphoma patients treated at an NCI CCC were prospectively administered a validated biopsychosocial distress questionnaire in their preferred language. The data was retrospectively stratified by language and Chi-square and ANOVA tests were performed to detect differences. Results: Spanish-speaking patients had the highest levels of reported distress in every category when compared to any other group. Of the 629 patients that reported Spanish as their preferred language, 400 (63.6%) took the questionnaire in Spanish (SS) with the rest taking it in English (SE). There was no difference in reported gender, marital status, education level or income between the two groups. The SS patients were younger (mean age 56 vs 60.5, P = 0.00) and reported significantly higher distress than the SE patients in every biopsychosocial domain except functional. The greatest difference was seen in “understanding treatment options” (40.1% SS vs 19% SE, p = 0.00) with a significant difference seen also in “fear of medical procedures” (38.2% SS vs 29.9% SE, p = 0.037), “finances” (66.5% SS vs 55.4% SE, p = 0.01), “finding community resources” (34.8% SS vs 26% SE, p = 0.03), “managing emotions” (40.3% SS vs 31.5% SE, p = 0.032), “needing help to coordinate care” (41% SS vs 23.4% SE, p = 0.00) and “transportation” (35.2% SS vs 21.9% SE, p = 0.001). The distress of the SE patients was more similar to that seen in the English-English patients, but was still significantly higher. Conclusions: These provocative data demonstrate distress levels are stratified by preferred language among cancer patients. Spanish speaking patients had the highest levels of reported distress but this difference was more pronounced when they were administered the questionnaire in Spanish. More studies are needed to determine culturally effective ways to identify distress in Spanish speaking populations.

Use of Short Assessment of Health Literacy for Spanish Adults (SAHLSA-50) to Determine the Health Literacy Rate of the Spanish-speaking Population in an Urban Emergency Department

Use of Short Assessment of Health Literacy for Spanish Adults (SAHLSA-50) to Determine the Health Literacy Rate of the Spanish-speaking Population in an Urban Emergency Department

Patient and provider perspectives on the potential value and use of a bilingual online patient portal in a Spanish-speaking safety-net population.

To assess patient and provider perspectives on the potential value and use of a bilingual patient portal in a large safety-net health system serving predominantly Spanish-speaking patients. We captured patient and provider perspectives through the administration of surveys to assess Internet access, barriers, and facilitators to patient portal adoption, along with portal preferences. We report on these survey results using descriptive and comparative statistics. Four hundred patients (82% response rate) and 59 providers (80% response rate) participated in the study. Although 73% of providers believed that the patient portal would increase patient satisfaction, just 39% planned to recommend portal use to patients, citing concerns related to time and reimbursement. In contrast, 72% of patients believed the patient portal would strengthen the patient-provider relationship and 77% believed it would improve the quality of care. Latino patients in particular believed the patient portal would strengthen the patient-provider relationship. Seventy-five percent of patients reported interest in a mobile version of the portal. Patients from a safety-net health system, most of whom were Spanish-speaking, reported a high level of interest in the patient portal. Providers at the same health system expressed reluctance about the portal due to concerns related to time and reimbursement. Bilingual patient portal implementation has considerable potential to promote health care engagement within Spanish-speaking safety-net populations; however, lack of provider engagement in the process could undermine the effort.

Spanish adaptation of the Solution-Focused Inventory (SFI)

The aim of this study was to examine the psychometric properties of the Solution-Focused Inventory (SFI) in a Spanish population, replicating the original validation study of Grant et al. (2012). The SFI, designed to evaluate solution-focused thinking, is a 12-item scale with three subscales: Problem Disengagement, Goal Orientation and Resource Activation. The instrument was adapted and translated into Spanish, then two studies were carried out to examine its psychometric properties. The first study confirmed the instrument´s structure, and its good internal consistency. The second study confirmed its convergent validity; SFI was positively correlated with measures of well-being, resilience, satisfaction with life and perspective taking, and negatively correlated with psychopathology. This second study confirmed the stability of the SFI scores across time. In sum, these two studies provide additional support for the reliability and validity of the SFI as a measure of solution-focused thinking, and open its use to Spanish-speaking populations.

The Latino Physician Shortage: How the Affordable Care Act Increases the Value of Latino Spanish-Speaking Physicians and What Efforts Can Increase Their Supply.

The United States Latino population is growing at a rapid pace and is set to reach nearly 30% by 2050. The demand for culturally and linguistically competent health care is increasing in lockstep with this growth; however, the supply of doctors with skills and experience suited for this care is lagging. In particular, there is a major shortage of Latino Spanish-speaking physicians, and the gap between demand and supply is widening. The implementation of the Affordable Care Act (ACA) has increased the capacity of the US healthcare system to care for the growing Latino Spanish-speaking population, through health insurance exchanges, increased funding for safety net institutions, and efforts to improve efficiency and coordination of care, particularly with Accountable Care Organizations and the Hospital Readmissions Reduction Program. With these policies in mind, the authors discuss how the value of Latino Spanish-speaking physicians to the healthcare system has increased under the environment of the ACA. In addition, the authors highlight key efforts to increase the supply of this physician population, including the implementation of the Deferred Action for Childhood Arrivals Act, premedical pipeline programs, and academic medicine and medical school education initiatives to increase Latino representation among physicians.

Validation of the Spanish Version of the Quality of Dying and Death Questionnaire (QODD-ESP) in a Home-Based Cancer Palliative Care Program and Development of the QODD-ESP-12

ContextImproving quality of death (QOD) is a key goal in palliative care (PC). To our knowledge, no instruments to measure QOD have been validated in Spanish. ObjectivesThe goals of this study were to validate the Spanish version of the quality of dying and death (QODD) questionnaire and to develop and validate a shortened version of this instrument by phone interview. MethodsWe enrolled caregivers (CGs) of consecutive deceased cancer patients who participated in a single PC clinic. CGs were contacted by phone between 4 and 12 weeks after patients' death and completed the Spanish QODD (QODD-ESP). A question assessing quality of life during last week of life was included. A 12-item QODD (QODD-ESP-12) was developed. Reliability, convergent validity, and construct validity were estimated for both versions. ResultsAbout 150 (50%) of 302 CGs completed the QODD-ESP. Patient's mean age (SD) was 67 (14); 71 (47%) were females, and 131 (87%) died at home. CGs' mean age (SD) was 51 (13); 128 (85%) were females. Mean QODD-ESP score was 69 (range 35–96). Kaiser-Meyer-Olkin measure of sampling adequacy was 0.322, not supporting the use of factorial analysis to assess the existence of an underlying construct. Mean QODD-ESP-12 score was 69 (range 31–97). Correlation with last week quality of life was 0.306 (P < 0.01). Confirmatory factorial analysis of QODD-ESP-12 showed that data fitted well Downey's four factors; Chi-square test = 6.32 (degrees of freedom = 60), P = 0.394 comparative fit index = 0.988; Tucker-Lewis Index = 0.987, and root mean square error of approximation = 0.016 (95% CI 0–0.052). ConclusionQODD-ESP-12 is a reliable and valid instrument with good psychometric properties and can be used to assess QOD in a Spanish-speaking cancer PC population by phone interview.

63: Using the questionnaire for urinary incontinence diagnosis as screening tool in low resource settings

The Questionnaire for Urinary Incontinence Diagnosis (QUID) is a validated and reliable 6-item urinary incontinence (UI) symptom questionnaire used to distinguish patients with urge (UUI), stress (SUI) and mixed incontinence (MUI). We aim to evaluate the utility of QUID as a tool for untrained community health workers (CHW) in low resource settings. We aim to determine whether the QUID can help identify patients with UI who will benefit from physician evaluation. A Spanish version of the QUID has been validated in Spanish-speaking populations in Latin America and the United States of America using the TRAPD (translation, review, adjudication, pre-testing, and documentation) method. We collaborated with Saving Mothers and the Institute for Latin American Concern Mission Center in Santiago, Dominican Republic, which outreaches to 160 rural communities with limited access to care. At an annual educational symposium, the CHWs or “cooperadoras” were taught to administer the QUID to women complaining of UI. These women were then referred to the main clinical evaluation center for a UI assessment. A clinician asked these women 3 stress-related and 5 urge-related questions. The diagnosis after administration of the QUID by the CHWs was correlated with physician diagnosis after asking these 8 clinician questions. Clinicians then performed a thorough physical examination, urine dipstick, post-void residual, cough stress test, and simple cystometrics on patients with a negative cough stress test. The QUID diagnosis was correlated to physician diagnosis after both clinician questions and physical examination. The CHWs administered the QUID to 101 women who had complaints of UI with following diagnoses: MUI 73.2%, UUI 6%, SUI 0%, and no incontinence 20.8%. After initial clinician evaluation and the 8 clinician questions, diagnoses were as follows: MUI 34.65%, UUI 4%, SUI 34.65%, and 26.7% with no incontinence. The correlation coefficient between the QUID and the clinician questions was 0.78. After thorough physical examination as above, final diagnoses were as follows: MUI 15.8%, UUI 14.9%, SUI 26.7%, 41.6% with no incontinence, and 1% with a urinary tract infection. The correlation coefficient between the QUID and the final diagnosis was 0.185 (Table 1). CHW diagnosis after QUID administration correlated well with clinician diagnosis after 8 clinician questions. This suggests that the QUID can be an excellent screening tool for CHWs in rural communities for triage, just as the 8 clinician questions are used to triage patients by physicians prior to physical examination and evaluation. It should be noted that the QUID does not diagnose SUI as frequently as physicians do with clinician questions on initial evaluation. The QUID diagnosis poorly correlated with physician final diagnosis. This is likely because additional tests, such as urine dipstick, post-void residual, cough stress test, and simple cystometrics supply more information to differentiate accurately between SUI and UUI, which were diagnosed much more frequently from the physician diagnosis than the QUID diagnosis. However, the QUID was able to identify high-risk women who should receive an evaluation by a physician for UI.

Development and evaluation of an intermediate-level elective course on medical Spanish for pharmacy students

Background and Purpose: The Spanish-speaking population in the United States is increasing rapidly, and there is a need for additional educational efforts, beyond teaching basic medical Spanish terminology, to increase the number of Spanish-speaking pharmacists able to provide culturally appropriate care to this patient population. This article describes the development and evaluation of an intermediate-level elective course where students integrated pharmacy practice skills with Spanish-language skills and cultural competency.Educational Activity and Setting: Medical Spanish for Pharmacists was developed as a two-credit elective course for pharmacy students in their third-professional-year who possessed a certain level of Spanish language competence. The course was designed so that students would combine patient care skills such as obtaining a medication list and providing patient education, and pharmacotherapy knowledge previously learned in the curriculum, along with Spanish-language skills, and apply them to simulated Spanish-speaking patients. Elements to promote cultural competency were integrated throughout the course through a variety of methods, including a service learning activity.Findings: Successful attainment of course goals and objectives were demonstrated through quizzes, assignments, examinations, and an objective structured clinical examination (OSCE). Based on these course assessments, students performed well during both offerings of the course.Discussion: While the class cohort size was small in the two offerings of the course, the Medical Spanish for Pharmacists elective may still serve as an example for other pharmacy programs as an innovative approach in combining Spanish language, specific pharmacy skills, cultural competency, and service learning.

Abstract TP199: Stroke Awareness in Argentina, the Sifhon Population Survey

Introduction: Stroke awareness in Latin America is scant. We conducted a large population survey in 13 provinces in Argentina to assess knowledge of cerebrovascular disease. Methods: We distributed 110,000 multiple-choice anonymous questionnaires using the house distribution system of a bottled water dispensing company, assessing information regards age, gender, educational level, general stroke information, attitude towards symptoms and treatment. Percentages of each choice were recorded for every question and a multivariate analysis was performed. Results: A total of 12,710 surveys were returned, age 51±17 years, 69% women. Almost 95% reported prior knowledge of the disease, 50% through public media, 37% through a relative/friend that had a stroke and 8% through their family doctor. The Spanish acronym for accidente cerebrovascular , ACV, was the most frequently identified name for stroke (79%), the Spanish equivalent to cerebral attack was used by 7% and 0,4% used the term “ictus”. Only 29% knew about TIA but 69% identified stroke risk factors. Although 73% recognized their signs and symptoms, 11% misinterpreted them as a heart attack and 34% ignored that stroke can present with severe headache. Although 73% considered the disease potentially disabling/fatal, 40% ignored its frequency. If symptoms, 25% would call 911 and 50% would go to an emergency room by own means. Only 63% knew the existence of a specific treatment. Lowest degree of knowledge was seen in young, single, non-university men. Conclusion: This study represents the largest general public stroke awareness survey in Spanish speaking populations. Respondents showed excellent recognition of risk factors, warning signs and need of a rapid response. The population had little knowledge of prevalence, severity, TIA, and acute treatment. Public media appear to have an essential role in education.