Health Information Seeking Behaviors and Preferences among Latino Immigrants: The Role of Acculturation and Functional Health Literacy.
Purpose. To determine sources of health information of Latinos and assess associations with acculturation level, functional health literacy and demographics. Methods. Focus groups (n 40) and Semi structured survey interviews were conducted with adults (n=212) Results. Over 60% of respondents had lived in the country for less than 10 years, were women with less than a high school degree, and under the age of 40 years old. Motivation for seeking health information was reported to be primarily due to illness (n 146, 71.9% and mostly for themselves (n 191, 90% The majority of participants chose to take the survey in Spanish and preferred Spanish for health information. Younger participants, recent immigrants, women, participants with lower education levels and lower acculturation to American culture were more likely to use other People and Self Help strategies as sources of information. Although most found information trustworthy and easy to obtain, 10% did not find their top source of information trustworthy, 20% reported difficulty accessing the information and 25% found the information insufficient. Barriers identified such as language and trust are explored and discussed. Lastly, participants with marginal and inadequate Functional Health Literacy (FHL) and low Acculturation/English proficiency were less likely to use Media sources and more likely to rely on friends, family and traditional medicine or healers. Conclusion. Specific implications for professional practice are presented; specifically, consideration for language preferences; formatting and material for audiences; readability and comprehension levels; cultural relevance and appropriateness; and physical location availability; and measures of literacy, FHL and acculturation. created following triangulation with existing literature. Survey development A set of survey questions on information sources, health information seeking behaviors and barriers to information access were developed, a review panel was convened to evaluate content validity. The panel was comprised of 3 experts who possessed bilingual and bicultural expertise as well as psychometric measurement expertise. Face validity was established by a small convenience sample of community members at a local venue. Test re test comparisons were made with a sample of community members at a local social service organization (n=16) following minor edits as suggested by the review panel. Correlation analysis showed an acceptable reliability coefficient value (r 0.750) The questions developed by the authors (information sources, health information seeking and barriers) were then utilized as additional items in the final questionnaire alongside the existing standardized scales (FHL and acculturation) See table 1 for a sampling of questions included in the questionnaire. Participants Participants in the survey were Latino adults in a metropolitan area in the Midwest region of the United States (n=212) Conversations with key individuals, community gatekeepers, organization managers, and community leaders were utilized to secure permission to recruit individuals and conduct data collection procedures at several locales. Participants were recruited from a variety of local venues such as health centers, community festivals, soccer games, community centers or other recreational facilities, health fairs, churches, and markets (grocery stores) Recruitment strategies included intercept and snowball sampling. Adults who selfidentified as Latino/Hispanic were invited to participate. Procedures All procedures and materials were approved by the Social and Behavioral Board of the University #09 03 02 05E) All survey administrators and study staff attended procedural and ethics training. Power analysis resulted in a required sample size of n >195 (confidence level =95% confidence interval =5) Given the lower literacy level expected, oral administration was utilized to increase participation. Participation was voluntary and confidential, participants could choose their language preference (English or Spanish) spent on average 23 minutes per survey, and received a small monetary gift card to a local grocer. Final Instrumentation The final survey was translated into Spanish and back translated into English by an independent professional to evaluate accuracy. The instrument included self report questions on demographics (e.g. age, marital status, education, sex, country of birth, perceived health status) health information seeking behaviors (reasons, sources, and barriers to access) a standardized measure of FHL, and a standardized bidimensional acculturation sub scale on Linguistic Proficiency. Acculturation was measured with the well established Bidimensional Acculturation Scale for Hispanics (BAS) by Marin and Gamba (1996) The four point Likert scale provides a linguistic proficiency score (range 1 4, cut off score 2.5) to the Ohio Development Services Agency (ODSA) and based on 2010 census data, the Latino population in the state grew by 63% since 2000 (n.d. Many disparities in health status and access to health care have been reported among Latinos. According to the Agency for Healthcare Research and Quality, Latinos received worse care for 39% of measures and had worse access to care for 63% of measures than their White counterparts (Agency for Healthcare Research and Quality, 2004) The ODSA also reports that approximately 80% of Latinos in Ohio are US born (n.d) As this growth of Latin American communities continues, health education professionals will need relevant information. Information about FHL, health seeking behaviors and preferred sources of health information are sparse in the professional literature. The AHRQ Evidence Report states that culturally competent and appropriate health education and health services should be specific to each community. Further, low literacy can be linked to: poorer health, less use of preventive care, poorer control of chronic disease, lower quality care, medical errors, poor outcomes, and disparities. The lack of this type of specific information has hindered professional practice (AHRQ, 2004) When considering the rapid growth of Latinos in Ohio, the diversity in acculturation levels, and the health and access disparities already reported by Rojas Guyler, King and Montieth (2008) and the variety of sources of health information currently available (Britigan, Murnan RojasGuyler, 2009) we feel that the key role of health education programs designed specifically for the appropriate health literacy levels warrants further investigation. Purpose The purpose of this research study was to determine sources of health information utilized by Latinos in a Midwestern tri state area and assess associations of these sources to participants' acculturation level, FHL level, country/ region of familial origin, and demographic characteristics.