A Novel Patient Education Tool for Latino Americans

Latino Americans, who include people of Cuban, Dominican, Mexican, Puerto Rican, and South or Central American descent, comprise the largest and fastest growing minority group in the United States. They also represent a high health risk group. Consider these facts:

• Latino Americans have 2 to 3 times the prevalence of type 2 diabetes mellitus than non-Latino Caucasians and are at higher risk for diabetes-related complications and poorer outcomes

• A large study published by Daviglus et al¹ in JAMA in 2012 revealed that 71% of women and 80% of the men surveyed had at least one major cardiovascular risk factor, such as hypertension, hypercholesterolremia, or obesity

• The HIV infection rate among Latino Americans in 2009 was nearly 3 times as high as that of Caucasians (26.4 vs 9.1 per 100,000 population)

High morbidity rates among US Latino populations translate into an ever-increasing burden on our healthcare system—and on taxpayers.

Given their high health-risk status, Latino Americans have become an important target audience for health educators.  Unfortunately, this group has lower literacy levels than non-Latino Caucasians. So, what is an effective way to educate this population and motivate them to adopt healthy lifestyle behaviors? 

 Soap operas as a patient education tool

"Telenovela" is the Spanish word for soap opera. Unlike American soap operas, which have all but disappeared from network TV, telenovelas continue to be an integral part of popular culture in many Central and South American countries. While the story lines may be exaggerated versions of real life, many viewers strongly identify with their favorite characters and are drawn in by the compelling twists and turns of the plot.

The great potential for telenovelas to influence health behaviors was realized in 1986, when a character on a Venezuelan telenovela was diagnosed with breast cancer. This triggered an avalanche of women getting checkups in both Venezuela and Spain, where the series also aired. Here in the US, in the summer of 2001, a long-running daytime soap opera, The Bold and the Beautiful, began a subplot about HIV and displayed the CDC National STD and AIDS Hotline phone number while the scenes ran. Researchers at the CDC recorded dramatic spikes in the number of hotline calls (1,426 and 1,840 vs the average of 200 calls or less) following just 2 episodes of the HIV subplot. They concluded: "...many members of the American public can be motivated to seek health information by a dramatic, televised storyline that addresses health issues."³

Telenovelas' wide popularity and demonstrated ability to impact health behaviors has prompted researchers and clinicians, in recent years, to tailor telenovelas for patient education. Here are 2 examples.

The Challenge of Being Healthy: Martha and Sandra's Story

Researchers at the University of Massachusetts Medical School created a 6-episode telenovela as part of a 3-year study called the Lawrence Latino Diabetes Prevention Project.² The study evaluated the impact of weight control, nutrition, and exercise programs for 312 low-income residents of the largely Hispanic town of Lawrence who were determined to be at high risk of developing diabetes.

Participants watched the telenovelas and then took part in a guided discussion about the decisions made by the characters, some of whom were overweight. Bad decisions included bringing doughnuts to a party and buying sofrito, a widely popular Latino cooking sauce that contains excess sodium. A positive episode was based on a daughter who decides to enroll in healthy cooking classes, and her reluctant mother, who eventually tastes the food and decides it's not so bad.

The lead researcher commented, “I realized we had a lot of potential from a video rather than a book. With the soap opera, they got engaged, and they identified with the characters. It allowed them to talk about their own challenges and how they perceived themselves...It was entertaining, as opposed to sitting in a lecture.”

Researchers reported the results of the study to be small but meaningful: A weight loss of just five pounds produced substantial reductions of prediabetic indicators, including insulin resistance. 

Sin Vergüenza (Without Shame)

By 2011, the HIV prevention manager at Alta Med, a Los Angeles health clinic, had concluded that traditional patient HIV education methods were insufficient to raise HIV awareness and decrease stigma among neighborhood Latinos. With a federal grant, she and her colleagues created a 4-episode telenovela addressing various aspects of HIV and AIDS. 

Sin Vergüenza (Without Shame) encourages Latinos to get tested for HIV as a routine part of their preventive health care, and to seek medical care should they test positive. The videos introduce family members who each represent a different age group, sexual orientation, and marital status. Each character also represents a separate HIV risk group. The series, airing on YouTube and accessible at altamed.org, weaves HIV education among broader (and more entertaining) topics such as stigma, infidelity, and family secrets. While addressing the difficult issues surrounding HIV, the videos also portray the unconditional love and support that carries this family through challenging times—qualities that strongly resonate with Latino audiences.

Why are telenovelas effective as patient education tools?

Research has found soap operas to more effective than other broadcast formats, such as PSAs, news shows, and evening dramas for disseminating health information to Latino populations because:

•        Latino households watch more daytime television than other audiences, according to Nielsen Media Research

•          Soap operas are viewed as a credible source of information by many Latinos

•          Content is delivered in a dramatic, engaging style by characters whom the viewers care about and with whom they can identify

•          The serialized format provides opportunities to repeat and build upon preventive health messages, enhancing both comprehension and retention

•          Viewers display better recall of the health messages when the content is presented in a story format that they can follow over time  

Artcraft Health Education takes on the cultural challenge

Artcraft Health Education has extensive experience in effectively communicating with multicultural patient audiences. Our award-winning animation and print materials promoting testing and treatment for hepatitis B have been translated into 14 languages. At the time of this writing, we are having a brochure and poster educating about COPD translated into 5 languages. We have also proposed a telenovela that can be viewed in waiting rooms and on the brand's Web site. If your needs include creating patient education materials for multicultural audiences, Artcraft Health Education is here to help.

Tina Ryman, MS

Senior Medical Writer

References

1.  Daviglus ML, Talavera GA, Avilés-Santa ML, et al. Prevalence of major cardiovascular risk factors and cardiovascular diseases among Hispanic/Latino individuals of diverse backgrounds in the United States. JAMA. 2012;308;1775-1784.

2.   Merriam P, Tellez T, Rosal M, et al. Methodology of a diabetes prevention translational research project utilizing a community-academic partnership for implementation in an underserved Latino community. BMC Med Res Methodol. 2009;9:20.

3.  Increases in calls to the CDC National STD and AIDS Hotline following AIDS-related episodes in a soap opera. Hollywood Health and Society Web site. http://www.hollywoodhealthandsociety.org/sites/default/files/for-public-health-professionals/research-and-evaluation/BBHotline.pdf. Accessed September 12, 2013.