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Theoretical Background and research questions/hypothesis: Public health emergencies are stressful events that can impair a person’s ability to understand information and take action. In such situations, having public health messages in clear, easy-to-understand language increases comprehension of messages and the willingness to take appropriate action. Understanding of emergency information is further complicated for individuals who speak little English and can be classified as limited English proficient (LEP). The majority of emergency response materials currently exist only in English; some materials are translated but may lack validation or are written at an advanced reading level. Ineffective messaging increases the vulnerability of some audiences, including LEP Spanish speakers. Many federal agencies, including the Centers for Disease Control and Prevention (CDC), have been developing materials for vulnerable populations prior to an emergency. However, to ensure the messages are understood and actionable, they must first be validated with members of the target audience. Traditional recruiting methods, such as using a market research panel, may not be viable because vulnerable populations, such as LEP Spanish speakers, can be hard to reach. By working with community-based organizations (CBOs) to plan, recruit, and host focus groups with these audiences, health communicators can increase participants’ comfort and trust, which can improve recruitment and participant engagement.
Methods: CDC sought to fill a gap in validated anthrax emergency response materials for LEP Spanish speakers. Pictograms with short messages were developed, translated into Spanish, and tested with the target audience. CBOs providing services to LEP Spanish speakers were contracted to aid in recruitment and provide an environment to conduct the focus groups where participants felt comfortable. Fifteen focus group discussions in three states provided qualitative data on the materials. Transcripts obtained from each focus group were translated into English and analyzed to gain insight into participants’ knowledge, attitude, and beliefs about anthrax, their comprehension of the messages, and the impact of the materials on the intended behaviors. Based upon the findings, the materials were revised to improve clarity and help encourage willingness to take recommended action.
Results: CBOs in Tennessee, California, and Florida recruited 8–10 LEP Spanish-speaking participants from three age groups and from various countries of origin for each focus group. In total, 143 participants from 13 different countries took part in 15 focus group discussions. Overall, participants understood the pictograms, but some areas required improvement, including changes to:
- Focus emotional response to increase target behaviors
- Improve clarity in the sequence of action
- Strengthen comprehension of numeracy in antibiotic dosage
Conclusions: Findings revealed participants were motivated to take action as a result of reviewing the materials. Key revisions to the pictograms and messages were made to increase comprehension among LEP Spanish speakers and ultimately improve their ability to respond appropriately in the event of an anthrax emergency.
Implications for research and/or practice: Collaboration with CBOs to conduct focus groups with vulnerable populations can greatly impact the success of a project. In a trusted environment, participants are more likely to participate and respond with honest answers leading to more accurate and complete data, which contributes to producing educational materials that better address audience needs.