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Spring 2015

GIP in Focus

A Spanish Asthma Action Plan—!Se Necesita!

Imagine for a moment that you are new to this country—you speak a bit of English but are fluent in Spanish—and your seven-year-old has asthma that flares up frequently.

What you need is help getting her asthma under control so that both of you can sleep through the night and she can be ready to learn and you can be ready to work. The Asthma Action Plan (AAP) that you have, however, is in English. And though you’re capable of reading it, you’re still confused about what needs to be done every day.

What next?

Mother helps daughter use inhaler with spacer

If you live in Connecticut you can turn to the Asthma Center at Connecticut Children’s Medical Center in Hartford. The Asthma Center’s Asthma Action Plans—called asthma treatment plans—come not just in Spanish but also in six other languages including Arabic, Bosnian, and Mandarin.

AAPs are written plans developed specifically for each patient in partnership with the health care provider, providing instructions for asthma management ranging from daily actions, such as what kind of medication to take and when, to guidance on when to call your doctor or go to the emergency room. These plans are a key component of helping bring a patient’s asthma under control—and keeping it that way.

And when the plans are not understood, the result can mean increased visits to the emergency department and hospitalizations, which are a strain and financial drain on families and health care providers, not to mention the physical and emotional toll that they take on the person with asthma.

Michelle M. Cloutier, M.D., a pediatric pulmonologist for the Asthma Center, reports that of its 41,000 Hartford-based patients, 42% are Latino and one in three does not speak English. That’s why all of the center’s asthma resources for Spanish-speaking patients, including its AAP, have been adapted to and rigorously field-tested in Spanish.

Through this process Dr. Cloutier and her team discovered that the standard procedure of translating from English to Spanish and back to English is not enough.

“Translation is important but is not sufficient. We found that many times the families could read the instructions but they did not understand what action was being requested of them,” stated Cloutier during a Nov. 4 webinar on bridging asthma disparities in the Latino community. “Materials needed to be culturally relevant as well as account for literacy.”

Asthma Action Plan page in Spanish training manual

Dr. Cloutier recounted changing a drawing in one of the center’s materials based upon reader feedback that part of the drawing was confusing.

“If you never ask, you will never know,” said Cloutier.

It is these types of details that were considered in the development—and tested with the target audiences—of the National Heart, Lung, and Blood Institute’s (NHLBI) new A Breath of Life/Respirar es vida asthma-education resources.

These resources include a Spanish-language Asthma Action Plan, and seek to train both the Latino parents of children with asthma and the community health workers/promotores who reach many of them.

“We knew from experience that the promotores had the passion, the compassion, the cultural knowledge, and other sensitivities needed to help Latino families get their children’s asthma under control using a Spanish-language Asthma Action Plan in conjunction with our other resources,” said Gloria Ortiz, M.S., a key member of the NHLBI team that developed the materials.

Dr. Cloutier also has high praise for community health workers, and believes that having NHLBI materials to train them about asthma will prove invaluable.

“These are exactly the kinds of materials that are critical to providing a high-level of professionally appropriate education to community health workers to help them work with families,” said Cloutier.

The new Spanish AAP is already available online.

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Last Updated May 2015