Future Docs

Student researchers find the best way to reach refugees and immigrants with COVID knowledge

Vital Signs » Summer 2022

The COVID-19 pandemic underscored the difficulties in getting information about the virus, its vaccines, and preventative measures into the hands of global refugees and others in America with limited English language proficiency.

But research being conducted by BSOM students is probing refugees’ and immigrants’ knowledge and attitudes toward the pandemic and how to best reach them with potentially life-saving information.

Among their findings: Secondary English speakers, or SES, were much more likely than other local residents in the survey to trust COVID-19 information provided by the U.S. government and to believe the government has ensured their safety during the pandemic.

“The SES were more likely to have positive attitudes about the COVID-19 vaccine and exhibit disease prevention measures,” such as mask wearing, said Estelle Viaud-Murat, who is leading the research team along with fellow BSOM student Monica George.

The researchers are particularly interested in breaking down language barriers in communicating health information. The team also includes BSOM students Natalie Castillo, Colette Beard, and Josef Rivera.

English is not the first language for about 22 percent of the U.S. population, and studies have shown that people with limited English proficiency suffer more medical errors in the U.S.

The COVID-19 pandemic unleashed a flood of information—news reports, social media posts, billboards, pamphlets, and newsletters—but it was overwhelmingly in English, the BSOM study pointed out.

“So much of our information was online, including translated information,” Viaud-Murat said. But BSOM’s research shows that secondary English speakers prefer traditional printed pamphlets from trusted sources for their information, perhaps because many don’t have easy access to the internet.

“This initial communication surge illuminated the gaps in our health care system for those who are secondary English speakers,” according to a BSOM research paper. “Although numerous state (health) departments gradually included Spanish and American Sign Language, the global population had to continue to find resources in a language that they could understand.” SES patients had to find translated information on their own, “opening the door to misinformation, and exacerbating the disparate care for already vulnerable populations.”

The BSOM research paper reported on the results of a survey of 144 adult patients of Five Rivers Health Center in Dayton, conducted between February and April 2021.

While most of the participants were primary English speakers, 23 percent identified as secondary English speakers, often refugees, hailing from 15 different countries. The survey was available in seven languages. The participants were compensated with a gift card.

More than 90 percent of both primary and secondary English speakers felt that COVID-19 is a serious problem and more than 80 percent felt that contracting COVID-19 personally would cause a serious illness. Two-thirds of both groups wanted to get the vaccine when it was available.

But there were significant differences between the two groups:

Secondary English speakers were more likely to trust pandemic information provided by the U.S. government and by their health care providers. George theorizes their faith in government is greater because they’re accustomed to working with government entities and following government rules during the resettlement process.

The SES participants were significantly more likely to feel that social distancing could help reduce the spread of the COVID-19 virus and feel that everyone should be vaccinated.

Global patients were significantly less likely to believe that their cultural needs had been met throughout the pandemic. They also were more likely to fear the financial impact of contracting COVID-19.

Additionally, secondary English speakers were more likely than primary English speakers to believe they were well-informed about COVID-19, yet the study found they were less successful in identifying possible symptoms of the virus. Of 15 possible symptoms, PES participants could identify an average of 9.21, compared with only 6.39 for secondary English speakers, the study found. Fewer than half of SES participants knew that loss of taste or smell is a COVID-19 symptom, compared with almost 80 percent of the PES participants.

Television and radio reports were the main sources of information for both groups, but these sources were the least trusted. TV and radio were trusted by only 30 percent of SES and 18 percent of PES participants.

Health care professionals were trusted by 82.88 percent of PES patients and more than three quarters of SES patients. State government agencies were trusted by almost half of SES patients, and 38.74 percent of PES patients.

Where primary English speakers favored internet postings and email handouts from trusted sources for their pandemic information, the refugees and other immigrants preferred translated mailed handouts, followed by phone calls in their primary language.

As a result, the researchers developed a brochure covering precautions against COVID-19, symptoms of the virus, and what patients should do if they contract it. They also created a manual for health professionals covering the brochure material in greater depth.

In a second phase of the research, now under way, SES patients at Five Rivers are being given the translated brochure at a visit. Some are also being given verbal instructions about the virus derived from the training manual, Viaud-Murat said. Participants then will take a survey to determine how the brochure and verbal instructions may have changed their knowledge and attitudes. Results of the Phase One survey will be used as the baseline.

These new surveys are designed to gauge the effectiveness of the brochure and verbal instructions in reaching SES patients with COVID-19 information.

“Once we know what works and doesn’t work, we want to expand the research to other cities in the United States and Canada,” Viaud-Murat said.

George said the information can be of continued usefulness in the COVID-19 pandemic, and it also could help to disseminate information to refugees in any future health emergency.

“The goal is to have the framework for next time there’s a need to vaccinate, mask, and implement other health protection measures,” she said.—Tom Byerlein

Last edited on 06/06/2022.