Targeting Demographics: Increasing Adherence through Cultural

Targeting Demographics: Increasing Adherence through
Cultural Insights and Mobile Platforms
Dirk G. Schroeder, ScD MPH
March 8, 2012
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Emergency Meeting
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Mission Critical for Health Plans and Employers
“We’re a 100 year old company
and if we don’t stop these trends
(of increasing diabetes among
Hispanics), we’re going to go out
of business”
Beth Common
Director HR
H-E-B Supermarkets
The Changing Face of America:
Relevance for Patient Adherence
Dirk’s Mom
4
Millions in U.S. that Speak Another Language
besides English at Home
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Polish
Russian
Korean
Italian
Vietnamese
Tagalog
German
French
0.7 0.7 0.9
1
1
1.2 1.4 1.6
Chinese
2
0
Millions of people that speak at home (U.S.Census)
7
Millions in U.S. that Speak Another Language
besides English at Home
Spanish
28.1
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Polish
Russian
Korean
Italian
Vietnamese
Tagalog
German
French
0.7 0.7 0.9
1
1
1.2 1.4 1.6
2
Chinese
Spanish
Millions of people that speak at home (U.S.Census)
8
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9,000,000
Additional Hispanics are
projected to be covered under the
Affordable Care Act 2014+
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Back to the Large Employer
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Vietnam
Vietnam
Even in the poorest communities – there were a
few families whose children were growing WELL!
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Interviews with these Families: PD Inquiries
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Shrimp & Crabs & Greens
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Trial of PD in Vietnam
Randomized
whole
villages to PD
or usual care
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Children in PD Villages were taller
Even Younger Siblings who were born
AFTER Save the Children had left!
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From Vietnam back to the Large Employer
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What motivates Hispanics to Adhere!?!
Discovering Culturally-Relevant
and Sustainable Diabetes
Management Strategies among
Hispanic Employees
Application of the Positive Deviance
Approach
With funding from Merck
Distribution of Hispanic Employees according to
How Well They Prevent or Manage Diabetes
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How did THEY become
MOTIVATED?
How do they DO it?
Positive
Deviants
Worse
Better How to Find Them? Positive Deviance Score
PD Score: 24 Indicators of self-care
• Five datasets: Employer, Health Plan, Vendors
• HRA: Dietary, exams, exercise,
• DM Indicators: Doctor Visits, Counseling
3. Discover and Analysis
• 78 Hispanics (Eng. and Sp.) Group and
individual discussions
• 2,000+ pages of material
• Qualitative Software: coded Frequency
and Passion
Positive Deviance Inquiry
Video
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What Motivates You to Prevent or Control Your Diabetes?
Frequency/Passion
Level
High
Motivators
• Prevent complications
• Family
Medium
Low
• Feel better
• Religion
• Fewer medications and doctor
visits
Most feared by Hispanic PD Diabetics
Consequence or
Complication
Number of
Independent
Mentions
Amputation
Blindness
16
10
Premature Death
Heart Attack
Stroke
Kidney Failure
Fear of Dialysis
Impotency
7
3
3
2
2
1
Archetypes --- Care Taker vs. Realist
• “Plays the hand they are
dealt”
• Takes the “bull by the
horns”
• Determined. Educated and
wanting to learn more
• Usually women
• Family – helps each other
remember appts/meds
• Responsible for others (i.e.
children or parents)
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Variation AMONG Hispanics Beliefs / Practices
Beliefs regarding
What Causes
Diabetes?
Puerto Ricans
Eating Too Much
Sugar
Mexican Americans
“Susto”
Engaging Hispanics with key beliefs increased
readership from 18% to 72%!
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What causes Type 2
Diabetes?
What causes Type 2
Diabetes?
Anyone can get type 2 diabetes.
However, those at highest risk for
the disease are those who are
obese or overweight, people with
family members who have type 2
diabetes and people who have
metabolic syndrome (a cluster of
problems…...
Your grandmother may have
told you that diabetes is
caused by susto.
In fact, anyone can get type 2
diabetes. However, those at
highest risk for the disease are
those who are obese or
overweight, people with family
members who have type 2
diabetes and people who have
metabolic syndrome (a cluster
of…
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Hispanics Use Mobile Phones for Health
Have used mobile phone to look up
health information
Hispanic
White
Blacks
25.0%
19.0%
15.0%
Pew Internet Study, 201028
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Univision Salud - Mobile Offering
30% of total usage is on mobile vs. computer.
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Roadmap to Mobile
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Summary: Adherence Drivers for Hispanics
Seriousness
(Fear)
CulturallyTailored
Mobile
31
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Fast Pitch / Team Work
32
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Team Challenge
Your team (table) has been approached by your
SVP of Managed Care Markets.
He wants to know how to advise his health plan
clients on ways to improve patient adherence
among Hispanics and other multicultural groups,
especially in anticipation of 2014.
He wants answers to two specific questions:
33
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Team Challenge: Two Key Questions
1)
Should the Company work with the Plans to highlight
the SERIOUS CONSEQUENCES of diseases (e.g. through
fear, graphical imagery) in communications and
programs (YES/NO)? What are the pros/cons? If so, what
are some of the best ways to do so?
1)
What priority (HIGH/LOW) should he given mobile
technology in delivering culturally-tailored messages?
What are the pros/cons? If so, what are some of the best ways
to do so?
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In Closing
The New American Reality
35
Patient Adherence Framework: Cultural & Language
36