A Hospital-Based Model for Culturally Sensitive Healthcare
Kleinman, Juliette, Aging Today
Americans age 65 and older who identify as Hispanic or Latino number 5.6 percent of all older Americans. By 2050, this population is expected to increase to 16.4 percent. Studies show that this cohort experiences health disparities related to low socioeconomic status, limited English language proficiency and challenges with access to medical insurance.
Additionally, research shows that the socio-cultural differences between doctor and patient, the patient's health literacy level and the quality of doctor-patient communication strongly influence clinical decision-making and are critical to positive health outcomes. When these aspects are not addressed, the result is patient dissatisfaction, poor adherence to medical recommendations and poorer health outcomes (see http://geriatrics.stanford.edu/ ethnomed/latino/index.html for a learning module for healthcare trainees).
Raising a VOICE Against Health Disparities
VOICES 60+ is a hospital-based social work advocacy program led by a gerontology social worker. Launched in March 2007, the program serves patients ages 60 and older with arthritis and related conditions. VOICES 60+ serves low income, ethnically diverse patients, approximately 40 percent of whom are Spanish-speaking. The program's goal is to enhance the patient's medical care experience, including improving patient-doctor communication and understanding of health information, assessing social service needs and linking patients to community resources.
Through targeted outreach, evaluation, focus groups, program enhancements and partnering with community organizations, VOICES 60+ has identified and seeks to address the culturally based needs of Hispanic patients, and hopes to provide a model for older adult service providers. Recently it expanded its reach to provide services for communitydwelling older adults as part of the Hospital's Community Service Plan for the New York State Department of Health.
Results from an early program evaluation of 40 users demonstrated that 93 percent surveyed were satisfied with VOICES 60+. Spanish speakers reported, however, that the program was less likely to improve communication with their healthcare team. Only 30 percent of Spanish speakers reported the program improved their communication with the healthcare team "extremely" (10 percent) or "very much" (20 percent).
One participant said, "I like the program, but they need someone to speak in Spanish with me. I was frustrated because they only spoke English and it was difficult to get the information I needed." Although Spanish interpretation services are always available, this served as an additional impetus for VOICES 60+ to implement new initiatives.
Focusing on Improvement
VOICES 60+ had a focus group conducted in Spanish to learn more about culturally specific needs. The findings correlated with research, underscoring the importance of language access, respect for cultural values, including the key role of the family, use of complementary medicine and recognition of spiritual belief systems in coping with illness.
"I do a lot of exercises and following the exercises I rub my joints with Vicks in the name of the lord ... faith moves mountains and is the best medicine," said one program participant.
With this new information, VOICES 60+ added elements to the program, and made Spanish-speaking staff available to patients. …