# Presentation: 585955

## Tailoring Risk Communications for Underserved Communities: Differential Source Preferences and ResponsesPresented byDavid L. Driscoll, PhD, MPH Presented atThe National Prevention Summit,Washington, D.C., October 26–27, 2006

*RTI International is a trade name of Research Triangle Institute*

- 3040 Cornwallis Road     ■     P.O. Box 12194     ■     Research Triangle Park, NC 27709

- Phone 919-541-6565

- e-mail Driscoll@rti.org

- Fax 919-5417384

## Terms Defined

**Message Tailoring**
- The adaptation of information and interventions that best fit the relevant needs and characteristics of specified target populations*.*
**Cultural Tailoring**
- The development of interventions, strategies, messages and materials to conform with specific cultural characteristics.
- 			Pasick *et al.*1996
**Cultural Model**
- The culturally-transmitted conceptual framework composing a _specific domain of knowledge and activity_*.* Cultural models are structured along key elements, and can include such variables as social expectations, associations, and decision-making processes.
**	****	****	***sensu lata*** **D’Andrade 1984;** **Dressler and Blindon 2000

## Human exposure to methylmercury in fish

## Subsistence Fishers Risk Communication Project: Data Collected

- Formative
- Structured observations
- Unstructured, informal interviews
- Asset mapping
- Materials development and assessment
- Semi-structured, formal interviews
- 82 residents (25 from the African-American, 25 from the Latino, and 32 from the Native-American communities)
- Evaluation
- Semi-structured, formal interviews
- 62 residents, organizational leaders, and resource organization representatives (21 from the African-American, 14 from the Latino, and 27 from the Native-American communities)

## Subsistence Fishers Risk Communication Project

*Objective:***  ****	**Develop and test three risk communication toolkits to promote the capacity of down-east North Carolina community residents to make informed decisions about methylmercury contamination in local fish.
*Design:*** ****	**Three-community experimental design. Communities matched by social capital, population density, and level of exposure. Communities possess differing demographic profiles; majority (at least 65%) African-American, Latino, or Native-American (Lumbee) residents.
*Intervention:*** ****	**Three culturally-tailored toolkits featuring structured risk communications, contact information for preferred resource organizations in each community, and responses to frequently asked questions.

## Cultural Tailoring: Methylmercury Exposure

## Cultural Tailoring: Analytic Categories

- Risk Elements:
- Risk Status
- Age
- Gender
- Pregnancy
- Nursing
- Fishing Behaviors
- Consumption
- Size/Age of catch
- Location(s) of catch
- Species preferences
- Eating Habits
- Self caught
- Frequency
- Serving size
- Species preferences

## Cultural Tailoring: Native-American Model

## Cultural Tailoring: Native-American Toolkit

**Notes:**
Educational content on key issues and preferred resources integrated. 

Three key risk communication components and additional resources: one for each community
Double fold brochure with eight panels
Latino community toolkit written in Spanish
All versions at 6th-8th grade reading level
Designed and edited by document preparation professionals
500 copies printed for dissemination in each community

## Cultural Tailoring: Preferred Sources of Health Risk Communication

- Analytic Categories:
- Culturally-sensitive
- Understandable
- Engaging
- Relevant
- Credible
- Trusted
- Accurate
- Actionable

## Cultural Tailoring: Resource Preferences(African-American)

- Religious
- Ministers/pastors
- Newsletters
- Church-affiliated community centers
- Governmental
- County Health
- WIC office
- Health Education Center
- Social Services
- Fish and Wildlife (game warden)

## Cultural Tailoring: Resource Preferences (Latino)

- Spanish media
- Radio (La Ley 96.9)
- Television (Univision WUVC 40)
- Newspaper (Que Pasa)
- Religious
- Catholic outreach
- Governmental
- Hispanic Outreach Center
- County Health
- Partnership for Children (Latino)

## Cultural Tailoring: Resource Preferences (Native-American)

- Tribal
- Tribal Council
- Native American Resource Center
- Native Home Health Care
- Healing Lodge
- Governmental
- Fish and Wildlife (game warden)
- Health Department
- Environmental Health Center
- Community Health Education Center

## Resource Preferences: Commonalities

- Social nature of risk decision-making:
- Shared values
- “They know what I want to learn...how we live.”
- Familiar
- “I can talk to them, and can understand what they’re telling me about this.”
- Trusted
- “I know that I can believe what they tell me.”

## Responses and Conclusion

- African-American
- Knowledge dramatically increased from baseline.
- Exposure reduction: high self- and high response-efficacy.
- Moderate additional resource contacts.
- Latino
- Knowledge moderately increased from baseline.
- Exposure reduction: moderate self- and low response-efficacy.
- No additional resource contacts.
- Native American
- Knowledge moderately increased from baseline.
- Exposure reduction: high self- and high response-efficacy.
- Highest additional resource contacts.

**Notes:**
Evaluation looked at three metrics for each community; knowledge change pre/post, self and response efficacy for exposure reduction, and information seeking behavior.

African-American community informants in general experience dramatically increased knowledge. This was largely related to very low knowledge levels prior to receiving the toolkit. Some indicated that visible trash was a concern, but few were aware of methylmercury in fish. Many residents ate fish, and those in the low-risk group intended to continuing doing so for economic reasons.  Those in the high-risk group, particularly young women with children, indicated that they would not eat fish at all if there was a chance it could harm their children. Again, self and response efficacy were high in this population. Those resource organizations we polled suggested a moderate uptick in contacts for more information on methylmercury compared to the other two communities.

Residents of the Latino community generally increased knowledge, but less so than members of the African-American community despite the fact they were both largely unaware of the problem.  Few had any concerns about the environment.  Informants who were in the high risk group and parents of young children were alarmed to discover the possible affects of mercury contamination.  Once made aware, Latinos were concerned and wanted to know how they might avoid exposure. They were less confident in their ability to act on the recommendations, and less sure that doing so would protect them. This latter is probably due to relatively low perceptions of risk. No additional contacts identified.

Lumbee community informants were the most concerned with environmental issues in general, and mercury specifically. A number of the informants explained that water pollution in general was a concern for them and many inquired what could be done to reduce levels of pollutants. Many Lumbee fish, and those in the low-risk groups generally intended to continue due to the culturally-significant nature of subsistence fishing. Lumbee in the high risks group indicated that they would not consume fish because of the dangers it could pose to their children. Self and response efficacy were high in this population. Lumbee resource organizations described the largest increase in contacts.

These findings suggest that culturally tailored risk communications for these communities need to be aware of the differing preferences among existing sources of information. In each community, governmental sources were a distant second to more accessible and engaging informational sources with ongoing and consistent contacts with community residents. Even among governmental sources, those that provided information were preferred over those that did not. In short, when both variables were fulfilled, residents preferred greater levels of cultural sensitivity over credibility. 

Finally, the lack of local, accessible, and culturally-sensitive health risk informational sources in Latino communities represents an obstacle for local health risk communications to these groups. We must do a better job identifying and leveraging local resources for risk communications focused on any number of disease threats and health promotion campaigns.

## Tailoring Risk Communications for Underserved Communities: Differential Source Preferences and ResponsesPresented byDavid L. Driscoll, PhD, MPH Presented atThe National Prevention Summit,Washington, D.C., October 26–27, 2006

*RTI International is a trade name of Research Triangle Institute*

- 3040 Cornwallis Road     ■     P.O. Box 12194     ■     Research Triangle Park, NC 27709

- Phone 919-541-6565

- e-mail Driscoll@rti.org

- Fax 919-5417384