Medicare Prescription Drug Teleconference Training

1
Promoting Medicare Fraud Prevention Among Ethnic
Populations II Developing Culturally
Appropriate Marketing Materials
Drs. Mark Grey and Michele Yehieli University of
Northern Iowa
This presentation was supported in part by a
grant from the Administration on Aging,
Department of Health Human Services. Grantees
under government sponsorship are encouraged to
express freely their findings conclusions.
Therefore, points of view or opinions do not
necessarily represent official Administration on
Aging policy.
2
Presenters

• Dr. Mark Grey
• Professor and Executive Director
• Iowa Center on Immigrant Leadership and
  Integration
• University of Northern Iowa
• Dr. Michele Yehieli
• Associate Professor and Executive Director
• Iowa EXPORT Center on Health Disparities
• University of Northern Iowa

3
Outline of Topics

• Review of Major Themes from the Previous Webinar
• Comment The number 9 in Chinese Language and
  Culture
• Comment Jewish and Other Religions vs.
  Nationality
• Comment Russian Culture and Playing Cards
• Comment Colors, Color Blindness and the Elderly
• Ethnic-Specific Examples of Graphic Design and
  Marketing Latinos/Hispanics
• Designing Simple Graphics
• Conclusion Health Literacy and Medicare Fraud
• References

4
Review
5
Americas Changing Ethnic Landscape

• By the year 2050, demographers predict that
  minorities together will comprise more than 50
  of the US population, with no single group
  representing a majority
• It may be even sooner
• According to 2005 Census estimates
• Whites accounted for only 19 of the nations
  total population growth
• Hispanics continue to be fastest growing group,
  representing almost half of the nations total
  population growth 2004-2005
• Asian population grew by 3
• Black population grew by 1.3
• Native Hawaiians and Pacific Islanders grew by
  1.5

6
Americas Changing Ethnic Landscape

• In 2000, one in four Americans were minorities.
• Already in 2005 1 in 3 U.S. residents were
  non-white minorities!

7
Ethnicity and Identity

• Thinking in terms of ethnicityversus raceis
  critical because it reflects how people
  understand their own identity, rather than using
  their appearance to impose an artificial identity
  on them.
• Identity is the key
• How does one identify with certain symbols,
  colors, photo images, etc.?

8
What Makes an Ethnic Group Ethnic?

• The danger in relying on race to categorize
  people is that it contributes to stereotypes.
• There is always a great deal of ethnic diversity
  among people who otherwise share physical
  characteristics.
• An ethnic group is a group of people recognized
  as a distinct sub-population on the basis of
  certain distinctive characteristics such as
  religion, language spoken at home, ancestry,
  culture or national origin.

9
Cultural Filters

• Cultural filters are used to understand and
  interpret visual and other phenomena.
• Cultural filters are influenced by experience,
  language, values, etc.
• The importance of cultural filters are often
  underestimated or misunderstood.
• How will it play in Peoria may target Middle
  (White) America, but it leaves out entire
  populations

10
Classic Mistakes!

• The history of marketing is replete with examples
  of how assumptions about one-size-fits-all
  marketing campaigns have failed
• Trying to sell the Chevrolet Nova in Mexico
• In Spanish, nova means doesnt go
• Trying to sell life insurance in Asian countries
  that have multi-generation mortgages
• In the US, Harley-Davidson tattoos are as
  American as apple pie
• But in Asia, they are associated with gangsters
• In Europe, these images evoke a negative response
  because of biker gang and neo-Nazi problems

11
Target Marketing Works

• Many in the Medicare Fraud prevention business
  believe they are doing something different from
  (or more important than) marketing.
• But convincing people to pay attention to their
  MSNs and report suspicious claims takes the same
  sort of tools and approaches as convincing
  someone to buy something. It has to appeal to
  people at their gut cultural and ethnic level.

12
Target Marketing Can Dissuade

• This Anti-Smoking advertisement targets African
  Americans
• Of particular interest is the name of the
  sponsor www.whitelies.tv. Not only do the image
  (the dreaded rat) and text (..poison) attempt to
  raise awareness of the dangers of smoking, but
  this ad also plays on widespread mistrust of
  White dominated institutions (Tuskeegee, etc.)

13
Correction The Number 9 in Chinese Language
and Culture
14
Correction

• The number 9 is a good number in Chinese.
• It is a pun for "long time" because the two
  characters have the same pronunciation

15
(No Transcript)
16
Comment Jewish vs. Nationality
17
Ethnic Identity by Religion

• Remember that self-identification of culture can
  go beyond just nationality or the physical traits
  of race.
• For example, some people may prefer to
  self-identify by religion or ethnic group, rather
  than by nationality. At times, the
  self-identification can change and be fluid,
  depending on their point of reference.
• Consider the 4 ethnic groups below that live in
  the United States and usually consider themselves
  American. They have significant cultural
  differences between them, although their physical
  racial differences are usually relatively
  minimal.
• Polish Jews
• Bosnian Muslims
• Irish Catholics
• Old Order Amish

18
Comment Playing Cards and Russian
Culture/Religion
19
Comment Playing Cards and Russian Culture
Some SMP members noted that Russian elderly
people may consider playing with cards
sacrilegious.
20
Comment Colors, Color Blindness and the Elderly
21
Color and the Elderly

• Last week, we discussed the cultural meaning of
  colors
• We now address two issues
• Color blindness
• Color among the Elderly

22
Color Blindness

• The human eye perceives colors as combinations of
  red, green, and blue (plus black and white)
• People missing "red" cones in their eyes cannot
  distinguish lights which produce equal ratios of
  activity in the "green" and "blue cones.
• Similarly, a person missing "green" cones, cannot
  distinguish lights that produce identical
  activity ratio between the "red" and "blue" cones.

Ishihara Test for Color Blindness
23
Bad Color Combination
24
Vision, Colors and the Elderly

• Vision declines with age in several ways, but the
  most relevant for color design is the yellowing
  and darkening of the lens and cornea and the
  shrinking pupil size.
• Yellowing selectively blocks short wavelength
  light, so blues look darker.
• Moreover, the elderly have difficulty
  discriminating colors which differ primarily in
  their blue content
• blue-white, blue-gray, green-blue green,
  red-purple, etc.

25
Vision, Colors and the Elderly

• Aging also reduces the amount of light reaching
  the photoreceptors compared to the young viewer.
• All colors will be dimmer and visual resolution
  lower.
• For example, a moderately bright yellow may
  appear brownish and dimmer blues will appear
  black.
• When designing for the elderly, use bright colors
  and make sure that brightness contrast is
  especially high (and text larger) to help
  compensate for acuity loss.

26
Ethnic-Specific Examples

• Latinos/Hispanics

27
Meaningful Icons
Mexico and the Virgin of Guadalupe
28
The Appearance of the Virgin of Guadalupe in 1531
led to the mass conversion of indigenous people
to Catholicism.
29
A recognized image, but be careful to avoid
contributing to stereotypes
30
Graphic Messages

• Latinos/Hispanics

31
Cartoons Can Be Effective

• Here is an example used by the U.S. Department of
  Justice

32
(No Transcript)
33
(No Transcript)
34
(No Transcript)
35
(No Transcript)
36
(No Transcript)
37
(No Transcript)
38
Target Marketing

• Latinos/Hispanics

39

• Themes
• Family
• Home
• Children
• Security

40
(No Transcript)
41
Simple Graphics

• Using Common Software

42
Tobacco company advertisement in Japanese and
English..from last week
43
? ?
Something suspicious on your Medicare Summary
Notice? Contact Your State SMP Visit the SMP
Locator at www.smpresource.org
44
Pain Scale
45
Insert symbol of theft?
Greenpeace Invoice
46
(No Transcript)
47
Review

• Do the math. We lost 12 billion to Medicare
  fraud last year.
• Think you are the victim of Medicare fraud?
• Call 1-800-423-2449

48

• One out of every ten Medicare dollars are lost to
  waste and fraud.
• Do you suspect fraud?
• Call 1-800-423-2449

49
Ad Council Advertisement RE Cancer
Simple, meaningful image. Black and white.
Handwriting portrays graffiti. Or, the
handwriting is on the wall.
50

• .

An open door to your identification can lead to
Medicare fraud.
If you suspect Medicare fraud, call 1-800-423-2449
51
Do you suspect Medicare fraud?

• ? 1-888-555-1313

Fraud is everybodys business
52
Conclusion

• Medicare Fraud Prevention Marketing
• as a Campaign to Improve
• Health Literacy

53
Low Literacy

• Lower literacy rates can be common challenge when
  working with at-risk clients, particularly if
  they are older or come from certain diverse and
  underserved backgrounds
• May be due to limited educational opportunities
  as child physical impairments that are common
  with aging second language challenges, and
  other factors

54
Health Literacy

• Health Literacy is defined as the degree to
  which individuals have the capacity to obtain,
  process, and understand basic information and
  services needed to make appropriate health
  decisions. (Includes decisions and actions
  related to preventing and recognizing healthcare
  fraud.)
• It is more than a than a measurement of reading
  skills. Also includes writing, listening,
  speaking, arithmetic, and conceptual knowledge
  needed to understand information.
• Even well educated people with strong reading and
  writing skills may have trouble comprehending a
  medical form, following doctor's instructions
  regarding drugs or nutrition regimens, monitoring
  statements for Medicare fraud, etc.

55
Health Literacy

• Nearly half of all American adults--90 million
  people--have difficulty understanding and using
  health information
• Low health literacy associated with
• Poorer health status
• More chronic diseases
• More infectious diseases
• More limited activities of daily living
• Etc.
• Low health literacy can lead to billions of
  dollars in avoidable health care costs and fraud

56
Health Literacy

• IOM recommends a concerted effort by the public
  health and medical care systems, educators, the
  media, and consumers to improve the nation's
  health literacy.
• If patients cannot comprehend information,
  attempts to improve the quality of care, reduce
  health care costs, prevent fraud, lower costs,
  and prevent disparities may fail.
• All elements of health care system, including
  SMPs, AOA staff, and others, should develop and
  support programs to reduce improve health
  literacy and promote understanding

57
Health Literacy

• Example Age Differences Online
• Only 22 of seniors (65) use internet
• Only 14 of seniors (65) seek health info
• Mostly whites with higher incomes/education
• 58 of 50-64 yrs use internet
• Those seniors not using internet are very
  reluctant to start trying do not trust it or
  understand it

58
Health Literacy

• Example Ethnic Class Differences Online
• 75 of Asians that speak English use internet
• 58 of Whites use internet
• 50 of Hispanics use internet
• 43 of Blacks use internet
• 68-75 of households with less than 30,000
  incomes do not use internet
• 57 of rural residents have no internet access,
  compared to about 46 of urban/suburban residents

59
General Guidelines

• Low health literacy can carry negative stigma in
  some societies clients may not want people to
  know they cant read or understand information
• Do not assume that all clients can read or
  comprehend written material
• Avoid temptation of over-reliance on written
  education materials like flyers, brochures, and
  websites to get message across

60
General Guidelines

• Remember to differentiate between the ability to
  read, vs. the ability to comprehend
• Staff should maintain respect and confidentiality
  of clients if they have low literacy rates, and
  interact with them in a non-judgmental way
• Emphasize empowerment and learning through
  alternative means avoid using fear and
  victimization techniques to change behavior and
  increase knowledge

61
General Guidelines

• In general, produce written materials at 6th
  grade reading level or lower, even with literate
  audiences
• Break down complicated messages into step-by-step
  information
• Use simple terms avoid medical language

62
General Guidelines

• Where possible, emphasize face-to-face learning
  techniques, small group educational sessions, and
  the like, rather than just written materials
• Teach in traditional learning style.
• Use real props, videos, radio, television, and
  other non-written forms of communication

63
General Guidelines

• Consider other forms of literacy as well, such as
  cultural literacy and visual literacy
• Avoid temptation to focus just on translation
• Remember that different cultures can have
  different interpretations of
• Words and Fonts
• Colors and Shapes
• Pictures and Images
• Numbers and Dates, etc.

64
General Guidelines

• Have native speakers and focus groups review,
  pre-test, and modify any materials being
  distributed in foreign languages
• Make all written outreach messages culturally
  specific, and try to avoid one-size fits all
  marketing
• Use clients native language in developing
  education and outreach materials

65
General Guidelines

• Remember to target your messages not just to the
  elderly themselves, but also to their adult
  children, extended family members, assisted
  living staff, and others who care for them
• Incorporate target audience members into on-going
  development and evaluation processes
• Ultimately, recognize that improving health
  literacy ALONE will not eliminate healthcare
  fraud must be part of broader comprehensive
  effort

66
References

• L.K. Peterson and C.D. Cullen (2000). Global
  Graphics Color. A Guide to Design with Colors
  for an International Market. Rockport Publishers.
• R. Lipton (2002). Designing Across Cultures How
  to Create Effective Graphics for Diverse Ethnic
  Groups. HOW Design Books.
• J. Krause (2001). Layout Index. HOW Design Books.
  
• A.R. Miller, J.M. Brown and C.D. Cullen (2000).
  Global Design Symbols. Designing with Symbols
  for an International Market. HOW Design Books.

67
References, continued

• C. Tappenden, L. Jefford, and S. Farris (2004).
  Graphic Design. Cassell Illustrated.
• G. D. Finke and C. Warmke (2002). Powerful Page
  Design. HOW Design Books.
• D.E. Carter (2003). The Little Book of Layouts
  Good Designs and Why They Work. Collins Design.

68
References, continued

• C. Fishel (2000). Redesigning Identity. Rockport.
  
• R.Lipton (2002). Information Graphics and Visual
  Clues Communicating Information through Graphic
  Design. Rockport.
• F. Johnston (1981). The Wonder of Guadalupe.
  Liberias Nueva SECAM.

69
Thank you!

• Dr. Mark Grey
• Dr. Michele Yehieli