Health information preferences among Hispanic/Latino immigrants in the U.S. rural Midwest

Implementation Evaluation of a Parks- and Faith-Based Multilevel Intervention to Promote Physical Activity Among Latinos

BACKGROUND

Latinos in the United States face multiple barriers to engaging in physical activity (PA). We implemented a faith-based multilevel intervention to promote PA in parks for Latino adults, which was partially adapted to a virtual platform during the COVID-19 pandemic, and evaluated it using the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework.

METHODS

We conducted in-depth semistructured interviews (83% in Spanish) with 24 intervention participants (75% women) participating in a cluster randomized controlled trial in 2019-2022 that linked 6 churches (3 intervention, 3 control) with parks in East Los Angeles, CA. The intervention included in-person, park-based fitness classes, which were adapted to Facebook during the pandemic; PA motivational text messages; and other activities. Interviews assessed Reach (participation), Effectiveness (perceived impacts), Implementation (participation barriers/facilitators), and Maintenance (plans for sustaining PA), as well as perceived pandemic impacts.

RESULTS

About 80% of interviewees participated in ≥1 park class and 67% in ≥1 virtual class (Reach). Interviewees perceived positive intervention impacts across multiple health and well-being domains (Effectiveness) despite perceived negative pandemic impacts; several facilitators to participation (personal, social, program) and few barriers (personal, virtual, environmental; Implementation); and plans for maintaining PA (eg, revisiting intervention text messages and video recordings; Maintenance).

CONCLUSIONS

Findings support the utility of Reach, Effectiveness, Adoption, Implementation, and Maintenance to understand the broad impacts of a faith-based PA intervention. Findings point to the adaptability and robustness of the intervention during a public health crisis. Overall, findings may help inform the translation of the intervention to other communities to advance health equity.

Spanish-Speaking Caregiver Preferences for Social Determinants of Health Screening

Equitable social determinants of health (SDOH) screening has been recommended by the Centers for Medicare & Medicaid Services and the Joint Commission; however, little is known about Spanish-speaking caregiver preferences on how they would like to be screened. We conducted a cross-sectional study at 3 pediatric clinics (October-December 2019). Caregivers completed (in English or Spanish) an SDOH screening preferences survey. Three hundred eighty-two of 443 caregivers approached (response rate = 86.2%) completed the survey. Most were female, preferred Spanish, and completed only high school. Spanish-speaking caregivers had greater odds of preferring verbal SDOH screening (odds ratio: 4.1; 95% confidence interval, 1.8-9.2) than English-speaking caregivers. Verbal SDOH screening should be a consideration in families who speak Spanish. Future studies should utilize qualitative methods to further explore Spanish-speaking caregiver preferences for SDOH screening.

Validity evaluation of the Health Information Preferences Questionnaire among college students

Objective

This study aims to explore the association between health information preferences and specific health behaviors and outcomes, such as preventive measures and chronic disease management among college students. It assesses how different levels of health information preference influence individuals' utilization, perception, and self-efficacy within healthcare and health information contexts. Given the rising prevalence of non-communicable chronic diseases among younger populations in China, this research seeks to understand how tailored health information preferences can support effective health education and behavioral interventions. The development of the Health Information Preference Questionnaire (HIPQ) aims to bridge the existing gap in tools for assessing health information preferences among Chinese college students, with a focus on collecting validity evidence to confirm the HIPQ's applicability in this group.

Methods

The study employed a mixed-methods approach, beginning with an initial item pool derived from a comprehensive review of existing research tools, literature, and expert inputs. An expert review panel conducted item evaluations, leading to item reduction for clarity and relevance. The validation process utilized two independent samples of college students, detailing the sample size (n = 446 for preliminary testing, n = 1,593 for validation) and characteristics (age, major, urban vs. rural background) to enhance the understanding of the study's generalizability.

Results

The HIPQ, comprising 25 items across five dimensions-prevention-oriented approaches, relationship with healthcare providers, self-efficacy in obtaining health information, perception of the importance of health information, and health information behavior-demonstrated excellent content validity (ICVI ranged from 0.72 to 0.86). Factor analysis confirmed significant loadings for each item across the anticipated factors, with fit indices (RMSEA = 0.065, CFI = 0.942) supporting good model fit. The HIPQ's reliability was underscored by Cronbach's alpha coefficients (>0.8) for each subscale, with significant correlations across all subscales, indicating strong internal consistency and construct validity.

Conclusion

The HIPQ proves to be a reliable and valid instrument for assessing health information preferences among Chinese college students, highlighting its potential for broader application in health education and intervention strategies. Recognizing the study's focus on a specific demographic, future research should investigate the HIPQ's adaptability and utility in broader populations and different cultural settings. The study's limitations, including its concentrated demographic and context, invite further exploration into the HIPQ's applicability across diverse groups. Additionally, potential future research directions could include longitudinal studies to assess the impact of tailored health information on actual health outcomes and behaviors.

Relationship between religiosity and HPV vaccine initiation and intention in urban black and hispanic parents

OBJECTIVE

Religion is believed to be an important sociocultural influence in the U.S., but little is known about how religiosity shapes the human papillomavirus (HPV) vaccine decision in racial/ethnic minorities. The purpose of this study was to examine the relationship between religiosity and HPV vaccine initiation and intention among urban, racial/ethnic minority parents of adolescents 11-14 years old.

DESIGN

This study employed a descriptive, cross-sectional design using baseline data from Black and Hispanic parents (N = 175 and 285, respectively) recruited from medically underserved communities. Chi-square tests for independence and independent-samples t-tests were run to assess sociodemographic differences in vaccine initiation and vaccine intention. Binary logistic regression analyses were conducted to determine whether religious attendance and religious salience were associated with parents' HPV vaccine decisions for their children.

RESULTS

Approximately 47% of Black parents had vaccinated their youth against HPV. Of those who had not initiated the vaccine for their child, 54% did not intend to do so. 54% of Hispanic parents had initiated the HPV vaccine for their youth. Of those who had not initiated the vaccine for their child, 51% did not intend to do so. Frequency of attendance at religious services and the importance of religion in one's life was not significantly correlated with HPV vaccine decision-making for Black nor Hispanic parents.

CONCLUSION

This study suggests that religiosity does not influence the HPV vaccine decision for urban, Black and Hispanic parents. Future studies using measures that capture the complexity of religion as a social construct are needed to confirm the findings. In addition, studies with representative sampling will enable us to make generalizations about the influence of religion on HPV vaccine decision-making for urban, racial/ethnic minority parents.

Community-Engaged Research (CEnR) to Address Gaps in Chronic Kidney Disease Education among Underserved Latines-The CARE Study

Ensuring equitable chronic kidney disease (CKD) education for Latine patients with low health literacy and low English proficiency stands as a critical challenge, and the "Caridad Awareness and Education" (CARE) initiative represents our ongoing effort to address this imperative issue. In collaboration with twenty-three patients living with CKD, diabetes and/or hypertension and twelve trained Community Health Workers (CHWs) from diverse Latine subgroups, we conducted a research initiative funded by the National Kidney Foundation. Our primary objective was to co-design and test culturally tailored patient education materials (PEMs) for underserved Latine adults at risk for or diagnosed with CKD. We effectively integrated Community-Engaged Research (CEnR) principles with a Human-Centered Design (HCD) approach to create a range of CKD-PEM prototypes in Spanish. Patient preferences for printed educational materials were clear. They favored printed materials that incorporated visual content with concise text over digital, email, texts, or online resources and personalized phone outreach and the involvement of CHWs. Additionally, patients identified their unwavering commitment to their families as a forceful motivator for caring for their kidney health. Currently, a culturally and linguistically tailored CKD flipchart for one-on-one education, led by CHWs, is undergoing a pilot testing phase involving a sample of one hundred Latine patients at risk for or diagnosed with CKD. This innovative approach signifies a commitment to amplifying the insights and expertise of the Latine community afflicted by kidney health disparities, effectively embracing a CEnR to forge meaningful and impactful CKD-PEMs.

How scared are Americans of the Zika virus? The role of threat, efficacy, and third-person perception to induce protective behaviors

This study examines how public perception of threat and efficacy (on self and others) influence their tendency to take preventive action against the Zika virus by surveying 1,152 U.S. adults in Texas and Florida. Findings show that individuals were likely to take protective actions when they: (1) saw a high risk of the disease (high threat) and were confident about their ability to reduce the danger (high efficacy); and (2) perceived others as having a high risk (high threat), but lacked the ability to reduce the danger (low efficacy). Further, the study discusses practical implications for the design of public health campaigns.

Rural Latino Men’s Experiences and Attitudes Toward Health: A Pilot Photovoice Study

Much of the research regarding Latino men’s health tends to focus on specific health outcomes (e.g., HIV or diabetes). Few studies have examined how Latino men perceive factors that influence their health and/or health-related behaviors. This study explored rural Latino men’s experiences and attitudes toward health, using photovoice, in the context of a community-based participatory research partnership. We recruited nine Latino men living in a small town in Southeastern Iowa. Four to nine men attended four sessions and led a community forum. All the men were foreign-born, identified as Latino, aged between 34 and 67 years, and had lived in the United States for at least 7 years. Five themes were identified: (a) cultural conflict, (b) too much and discordant information, (c) lifestyles conflict, (d) sacrifice, and (e) family connectedness. An important implication of this study derives from familial and community connections and sacrifice. Feeling disconnected from family may impact physical and mental health and health-promoting behaviors. Future research should explore ways to inform community- and family-level interventions to connect rural Latino men more strongly to their family and local community and help them to take better control of their health.

A randomized controlled trial of generic and localized MedlinePlus-based information resources for hard-to-reach urban Hispanic community

OBJECTIVE

To determine if the Conexion digital localized health information resource about diabetes and depression could increase patient activation among Hispanic low-income adults.

MATERIALS AND METHODS

A nonblinded randomized controlled trial was conducted (NCT03984929). Participants at least 18 years old living in Washington Heights/Inwood, New York, were recruited from the community between July 2019 and August 2020 and randomized 1:1 to either the intervention group (localization of MedlinePlus resources customized with community components) or the control group (no localized community components). The primary outcome, patient activation, and secondary outcomes, knowledge, self-efficacy, and behavior change, were collected through surveys at 1-month follow-up.

RESULTS

Of the 134 participants recruited, 50.7% (n = 68) completed the 1-month follow-up. We found no statistically significant differences in the sociodemographic and baseline characteristics between those who missed the 1-month survey and those who completed it. No significant differences were observed in patient activation at 1-month. However, patient activation among all participants (n = 68) significantly increased (P = .048). Statistically significant improvements were also found in self-efficacy (P < .03). In multivariate analysis, birth country outside the United States and higher self-rated attachment to the community emerged as significant predictors of higher patient activation scores.

DISCUSSION

While the trial did not detect significant differences between groups, all participants demonstrated increased patient activation scores and improved secondary outcomes. While other factors may have contributed to this increase, our study suggests that access to carefully selected high-quality health information materials delivered digitally in the context of a community may result in improvements comparable to localized content in a hard-to-reach urban Hispanic population.

CONCLUSIONS

Our study highlights the potential of making carefully selected digital information accessible to hard-to-reach communities.

Communicating PNPLA3 genetic risk status for NAFLD among Mexican-origin men

Introduction

The burden of non-alcoholic fatty liver disease (NAFLD) continues to disproportionately impact under-resourced communities in the U.S., particularly Mexican-origin populations. Genetic polymorphisms such as the rs738409 C/G variant in patatin-like phospholipase domain-containing 3 (PNPLA3) have been associated with higher prevalence of and progression along the NAFLD spectrum. This qualitative study conducted in the U.S. Southwest aimed to assess Mexican-origin men's experience receiving genetic testing for PNPLA3 risk carrier status.

Methods

Semi-structured interviews were conducted with 17 Mexican-origin men whose NAFLD status and genetic predisposition were determined as part of a previous cross-sectional study. The interview guide included questions exploring participants' insights on how genetic risk status was delivered, how the information influenced their motivation for lifestyle modification to reduce NAFLD risk, and any knowledge sharing that occurred with family members after learning of their PNPLA3 risk status. Interviews were conducted and audio recorded in English (n = 6) and Spanish (n = 11) and uploaded into NVivo software for data analysis and interpretation. Guided by the Health Belief Model, a thematic analysis approach was used to identify primary themes.

Results

Results highlighted men's preference for receiving this type of genetic risk information through a letter sent to their homes. General comprehension of PNPLA3 risk status was deemed high and most men stated sharing their genetic predisposition to NAFLD with their immediate family members. Participants also indicated that family and awareness of this genetic risk acted as primary motivators for implementing behavior changes (e.g., diet, physical activity) toward the prevention of more severe liver conditions.

Discussion

Findings from this qualitative study suggest the feasibility of communicating genetic risk for NAFLD among Mexican-origin men. Future strategies for the dissemination of genetic risk results among Mexican-origin individuals should consider familial and cultural appropriate strategies.

How do Hispanics/Latinos Perceive and Value the Return of Research Results?

Introduction: Interest in the return of research results has been increasing; however, little is known about how Hispanics/Latinos perceive and value receiving results. This study examined differences among Hispanics/Latinos by education and income in the experience and expectations about the return of research results, perceived value of specific types of information, and the least and most valuable specific information. Method: Retrospective observational design using a cross-sectional national survey sample of Hispanics/Latinos (n = 327). Results: Higher educational attainment was positively associated with the expectation to receive research results, likelihood to participate in research if given study findings, and likelihood to trust researchers if given results. Higher income was positively associated with the perceived value of getting results. Respondents with higher education specifically perceived greater value in information about how lifestyle and genetics affect their risk of disease, how genetics affect how they respond to medications, their ancestry, available clinical trials near them, and how to connect with other study participants. Respondents with higher income perceived greater value in information about how genetics affect their risk of disease and how they respond to medications. Conclusion: The findings offer important insights for planning research initiatives and for developing culturally targeted educational materials for Hispanics/Latinos.

The Intersection of Workplace and Environmental Exposure on Health in Latinx Farm Working Communities in Rural Inland Southern California

Workplace and environmental exposures pose health risks for racial/ethnic minorities in rural agricultural communities, placing them at a disadvantage in accessing needed health care. Over three fourths (76%) of the 2.4 million farmworkers in the United States are immigrants, mostly from Mexico. However, little is known of the community health concerns and barriers to care of Latinx farmworkers in inland southern California. This qualitative study used a community-based participatory research approach, conducting nine in-home meetings to obtain meaningful community input on health concerns and barriers to access healthcare services among rural residents of the Eastern Coachella Valley, who are also located near the desert-bound Salton Sea of inland southern California. All interviews were audio-recorded and analyzed via listening to the audio recordings and summarizing data in templates and matrices. Participants discussed health concerns related to agricultural labor, including heat-related illness, musculoskeletal ailments and injuries, skin disorders, respiratory illness, and trauma. Participants raised concerns about environmental exposures related to agriculture and the nearby Salton Sea, a highly saline lakebed, and proposed solutions to improve the health of their communities. The findings from this study suggest farmworkers are aware of the health risks posed by living and working in rural farmlands but lack resources and information to act upon and advocate for improved public health.

Improving Sexual Health in U.S. Rural Communities: Reducing the Impact of Stigma

Sexually transmitted infections (STI), including HIV, are among the most reported diseases in the U.S. and represent some of America's most significant health disparities. The growing scarcity of health care services in rural settings limits STI prevention and treatment for rural Americans. Local health departments are the primary source for STI care in rural communities; however, these providers experience two main challenges, also known as a double disparity: (1) inadequate capacity and (2) poor health in rural populations. Moreover, in rural communities the interaction of rural status and key determinants of health increase STI disparities. These key determinants can include structural, behavioral, and interpersonal factors, one of which is stigma. Engaging the expertise and involvement of affected community members in decisions regarding the needs, barriers, and opportunities for better sexual health is an asset and offers a gateway to sustainable, successful, and non-stigmatizing STI prevention programs.

Reaching "hard to reach" workers: Evaluating approaches to disseminate worker safety information via the Mexican consular network

Mexican immigrants suffer a disproportionately large number of work-related injuries and deaths given their share of the workforce. Barriers of language, culture, and mistrust are often cited as factors that complicate efforts to reach these workers with occupational safety and health (OSH) interventions. By partnering with the Mexican government and its consulate network in the United States, researchers from the National Institute for Occupational Safety and Health were able to assess the impact of four different information dissemination approaches (posters, passively distributed brochures, actively distributed brochures, and video kiosks) in Spanish in a five-phase study. Exit interviews conducted with Mexicans seeking consular services indicated that while nearly all respondents considered OSH to be of importance, significant differences in impact measures, such as noticing the materials and liking of content, were found when comparing the different approaches. Despite these differences, even the least effective approaches were noticed by large numbers of individuals and significantly increased their stated behavioral intentions regarding OSH. Considering all materials together, significantly more participants reported liking the materials (p < 0.001) than did not, learning something new (p < 0.01), trusting the information (p < 0.05), intending to seek out additional OSH information (p < 0.01), and intending to speak to their bosses about OSH (p < 0.05). These findings contribute to building an evidence base for moving research knowledge into practice, which is an essential, but often overlooked, element of occupational safety and health research, particularly among workers from underserved communities.

Targeting of Enrollment Assistance Resources in Health Insurance Television Advertising: A Comparison of Spanish- Vs. English-Language Ads

Latinx adults, especially immigrants, face higher uninsurance and lower awareness of the Affordable Care Act's (ACA) provisions and resources compared to other racial/ethnic groups. Television advertising of ACA health plans has directed many consumers to application assistance and enrollment, but little is known about how ads targeted Latinx consumers. We used Kantar Media/CMAG data from the Wesleyan Media Project to assess Spanish- vs. English-language ad targeting strategies and to assess which enrollment assistance resources (in person/telephone vs. online) were emphasized across three Open Enrollment Periods (OEP) (2013-14, 2014-15, 2015-16). We examined differences in advertisement sponsorship and volume of Spanish- versus English-language ads across the three OEPs. State-based Marketplaces sponsored 47% of Spanish-language airings; insurance companies sponsored 55% of English-language airings. The proportion of Spanish-language airings increased over time (8.8% in OEP1, 11.1% in OEP2, 12.0% in OEP3, p <.001). Spanish-language airings had 49% lower (95%CI: 0.50,0.53) and 2.20 times higher odds (95%CI: 2.17,2.24) of mentioning online and telephone/in-person enrollment assistance resources, respectively. While there was a significant decrease in mention of telephone/in-person assistance over time for English-language airings, these mentions increased significantly in Spanish-language airings. Future research should examine the impact of the drastic federal cuts to ACA outreach and marketing.

Availability of Concussion Information in Spanish for Parents of Youth Athletes

All but one U.S. state has passed legislation requiring that concussion information be provided to parents of youth participants in school-sponsored sport. Such information should be accessible and easily understood if it is to be used by parents to make informed decisions regarding their children's health and safety. Accessing and understanding information about concussion may be challenging for parents who lack fluency in English. The current study sought to describe the extent and nature of Spanish-language concussion information available on the websites of U.S. public high school athletic associations. We also examined information provided by leading youth sports and health organizations as well as the top U.S. children's hospitals. We sought to quantify the proportion of these websites with Spanish-language translation of concussion education materials and describe the readability, accessibility, and completeness of these translations. Only one quarter of the websites examined contained any concussion information in Spanish, and none of these websites offered a mirrored Spanish-language translation. Spanish information was also difficult to access, with the search process requiring English-language ability. Finally, the readability of the concussion information in both English and Spanish was higher than recommended guidelines. Our findings suggest that non-English-speaking parents may be inadequately informed about concussion because translation of concussion educational materials is absent, incomplete, or hard to access. This raises questions about whether they are able to provide informed consent for their children's participation in contact sport and suggests the need for improved translation of such informational materials.

Preferences for multigene panel testing for hereditary breast cancer risk among ethnically diverse BRCA-uninformative families

Until recently, genetic testing for hereditary breast cancer has primarily focused on pathogenic variants in the BRCA1 and BRCA2 (BRCA) genes. However, advances in DNA sequencing technologies have made simultaneous testing for multiple genes possible. We examined correlates of interest in multigene panel testing and risk communication preferences in an ethnically diverse sample of women who tested negative for BRCA mutations previously but remain at high risk based on their family history (referred to as "BRCA-uninformative") and their at-risk female family members. Two-hundred and thirteen women with a previous breast cancer diagnosis and a BRCA-uninformative test result and their first-degree relatives completed a survey on interest in multigene panel testing, communication preferences, and sociodemographic, psychological, and clinical factors. Stepwise logistic regression was used to identify factors associated with testing interest. Chi-square analyses were used to test differences in risk communication preferences. Interest in multigene panel testing was high (84%) and did not considerably differ by cancer status or ethnicity. In multivariable analysis, factors significantly associated with interest in genetic testing were having had a mammogram in the past 2 years (odds ratio (OR) = 4.04, 95% confidence interval (CI) 1.80-9.02) and high cancer worry (OR = 3.77, 95% CI 1.34-10.60). Overall, the most commonly preferred genetic communication modes were genetic counselors, oncologists, and print materials. However, non-Hispanic women were more likely than Hispanic women to prefer web-based risk communication (p < 0.001). Hispanic and non-Hispanic women from BRCA-uninformative families have a high level of interest in gene panel testing. Cancer-related emotions and communication preferences should be considered in developing targeted genetic risk communication strategies.

Health-Related Decisions for Serious Illness Among Ethnically Diverse Older Adults

We investigated the influence of sociodemographic factors, acculturation, ethnicity, health status, and spirituality on older adults' health-related decisions when confronted with a choice between competing options. The sample included 451 participants: African Americans (15.74%), Afro-Caribbeans (25.5%), European Americans (36.36%), and Hispanic Americans (22.4%). Compared with others, European Americans and Hispanic Americans favored quality of life over a lengthy life. Sociodemographic factors, acculturation, ethnicity, health status, and spirituality accounted for variations of decisions. The variability of decisions calls for multiple care options to explore the value of different trade-offs in order to avoid predetermined clinical practice guidelines, especially in nursing.

Older Adults of Underrepresented Populations and Their End-of-Life Preferences: An Integrative Review

This integrative review was conducted to examine the evidence for understanding diversity in end-of-life preferences among older adults of underrepresented groups. Findings from 21 studies were critically examined, grouped, and compared across studies, populations, and settings. Five major themes emerged: advance directives, hospice and palliative care, communication, knowledge and information, and home and family. Despite multidisciplinary attention, content and methodological limitations narrowed understanding of what matters most to these groups when making decisions at end of life. Rigorous longitudinal studies with more ethnically diverse samples are needed to detect modifiable factors related to disparities at the end of life.

Correlates of online health information-seeking behaviors in a low-income Hispanic community

OBJECTIVE

The purpose of this study was to explore the correlates of online health information-seeking behaviors among Hispanic residents of a low-income urban neighborhood.

METHODS

Data were collected with a community survey from 1045 unique participants at ambulatory care clinics in a largely Hispanic immigrant community in northern Manhattan, New York. A descriptive correlational analysis was conducted using logistic regression.

RESULTS

A majority of the participants were born outside the United States (85.7%), and half (50.3%) had completed high school. A logistic regression revealed that five independent variables were significantly correlated with online health information-seeking behaviors: age, education, marital status, primary language, and health literacy. Age and Spanish as preferred language were negatively associated with online health information-seeking (OR = 0.93 and 0.50), whereas education and health literacy were positively associated with online health information-seeking (OR = 4.28 and 1.28).

CONCLUSIONS

The findings have implications for designing online health information resources and interventions appropriate for the populations they are likely to reach. Furthermore, the findings highlight the need for special efforts to ensure access to reliable health information for immigrant populations and those with low health literacy.