Dietary changes, medication management, physical activity and a host of other behavioral modifications all contribute to successful therapy. For providers, however, improving cultural literacy is the key to helping Spanish-speaking patients understand these lifestyle management techniques and providing the tools to implement them.
Kymberly Aoki, Anna Dermenchyan, Cheryl Le Huquet, Nancy Exarchos and Elvina Luistro — all registered nurses at Ronald Reagan UCLA Medical Center — designed their Patient Voice Project, Yo Entiendo, to better understand the health literacy disparities and cultural barriers facing their Spanish-speaking heart failure patients.
Yo Entiendo ('I understand')
Because 7 percent of patients at the medical center are Spanish-speaking, Aoki and her team devoted their project to learning what those patients felt and thought about their care. Having interviewed seven patients at risk for heart failure using Spanish-language interpreters, they decided to focus on three main themes: cultural sensitivity, communication between the provider and patient and coordination of care.
From these themes, the team held an ideation session that included stakeholders, providers, nurses and administrators. Together, they discussed the results of the interviews as well as the needs of the providers, and decided to focus on two main interventions. First was to provide cultural competency training for providers, and second was to create discharge resources, improve coordination of care and streamline the use of interpreter services.
The cultural milieu in which the patient lives has a significant impact on his or her health behaviors. With respect to the project's Hispanic population, this includes the importance of family, caregivers, rapport with patients, and the role of food as part of the culture itself.
Currently, the team is assessing cultural competency resources available and determining if they are appropriate or in need of new materials altogether. These materials would be delivered to new nurses, residents and those involved in Care Partner training. A pilot program of the cultural competency training is being developed with residents in the Cardiac Care Unit, with the hope of scaling it to all physicians, nurses and ancillary staff.
Results of the Patient Voice project also emphasize the need for improved communication between patients and providers. Interventions in this portion of the project include using the teach-back method of patient education to ensure understanding, as well as gauging the patient's and caregiver's level of health literacy.
In addition to increased awareness about the importance of communication between patients and providers, Yo Entiendo looks to improve the process for requesting Spanish-language interpreters and increase their effective usage.
Coordination of care
Aoki's team found that patients were overwhelmed with the number of follow-up appointments after being discharged from the hospital. Improved coordination of these follow-up appointments, as well as patient referrals to resources in UCLA and the community, can help them receive the care they need to prevent their condition from worsening.
Our patients, ourselves
"It's been a lot of work, but it's a good process ... to take a step back, throw your assumptions aside and [listen] to what the patients have to say," Aoki says of the Patient Voice process. "It was also a good experience for me personally to think, 'how would I function in this same situation if our roles were reversed?' It gives me a perspective that I really appreciate because I'm learning a lot about this community but a lot about myself as well, and I think that will help me work more effectively with this population."
By Kyleigh Roessner