How to use text messaging to AA and NHPI patient care

May is Asian American, Native Hawaiian, and Pacific Islander (AA and NHPI) Heritage Month, which highlights healthcare and communication provisions within these communities. Statistics show that Asian American adults are the least likely among all racial and ethnic groups to report that their healthcare provider always involves them in healthcare decisions. Organizations providing care in communities that have suffered from historical disparities need to communicate proactively. Communication methods such as text messaging offer a secure and easily accessible means to improve patient care with a wider reach. 

The importance of considering cultural and linguistic diversity 

AA and NHPI communities are made up of a vast array of ethnic groups, each with distinct cultural and linguistic characteristics. The demographic composition of these communities is incredibly diverse, including individuals of Chinese, Filipino, Japanese, Korean, Vietnamese, Native Hawaiian, Samoan, and Chamorro descent, among others. This diversity is reflected in the more than 100 languages and dialects spoken within these communities, ranging from Tagalog and Hindi to Tongan and Tahitian. 

A 2005 study on linguistic and cultural diversity in students provided two interesting insights into the impact of both languages and cultures of diverse groups. Relating to language it stated, “Language is central to culture, but culture is much broader than language.” In relation to culture it provided the following definition, “Culture can be defined in a variety of ways, but for the purpose of this article, culture is defined as the values, norms, and traditions that affect how individuals of a particular group perceive, think, interact, behave, and make judgments about their world (Chamberlain & MedeirosLandurand, 1991).”

Effective communication in healthcare for AA and NHPI communities, therefore, requires more than just language translation. It involves cultural competence — a deep understanding and respect for cultural beliefs and practices that influence health behaviors. This is why healthcare providers need to undergo training in cultural competence so that they can engage effectively with patients from diverse backgrounds.

See also: Causes of language barriers in healthcare

The disparities in AA and NHPI patient care and communication

During the COVID 19 pandemic, AAPI individuals faced heightened levels of racism and xenophobia, often fueled by the rhetoric associating the virus with geographic origins in Asia. Such stigmatization not only led to increased rates of harassment and hate crimes but also impacted these communities' interactions within healthcare settings. Fear and distrust generated by these societal attitudes can hinder Asian American and Pacific Islander patients from seeking necessary medical care or from communicating effectively with healthcare providers.

A 2021 memorandum issued by the Biden-Harris Administration was created with these injustices in mind offering its purpose as, “Advancing inclusion and belonging for people of all races, national origins, and ethnicities is critical to guaranteeing the safety and security of the American people. During the coronavirus disease 2019 (COVID–19) pandemic, inflammatory and xenophobic rhetoric has put Asian American and Pacific Islander (AAPI) persons, families, communities, and businesses at risk.”

The considerations when communicating with diverse populations

Based on the US Department of Health and Human Services Office of Minority Health (OMH) guidance the following basic considerations should be in place: 

Language proficiency:

• Assess the language needs of the community.
• Provide professional translation and interpretation services where needed.
• Avoid relying on machine translation tools which may not accurately capture cultural nuances.

Cultural competence:

• Understand and respect cultural differences, beliefs, and practices.
• Engage cultural consultants or liaisons who can provide insights into community norms and values.
• Ensure that communication materials and messages do not perpetuate stereotypes or cultural insensitivity.

Cultural appropriateness:

• Tailor messages to align with cultural values and practices.
• Use examples, metaphors, and references that are relevant and respectful to the culture.

Accessibility:

• Ensure that all communication materials are accessible to individuals with disabilities.
• Consider the diverse educational backgrounds of the audience by simplifying technical language without diluting the message’s accuracy.
• Use various formats (audio, visual, print) to cater to different learning and communication preferences.

Engagement strategies:

• Involve community members in the planning and development phases of communication campaigns.
• Use community input to shape messages and choose the most effective communication channels.
• Establish trust through consistent, honest, and transparent communication.

Religious and ethical values:

• Be mindful of religious and ethical considerations that may influence perceptions, behaviors, and openness to messages.

Socioeconomic factors:

• Understand that socioeconomic factors may affect the ways in which messages are received and acted upon.
• Tailor messages that consider these factors, potentially offering multiple options or solutions that can fit various circumstances.
  
  

The benefits of using text messaging

When designing text messaging services for minority groups, such as AA and NHPI communities, both linguistic accuracy and cultural sensitivity should be prioritized. As a resource, it allows for text messages to be translated into the primary languages spoken by the community members as well as respect for the nuances of each language. For example, a message intended for a Filipino audience might use Tagalog and include local expressions that resonate with their everyday communication style.

Cultural considerations extend beyond language. The content of the messages should align with cultural values and practices. It might involve referencing cultural holidays, using respectful forms of address, or framing health advice in a way that acknowledges traditional beliefs. For instance, a health reminder could link recommended medical practices with well-established community values, like family welfare or community well-being.

The guidelines for implementing HIPAA compliant text messaging

Culturally adapted messaging platforms

1. Select platforms supporting unicode: Choose HIPAA compliant text messaging platforms that support Unicode to accommodate a variety of non-Latin scripts used by diverse AA and NHPI languages, such as Chinese, Hindi, or Tagalog.
2. Interface customization: Opt for platforms that allow interface customization to reflect cultural elements, which can make the technology more approachable and user-friendly for patients from diverse backgrounds.
   

Culturally and linguistically tailored content

1. Hiring bilingual staff: Employ bilingual healthcare providers or support staff who can communicate effectively in the patients’ native languages and understand cultural nuances.
2. Cultural competence training: Regularly train all personnel involved in drafting and sending messages on cultural competence to ensure sensitivity in communication.
3. Template development: Develop message templates in various languages that are culturally adapted, which can be reviewed and approved by cultural consultants to ensure appropriateness and accuracy.
   
   

Consent processes

1. Informed consent in multiple languages: Provide clear, multilingual explanations of how text messaging will be used, what information will be shared, and the patient's rights, including how they can opt out at any time.
2. Visual consent aids: Use infographics and other visual aids in various languages to help explain consent forms and privacy notices, ensuring patients fully understand the information before agreeing.
   
   

Community engagement and partnership

1. Community health representatives: Engage community health representatives from AA and NHPI communities to serve as liaisons who can provide feedback and guidance on effective communication strategies.
2. Partnerships with cultural organizations: Form partnerships with local cultural organizations to help validate messaging content and to co-develop community health messages.
   
   

Technical support and accessibility adjustments

1. Support for older devices: Since not all patients may have access to the latest technology, ensure that the text messaging solutions are compatible with older mobile devices.
2. Adjustable text size and visuals: Include features that allow patients to adjust text size or provide visuals to assist those with visual impairments or literacy challenges.

See also: Top 12 HIPAA compliant email services

FAQs

Is text messaging a cost-effective method for patient communication?

Yes, text messaging is generally cost-effective compared to other forms of communication like phone calls or postal mail. 

What types of messages are typically sent to patients via text?

Common types of messages include appointment confirmations and reminders.

How do healthcare providers handle language preferences in text messaging?

Collect information on patients' preferred languages during initial registration and ensure that text messages are sent in those languages.