LINGUISTIC AND CULTURAL ADAPTATION OF A COMPUTERIZED EHEALTH EDUCATION INTERVENTION FOR PERSONS WITH CHRONIC ILLNESS

Lack of understanding of one's health condition and/or medications and how to take them is associated with poor medication adherence in persons with chronic illness, which can lead to poor health outcomes. As linguistic minorities, Spanish-dominant Hispanics (SDH) in the United States (US) face challenges such as difficulties in obtaining and understanding accurate information about their conditions and its treatment. Traditional health educational methods (e.g., pamphlets, talking) may not be as effective as delivering through alternate venues. Moreover, medical staff and pharmacists may not be bilingual and written materials may not be available in languages other than English. Technology-based health information interventions that are linguistically and culturally appropriate have the potential for being readily available on desktop computers or over the Internet. The purpose of this report is to explicate our methods used to adapt a computer health education application (initially developed for English-speaking persons) that provides linguistically and culturally appropriate health education for patients with limited English skills using Internet and computer-based applications. Using our findings from our mixed methods study of 5 healthcare providers and 25 patients from a clinic serving the indigent/non-insured Hispanics in South Florida, United States, we discovered disease-related stigma, the role of familia (family), social support, and depression were major themes within cultural contexts relevant to understanding psychosocial and cultural factors related to medication adherence. Using this data, we culturally and linguistically adapted a tailored intervention that provides information about the patients' illness, treatment, and medication related problem solving skills (proven effective in English-speaking populations) that can be delivered using touch-screen computers, tablets, and smartphones. Culture-specific psychosocial factors and linguistic appropriateness in addition to provision of disease and medication information can affect patient outcomes, particularly with regard to medication adherence. Internet-based eHealth education interventions that builds on knowledge and also targets core cultural determinants of medication management may prove a highly effective approach to improve health outcomes and medication decision-making in this group. This adaption method can be applied to eHealth education computer applications designed for non-English speaking persons living with chronic conditions that requires medication management to improve health outcomes.