• Supported by funding from the Duke Endowment & HRSA
• We would like to thank MUSC College of Nursing Staff: Melanie Slan & Maria Toler & Jason Roberson, Language Specialist & Medical Interpreter
• Student volunteers who conducted the health survey from the MUSC College of Nursing and MUSC Hispanic Health Alliance

Increase in Hispanic population

Health systems must keep up with the change:

   Patient identification (ethnicity & language status)

   Language access

   Provide interpreter, signage, & Spanish language materials

   CLAS Standards

• Spanish Language Code
• 1995 186 total patients (SPA)
• 2000 1983 total patients (SPA)
• 2005 19,604 total patients (SPA)

Spanish Speakers are 72% of Second Language Speakers in South Carolina

(image: bar graph titled "Second Language Status in South Carolina" Year 2000)

44.9% = LEP Comparison: California - 20%

(image: pie chart titled "Second Language Speakers in the Low Country & Ability to Speak English..")

• QUESTION:
• "How do you check to see if a patient has LEP..limited English proficiency?"
• ANSWER: "You mean if they speak English…You just ask them. If they stand there like a deer in head lights, then you know." Area that uses consent forms.

(image: photo of businessmen)

• Diabetes
• Stomach & liver cancer; cervical cancer
• Prenatal Care (Late)
• Unintentional Injuries & Accidents
• HIV/AIDS (15% of cases)
• Over 65 year flu immunization
• Obesity

http://www.hispanichealth.org/

(image: document titled "Hispanic Health Needs Assessment: A Community Guide for Documenting Health Status and Establishing Priorities")

• Open-ended nature of questions
• Venues for the sample (More health motivated)
• 1/3 asked interviewers to read and write for them (Spanish)
• Missing data (Topic*)
• Would benefit from fixed choice ranking, now that we know more of the choices

(image: bar graph titled "Average Education of Low Country Survey Respondents")

(image: bar graph titled "Comparison with Non-Hispanic Education for Charleston County")

(image: two bar graphs, titled "Age Groups for Hispanics in Survey" and "Overall Age Groups in Charleston County")

• Alcoholism
• Cancer
• Diabetes
• Cardiovascular disease
• Depression & mental health
• Drug use & addiction
• Occupational injuries & accidents
• HIV/AIDS and STDs

Interview with Hospital Administrator: "Some services…it's very hard to get Hispanics to come into care. Like mental health and drugs…. you hardly ever see them."

• Top 3 out of 6 are psychosocial:
  • Addiction
  • Alcoholism
  • Depression
• Community-identified concerns consistent with CDC (cancer, diabetes, HIV, etc)
• Accidents & injuries in Top 10, consistent with young age & occupational groups

(image: bar graph titled "Where do you go for help?")

58% Reported Barriers on Open-Ended Questions about Problems Getting Health Care

(image: two pie charts titled "Access to Services by Females" and "Access to Services by Males")

• 25% Hearing & vision problems
• 12% Obesity
• 12% Allergies & ear infections
• 10% Nutrition
• 10% Vaccinations

(image: photo of family playing football together)

• Addiction
• Accidents
• Stress
• Sexually Transmitted Diseases
• Prenatal care
• Pollution* (Caution: Language)
• Physical health^**

• Smokers (12% Smoke)
• Alcohol use (Non-drinkers 35%; <10% everyday)
• Diabetes (Self-Report 3%)
• Hypertension (Self-Report 9%; Don't know = 64%)

• Mammography
  Mean age of women = 29
  Range 15 to 65 years
  Possible candidates:
  15% sample(35-65 years)
  17% sample "Yes"
  
• Depression
  • 24% screened positive on the Primary Care 2 Question
  • 19% did not answer

(image: pie chart titled "Seat Belt Reports From Hispanic Survey")

(image: bar graph titled "Primary Barriers to Care")

• "Thank God I haven't had a problem"
• "I don't need anything"
• "I just go to the ER if I need something"
• "Just take medicines at home"
• "Here there are no health centers"

(image: drawing of ambulance)

• "I don't speak English well"
• "They (the hospital) had no interpreters"
• "The Doctors/Clinics don't speak Spanish"
• "I don't know what to say about the health problem" (Culture)
• "I couldn't explain what was bothering me"

(image: drawing of a four person conference)

• "I have no health insurance"
• "The care is very expensive"
• "Not enough money"
• "Many companies don't give Hispanics benefits"
• "High price of consultations"
• "I found insurance complicated"
• "My insurance does not cover that"

(image: drawing of men and a giant dollar sign)

EXCUSES:

• Need a social security number
• Would not attend me because I did not have a medical history
• Without an ID from this country, you cannot make an appointment
• Because it would be too expensive

(image: drawing of female doctor)

• "Racism"
• "To be Hispanic, you don't always get good service"
• "Discrimination"
• "Attention given to Latinos is very superficial"
• "One time they infected me and left me nothing…and because of the language I didn't know who could help me"

• Deportation
• "We need safe places to go when we are sick"

• Community partners identified
• Joint projects for Hispanic health
• Students & Faculty immersions affect curriculum
• Changes in language access in participating hospital
• Identified questions for subsequent investigations