Development of a Culturally-Adapted Graphic Novella about Emergency Communication: Collaborations with a Limited English Speaking Chinese Immigrant Community.

Bystander CPR doubles survival from cardiac arrest but limited English proficient (LEP) individuals face barriers calling 911 and performing CPR. Previous training increases the chance that an individual will perform CPR, yet access to classes in non-English speaking populations is limited. We used a cultural adaptation approach to develop a graphic novella for Chinese LEP immigrants about how to call 911 and perform bystander CPR.

Facilitators and Hindrances of Implementing Colorectal Cancer Screening Intervention Among Vietnamese Americans.

Background: Little is published about the factors that facilitate and hinder the intervention implementation process.

Objective: The aim of this study was to examine factors that facilitated and hindered the implementation of a culturally appropriate colorectal cancer screening intervention targeting Vietnamese Americans in a Federally Qualified Health Center located in the Puget Sound area of Washington.

Methods: Three focus group discussions (2 during the implementation phase and 1 during the maintenance phase) with the medical assistants (N = 13) who were the intervention implementation agents were conducted at the Federally Qualified Health Center.

Medicaid Coverage Expansion and Implications for Cancer Disparities.

Objectives: We estimated the impact on cancer disparities in US states that have chosen or not chosen to expand Medicaid since passage of the Patient Protection and Affordable Care Act.

Methods: Data came from the 2013 Uniform Data System for colorectal and cervical cancer screening rates among patients of federally qualified health centers (FQHCs); the 2012 Behavioral Risk Factor Surveillance System for colorectal, cervical, and breast cancer screening rates; and the US Cancer Statistics (2007-2011) for colorectal, cervical, and breast cancer mortality-to-incidence ratios (MIRs). Dyads of Medicaid expansion decisions with cancer screening rates and MIRs were mapped using ArcMap.

Is Availability of Mammography Services at Federally Qualified Health Centers Associated with Breast Cancer Mortality-to-Incidence Ratios? An Ecological Analysis.

Objective: Mammography is the most effective method to detect breast cancer in its earliest stages, reducing the risk of breast cancer death. We investigated the relationship between accessibility of mammography services at Federally Qualified Health Centers (FQHCs) and mortality-to-incidence ratio (MIR) of breast cancer in each county in the United States.

Methods: County-level breast cancer mortality and incidence rates in 2006-2010 were used to estimate MIRs.

Contexts for Sustainable Implementation of a Colorectal Cancer Screening Program at a Community Health Center.

Background: "Context" is a mediating construct that significantly influences the initiation and maintenance of program implementation, but it has seldom been studied in process evaluation. This case study describes the contextual factors that encourage or impede the implementation processes of a research-tested program at a Federally Qualified Community Health Center.

Method: We conducted 14 key informant interviews with providers, nurses, medical assistants, and clinic staff in leadership and management positions during the 24 months of active implementation.

Decreased Cancer Mortality-to-Incidence Ratios with Increased Accessibility of Federally Qualified Health Centers.

Federally qualified health centers (FQHCs) offer primary and preventive healthcare, including cancer screening, for the nation's most vulnerable population. The purpose of this study was to explore the relationship between access to FQHCs and cancer mortality-to-incidence ratios (MIRs). One-way analysis of variance was conducted to compare the mean MIRs for breast, cervical, prostate, and colorectal cancers for each U.

Adaptation of an evidence-based intervention to promote colorectal cancer screening: a quasi-experimental study.

Background: To accelerate the translation of research findings into practice for underserved populations, we investigated the adaptation of an evidence-based intervention (EBI), designed to increase colorectal cancer (CRC) screening in one limited English-proficient (LEP) population (Chinese), for another LEP group (Vietnamese) with overlapping cultural and health beliefs.

Methods: Guided by Diffusion of Innovations Theory, we adapted the EBI to achieve greater reach. Core elements of the adapted intervention included: small media (a DVD and pamphlet) translated into Vietnamese from Chinese; medical assistants distributing the small media instead of a health educator; and presentations on CRC screening to the medical assistants.

Changes to DA-CPR instructions: can we reduce time to first compression and improve quality of bystander CPR?

Introduction: Dispatcher-assisted CPR (DA-CPR) can increase rates of bystander CPR, survival, and quality of life following cardiac arrest. Dispatcher protocols designed to improve rapid recognition of arrest and coach CPR may increase survival by (1) reducing preventable time delays to start of chest compressions and (2) improving the quality of bystander CPR.

Methods: We conducted a randomized controlled trial comparing a simplified DA CPR script to a conventional DA CPR script in a manikin cardiac arrest simulation with lay participants.

Delivering 9-1-1 CPR Instructions to Limited English Proficient Callers: A Simulation Experiment.

Having 911 telecommunicators deliver CPR instructions increases cardiac arrest survival, but limited English proficiency (LEP) decreases the likelihood callers will perform CPR and increases time to first compression. The objective of our study was to assess which 9-1-1 CPR delivery modes could decrease time to first compression and improve CPR quality for LEP callers. 139 LEP Spanish and Chinese speakers were randomized into three arms: receiving CPR instructions from a 9-1-1 telecommunicator (1) with telephone interpretation, (2) using alternative, simple ways to rephrase, or (3) who strictly adhered to protocol language.

Emergency communications within the limited English proficient Chinese community.

Limited English speaking communities face communication challenges during emergencies. Our objective was to investigate Chinese limited English proficiency individuals' perceptions of and inclination to interact with emergency communication systems. A telephone survey was conducted in Mandarin or Cantonese with 250 ethnic Chinese individuals who spoke little or no English.

The effect of language barriers on dispatching EMS response.

Objective: The objective of this study was to investigate the effect of language barriers during medical 9-1-1 calls, on the time to dispatch and level of medical aid (Basic or Advanced Life Support).

Methods: All 9-1-1 medical calls to two large call centers during one week for each of the months of August, October, December 2010 and February 2011, were reviewed for a notation of language barrier (LB). Non-language barrier calls were identified from the same time period such that there were an equal proportion of LB and non-LB calls by dispatch code and dispatcher.

A health literacy model for limited English speaking populations: sources, context, process, and outcomes.

Health literacy is critical to effective communication between individuals and their health care providers. However there is little consistency in conceptualization and measure of health literacy. The objective of this review is to examine existing health literacy models and measures to assess their application to limited English proficient population in the context of information and communication technology.

Applying systems engineering to implement an evidence-based intervention at a community health center.

Impressive results in patient care and cost reduction have increased the demand for systems-engineering methodologies in large health care systems. This Report from the Field describes the feasibility of applying systems-engineering techniques at a community health center currently lacking the dedicated expertise and resources to perform these activities.

Diffusion of cardiopulmonary resuscitation training to chinese immigrants with limited english proficiency.

Cardiopulmonary resuscitation (CPR) is an effective intervention for prehospital cardiac arrest. Despite all available training opportunities for CPR, disparities exist in participation in CPR training, CPR knowledge, and receipt of bystander CPR for certain ethnic groups. We conducted five focus groups with Chinese immigrants who self-reported limited English proficiency (LEP).

Preparedness for cardiac emergencies among Cambodians with limited English proficiency.

In the United Sates, populations with limited English proficiency (LEP) report barriers to seeking emergency care and experience significant health disparities, including being less likely to survive cardiac arrest than whites. Rapid utilization of 9-1-1 to access emergency services and early bystander cardiopulmonary resuscitation (CPR) is crucial for successful resuscitation of out-of-hospital cardiac arrest patients. Little is understood about Asian LEP communities' preparedness for emergencies.

The role of self-efficacy in communication and emergency response in Chinese limited english proficiency (LEP) populations.

Background: Failure to engage in emergency preparedness, response, and recovery contributes to the differential outcome experienced by limited English proficiency (LEP) populations. Little is known about how psychosocial factors influence LEP individuals' perception of emergency and their process of understanding, collecting, and synthesizing information. The purpose of this exploratory study is to understand how LEP conceptualize an emergency situation to determine when help is needed.

Barriers and facilitators to using 9-1-1 and emergency medical services in a limited English proficiency Chinese community.

Effective communication during a medical emergency is crucial for an appropriate emergency medical services (EMS) response. This exploratory qualitative study explored intentions to use 9-1-1 in a Chinese speaking community and the barriers and facilitators to accessing EMS. Focus groups with Chinese adults who self-reported limited English proficiency were conducted.

Continuity of care and colorectal cancer screening by Vietnamese American patients.

Background: Colorectal cancer (CRC) screening rates among Asian Americans are 30-50% lower than among Whites. Using practice management and electronic medical records data from a community health center, we examined the association of CRC screening with continuity of care and comorbidity. These variables have not previously been studied in Asian American and limited-English proficient populations.

Using photovoice to understand cardiovascular health awareness in Asian elders.

Photovoice, a qualitative methodology using photography by study participants, is an ideal tool for collecting information on awareness of cardiovascular health from the perspective of persons of different cultural backgrounds and English-speaking abilities who are often subject to health disparities. Participants of Chinese, Vietnamese, and Korean ethnicity were provided disposable cameras to photograph their perceptions of scenes promoting or acting as barriers to cardiovascular health. After the pictures were developed, they returned for a discussion in their native languages to contextualize the stories told in their photographs.

Information-seeking behaviors and response to the H1N1 outbreak in Chinese limited-English proficient individuals living in King County, Washington.

Objectives: To investigate the information seeking behaviors and response to the HIN1 outbreak by limited-English proficient (LEP) Chinese speakers.

Methods: We conveniently sampled 100 adult Chinese LEP individuals between June 2 and June 11, 2009, during the time the World Health Organization (WHO) declared global pandemic alert level at phase 6 and the development of a H1N1 vaccine was still underway.

Results: Participants demonstrated a basic understanding of the disease and were unconcerned by the outbreak.

A cross-border comparison of hepatitis B testing among chinese residing in Canada and the United States.

Background: The Western Pacific region has the highest level of endemic hepatitis B virus (HBV) infection in the world, with the Chinese representing nearly one-third of infected persons globally. HBV carriers are potentially infectious to others and have an increased risk of chronic active hepatitis, cirrhosis, and hepatocellular carcinoma. Studies from the U.

Evaluation of a hepatitis B lay health worker intervention for Chinese Americans and Canadians.

Hepatitis B testing is recommended for immigrants from countries where hepatitis B infection is endemic. However, only about one-half of Chinese in North America have received hepatitis B testing. We conducted a randomized controlled trial to evaluate the effectiveness of a hepatitis B lay health worker intervention for Chinese Americans/Canadians.

Development of intervention materials for individuals with limited English proficiency: lessons learned from "Colorectal Cancer Screening in Chinese Americans".

Background: According to recent US census data, 52 million people reported speaking a language other than English at home, and almost 45% of this population reported limited English proficiency (LEP). Colorectal cancer (CRC) ranks among the top 3 most common cancers for several Asian ethnic groups, yet screening remains underutilized by Asian Americans.

Objectives: This article describes the development of culturally and linguistically appropriate intervention materials for individuals with LEP.