The United States Census Bureau projects that by the year 2040, there will be 87.5 million Hispanic individuals living in the United States, comprising 22.3 percent of the population.¹ The increasingly diverse population in the U.S. presents a unique challenge to public health practitioners. In the field of health communication and social marketing, we work to craft messages and develop images that will appeal to individuals, but what happens when our target audience speaks a language other than that of the public health professional? How do we bridge the cultural gaps we face when trying to persuade immigrant populations to adopt or change a health behavior? Finding answers to these complex questions is a priority since minority and immigrant populations have historically experienced disparities in access to and quality of healthcare.² These disparities have been linked to language and cultural barriers, issues that public health professionals must address in order to achieve success.

Public health communication and marketing specialists can and do lead efforts to reach these vulnerable individuals by creating culturally sensitive, multi-lingual health messages and materials. Volume 2 of Cases in Public Health Communication & Marketing features three examples of public health campaigns that employed materials specifically tailored to reach culturally segmented target audiences in the U.S.

The case study entitled "A Syphilis Elimination Media Campaign in Oklahoma County" is one example of public health professionals working to decrease syphilis rates by creating bilingual, culturally sensitive health communication materials. In this case, program planners discovered that in Oklahoma County, Latinos between 20 and 39 years of age had high rates of syphilis and chose this group as their target audience. Throughout development, from the formative research process through message testing, focus groups were conducted in Spanish. The advertising agency that created the print ads translated materials into Spanish and radio PSAs in Spanish ran on local radio stations.

Another case study focusing on bilingual communication efforts is entitled "Voices and Images: Tuberculosis Photovoice in a Binational Setting." In this case, photography and photo-interviewing techniques were used as part of a campaign to address issues surrounding Tuberculosis (TB) in border communities in both the United States and Mexico, an area where TB prevalence is very high. The target audience was composed of disenfranchised Spanish-speaking TB patients, many with low levels of literacy and education. In order to meet the project's goal to "spread the word, not the disease," exhibits of the patients' artwork rotated throughout the border communities. Ultimately, Photovoice increased TB awareness, reduced stigma associated with the disease in participating communities, and opened communication with policymakers whose actions could improve this population's quality of life. Additionally, by sharing and discussing their photographs, patients developed a support network. This intervention was unique in its use of photography to decrease the barriers posed by language and literacy, a technique which proved highly successful in achieving the program's goal.

The case study "Talk to the Fifth Guy: A Lesson in Social Marketing" also explores an intervention targeting a diverse audience. In this case, practitioners developed a campaign to prevent the spread of pandemic flu in Florida by targeting the general population, including its large Hispanic and Haitian segments. Practitioners used formative research to create a campaign focused on the social norms surrounding hand-washing and other hygienic behaviors. Recognizing the need for culturally sensitive materials to achieve success with their diverse target audience, researchers conducted separate formative research and pilot-test focus groups with each of Florida's most prevalent segments: the general population (Caucasians and African Americans), Hispanics and Latinos, and Haitians. Billboards, posters, and stickers were translated into Spanish and Creole by native speakers to ensure "cultural sensitivity and accurate translation" and radio and television spots were aired on both Hispanic and English stations to ensure that messages reached their target. The involvement of native speakers in the message development process and the identification of effective avenues for message delivery resulted in high campaign recall and increased self-report of hygienic behavior throughout the diverse target audience.

The above case studies illustrate the utility of conducting formative research and message testing with all cultural segments in a target audience, as well as the importance of involving native speakers to translate campaign materials and conduct focus groups. The full-length case studies featured in Volume 2 of Cases in Public Health Communication & Marketing offer examples of efforts to reach diverse target audiences using bilingual materials and outreach. By sharing our experiences and lessons learned, we can build on them to meet the challenges presented by our changing population more effectively and ultimately, better serve all who rely on us as public health professionals.

References

1. Census Bureau, The Hispanic Population in the United States: 2002
2. The Health Care Challenge: Acknowledging Disparity, Confronting Discrimination, and Ensuring Equality. United States Commission on Civil Rights, Sept. 1999.