Cultural and Linguistic Adaptation of a Multimedia Colorectal Cancer Screening Decision Aid for Spanish-Speaking Latinos

Abstract

As the United States becomes more linguistically and culturally diverse, there is a need for effective health communication interventions that target diverse and most vulnerable populations. Latinos also have the lowest colorectal (CRC) screening rates of any ethnic group in the U.S. To address such disparities, health communication interventionists are often faced with the challenge to adapt existing interventions from English into Spanish in a way that retains essential elements of the original intervention while also addressing the linguistic needs and cultural perspectives of the target population. We describe the conceptual framework, context, rationale, methods, and findings of a formative research process used in creating a Spanish language version of an evidenced-based (English language) multimedia CRC screening decision aid. Our multi-step process included identification of essential elements of the existing intervention, literature review, assessment of the regional context and engagement of key stakeholders, and solicitation of direct input from target population. We integrated these findings in the creation of the new adapted intervention. We describe how we used this process to identify and integrate socio-cultural themes such as personalism (personalismo), familism (familismo), fear (miedo), embarrassment (verguenza), power distance (respeto), machismo, and trust (confianza) into the Spanish language decision aid.

Understanding the supportive care needs of Hispanic men cancer survivors

“…A way to build trust and open up communication between the provider and the cancer survivor is to use the explanatory models approach described by Kleinman (Kleinman 1978). Embracing the value of personalismo and familismo will help engage Hispanic cancer survivors (Ko et al 2014). This can be done by getting to know and understand their viewpoint, expectations and what may be at stake for them (e.g., ability to work) as well as the stressors they are experiencing.…”

Colorectal Cancer Screening in Vulnerable Patients

“…The primary objective of this study was to test the effect of a CRC screening decision aid, available in English 31,37 and Spanish, 38 and viewed before a primary care encounter, on patient-reported communication and decision-making outcomes in a racially and ethnically diverse safety net clinic population. To improve generalizability, study sites, described below, were selected in locations representative of new and established socio-historic immigration contexts.…”

Culturally adapting a physical activity intervention for Somali women: the need for theory and innovation to promote equity

“…Disparities persist for many racial/ethnic minority groups in health outcomes [4], as well as representation in clinical research and interventions [2,5]. Culturally, adapting current evidence-based interventions (EBIs) for use with more diverse target populations offers great potential for decreasing health disparities and increasing access to EBIs, yet there is a need to advance this science with broader applications within diverse populations [6][7][8][9].…”

“…Disparities persist for many racial/ethnic minority groups in health outcomes [4], as well as representation in clinical research and interventions [2,5]. Culturally, adapting current evidence-based interventions (EBIs) for use with more diverse target populations offers great potential for decreasing health disparities and increasing access to EBIs, yet there is a need to advance this science with broader applications within diverse populations [6][7][8][9].There are several cultural adaptation theories and frameworks proposed in the literature, but few comprehensive illustrations of program adaptations, which are needed to guide best practice. Herein, we detail the cultural adaptation of an efficacious physical activity (PA) program following the heuristic framework laid out by Barrera and Castro [10].…”