Asthma education brochures aimed at minorities miss the mark in Wisconsin

A Wisconsin study found that take-home educational materials designed for the state's minority children with asthma do not adequately address the cultural and linguistic issues unique to racial/ethnic minority groups.

The study evaluated the educational pamphlets using a tool created by the Wisconsin Asthma Coalition, a group of administrators, researchers and health care professionals. The researchers analyzed the strengths and weaknesses of the language, visuals, depictions of cultural attitudes and medical provider practices.

“This is a first of its kind. No one has developed a tool to gauge the cultural competence of asthma education materials,” said lead study author Jane Brotanek, M.D. “It may serve as a model for other states.”

The study appears in the autumn issue of the journal Ethnicity & Disease .

The research team hoped to find asthma educational materials that addressed cultural values and parent-patient beliefs related to asthma care and prevention, but Brotanek said the fliers failed that test.

“Mostly the information was just translated to another language,” said Brotanek, assistant professor of pediatrics at the University of Texas Southwestern Medical Center. She conducted the study between October 2004 and March 2005 while working at the Medical College of Wisconsin.

The study identified 17 asthma educational handouts targeting minority children and their families in Wisconsin. None of the asthma educational materials specifically targeted African-Americans.

“It's definitely concerning, because the African-American population in Wisconsin is growing, particularly in Milwaukee. It's now a minority-majority city,” Brotanek said.

Sixteen fliers were for Hispanics and Brotanek's team found many erroneous translations in the Spanish-language materials.

One pamphlet was for American Indians. The flier is distributed in a county where many Ho-Chunk (or Winnebago) Indians live and included a photo of an Indian at a tribal dance. However, Brotanek said it was otherwise identical to other brochures.

She said the revised pamphlet did not address cultural issues specific to American Indians in Wisconsin, such as distrust of maintenance asthma medications and smudging — a cleansing ritual in which sage, sweat grass or tobacco are burned, creating potential asthma triggers.

Cultural competency in asthma care matters, Brotanek said, because “minorities are significantly more likely to be hospitalized for or die from asthma.” She added, “The research suggests that some of that could be avoided if parents were better educated.”

Previous research has found that some minorities view their child's asthma as a series of distinct bouts of illness and that this perception might keep parents from providing proper preventive care.

“Some Navajo families in particular don't see asthma as a chronic disease, so they don't use daily controller medication to keep it in check. They fear their child will become dependent on the medicine, so some parents even try to wean their child off the medicine,” Brotanek said.

“It's important to address this distrust, but the materials we found didn't do that,” she said. “It's not sufficient to simply translate asthma educational materials into other languages or add photos of different racial/ethnic groups to make them culturally competent.”

Brotanek's study does not test whether or not the educational materials lead to better quality of care. Health researcher Alex Ortega said he is most interested in knowing if the targeted literature makes a difference to health outcomes and if it conveys accurate information.

“Cultural competency isn't just providing pamphlets in another language. What matters most is what happens in the patient-provider interaction,” said Ortega, an associate professor and director of research programs in the Department of Health Services, University of California, Los Angeles School of Public Health.

Brotanek agrees that health education materials are just one component of culturally appropriate care. Still, it is an important component, she said. “Many parents need brochures to take home with them. They take it out of their purse to remember what the doctor said.”

“We're in a continual process of refinement and quality improvement as we continue to institute cultural competency in health care,” Brotanek said.