Cultural Sensitivity in Spanish Online Hand Surgery Materials: Are Plastic Surgeons Failing to Appropriately Communicate and Meet the Health Needs of the Largest Growing Demographic in the United States?
Anna R. Johnson, Andres F. Doval, MD, Sabine A. Egeler, MD, A. Samandar Dowlatshahi, MD, Samuel J. Lin, MD MBA FACS, Bernard T. Lee, MD MBA MPH FACS.
Beth Israel Deaconess Medical Center, BOSTON, MA, USA.
Background: Carpal tunnel surgery is one of the most common performed hand procedures. Root causes of disparities in health care outcomes are multifactorial and can include variations in health beliefs, values, and preferences. These factors can lead to misunderstandings and poor health outcomes. The internet is increasingly being used as the primary source to obtain health care information. Online materials for Spanish-speakers are are frequently provided by health professionals and health care organizations. However, the quality, cultural sensitivity, and understandability of these Spanish resources remains largely unexamined.
Methods: A web search using the English search term “carpal tunnel surgery” was performed using Google, Bing, and Yahoo to identify the first 10 websites which provided carpal tunnel surgery information in both English and Spanish (a total of 20 unique websites). These websites were analyzed for cultural sensitivity using the Cultural Sensitivity Assessment Tool (CSAT), understandability and actionability using the Patient Education Materials Assessment Tool (PEMAT), and Readability Studio Professional Edition (v2012.1) to determine mean reading grade level.
Results: The majority of Spanish online health resources were direct translations of their English counterparts and were often inaccurate, included images with accompanying English subtext, and were not contoured to the unique needs of this demographic. A total of 125 search results were analyzed in order to identify 10 websites providing information in both English and Spanish, illustrating the limited availability of Spanish online resources. Cultural sensitivity scores (CSAT) for Spanish materials were significantly lower than those written in English (p=0.015). Average understandability scores were lower for Spanish materials (42.3%) than English materials (51.2%), (p=0.007). No website in Spanish was written at the recommended 6th grade reading level by the American Medical Association.
Conclusion: Online carpal tunnel resources for Spanish-speakers are culturally insensitive, written at an inappropriate reading grade level, and overly complex. The chasm between the increasing number of readily available online health materials and a patient population unequipped to comprehend this information continues to widen. In our current healthcare environment, the internet has been championed for its potential utility as a vehicle for delivery of health information. It is incumbent upon providers and health entities to ensure that materials developed are appropriate for the literacy levels of the Spanish-speaking population.
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