Latino program improves bone health actions

Wednesday, 26 October 2011 07:08

The ¡Huesos Fuertes Ahora! (Strong Bones Now!) program is a collaborative of community-based organizations that have created a linked and coordinated continuum of culturally competent, accessible services to increase the prevention, identification and treatment of osteoporosis among older Latinos. The partners include the Foundation for Osteoporosis Research and Education, American Bone Health, La Clínica de la Raza, California Hispanic Osteoporosis Foundation and Latino Consultants. Nearly 1,600 older Latinos were screened and 45% of them qualified to enter the program based on their screening results.

The organizations work together to provide ¡Huesos Fuertes Ahora! with expertise in the areas of facilitation, social marketing, osteoporosis prevention, detection and treatment, culturally appropriate clinical services and health education - all working together to fill a critical gap in health care services for older Latinos. The continuum includes outreach and awareness activities, screening events, clinical follow-up and patient support.

Spanish language social marketing through radio, bus shelter posters, and flyers welcomed Latinos aged 50 and over to receive an initial bone density screening of their wrist (peripheral DXA) at outreach events. All screening participants receive education about their screening results and strategies for strengthening and maintaining healthy bones from peer educators called promotores. The promotores receive eight hours of training on osteoporosis prevention, detection and treatment to prepare them to interact with participants at the events.

Latinos who were identified through the screening as "at-risk" for osteoporosis (defined as T-score of -2.0 or lower) were referred to a La Clínica community clinic where they would get clinical follow-up, that included a hip and spine scan (central DXA), and an appointment with a medical provider and a clinical health educator. Home visits and group classes were also part of the patient support offered by the program.

An external evaluation by Professional Evaluation Group from October 2008 through June 2010 (Year 3 data is current being analyzed) collected quantitative and qualitative data from program stakeholders.

Highlights of the program evaluation

Educating Latinos in Contra Costa County about osteoporosis

• The ¡Huesos Fuertes Ahora! program increased knowledge about osteoporosis among La Clínica's administrative, medical and community health staff through multiple trainings, substantially improving their ability to address the bone health needs of their Latino patients.

• The bilingual social marketing campaign resulted in over 6 million media impressions over two program years. The multimedia approach includes a web site, public service announcements, radio/television advertising and broadcasts, promotional posters and fliers – and featured celebrity spokeswoman Dr. Aliza Lifshitz, a respected physician well known in the Latino community.

• Culturally-appropriate materials provide program participants with a bilingual resource for maintaining healthy bones and a roadmap to educate participants on how to follow the program's continuum of care. Extensive field-tests with a sample of the target population verified that the program's educational materials were well liked, useful, easy to understand and informative. In a telephone interview, one program participant told the interviewer, "I still have [the brochure] and check from time to time when I want to remember about what I should be eating and doing".

• La Clínica's Promotores (community health educators) received specialized training to qualify them as bone health educators at program screening events and in their communities. Their growth in terms of confidence, knowledge of osteoporosis and managing logistics at the screening events was a noteworthy program success.

• In the program's second year, more than 90% of screening participants surveyed felt they learned something new about osteoporosis at the event. Pre and post tests indicated an increased understanding of what the term osteoporosis means (66% to 90%) and that osteoporosis is not a normal part of the aging process (31% to 62%). Participants also demonstrated an increased ability to identify critical components of bone health (calcium, vitamin D and exercise) after their results and education.

Providing access to bone density screenings and follow-up care to at-risk older Latinos

• The program implemented a successful campaign to screen older Latinos for low bone density and inform them of their bone health status. 1,564 Latino seniors were screened through 50 outreach events over two years.

• 45% of Latino seniors screened were considered "at-risk" for osteoporosis. This finding supports the growing body of research that indicates osteoporosis is a serious threat for Latinos. One screening participant shared her feelings about her results, "I have a moderate problem. I need to do something because I want to stay healthy".

• Many participants noted the free services as a key benefit of the program. One woman explained, "My husband is already retired and money is a problem for us. For this reason I think the program was very important for us".

• In-depth interviews with participants who went through the whole continuum of care highlighted the benefits of participation. Compared to participants who only went through the initial screening, the full continuum group was more knowledgeable, compliant and passionate about keeping their bones healthy.

Compliance with Treatment Recommendations

• Calcium consumption among screening participants with low bone density rose dramatically, from 34% who took a daily supplement before their screening to 71% one year later (n=122). Of those taking calcium, 77% knew that their calcium supplement contained vitamin D.

• Though not many in the sample had been prescribed pharmaceutical bone medication (n=16), more than 90% of these seniors filled their prescriptions, and one year later, 81% were still taking their medication as prescribed.

• Since the screening event and the education received there, 21% said they had increased the amount of calcium in their diet. Reports of physical activity were equally positive, with 83% of survey respondents reporting physical activity three or more times per week and 14% saying they increased their activity level since the bone density test.

Quote from a ¡Huesos Fuertes Ahora! Program Participant

"I was really lucky to have had the opportunity to learn about osteoporosis. My mother died from a fracture and we didn´t know she had it. Now I can do many things to take care of myself. I think I am more active now, I walk for one hour every day. I feel good! My daughter has come with me to everything, she also has learned. She brings food to our house and now she buys better food."