Strategies for Disseminating Information on Biomedical Research on Autism to Hispanic Parents

A systematic review and narrative synthesis of health literacy interventions among Spanish speaking populations in the United States

BACKGROUND

While many populations struggle with health literacy, those who speak Spanish preferentially or exclusively, including Hispanic, immigrant, or migrant populations, may face particular barriers, as they navigate a predominantly English-language healthcare system. This population also faces greater morbidity and mortality from treatable chronic diseases, such as hypertension and diabetes. The aim of this systematic review was to describe existing health literacy interventions for patients with a Spanish-language preference and present their effectiveness.

METHODS

We carried out a systematic review where Web of Science, EMBASE, and PubMed were queried using MeSH terms to identify relevant literature. Included articles described patients with a Spanish-language preference participating in interventions to improve health literacy levels in the United States. Screening and data abstraction were conducted independently and in pairs. Risk of bias assessments were conducted using validated appraisal tools.

RESULTS

A total of 2823 studies were identified, of which 62 met our eligibility criteria. The studies took place in a variety of community and clinical settings and used varied tools for measuring health literacy. Of the interventions, 28 consisted of in-person education and 27 implemented multimedia education, with 89% of studies in each category finding significant results. The remaining seven studies featured multimodal interventions, all of which achieved significant results.

CONCLUSION

Successful strategies included the addition of liaison roles, such as promotores (Hispanic community health workers), and the use of multimedia fotonovelas (photo comics) with linguistic and cultural adaptations. In some cases, the external validity of the results was limited. Improving low health literacy in patients with a Spanish-language preference, a population with existing barriers to high quality of care, may help them better navigate health infrastructure and make informed decisions regarding their health.

REGISTRATION

PROSPERO (available at https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021257655.t ).

Improving health and scientific literacy in disadvantaged groups: A scoping review of interventions

OBJECTIVE

To explore approaches for developing and implementing interventions aimed at improving health literacy and health-related scientific literacy in disadvantaged groups.

METHODS

A scoping review of literature published in 2012-2022 was conducted, followed by quality appraisal of eligible studies.

RESULTS

Interventions were conducted mainly in community settings, where the most popular venues were adult education facilities. The primary target groups were those with limited income or education, ethnic minorities, or immigrants. Programs were often held in-person using interactive and culturally appropriate methods. They were predominantly focused on functional and interactive health literacy dimensions rather than on critical and scientific ones. Evaluations measured knowledge, health literacy, behavioral and psychological outcomes using various quantitative and qualitative instruments.

CONCLUSIONS

The findings offer a comprehensive overview of the ways to design and evaluate health and scientific literacy interventions tailored to disadvantaged groups.

PRACTICE IMPLICATIONS

Future interventions should prioritize participatory designs, culturally appropriate materials, and shift focus to critical and scientific health literacy, as well as to program scalability in less controlled conditions.

Pediatricians' role in healthcare for Latino autistic children: Shared decision-making versus "You've got to do everything on your own"

LAY ABSTRACT

Latino parents may choose to use complementary health approaches, such as vitamins, supplements, and special diets, for their autistic children. However, they might not tell their pediatrician about their complementary health approach use if they worry that the pediatrician will disapprove or judge them. This fear, along with pediatricians' lack of autism knowledge, creates barriers to "shared decision-making" between parents and pediatricians. Shared decision-making is a process where families and healthcare providers collaborate and exchange information in order to come to an agreement about treatment options. In our qualitative study with 12 bilingual Latino families of autistic children, we interviewed and observed families to learn about their experiences with both conventional healthcare (their pediatrician) and complementary health approaches. Our study results describe the parents' different pathways to an autism assessment, a process that is sometimes called the "diagnostic odyssey." The parents reported that conventional healthcare met their needs for their child's physical health but not for their child's developmental challenges. The parents who used complementary health approaches for their autistic children were more frustrated about a lack of autism information from pediatricians than those who did not use complementary health approaches. Finally, we describe two examples of successful shared decision-making between parents and pediatricians. We conclude that pediatricians who are able to talk about complementary health approaches with Latino families may help to facilitate shared decision-making and reduce healthcare disparities for Latino autistic children.

Parental Perceptions of Autism Spectrum Disorder in Latinx and Black Sociocultural Contexts: A Systematic Review

Parents of children with autism spectrum disorder (ASD) face challenges in accessing diagnostic and treatment services; these challenges vary by race, ethnicity, and culture. This systematic review examines parental perceptions of ASD within Latinx and Black American communities. Findings indicate that interconnections with family and religious groups promoted positive coping and describe positive impacts of having a child with ASD. Relative to White families, community members reported reduced access to information and more inaccurate beliefs about ASD, higher levels of ASD-related stigma, and more negative experiences with healthcare providers, which serve to exacerbate healthcare disparities. Conclusions are limited by an underrepresentation of minority groups in research. We call for efforts to address the specific needs of racial and ethnic minorities.

Necessary Information for the Families of Children with Autism Spectrum Disorder: An Integrative Review

Objective: To identify the available evidence on the necessary information for the families of children with Autism Spectrum Disorder (ASD). Method: An integrative literature review carried out in six databases with specific descriptors for each one. Studies published on the theme between January 2014 and February 2020 available in full and free of charge were selected. For synthesis and analysis of data, thematic categorization was performed. 41 articles were included. Results: Two thematic categories were obtained. In the first category (“need for information”), the families’ lack of knowledge about ASD (treatment, how to deal with the child’s behavior, and future perspectives), rights of the child with ASD, and resources to obtain information were identified. The second category (“information support sources accessed by the families”) comprised informal sources (family members, friends, neighbors, and parents of children with ASD), formal sources (professionals and institutions), the Internet, and other resources (books, workshops, podcasts). Positive and negative aspects were found in the use of these sources. Conclusions: A pattern of information requested by the family was verified, as well as sources used to obtain it. These data are relevant to support the organization of sources of informational support for the families and the community.

Les enjeux de littératie dans la communication aux parents du diagnostic de trouble du spectre de l’autisme chez l’enfant

Informer les parents dont l’enfant vient de recevoir un diagnostic de trouble du spectre de l’autisme (TSA) est un enjeu majeur. Il est nécessaire de mieux comprendre comment les parents interprètent et s’approprient cette information dans leur vie quotidienne afin de mieux répondre à leurs besoins.

Objectif Mettre en évidence les besoins d’information, le processus de recherche d’information à partir de cadre conceptuel de la littératie en santé (accès, compréhension, interprétation et utilisation) ainsi que les obstacles et les éléments facilitateurs rencontrés.

Méthode Une recherche qualitative auprès de groupes de discussion a été menée avec des parents d’enfants ayant reçu un diagnostic de TSA dans les deux dernières années. Deux des trois groupes étaient formés de parents présentant des facteurs de risque associés à un faible niveau de littératie : monoparentalité, faible scolarité, sans-emploi, immigration récente.

Résultats Un manque généralisé d’information sur l’autisme et des préoccupations quant à la qualité de l’information trouvée sur Internet sont constatés. Tous les parents ont exprimé leur difficulté à comprendre l’information présentée. Le nombre d’obstacles rencontrés par ces derniers dans la recherche d’information s’est révélé être amplifié par des besoins importants de soutien social.

Conclusion Ces résultats soulèvent la nécessité de mieux répondre aux besoins d’information des parents en adaptant les outils proposés en termes d’accès et de compréhension pour la prise de décisions. En plus du soutien informationnel, il demeure crucial d’offrir différentes formes de soutien social, et ce, tout particulièrement aux parents en situation de vulnérabilité. Des propositions pour améliorer la communication sur l’autisme autour du diagnostic sont proposées.

Athletes for life: Rationale and methodology of a community- and family-based randomized controlled trial to promote cardiovascular fitness among primarily Latino families

BACKGROUND

Community-based programs have had modest success in combating obesity in Latino populations. Latino families' norms and beliefs about weight often hold larger body sizes to be normal, leading to lower engagement in weight-focused programs. Because improvements in cardiorespiratory fitness confer health benefits, regardless of weight, they offer an alternative to obesity-focused approaches. We describe the rationale and design of Athletes for Life (AFL), a community- and family-based intervention for Latino families.

METHODS/DESIGN

This two-group randomized controlled trial will test the efficacy of AFL for improving cardiorespiratory fitness and diet in 6- to 11-year-old children (N = 160) and their parents, relative to a wait-list control group. Children will participate in 12 weeks of semiweekly sports skill programing and nutrition sessions. Concurrently, parents will participate in sports-focused activity and behavior change sessions that focus on nutrition, chronic disease prevention, and healthy eating. Cardiovascular fitness will be measured by the 1-mile run and 3-min step-test for both parents and children. Secondary outcomes include changes in objectively measured physical activity, dietary measures, body composition, and cardiometabolic risk (waist circumference, blood pressure, blood lipids, glucose, insulin, and C-reactive protein).

DISCUSSION

AFL, implemented with a strong community partnership, will provide a test of the efficacy of culturally tailored intervention programming to promote positive health behaviors and improve health outcomes in Latino families. Intervention content, structure, and messaging will provide guidance for future methods to engage Latino families in health promotion programs that highlight their cultural norms, and beliefs.

TRIAL REGISTRATION

Clinicaltrials.gov Identifier NCT03761589 (12/3/2018).

It's time for a change!: The appreciative inquiry/bootcamp translation to address disparities in the Latino community with autism spectrum disorders

OBJECTIVE

Autism spectrum disorder (ASD) is underidentified and misidentified in the Latino community, and numerous barriers limit this community's ability to access quality health care for ASD. Appreciative inquiry/boot camp translation (AI/BCT) is a novel method of community engagement that can be used within community-based participatory research partnerships. AI/BCT uses qualitative methods to uncover strategies that the community is already successfully using and develops actionable messages to increase the use of those strategies throughout the community. We describe this method and outline how it is likely to be more effective at reducing disparities related to ASDs in the Latino community than traditional methods.

CONCLUSION

AI/BCT is a promising method of community engagement that is responsive to cultural differences. It is a strength-based approach focused on increasing the use of strategies that already work within the community. Therefore, it has the potential to reduce health disparities in the Latino community who have loved ones with autism ASD much more rapidly than traditional methods of inquiry. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Engaging Study Participants in Research Dissemination at a Center for Population Health and Health Disparities

BACKGROUND

Research dissemination is a priority for The Partnership for Understanding and Eliminating Disparate Outcomes (PUEDO) for Latinas, a Center for Population Health and Health Disparities located at the Fred Hutchinson Cancer Research Center (FHCRC).

OBJECTIVES

We aimed to identify types of PUEDO research findings our participants wanted and why, dissemination audiences beyond PUEDO participants, and strategies to communicate diverse findings about breast cancer and breast cancer disparities.

METHODS

Five focus groups with PUEDO study participants (N = 25) were transcribed for qualitative content analysis (average participants per focus group, 5; range, 2-11).

RESULTS

Participants reported wanting to learn aggregate and personal results and were influenced by their life experiences, their experiences as study participants, and the relevance they believed specific results would have for their lives. Women advocated for broad dissemination and inclusive communication using a simple paper-based strategy that would be accessible to diverse audiences (e.g., study participants, policymakers, recent immigrants).

CONCLUSIONS

Focus groups informed PUEDO's dissemination strategy, which concentrates on study participants and the regional Latino community. This approach to dissemination should maximize information uptake and community benefit.