2004 REACH National Medicare Training Program
Speaker Name
Group Name
Date
1
Reaching Medicare Beneficiaries
With a Focus on Addressing Issues of
Language, Literacy, Location, and Culture
Module 8
2
Session Topics
•
•
•
•
Snapshot of Medicare beneficiaries
Overview of NMEP
CMS partners
General communication guidelines and
strategies
• Reaching those who are not being reached
• Prototypes and research findings
3
Medicare Beneficiaries
4
Medicare in 2004
•
•
•
•
Serves over 41 million beneficiaries
Covers 97% of those over 65
Has impacted life expectancy
Has improved quality of life
5
N u m b e r o f M e d ic a re B e n e fic ia rie s
T h e n u m b e r o f p e o p le M e d ic a re s e rv e s w ill n e a rly d o u b le b y 2 0 3 0
7 6 .8
80
D is ab le d & E S R D
70
8 .6
E ld e rly
6 1 .0 *
M e d ic a re E n ro llm e n t
(m illio n s )
60
8 .7
50
4 5 .9
3 9 .6 *
40
3 4 .3
2 8 .4 *
30
2 0 .4
5 .4
68.2
3 .3
3 .0
52.2
20
10
20.4
7 .3
25.5
31.0
34.1
1990
2000
38.6
0
1970
1980
2010
2020
2030
C a le n d a r Y e a r
* N um be rs m a y no t sum d ue to ro u nd in g.
S o u rce : C M S , O ffice o f the A ctua ry.
6
J un e 2 00 2 E d itio n
C e n ters fo r M e d ic are & M e d ica id S ervice s
S ec tio n III.B .1 . P a g e 4
What the Numbers Show
• By 2030
– Number of beneficiaries will nearly double
– Number will reach nearly 77 million
– 68.2 million over 65
– 8.6 million disabled or ESRD
7
A g e a n d G e n d e r o f th e M e d ic a re P o p u la tio n , 2 0 0 0
T h e p rop o rtio n o f w o m e n inc re a se s as th e p o p ula tio n g ro w s old e r.
20
F e m a le s
1 7 .9 m illio n
E n ro lle e s (m illio n s )
18
M a le s
16
14
54%
1 2 .6 m illio n
12
10
59%
8
6
4
5 .5 m illio n
44%
4 .7 m illio n
46%
2
41%
56%
29%
0
Un d e r 6 5
71%
6 5 -7 4
7 5 -8 4
85+
N o te : F ifty-s ix p e rc en t (2 3 m illio n ) o f a ll M e d ic a re ben e fic ia rie s a re fem a le ; 4 4 % (18 m illio n ) a re m a le s .
D a ta re fle c t M e d ic a re be ne fic ia rie s ev e r en ro lle d in th e p ro g ram du rin g th e ye a r.
S o u rc e : C M S , O ffic e o f R e se a rc h , D ev e lo pm e n t, an d In fo rm a tio n : da ta from the M e d ic a re C u rre n t
B e ne fic ia ry S u rv e y (M C B S ) 2 0 0 0 A c ce ss to C a re F ile .
8
J u n e 2 0 0 2 E d itio n
C e n te rs fo r M e d ic a re & M e d ic a id S e rv ic e s
S e c tio n III.B .1 . P a g e 5
Age and Gender in 2000
• Proportion of women increases with age
–
–
–
–
Under 65
65 to 74
75 to 84
85 & over
44% women
54% women
59% women
71% women
56% men
46% men
41% men
29% men
9
R a c e /E th n ic ity D is trib u tio n o f M e d ic a re B e n e fic ia rie s , 2 0 0 0
M in o rity b e n e fic ia rie s a re d is p ro p o rtio n a te ly re p re s e n te d a m o n g th e d is a b le d .
E ld e rly
H is p an ic
6 .5 %
D is a b le d
O th e r
3 .8 %
O th e r
4 .7 %
B la c k
n o n -H isp a n ic
8 .1 %
H is p an ic
1 0 .1 %
B la c k
n o n-H isp a n ic
1 7 .1 %
W h ite
n o n-H isp a n ic
8 1 .6 %
W h ite
n o n-H isp a n ic
6 8 .1 %
T o ta l = 3 5 .2 M illio n
T o ta l = 5 .5 M illio n
S o u rc e: C M S , O ffic e o f R e se a rc h, D ev elop m e nt, a nd Info rm a tio n: D a ta from the M e dic are C urre nt
B e ne ficia ry S urv e y (M C B S ) 20 0 0 A c c e s s to C a re F iles .
J u ne 200 2 E d itio n
C e n te rs fo r M e d ic are & M e d ica id S erv ice s
S e c tio n III.B .1 . P a ge 6
10
Race/Ethnicity in 2000
• Of 35.2 million 65 and older
–
–
–
–
81.6% White non-Hispanic
8.1 % Black non-Hispanic
6.5% Hispanic
3.8% Other
• Of 5.5 million disabled
–
–
–
–
68.1% White non-Hispanic
17.1% Black non-Hispanic
10.1% Hispanic
4.7% Other
11
In c o m e D is trib u tio n o f M e d ic a re B e n e fic ia rie s , 2 0 0 0
N e a rly 65 p e rc e n t o f M e d ic a re b e n e fic ia rie s h av e a n n ua l in c o m e s b e lo w $ 2 5 ,0 0 0 .
$ 5 ,0 0 0 o r le s s
5%
$ 4 0 ,0 0 1 o r m o re
16%
$ 5 ,0 0 1 - $ 1 0 ,0 0 0
20%
$ 2 5 ,0 0 1 - $ 4 0 ,0 0 0
20%
$ 1 0 ,0 0 1 - $ 1 5 ,0 0 0
17%
$ 1 5 ,0 0 0 - $ 2 5 ,0 0 0
22%
N o te s : 1 ) N um b e rs m a y no t s um d u e to ro u nd ing ; 2 ) a n n ua l inc o m e fig ure s a re fo r c a le nd a r y e a r 2 0 0 0 .
S o u rc e : C M S , O ffic e o f R e s e a rc h, D e v e lo p m e nt, a nd Info rm a tio n: D a ta fro m the M e d ic a re C urre nt
B e ne fic ia ry S urv e y (M C B S ) 2 0 0 0 A c c e s s to C a re F ile .
J u ne 2 00 2 E d itio n
C e n te rs fo r M e d ic a re & M e d ic a id S e rv ic e s
12
S e c tio n III.B .1 . P a g e 7
Beneficiaries’ Income in 2000
• Nearly 65% below $25,000
• 25% $10,000 or less
• Only 16% over $40,000
13
L ivin g A rra n g e m e n ts o f M e d ic a re B e n e fic ia rie s , 2 0 0 0
A m o n g th e ne a rly 3 0 p e rce n t o f b e n e ficia rie s livin g a lon e ,
a la rg e p ro p ortio n a re w o m e n an d h a ve lo w in co m e s.
L iv e in LT C
F a c ility
6%
L iv e w ith
C h ild re n/O th e rs
16%
L iv e A lo n e
29%
$
56% have
a n inc o m e
< $ 1 5 ,0 0 0
7 2 % a re
w om en
85+
1 5 % a re
o v e r th e
a g e of 8 5
L iv e w ith S p o u s e
49%
S o u rc e : C M S , O ffic e of R e s e a rc h, D e v e lo p m e nt, a n d In form ation : D a ta from th e M e d ic a re C u rre n t
B e n e ficia ry S u rv e y (M C B S ) 2 0 0 0 A c c e ss to C a re F ile .
14
Living Arrangements in 2000
•
•
•
•
Nearly half live with a spouse
16% live with their children
6% live in a long-term care facility
29% live alone
– 56% have incomes < $15,000
– 72% are women
– 15% are over 85
15
M e d ic a re B e n e fic ia rie s ’ S e lf-R e p o rted D is e as e s
a n d C h ro n ic C o n d itio n s b y G e n d e r, 2 0 0 0
F e m a le b e n eficia rie s a re m o re like ly to re p o rt h yp e rte nsio n , a rthritis,
o ste o p o ro sis, a n d A lzh e im e r's dise a se .
60%
61%
58%
52%
D is e a s e /C o n d itio n
P e rc e n t o f B e n e fic ia rie s w ith
70%
49%
50%
40%
30%
25%
17%
20%
19%
14%
10%
16%
11%12%
6%
6%
3%
0%
H yp e rte n sio n
D iab e te s
Arth ritis
O ste o p o ro sis
P u lmo n ary
D ise ase
F e m a le
S tro ke
Alz h e ime r's
D ise ase
M a le
S o u rc e : C M S , O ffic e of R e s e a rc h, D e v e lo p m e nt, a n d In form ation : D a ta from th e M e d ic a re C u rre n t
B e n e ficia ry S u rv e y (M C B S ) 2 0 0 0 A c c e ss to C a re F ile .
16
Self-Reported Diseases/Conditions
In 2000
• Significant proportions report
–
–
–
–
–
Arthritis
Hypertension
Osteoporosis
Diabetes
Pulmonary disease
17
B e n e fic ia ry K n o w le d g e A b o u t th e M e d ic a re P ro g ra m b y A g e , 2 0 0 0
B e n e ficia rie s u n d e r a g e 6 5 a n d o ve r 8 5 re p o rte d th e b ig g e st kn o w le d g e g a p a b o u t
M e d ica re -co ve re d se rvice s.
P e rc e n t o f B e n e fic ia rie s
100%
90%
80%
29%
29%
31%
28%
39%
38%
70%
60%
50%
40%
28%
32%
30%
20%
10%
40%
43%
65 - 74
75 - 84
29%
34%
0%
Un d e r 6 5
K n o w All o r M o s t
Know Some
85+
K n o w L ittle o r No n e
N o te : D o e s no t includ e b e ne ficia rie s in fa cility ca re .
S o u rce : C M S , O ffice o f R e se a rc h, D e ve lo p m e nt, a nd In fo rm a tio n: D a ta f ro m the M e d ica re C urre n t
B e ne ficia ry S urve y (M C B S ) 2 0 0 0 A cce ss to C a re F ile .
J u n e 20 0 2 E d itio n
C e n te rs fo r M e d ic a re & M e d ic a id S e rv ic e s
S e c tio n III.B .7 . P a g e 3
18
Understanding of Medicare
In 2000
• Majority have some or little knowledge of
Medicare
• Biggest knowledge gap
– Beneficiaries under age 65
– Beneficiaries over 85
19
B e n e fic ia ry P re fe re n c e s fo r K e e p in g U p W ith P ro g ra m
C hanges by R ace, 2000
T h e p re fe rre d w a y o f re c e iv in g M e d ic a re in fo rm a tio n is b y ta lk in g w ith
s o m e o n e fa c e to fa c e .
P e rc e n t o f B e n e fic ia rie s
60%
54%
50%
40%
37%
36%
34%
30%
25%
20%
15%
11% 11%
15%
9% 9%
10%
9% 9% 8%
6%
1% 1% 1%
0%
T a lk F a c e to
T a lk o n th e
Re a d a
F r o m th e
Face
Phone
P a m p h le t
M e d ia
In te r n e t
Does not
W a n t o r Ne e d
In fo
W h ite n o n -H is p a n ic
B la c k n o n -H is p a n ic
H is p a n ic
N o te : D oe s no t in c lu d e b en e fic ia rie s in fa c ility c a re .
S o u rc e : C M S , O ffic e o f R e se a rc h , D ev e lo pm e n t, an d In fo rm a tio n : D a ta f rom th e M e d ic a re C u rre n t
B e ne fic ia ry S u rv e y (M C B S ) 2 0 0 0 A c ce ss to C a re F ile .
20
J u n e 2 0 0 2 E d itio n
C e n te rs fo r M e d ic a re & M e d ic a id S e rv ic e s
S e c tio n III.B .7 . P a g e 8
Preference for Receiving
Medicare Information, 2000
1.
2.
3.
4.
5.
Talking face-to-face
Pamphlet
Telephone
Media
Internet
21
Remember…
The Faces Behind the Numbers
22
National Medicare Education Program
(NMEP)
“The Approach”
23
NMEP Goals
• Create awareness
• Generate understanding
• Empower beneficiaries
“To help people become more active
participants in their health care decisions”
24
Key Components








Beneficiary print materials
Toll-free telephone services
Internet activities
REACH Campaign
National Alliance Network
National training and support
Enhanced SHIP counseling
Assessment of Education Model
25
Beneficiary Print Materials
• Medicare & You handbook
– Mailed each fall since 2000
– Mailed to new enrollees
– Available in multiple versions
• Topic-specific educational pamphlets
26
Toll-Free Telephone Services
• 1-800-MEDICARE
– Operators available 24 hours per day
– Can respond to English and Spanish inquiries
– Provide targeted educational pamphlets
• 1-800-MEDICARE (1-800-633-4227)
• TTY/TDD 1-877-486-2048
27
Internet Activities
• www.medicare.gov
– Beneficiary-focused website
– Information on topics of interest
– Search tools
– Publications
– Helpful contacts
28
REACH Campaign
Regional Education About Choices in Health
• Community-based outreach and education
• Conducted by CMS ROs and partners
• Focus on populations with communication
barriers
– Language
– Literacy
– Location
– Culture
29
CMS Partners
•
•
•
•
Who they are
Primary mission/responsibility
Relationship with CMS
CMS oversight
30
Some Key Partners
•
•
•
•
Social Security Administration
Medicare contractors
End-Stage Renal Disease networks
Quality Improvement Organizations
– Formerly Peer Review Organizations
• State Health Insurance Assistance Programs
31
Social Security Administration
• Federal agency
• Medicare responsibilities
– Take applications
– Determine eligibility
– Issue Medicare cards
– Handle some premium issues
32
Medicare Contractors
• Private organizations
– Carriers
– Fiscal Intermediaries
– Durable Medical Equipment Regional Carriers
– Regional Home Health Intermediaries
– Program Safeguard Contractors
• Process payments
• Responsible for program integrity
33
ESRD Networks
•
•
•
•
Ensure administration of ESRD benefits
Develop quality standards
Assess treatment modalities
Provide technical assistance to dialysis facilities
34
Quality Improvement Organizations
•
•
•
•
Promote quality of health care services
Evaluate standards of care
Process Medicare hospital discharge appeals
Perform reviews
35
State Health Insurance Assistance
Program (SHIP)
•
•
•
•
•
Provide information
Provide one-on-one counseling
Use volunteer counselors
Operate under a grant program
Provide free service to beneficiaries
36
Other Partners
•
•
•
•
•
•
Administration on Aging
State departments of insurance
State Medicaid offices
State survey agencies
State units on aging
Consumer and elderly advocacy groups
37
Administration on Aging
•
•
•
•
•
•
Agency in HHS
Federal focal point and advocate for older persons
Works to heighten awareness
Seeks to educate older people and caregivers
Works with nationwide network
Collaborates with
– Federal agencies
– National organizations
38
State Departments of Insurance
• Responsible for regulating
– Insurance companies
– Medicare carriers
– Fiscal Intermediaries
– Durable Medical Equipment Regional
Carriers
– Rural Home Health Intermediaries
• Enforce insurance-related statutes
39
State Medicaid Offices
• Federal government establishes general guidelines
• States administer Medicaid program at local level
– Establish guidelines for eligibility and services
– Process claims
• Names of state Medicaid offices vary
– Social Services
– Public Assistance
– Human Services
– Community Services
40
State Survey Offices
• Conduct periodic inspections
• Ensure health care facilities comply with
health safety standards
• Ensure health care facilities comply with
quality standards
41
State Units on Aging
• Sometimes called departments of aging
• Responsible for enforcing statutes
• Provide services for aged and sometimes for
disabled
• Administer aging programs
– Information and referral help lines
– Nursing home ombudsman
42
Consumer and Advocacy Groups
• Advocates for issues involving elderly
• Provide information about
– Private health insurance
– Managed care
– Medicare and Medicaid
– Other health-related issues
43
Reaching Medicare Beneficiaries
Communication Strategies
44
Understanding the Audience
•
•
•
•
•
•
First step in designing effective products
Who they are
Where they live
Cultural factors that influence behavior
Behaviors when seeking health information
Levels of health literacy
45
Print Products
46
Design, Layout, and Format
•
•
•
•
•
Critical to attracting and holding attention
Inspires to read and re-read the text
Is it visually appealing?
Is message clear, simple, and direct?
Are photos and illustrations culturally
appropriate?
• Keep message short, simple, to the point
47
Color
• Important for all elderly populations
– Catches the eye
– Helps those with declining vision
• Preferred by all seniors and easiest to read
– Black on a light background
– Additional color for accent
48
Typestyle
• Easy to read
– Times or Garamond (serif fonts)
– Ariel or Verdana (sans serif fonts)
• No more than two typefaces
• 14-point font size
• Align text on left (“ragged right”)
49
The Message
• Use simple, basic language
• Use short sentences
• Follow the rules for newspaper articles
– Answer the questions “who, what, why,
when, where, and how”
• Include definitions of medical terms
• Avoid jargon and acronyms
50
Other Media
51
Outdoor Media
•
•
•
•
•
•
Know travel habits of audience
Keep message simple and short
Print should be large, clear, easy to read
Feature one large graphic
Make sure it is illuminated
Choose a high-traffic area
52
Educational Videos
•
•
•
•
•
•
Know your audience
Keep script simple
Focus-test the storyboards
Use animation, music
Allow for transitions
Consider using a production company
53
Public Service Announcements
• 15-, 30-, or 60-second format
• Feature respected spokespersons
•
•
•
•
Negotiate on talent
Tell who, what, why, where, when, and how
Use clear, simple language
Include a call to action and repeat it
54
Producing the PSA
• Research local radio and TV production studios
– Discuss budgets honestly with them
– If no budget, visit the public information officer
• Make sure everything is included when using a
production studio
• Background music helps attract attention
– Do not overpower vocals
– Find royalty-free music
– Research the need for a buy-out fee
55
Dissemination Strategies
56
Assessing Distribution Channels
• Select best channels
• Maximize message distribution
• Assess your audience by researching
–
–
–
–
Lifestyles
Media preferences
Geographic locations
Income and education levels
57
Media Placement
• With a limited budget, look for free
advertising
• Aim for legitimate news coverage
• Ask for free placement
– Call the public information officer
• CMS ROs can refer you to their contacts
58
Media Buying
• Buy media with the greatest impact
• Media prices are often inflated
– Ask for the lowest price
• Local television stations have a cadre of
faithful viewers
• Local radio call-in shows are good channels
59
Maintaining Contacts
• Keep your contacts working for you
– Call to say “thanks”
– Share any feedback or results
– Write a thank-you note on official stationery
60
Promoting Your Product
• Post/promote the product on your website
• Make sure government partners know about it
– Federal
– State
– Local
• Make sure everyone in your organization
knows it exists
61
Disseminating PSAs
• Tell them you are sending a PSA
– Send proper format
– Send instructions to run it as often as possible
• Follow up with a phone call
– Make sure he/she received the ad
– Discuss the importance of the message
62
Disseminating Print Media
• Submit an article signed by a Medicare official
– Follow up with a phone call
• Scan for related news stories
• Have a strong message with a fresh angle
63
Community Programs
• Public events and exhibits
– Especially shopping malls
• Traveling health booth
– Offer basic Medicare information
• Health and nutrition seminars
– Include visuals, a brief video, or charts
– Have experts available
64
Other Events
• Speakers series at places seniors congregate
• Neighborhood churches
• Housing facilities
• Community or senior centers
• Nutrition sites
• Health fairs
• Conferences
65
Remember…
The Faces Behind the Numbers
66
HORIZONS Project
Reaching Diverse Populations
• Culture- and language-appropriate Medicare information
• Overcome communication barriers in diverse populations
– African American
– Asian American/Pacific Islander
– Hispanic American
– American Indian/Alaska Native
• Focus on those with the greatest barriers
67
Supporting Research
• Minority-owned marketing firms
– Analyzed
• U.S. Census data
• Available CMS data
– Conducted formative research
• On health care information needs
• Product development and testing
68
HORIZONS Information
• Communication Toolkit for Serving Diverse Communities
– Medicare product prototypes
– Design guidelines and dissemination strategies
• Radio and television
• Brochures, displays and exhibits
• Outdoor advertising and special events
– Research findings
• Send e-mail to
[email protected]
69
Beneficiaries Who Are Not Being
Reached
• In general, individuals in this group
– Have a higher incidence of many preventable
diseases
– Have lower literacy levels in English and often
in a native language
– Are less likely to be aware of Medicare benefits
– Are less likely to practice healthy behaviors
70
Other Considerations
•
•
•
•
•
•
Misunderstanding/mistrust of health care system
Preference for more familiar traditional remedies
Fatalistic acceptance of the course of the disease
Lack of culturally appropriate health care messages
Limited English proficiency
Economic barriers to medical care
71
Limited English Proficiency
• Non-English speakers at a disadvantage
– Communicating health care concerns
– Receiving providers’ instructions
72
Developing Products and Strategies
• Research the population
• Can you adapt existing products?
• Is the population familiar with all terms?
– If not, include a glossary
• Work with community organizations
• Target places frequented by the population
• Focus-test the product
73
What Is Transcreation?
• Making a product
– Culture-appropriate
– Language-appropriate
• Using nuances, concepts, and phrases
familiar to the audience
74
Adapting Materials for
Beneficiaries with LEP
•
•
•
•
•
Don’t use a literal translation
Choose a translator who is bilingual and bicultural
Transcreate
Back-translate
Test with the audience
– Involve community partners
• Have several editors review
• Revise and retest as necessary
75
African-American Beneficiaries
76
Demographic Data
African-American Seniors
• In 2000
– 2,822,950
– 62% are women
– 38% are men
– 57% are age 65 to 74
– 43% are 75 or older
77
Demographic Data
African-American Seniors
• In 1996
– One-fourth had incomes below poverty level
• 43% of eligible not enrolled in Savings Programs
– Over half (55%) had < 12 years of education
78
Demographic Data
African-American Seniors
• In 1996
– Majority (59%) lived in central cities
– 34% lived alone
• 40% of females vs. 23% of males
– Majority of women were widowed
• 82% of those 85 and over
79
Where do they live?
Ten states account for 57% of African-American elderly
New York
Texas
North Carolina
Illinois
Virginia
California
Florida
Georgia
Ohio
Michigan
80
Where do they live?
42% live in metropolitan areas
New York City
Chicago
Philadelphia
Washington, DC
Detroit
Los Angeles
Baltimore
Atlanta
Norfolk
Cleveland
Miami
Houston
San Francisco
St. Louis
Dallas
81
Where do they live?
[Insert local information]
82
83
Health Status
• Glaucoma 6-8 times more common
• Hypertension rates among highest in the world
• Coronary heart disease most common cause of
death
• Stroke mortality is 1½ to 2 two times higher
• Diabetes mortality rates 2 to 3 times higher
• Prostate cancer mortality rate more than double
• Account for 31% of U.S. ESRD
84
Other Factors
• Consult with adult children/other relatives
– 16 percent live with their adult children
• Many describe themselves as religious
• Seek aid from significant others
85
Focus-Group Findings
• Preferences for receiving Medicare information
–
–
–
–
From a knowledgeable spokesperson
Someone older
Very few used Internet
Very few knew of SHIP offices
• Interested and would use them
– Would definitely watch a Medicare video
86
Design Strategies
• Portray people with whom they identify
• Incorporate themes from daily life
• Show African-American images
– As the centerpiece of the image
– Not just in the background
87
Dissemination Strategies
• Radio is important to many older African Americans
• Many African-American seniors enjoy television
– Often in the late afternoons and evenings
– News, gospel programs, court television, game shows
• Older African-American readers like
– AARP, African-American, and Christian magazines
– Local newspaper
88
Hispanic-American Beneficiaries
89
Demographic Data
• Hispanics now largest U.S. minority group
– 12.5% of total population (1 in 8)
• Rapid population growth driven by
– Natural increase (births minus deaths)
– Immigration
• Beneficiary population also growing rapidly
90
Demographic Data
Hispanic-Americans by Origin
Central and
South
American
15%
Puerto Rican
9%
Cuban
4%
Other Hispanic
6%
Mexican
66%
91
Language
• Spanish is second most common language in U.S.
– Spoken by 10.7% of residents 5 and over
– Many Hispanic-Americans speak English “less
than very well”
– Face-to-face education is essential
– A bilingual format is preferred
92
Demographic Data
Hispanic-American Beneficiaries
• Relatively young
• Less access to newer communication technologies
– VCRs
– Cable TV
– Internet
• More likely to live in metropolitan areas
• More likely to live with children or other relatives
93
Demographic Data
Hispanic-American Beneficiaries
• Reported lower income and education
– 73% reported incomes < $15,000
– 37% reported < 5 years of formal education
• 25% were covered by Medicaid
• Only 6% did not have health insurance
94
Where do they live?
95
Where do they live?
[Insert local information]
96
97
Health Status
• Only 56% of seniors receive vaccinations
• Leading disease-related causes of death
– Heart disease
– Diabetes
– Cancer
– Pneumonia
– Influenza
– Cerebrovascular diseases
– HIV infection
98
Other Factors
• Great diversity of Hispanic subgroups
• Most share cultural heritage and values
– Spanish language
– Catholic religion
– Central role of family
• May place medical needs of family
members over their own
• Less likely to have other sources of health
insurance
99
Focus-Group Findings
• Need information about the Medicare program
• Do not know about Medicare Savings Programs
• Want to understand
– Specific benefits covered under their plan
– Costs they are responsible for paying
– How to stay healthy
• Desire more materials and resources in Spanish
100
Design Strategies
• Determine language
– Spanish
– Bilingual
• Show Hispanic-American images
– Intergenerational family scenes are appealing
• Reflect the local culture
• Test with the audience
101
Design Strategies
Bilingual Formats
• Hispanic-American beneficiaries prefer
bilingual format
– Feature languages side-by-side
• Create both Spanish- and English-language ads
– One to reach Spanish speakers
– One for caregivers or others
• Use simple, basic Spanish
102
Design Strategies for PSAs
• Consider using a novela format
• In translating Spanish-language copy will
generally be longer
• Local talent or Hispanic celebrities are effective
• Music considerations
– Soft, classical for serious health care
messages
– Livelier tunes to promote a healthy lifestyle
103
Dissemination Strategies
• TV and radio preferred over print products
– Television is preferred over radio
• Target places frequented by seniors
– Doctors’ offices
– Pharmacies
– Senior centers
– Churches
– Grocery stores
• Advertise in Spanish-language newspapers
104
Asian-American and
Pacific Islander Beneficiaries
105
Demographic Data
• Approximately 30 ethnic groups
• More than 50 languages
• Population will triple to 1.9 million by 2010
106
Demographic Data
Chart 2. Nationwide Elderly Total Population of Seven Largest AAPI
Categories
(1990 and 2000 Census)
134
Chinese
236
104
Filipino
23
Asian Indian
67
15
Vietnamese
58
58%*
168
1990 Population
191%*
2000 Population
222%*
25
Korean
36%*
68
54%*
106
Japanese
161
53%*
14
21%*
17
Pacific Islander
0
50
100
150
200
250
300
In Thousands
*1990 - 2000 % Change
107
Where do they live?
Table 1. Asian-American and Pacific Islander Ethnic Populations in
Metropolitan areas and Central Cities (In Thousands) - 2000
Ethnicity
Population
Populations
Total U.S.
in
Percent
Central
Percent
Populations Metropolitan
Cities
Areas
ASIANS
Asian Indian
Chinese
Filipino
Hmorg
Japanese
Khmer
Korean
Laotion
Vietnamese
1,678
2,462
1,850
169
797
172
1,076
168
1,122
1,625
2,375
1,749
160
725
168
1,035
156
1,094
96.8
92.6
94.5
94.7
91.0
97.7
96.2
92.9
97.5
629
1,120
759
117
325
111
425
93
553
37.5
45.5
41.0
69.2
40.8
64.5
39.5
55.4
40.3
58
141
91
52
103
85
89.7
73.0
93.4
22
35
37
37.9
24.8
40.7
PACIFIC ISLANDERS
Guam Natives/Chamomo
Native Hawaiian
Samoans
Where do they live?
[Insert local information]
109
Demographic Data
Chinese-American Beneficiaries
• 235,995 Chinese U.S. residents age 65 and above
• Many immigrants are from Taiwan
– Speak Min Nan, rather than Cantonese
– Unlikely to join family-based “self-help” associations
• Nearly half live in central cities
• Chinatowns remain important social and cultural centers
– Nearly 63% over 65 live in four metropolitan areas
•Los Angeles
•San Francisco-Oakland
•New York City
•San Jose, CA
111
Health Status
• Leading disease-related causes of death
– Cancer
– Heart disease
– Stroke
– Chronic lower respiratory disease
– Influenza and pneumonia
– Diabetes
– Nephritis and related conditions
112
Health Status
• High prevalence of certain conditions and
risk factors
–
–
–
–
–
Chronic obstructive pulmonary disease
Hepatitis B
HIV/AIDS
Tobacco smoke
Tuberculosis
113
Focus-Group Findings
• Likely to select a clinician in Western
medical practice
– Confidence and trust placed in primary care
physician
– Some use a traditional healer or herbalist
• Extended family is source of individual
welfare and assistance
114
Asian-Born Beneficiaries
• Majority said they do not speak English well
• Most prefer oral communication
– Preferences varied among ethnic groups
• Confused by documentation requirements
• Varied understanding of Medicare eligibility
– Some thought citizenship a prerequisite
– Some thought it a form of charity
115
Design Strategies for Print
• Choose language for development
– There is only one written Chinese
– Avoid using colloquial Chinese
• Medicare terms should remain in English within
the Chinese text
• Use Chinese-American images
• Use appealing/culturally-appropriate colors
• For Chinese, use Ling Song font and 14-pt type
116
Design Strategies
Bilingual Format
• Decide if a bilingual format is feasible
• Single in-language version might be more effective
• If bilingual
– Feature the languages side-by-side
– Don’t make one language appear dominant
– Send separate Chinese and English formats for
radio/TV
117
Design Strategies for PSAs
• Create in both Chinese and English
• May have to be produced in several versions
– Mandarin and Cantonese for Chinese
– Tagalog and Ilocano for Filipinos
• Use local talent
– Use of celebrities generally not effective
• After newspapers, TV and radio are most effective
118
Dissemination Strategies
• Contact key organizations/partners
– Display and distribute the product
• Newspapers are most effective medium for
reaching Chinese Americans
– SingTao and World Journal
• Asian supermarkets are frequent gathering places
• Outdoor ads get great exposure
• Direct mail is also effective
119
Summary of Key Concepts
• Medicare beneficiaries need information to
make informed health care decisions
• Some have communication barriers
• It is important to understand the people you
are trying to reach
• The HORIZONS project has developed
guidelines for reaching these individuals
120
Remember the Faces Behind the Numbers…
121
Remember the Faces Behind the Numbers…
122
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Reaching Medicare Beneficiaries with Communication Barriers