Relating Ethnicity and Culture to Healthcare Marketing

1. Relating Ethnicity and Culture to Healthcare Marketing August 8, 2003

2. Pamela L. SchneiderSenior VP, Client Services DirectorRick Johnson & Company, Inc.

3. Our Agency Has a Plethora of Healthcare Experience • Integrated Health Systems • Hospitals • Managed Care • Physician Specialty Groups • Clinics and Solo Practitioners • Recruitment and Retention • Community Healthcare Leadership • The list goes on…

5. Let’s Begin Today by Discussing Some Statistics

6. Percent of Persons Who Are American Indian and Alaskan Native by County in New Mexico 36.9% to 74.7% Includes: San Juan, McKinley and Cibola Counties 10.9 – 16.3% Includes: Rio Arriba, Sandoval and Socorro Counties Source: United States Census Bureau Data: www.census.gov NOTE: Bernalillo County – 13.5% of NM NA pop. or 23,623

7. Percent of Persons who are Hispanic or Latino by County in New Mexico 72.9 – 81.6% Includes: Rio Arriba, Mora, San Miguel and Gaudalupe Counties 44.9 – 63.4% Includes: Taos, Colfax, Harding, Santa Fe, Valencia and Socorro as well as Grant, Hidalgo, Luna and Dona Ana Counties Source: United States Census Bureau Data: www.census.gov Note: Bernalillo County is 30.4% of NM Pop. or 236,285

8. Percent of Persons who are Anglo in New Mexico by County Source: United States Census Bureau Data: www.census.gov

9. U.S. Census Data on Nativity and Language Proficiency in New Mexico Source: United States Census Bureau Data: www.census.gov

10. U.S. Census Data on Nativity and Language Proficiency in New Mexico Source: United States Census Bureau Data: www.census.gov

11. Other Population Statistics – Census Bureau

12. 10 LEADING CAUSES OF DEATH IN THE AMERICAN INDIAN Source: The Center for Disease Control Website: www.webapp.cdc.gov

13. 10 LEADING CAUSES OF DEATH IN THE HISPANIC POPULATION Source: The Center for Disease Control Website: www.webapp.cdc.gov

14. Our DMA is One of the Top 15 Hispanic Markets in the Country Market%/TV HouseholdsHispanic Rank Los Angeles 30% (1,585,390) 1 New York 15% (1,100,030) 2 Miami-Ft. Lauderdale 37% (550,190) 3 Houston 22% (399,220) 4 Chicago 12% (384,140) 5 Dallas-Ft. Worth 15% (324,120) 6 San Antonio 44% (317,810) 7 San Francisco – Oak- SJ 13% (317,200) 8 Phoenix 16% (246,160) 9 Harl-Wslco-Brns-Mca 81% (232,270) 10 Albuquerque-Santa Fe 33% (206,710)11 Source: 2003 Nielsen Universe Estimates

15. Approximately 38% of the DMA Population is Hispanic Total DMA Population 1,597,000 Hispanic Percentage 38% Hispanic Population 602,000 Non-Hispanic Percentage 62% Non-Hispanic Population 995,000 Source: 2003 Nielsen Universe Estimates

16. Hispanics Growing Twice as Fast as Non-Hispanics A Rapidly Growing Population 19902000% Change Hispanic 579,224 785,386 32% Non-Hispanic 935,845 1,053,660 13% Source: 1990 and 2000 Census (New Mexico state population

17. More Than Four Out of Five Hispanic Households Speak Spanish Speak Spanish 82% Speak English Only 18% Source: 2003 Nielsen Universe Estimates

18. More Than Four Out of Five Hispanic Households Speak Spanish • Conveying your message to your target audience is accomplished most effectively in theirlanguage of comfort. • The language of comfort is the language spoken at home. • Spanish-language dominant Hispanics think and feel in Spanish. Source: 2003 Nielsen Universe Estimates

19. But It’s More than Just Spanish… ñ

20. It’s About Reaching Them with Relevance • It’s necessary to connect with target consumers • Emotionally • Rationally • Intellectually • Culturally • To connect in these ways, you must know about their level of acculturation

21. Acculturation, Not Assimilation • Assimilation: • A group leaves culture and customs behind and adopts culture and customs of another group • Acculturation: • A group adopts or borrows customs and traits from another culture

22. Acculturation is Defined as… • “Change resulting from contact between cultures” • “The process by which people adopt or borrow customs and traits from another culture” • “A merging of cultures as a result of prolonged contact” • “Mutual influence of different cultures in close contact” Source: “Acculturation” Microsoft Encarta Online Encyclopedia 2000 Strategy Research Corp. Webster New World Dictionary, Third College Edition

23. Key Indicators of Acculturation • Language • Values

24. Latino Acculturation Values (L.A.V.s.)™ UNACCULTURATED ACCULTURATED Success: Family/group satisfaction Success; Personal Achievement Class distinction/ authority Obedience/ attached to traditions Freedom/ open to change Equality Individualism Collectivism Avoidance of direct confrontation Assertiveness/ aggressiveness Cooperation/ respect Competition Control over destiny Fatalism

25. Latino Acculturation Stratification UNACCULTURATED ACCULTURATED CROSSCULTURER CULTURAL LOYALIST CULTURAL EMBRACER CULTURALINTEGRATORS (TM) • U.S. Born • 2nd, 3rd Generation • English • Preferred • Latino Proud • Retro-acculturation • Influential • Foreign Born • Resident • Spanish • Preferred • Professional • Aspirational • Foreign Born • Recent arrival • Spanish • dependent • Traditional values • U.S. Born • First generation • Bilingual & • Bicultural • Professional • Fashion-forward • In touch with roots

26. Acculturation Nationally Among Hispanic Adults 18+ Source: Strategy Research Corp.

27. Albuquerque is Highly Acculturated Market • Top 3 Most Acculturated Markets in U.S.: • San Antonio • Albuquerque • San Francisco

28. Acculturation Among HA 18+ - Albuquerque Source: Strategy Research Corp. Source: Strategic Research Corp. 2002

29. Factors Influencing Acculturation • Employment • Length of Residency in U.S. • Language Use/Preference (home and work) • Birthplace of Parents • Education • Generation U.S. Born (1st, 2nd, 3rd, etc) • Media Preferences (Spanish or English) • Values and Attitudes

30. Research Shows… • Advertising to Hispanics in English is not as effective as speaking to them in Spanish • Spanishlanguagecommercials have better ad recall. (61%) • Hispanics have better comprehension of Spanish-language commercials (57%). • Spanish commercials are 4.5% times more influential in making purchases decisions. Source: Roslow Research Group Inc., Spanish vs English Advertising Effectiveness Among Hispanics 2000

31. Ethnicity is defined as:rel: of, relating to, or originating from the traits shared by members of a group as a product of their common heredity and cultural tradition(s)

32. Culture is defined as syn:breeding, cultivation, polish, refinementrel: development, education, learning; enlightenment; refinement, breeding, erudition, manners, class

33. Culture-Sensitive Healthcare:Hispanic

34. “Hispanic” • The term “Hispanic” was created by the U.S. Census Bureau in 1970 as an ethnic category for persons who identify themselves as being of Spanish origin. • “Hispanic” denotes neither race nor color, and a Hispanic may be White, Black or American Indian • Many members of the younger Hispanic population demographic now prefer the term “Latino”.

35. “Hispanic” • The classification “Hispanic” includes people of many different origins and cultures. • Although there is a unifying thread of language and some cultural similarities inherited from the Spanish settlers – There is also a tremendous variety within the Hispanic community

36. Keys to a Good Professional Relationship with Your Hispanic Patients

37. Show respeto – • People from many Hispanic cultures offer (and expect to receive) deference on the basis of age, sex and status. • Patients will naturally offer respeto to the health provider, an authority figure with high social, educational, and economic status. • In return, patients rightfully expect to be treated with respect. • Source: Virginia Tech’s Office of Multicultural Affairs Home Page

38. The Healthcare Provider Shows respeto by: • Addressing Adults by title and family name (Mr./Señor, Mrs./Señora Y, or Madam/Doña) • Shaking hands at the beginning of each meeting. • Using usted rather than the informal tu for “you”, when speaking Spanish. • Making eye contact, without necessarily expecting reciprocation, since some (especially rural) patients may consider it disrespectful to look the health provider, an authority figure, in the eye. • Source: Virginia Tech’s Office of Multicultural Affairs Home Page

39. The Healthcare Provider Shows respeto by: • Speaking directly to the patient, even when speaking through an interpreter. • Source: Virginia Tech’s Office of Multicultural Affairs Home Page

40. Show personalismo. • Patients from many Hispanic cultures expect to establish a personal, one-on-one relationship – not to be confused with an informal relationship – with the health provider. • Although establishing a relationship based onpersonalismomay seem time-consuming, it can actually save time and prevent negative outcomes. • Source: Virginia Tech’s Office of Multicultural Affairs Home Page

41. The Healthcare Provider Shows personalismo by: • Treating patients in a warm and friendly – but not unduly informal – manner. • Showing genuine interest in and concern for patients by asking them about themselves and their family. • Sitting close, leaning forward and using gestures when speaking with the patient. • Source: Virginia Tech’s Office of Multicultural Affairs Home Page

42. Involve the Family in Decision Making and Care. • Families are a source of emotional and physical support and are expected to participate in important medical decisions. • The definition of “la familia” is much broader in most Hispanic cultures than in Anglo cultures • La familia may show loyalty and support by gathering at the hospital. • Source: Virginia Tech’s Office of Multicultural Affairs Home Page

43. Accept a different sense of time. • Many people from Hispanic cultures have what might be called a “global” or “indefinite” sense of time – rather than an exact sense of day and hour – in making and keeping appointments. • Similarly in presenting a complaint, they may not be able to attach a specific calendar date to the onset or conclusion of a medical complaint or an event. • Source: Virginia Tech’s Office of Multicultural Affairs Home Page

44. Accept a different sense of time. • They may instead be able to link the event to a season, a phase of the moon, or a particular occurrence, such as a holiday or celebration. • Source: Virginia Tech’s Office of Multicultural Affairs Home Page

45. Take pains to establish understanding and agreement. • Many patients’ sense of respect for authority may cause them to avoid conflict or confrontation with the health provider by saying too readily that they understand how to take a medication or will follow a treatment plan. • The health provider must ensure that understanding is achieved and must try to gain real acceptance of the treatment plan and a commitment to follow it. • Source: Virginia Tech’s Office of Multicultural Affairs Home Page

46. Respect the spiritual side of physical complaints. • Many Hispanic patients complain that health practitioners, by discounting supernatural and psychological causes of complaints, offer only a fragmentary approach to care. • To these patients, this amounts to treating the symptoms, not the disease itself. • Practitioners are advised to ask their patients what they believe to be the cause of a complaint and to refrain from ridiculing or discounting the patient’s belief in supernatural or psychological causes. • Source: Virginia Tech’s Office of Multicultural Affairs Home Page

47. Potential Culture-Related Health Concerns Among Hispanic Populations Source: Virginia Tech’s Office of Multicultural Affairs Home Page

48. Persons from some Hispanic cultures may have tendency toward certain health concerns because of cultural factors. • Specific concerns include: • High incidence of teenage pregnancy • Low incidence of breast feeding • Where breast feeding is practiced, a tendency to do so for a short period and to introduce solid foods earlier than recommended • Source: Virginia Tech’s Office of Multicultural Affairs Home Page

49. Specific concerns include: • Very low intake of vitamin A. • Alcohol abuse, especially by young Mexican males (abetted by cultural taboos against female disclosure of alcohol use). • Drug use at levels higher than among non-Hispanic Whites. • A high prevalence of undetected non-insulin- dependent diabetes • Source: Virginia Tech’s Office of Multicultural Affairs Home Page

50. Specific concerns include: • A high incidence of tuberculosis (recommend aggressive screening • A high risk for mental health problems such as depression, anxiety, and substance abuse. • Dietary concerns due to: • High consumption of fats (often lard, especially for lower income people) and fried foods • A traditional diet high in carbohydrates from beans and rice or corn tortillas • Source: Virginia Tech’s Office of Multicultural Affairs Home Page