Improving Enrollment and Adherence of Hispanics in Diabetes Programs

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• Improving Enrollment and Adherence of Hispanics
  in Diabetes Programs

Dr. Dirk G. Schroeder Assoc Professor, Emory
Univ. Exec VP, DrTango Inc
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Common Challenge How to get more Hispanics to
take advantage of diabetes programs services
Higher- Enrollment Adherence
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Presentation Aims Objectives

• Opportunities Collaborations
• DrTango - Hispanic Health
• Randomized Trial Robert Wood Johnson Foundation
  Study in Three States
• Florida Hispanic Obesity Prevention and Education
  (HOPE) Program
• Global Study of Hispanic/Latino Attitudes
  Practices related to Diabetes

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DrTango - Business Mission

• Help healthcare organizations better serve
  Hispanics by
• Communicating more effectively
• Improving Health Outcomes
• through culturally-optimized and effective
  solutions.
• Mission
• To help narrow the health disparities gap

• Services
• Cultural Adaptation
• Translations
• Health Management
• Research / Consulting

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Selected Clients
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• Building the Scientific Evidence for
  Culturally-Optimized Health and Wellness Programs

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Pulse of Hispanic Health Global Database

• 1 million online Hispanic households half
  outside U.S.
• Detailed diet, fitness, health and demographic
• Rapid quantitative research on attitudes, beliefs
  and practices
• Papers Obesity Health managemnet

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Qualitative ResearchWho do you trust for Health
Diet Information?
n 4,145
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Large Diabetes Disease Management Company Case
Study

• Problem
• Good Diabetes Program, but very low participation
  by Hispanics
• Project Objectives
• Understand Hispanic attitudes/behaviors regarding
  diabetes DM programs
• Review and Provide Feedback on
• Telephonic scripts for enrollment
• Mailing collateral Welcome letter and Basic
  Info
• Develop culturally-appropriate tools to engage
  Hispanics
• Methods
• Focus Groups, Key Informant Interviews, Expert
  Review

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Focus Group Findings Attitudes Beliefs

• High TRUST of doctors - High distrust of formal
  healthcare organizations
• Very suspicious and hesitant to share personal
  information.
• I would wonder how they found my name. Why they
  are asking
• Family Friends Primary sources of health
  information and guidance
• Other media telemarketing, TV, radio very low
• Personal Behavior Change ? Driven by tangible
  fear (e.g. Aunt has legs amputated),
  relationships (e.g. sexual function) not
  personal well being

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Sample Quotes Telephonic Enrollment Scripts

• I hate phone calls. People always trying to
  selling me something. I would only answer the
  phone and the call, if I have already heard about
  the program before hand.
• I HATE telemarketing calls I will hang upBUT
  If I get one in Spanish, I will listen.
• I must be aware of the program before
• Hispanic people living in the United States,
  people are always trying to taking to take
  advantage of us. People are always trying to
  take my money.
• Call people in the language they prefer most
  dont call in English and ask them then to hold
  and transfer to someone who speaks Spanish.

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Concept Recommendations - I

• People should be aware of program BEFORE the call
• Person needs to be from the same culture speak
  the language
• Developing TRUST is the Key
• This is FREE.

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Structural Concept Recommendations

• Doctor refers program
• Simple mailing communication pre-call
• Much more interactive
• Key - to develop TRUST!!

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Ultimate Objective - Changing BehaviorTranslation
vs. Cultural Optimization

• Translated - Understand

Culturally Appropriate - Engage
Culturally Optimized -Change Behavior
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DrTango - Robert Wood Johnson Foundation Research
Study

• 400,000 Research Project
• Goals
• Understand how to engage improve health of
  Hispanics
• Determine optimal delivery of culturally-optimized
  diet, fitness and healthy weight program
  (MiDieta)
• BCBS-Florida, New Mexico, Maryland
• Methods Randomized Trial

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Hispanic-optimized Content - MiDieta/MyDiet

• Diet, fitness and weight-management application
  for Hispanics that is
• Personalized
• Culturally and linguistically appropriate w.
  Latin Foods
• Has Videos, Evaluations, Newsletters, Social
  Networking,
• Backed by Latina Wellness Counselors
• Evidence-based and proven

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PanHispanicFoods A Cornerstone of MiDieta

• USDA Food Database - Translation
• Food Databases
• Mexico Guatemala Venezuela Peru Spain
• Processed and Prepared Foods
• Mexico Lean Cuisines -Restaurants in U.S.

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Country-specific Restaurants
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• Personal Home Page for each participant.
• Bilingual personalized menu fitness plan based
  on
• Gender
• BMI
• Goals
• Condition
• Food
• preferences

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Also available on paper

• Scannable Evaluation
• Personal Report
• DVD - custom
• Waist Tape
• Exchange Lists
• Eating Out Guide

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Enrollment Adherence in RWJF Study

• BCBSFL Direct mail
• CareFirst radio geo-targetting
• BCBSNM community outreach
• Enrollment success influenced by
• Health literacy of target population (MD)
• Personal contact (NM)
• Quick and clear follow-up to initial contact

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Adherence to Program

• Lots of ways to connect 3 phone s
• Spanish (70 - 30)
• Develop Personal Trusting Relationships
• Hola Eva
• Angela es mi Angel (Angela is my Angel!)
• Remember Erin Brochovich

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Results Weight Loss Florida (Ave per week
after 3 months)
Online
Offline
N201
N 200 P lt 0.03
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Scaling Up in Florida

• State-wide diet, fitness assessments
• Bilingual Website
• Multimedia awareness campaign
• Partnerships hospitals, managed care, media,
  pharma

• In 2007, the Florida legislature allocated 2.5
  million in general revenue funds for a Hispanic
  Obesity Prevention Education (HOPE) program.
• DrTango selected to design, implemented and is
  managing HOPE

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HOPE Florida Website - in 21 Days
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Awareness Campaign
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Hispanics Completing Health Assessments Where
You Found Out?
(June 6 September 6, 2007)
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Summary Some Generalities The Hispanic
Healthcare Consumer

• Hispanics
• Trusts Doctors Family
• Distrusts formal institutions
• More Fatalistic
• Motivated by
• Fear Relationships Personal Well-being
• Cultural is critical
• Language is key

• White/General Market
• Trusts Self Questions Authority
• Demands Service
• Controls destiny
• Motivated by
• Personal well-being, longevity physical

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Engaging Hispanics into Diabetes Programs

• Scientific evidence for benefit of making
  programs culturally-appropriate, NOT just
  translated.
• Strategies for communication may need to be
  altered for Hispanics vs. general market, e.g.
  doctor referral.
• Possible, through technology partnerships, to
  take these programs to large scale, e.g. Florida

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Summary - Opportunities for Collaboration

• Replicating HOPE in other states cities
• MiDieta forth-coming TangoLife
• Research Reports White Papers
• Up-coming Global Study 1 million Hispanics
  Diabetes

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Opportunity for Collaboration

• DrTango Global Study of Hispanic/Latino
  Attitudes, Knowledge, Practices - Diabetes
• Will be administered to global database of over
  one million Hispanic/Latinos in June 2009
• Seeking Input from programmers, collaborators
• Three questions ? Report

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Discussion
Dr. Dirk Schroeder dschroeder_at_drtango.com 678-749-
6772