Racial Ethnic and Language (REL) Brochures Focus Group Report African American Community
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Racial Ethnic and Language (REL)
Brochures
Focus Group Report
African American Community
Examining Massachusetts Hospital System (MHA) REL
Brochures for Cultural and Linguistic Appropriateness for
Use in Maine’s Health Care System
January 2012
Kolawole A. Bankole, M.D, M.S, Access Project Director
Minority Health Program
Public Health Division, Health and Human Services DepartmentReport sections
I. Purpose of focus group
II. Role of participants and facilitator
III. Recording technique
IV. Focus group location
V. Survey questions
VI. General observations
VII. Key Observations
VIII. Question detail
Responses grouped by themesAfrican American Community: MHA Racial, Ethnicity, and
Language (MHA REL) Brochure Testing Focus Group Results
I. Purpose of Focus Group:
A focus group serves as a means for assessing information and opinions concerning
Public Health initiatives from the community. The Minority Health Program (MHP) of the
Public Health Division, Health and Human Services Department, City of Portland conducted a
focus group and awareness session on Tuesday December 6th, 2011 with representatives of the
African American community to assess the appropriateness of brochures for use in increasing
cultural awareness and understanding, in the delivery of services, throughout Maine’s healthcare
systems.
The purpose of the focus group was to try to get a better understanding of what the
community members think about the racial, ethnic and language (REL) brochure in their
language and how appropriate and applicable it is to their community. We want to know how
people feel about the questions asked in the brochure and overall impression on improving the
care and health for their community by Maine hospitals/clinics. The information we collect may
be used to make it easier for those who receive care from our hospitals/clinics get good culturally
and linguistically appropriate services and to assist the hospital better collect patient race and
ethnicity information to better serve the REL community members. Thus topics discussed
explored awareness of the need to collect patient’s race and ethnicity information, likes and
dislikes of the REL brochure, and suggestions on how to best use this in the African American
community.
II. Role of Participants & Facilitator:
• Topics of discussion were facilitated by Dr. Bankole A. K, the MHP Access Project
Director
• Session recorded and written notes were taken by Jessica Loney.
• The facilitator administered the discussion and avoided off-topic conversations. The
facilitator explained the purpose of the project to the participants. He obtained both oral
and written/signed consents from each participant to participate in the focus group.
• During the focus group meeting the facilitator administered the discussion by reading
topic discussion questions to the group and also rephrasing/summarizing responses for
recording and note-taking purposes. The facilitator thus probed when necessary but kept
probing at a minimum due to time restraint factor. The group was very cooperative and
participants were actively involved in the discussions.
• Total attendance: Six (6) – Five African American community members and a facilitator.
• Participants were members of the African American community who were invited to
participate by Jessica Loney, a key member of the same community working with the
City of Portland Public Health Division- Minority Health Program. Participants
comprised of three females and two males with age range from 17 to 56 years, and 43
years as mean age.
• There were no observers present from other communities, with the exception of the
facilitator.
• The group session lasted approximately 105 minutes, with the focus group lasting about
90 minutes, followed by an awareness education by Bankole on the importance REL data
collection and its proper usage to improve the health for the community.• Each participant was given a $22 Hannaford gift card as incentive for participation time.
III. Recording Technique:
• Following a signed consent agreement from all participants, the session was recorded
using a RCA AVR (Auto Voice Recorder) and manually on a note pad.
IV. Focus group location:
• The focus group meeting was conducted at the Casey Family Services, 75 Washington
Avenue, Portland. The meeting place was closed-off and well suited to conduct the focus
group. Participants sat in a boardroom discussion style seating arrangement, with the
facilitator seated at the head of the table with clear visibility to participants. Facilitator
was flanked on left hand side by the note-taker. Refreshments were provided for all
participants.
V. Survey questions:
1. Awareness of the need to collect patient’s race and ethnicity information
1. When you think of collection of data based on race, ethnicity and language in the
hospitals or clinics, what comes to your mind?
2. Do you have any experience where you have been asked for your race, ethnicity and
language data?
3. For those who have experienced being asked: When were you first asked and where?
How did you feel about being asked?
4. For those without the experience: Would you have preferred to be asked and why?
Probes
• For those who have experienced being asked: Less than 6 months ago?
Between 6 months to a year ago? Between 1 and 2 years ago? Between 2 and 3
years ago? More than 3 years ago?
• For those without the experience: Do you have a home clinic or hospital?
If yes, when was your last annual check-up? Less than 6 months ago? Between 6
months to a year ago? Between 1 and 2 years ago? Between 2 and 3 years ago?
More than 3 years ago?
If no, why? (For example, you didn’t have health insurance? You move (live) too
far away? You do not have any health needs now?)
2. Likes and Dislikes
Community evaluation of the MHA REL brochure. Distribute and show brochure- read from
brochure – get thoughts on messages in brochure and how they “feel” to them.
The messages on this brochure are (read messages):
1. When you see this brochure, what do you like about it and why?
2. When you see this brochure, what do you dislike about it and why?
3. To you, what are the most important features of the brochure?
4. To you, what are the least important features of the brochure?
Probes
• What does the message mean to you?
• Are pictures and messages culturally appropriate in your culture? Etc…
• Is there a particular language(s) you like/dislike?
• Do you understand the message?
5. Do you think your friends would understand the message?
6. Specifically what about the message helps you understand the message?7. Would you share this information in the brochure with a family member?
3. Suggestions on how best to use this in your community
In other to help us know our patients better and to improve the health of all, we would appreciate
your suggestions on how best to use this brochure in the community.
1. What would be a good way to use or disseminate this brochure in the community? Why?
Probe: Locations and methods of distribution…
2. Are there other services or ways that you think the racial, ethnic and language data could
be asked from your community members?
3. Of the suggestions you have all come up with – what are the top 5 messages you would
want to be asked about your racial, ethnic and language data/information?
4. Any other concerns of importance to you on this topic?
VI. General group observations:
• Participants well represented the diversity and richness of the African American
community in Portland. All participants speak English as first choice language at home
and there was no need for an interpreter. All the participants were born and lived their
lives in the U.S.
• Awareness and involvement depicted by all participants during the topic discussion of
REL data collection and usage reflected the general level of education/knowledge
/awareness found among the target group within the African American community
concerning this topic issue.
• All participants were vocal and well-engaged in group conversation with the assistance of
the facilitator. They all felt comfortable in the group.
VII. Key Observations:
• The focus group started about 10 minutes later waiting for participants to arrive.
• The participants consented to both oral and written consent. All signed consent approval
to participate in the focus group.
• The general consensus was that people are skeptical of the real reason behind REL data
collection and its proper usage – was it to stigmatize the community and give less quality
care or really to give good care. There were doubts as to the general intent and how the
hospitals/clinics apply this in practice.
• Though some welcomed the idea of being asked for their REL data and may provide
answers to the questions; many felt that it’s being collected to be used against them.
• Participants responded both individually and also by group affirmation on some
responses of what they all agreed upon. There were unanimous agreement on many issues
and these are captured in themes and frequencies of agreements.
• General questions on the awareness of the need to collect patient’s race, ethnicity and
language information revealed some understanding and awareness on part of participant
of need to collect REL data while they all shared feelings of mistrust of the system.
• General consensus was that there was lack of confidence and trust in the system for them
to respond to such REL data collection. Many felt the community had been asked these
questions at different times and venues and had been used against them. They do not
know the primary reason why these data should be asked at all. Many noted that they self
identify themselves according to how they feel the data will be used. So, for example,
identification at a hospital (black or multicultural or other) may be different from that of
school application (African American, black).• The group agreed that there should be more community educational outreach on the
importance of the REL data collection by the hospitals/clinics, so, that African Americans
will feel comfortable to accurately identify themselves.
• Though all members appreciate the need to collect the REL data by the hospital/clinics but shared
need for the hospitals/clinics to use the data to improve care services to them as they promised.
They shared their feelings that emphasize that the data/information should not be used against
them in the provision of care.
• Many of the focus group members had personal experiences where their REL data had
been asked and at different times – military, clinics, schools, hospitals; over the past 2
years, etc. The general consensus was that of mixed experiences.
• The group also noted that they would be more likely to view this REL data request more
favorably, if they understood reasons why they are being asked and reassured that they
would be used to provide improved quality health care services to them.
• At the end of the group meeting, the group felt a strong need for the brochure to be
revised before it’s used in the community.
VIII. Question Detail:
The following section includes the details from the focus group. Questions are outlined in the
order asked during the focus group. The facilitator has grouped the responses by themes, which
are in italics. Individual team member responses are displayed with bullet points. Direct
quotations are indicated where quotation marks are utilized. Thus the flow is as follows:
numbered question, theme, bulleted responses.
1. Awareness of the need to collect patient’s race and ethnicity information
1. When you think of collection of data based on race, ethnicity and language in the hospitals or
clinics, what comes to your mind?
a. Participants responded in different ways on their REL awareness 5/5
• “Two reactions: how does the data get used and are those asking aware of the cultural
context”
• “I immediately wonder: if my service will be improved, what level of service is
associated with my race”
• “Here we go again”
• “What’s the benefit?”
• “My sister is white and when I accompany her and she is asked, I wonder why does it
matter; aren’t we all the same?”
• “Judgment”
• “I can think of good and bad reasons”
• “I think they have to meet a quota”
• “I’m not sure if I fit into the categories”
• “When I was in the military; people answered based on the idea that it would connect
them to needed services”
• “Negative response is felt; you are putting yourself out there; you are exposed”
2. Do you have any experience where you have been asked for your race, ethnicity and
language data?Facilitator asked by show of hands, how many have experienced been asked about their race,
ethnicity or language either on paper or in person?
a. All participants answered affirmatively- Yes
3. For those who have experienced being asked: How did you feel about being asked?
When were you first asked?
a. All (100%) participants were asked in the last 6 months
b. 2 of 5 said they have been asked frequently and often in the past years.
c. “Maybe white people doesn’t remember being asked because they probably ask
people of color more often”
Where were these questions asked?
d. Hospitals/clinic, Schools, Military, and, job applications.
How did you feel about being asked?
e. Participants shared specific feelings about the REL data collection
• “I felt neutral; like they were doing their job-for programs”
• “I have been asked often as a musician; before performances”
• “I feel there are 3parts to my response-social, physical, and psychological”
• “Filling out college applications; I couldn’t check off African American enough” x 3
• “I am participating today because I would like to see things change so that you are
counted and not discounted”
• “I think being black and white is positive because I fit in with white kids in ME and with
everyone else”
• “I feel that being Black is negative” x3
• “One winter while walking home from basketball some white kids jumped me because I
am Black; I didn’t understand why being Black is wrong”
• “Depends on what agency is collecting the data; I answer based on whether I feel like it
will help i.e.: African American for college applications, Multiracial or Other for housing
or employment”
• “This started in the 1600’s when we were brought as slaves, In ME I feel racism is more
benign than malicious. In the 1700’s whites established the one drop theory; so if you
have one drop of black blood in you; you were looked down upon” (participant shifting
in seat and visibly passionate about explanation for racism). Other participants nodded in
agreement.
• “I’ve had the worst experiences in the emergency room, my children too, that’s where
you see the worse discrimination by how long you wait”
• “Our health (in our communities) is handled in non-medical ways”
• “Like I went to his house (pointing to man seated in next chair) and I had a cold; he gave
me ginger tea and the cold was flushed out; these things have been taken away from our
community”
4. For those without the experience: N/A2. Likes and Dislikes
As a segue to the second main question, facilitator (Dr. Bankole) explained that this brochure
was created in the State of Massachusetts by the Hospital Association (MHA) and translated into
many languages there. The facilitator reiterated the purposes of this study and that the
information will be used by the Aligning Forces for Quality (AF4Q) REL Community Partners
to further enhance its work with ensuring that the hospital system collect and collate REL data/
information for better service provision. The City Minority Health Program is planning on using
it and modifying it based on the group responses to fit the needs of our specific community.
Community evaluation of the MHA REL brochure. Distribute and show brochure- read from
brochure – get thoughts on messages in brochure and how they “feel” to them.
The messages on this brochure are (read messages):
Dr. Bankole/Facilitator allowed the group some few minutes to read the brochure.
Likes:
1. When you see this brochure, what do you like about it and why?
a. Participants shared what they liked about the brochure 5 of 5
• “Because of the syntax the reader can’t judge the race of the author”
• “I like that they are stating the intent to give better care” x 2
• “I like the picture (of the African American family)” x 3
• “I like that they want to know more about the culture, language, etc. of the patients”
• “I like the bright colors”
Dislikes:
2. When you see this brochure, what do you dislike about it and why?
a. Participants shared what they disliked about the brochure
• “All of the families seem to be the same ethnically” x 2
• “It does not reflect the modern family structure (i.e. blended families, adopted, same- sex
parents)”
• “Seems like the pictures should be placed in an equal row rather than some at the bottom
of the hierarchy” x 3
• “There needs to be some images of darker skinned blacks”
• “The pictures defeat the purpose of the message; they have separated into groups rather
than displaying togetherness”
• “Needs more range of skin tones”
• “I thought we would be moving away from racial stereotypes and changing to more
humanistic self perceptions”
• “It seems like these pictures have moved away from American culture (i.e. obese)”
• “Literacy level questionable”
• “Small font is tough for low vision readers” x 3
• “Busy”
• “Blurry”
• “People won’t take this with them”• “I’m so sick of giving my information; I’ve already given away so much info.”
• “They should change from “Help us know our patients better” to “How can we best serve
you”
• “To “help us” is already negative in my mind”
Features:
3. To you, what are the most important/least features of the brochure?
a. Participants shared their views along the Likes and Dislikes lines (see above); but stated
suggestions for improvement on the brochures
• “Needs visual improvement to make it less blurry” x 3
• “It would be better if someone was there to explain it to the community”
• “If this came in the mail, I would throw it”
3. Suggestions on how best to use this in your community
In other to help us know our patients better and to improve the health of all, we would appreciate
your suggestions on how best to use this brochure in the community.
1. What would be a good way to use or disseminate this brochure in the community? Why?
Probe: Locations and methods of distribution…
a. Locations: Barbershops, hair salons, centers x 3
b. Methods:
• In monthly bill, newsletter, newspaper, or as a poster
• Could be shared at community locales (i.e.: Barbers, hair salons, centers) (x3)
• Perhaps in a food brochure at the grocery store, in a sale flyer, at restaurants
2. Are there other services or ways that you think the racial, ethnic and language data could be
asked from your community members?
• “In cities where there is more diversity”
• “When cigarettes and alcohol are sold to keep count on who is actually raising insurance
rates by self medicating”
• “In clinical settings that are private like dentists, naturopaths, and other specialists”
3. Of the suggestions you have all come up with – what are the top 5 messages you would want
to be asked about your racial, ethnic and language data/information?
a. Participants responded with many of the suggestions mentioned above.
• “The best way to get the word out to the community is to reach out to them through
the avenues mentioned already”
• “Hold one on one meetings to explain this with the community”
• “Do not use brochure as it is now, but make changes on it”
4. Any other concerns of importance to you on this topic?
How many people think this pamphlet CANNOT be used in community?
• Response: No personHow many people think it CAN be used in the community? • Responses: As is – 0 of 5. With suggested changes: 4 of 5. Did not respond: 1 of 5 Facilitator/Dr. Bankole: Spent some time to further explain the reasons why it is important for the hospitals/clinics to collect REL data to better improve the quality of care provided to our community. Kolawole Bankole, M.D,M.S
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