April 2007

Grant Results

SUMMARY

The Center for Public Service Communications held two meetings of experts on refugee and immigrant health to discuss ways to improve access to culturally and linguistically appropriate health care information among refugee and immigrant communities and their health care providers.

Discussions focused on the development of a Web-based database that individuals and agencies providing health care to refugees and immigrants could access; and the establishment of a Refugee Health Information Network to maintain and sustain the Web site and guide future efforts to improve health care for refugees and immigrants.

Key Recommendations

  • Establish a central repository of culturally and linguistically appropriate health information.
  • Create standards for translation and assessing and developing multilingual and multicultural materials.
  • Reach out to health care providers, community organizations, refugees and immigrants so they are aware of available information.
  • Ensure that the Refugee Health Information Network will be sustained by expanding network partnerships and seeking funding from outside sources.
  • Create a user-friendly Web site; understand the audience and allow users to interact with one another.
  • Maintain a high quality of information on the Web site; develop criteria for selecting materials and keep materials current.

Funding
The Robert Wood Johnson Foundation (RWJF) provided a total of $119,756 in support for the two meetings, which took place in July 2003 and October 2005.

 See Grant Detail & Contact Information
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THE PROBLEM

Refugees and immigrants to the United States often face language and literacy barriers. Such barriers contribute to racial and ethnic disparities in health care according to the 2005 Disparities Report from the Agency for Healthcare Research and Quality.

In 2001, the U.S. Department of Health and Human Services Office of Minority Health issued standards to ensure that all people entering the health care system receive culturally and linguistically appropriate services.

However, most refugee and immigrant health programs are managed at the state level and struggle to meet the federal standards for culturally and linguistically appropriate services, according to Project Director John C. Scott, president of the Center for Public Service Communications, an Arlington, Va., consulting firm.

In addition, because of lack of funding, health providers and organizations concerned with refugee and immigrant health seldom have met to discuss common challenges and share successful strategies in providing health care to these groups, Scott said.

Initial Development of a Refugee Health Information Network

In fall 2002, refugee health coordinators from health departments in Illinois, Massachusetts and Texas met with Scott to discuss ways to gather and share information about refugee and immigrant health.

They proposed creating a network of individuals and agencies providing health care to refugees and immigrants. The core feature of this network would be a central Web-based database of information accessible to everyone.

The group approached the Imaging Science and Information Systems Center at Georgetown University for assistance in developing the concept of a central Web-based database. The center sought funding from the National Library of Medicine for the initial development of the prototype Web site.

The National Library of Medicine provided a grant of approximately $300,000 over three years to Georgetown for this work.

The National Library of Medicine also provided a $200,000 contract to the Center for Public Service Communications, coinciding with the initial three-year grant, to add the state refugee health programs of California and Florida to the initial development process.

It remained clear, however, that two more pieces would be needed to develop the site:

  • More input from those who provide health services to the refugee and immigrant community.
  • More resources to support the creation and maintenance of the Web site.

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RWJF STRATEGY

RWJF has had a long-standing interest in health issues around culturally appropriate care. Its program Opening Doors: a Program to Reduce Sociocultural Barriers to Health Care addressed this issue.

In another RWJF-funded project, faculty at Harvard Medical School's Center for the Study of Culture and Medicine explored the influence and effects of culture and ethnicity on the access to and quality of health care services from an anthropology perspective. See Grant Results on ID# 022031. RWJF also funded two projects addressing the issue of health illiteracy. See Grant Results on ID# 021118 and on ID# 030763.

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THE PROJECT

RWJF provided partial support for two meetings of experts on refugee and immigrant health to discuss ways to improve access to culturally and linguistically appropriate health care information among refugee and immigrant communities and their health care providers.

Together with Scott, one staff member from the National Library of Medicine and refugee health service coordinators from California, Florida, Illinois, Massachusetts and Texas made up the steering committee of the network.

In addition to RWJF support, the U. S. Department of Health and Human Services Office of Minority Health provided $50,000 for the 2003 meeting.

The First Meeting

Approximately 60 people attended the first meeting, which was hosted by the National Library of Medicine in Bethesda, Md., on July 15–16, 2003, and was convened by the Center for Public Service Communications.

Participants included health administrators and providers from immigrant/refugee health divisions of state health departments, voluntary community agencies and community health centers.

Participants met in breakout groups and full-group meetings to discuss:

  • Opportunities and barriers to improving access to health care information among refugee and immigrant communities and their health care providers.
  • Development of a Web-based data base that individuals and agencies providing health care to refugees and immigrants could access.
  • Creation of a formal Refugee Health Information Network to maintain and sustain the Web site and guide future efforts to improve health care for refugees and immigrants.

Over the next two years, work continued on the development of the Web-site prototype under National Library of Medicine funding. The steering committee created a series of work groups to help develop the Web site.

The workgroups focused on:

  • Web site usability
  • Keywords/terminology
  • Interpreting/translation/quality

The Second Meeting

Approximately 60 people attended a second meeting in October 2005 to critique and suggest improvements to a prototype Web-based database.

The meeting was hosted by the National Library of Medicine and convened in Bethesda, Md., October 18–19, 2005, by Health-Equity.Org, a nonprofit organization that serves as fiscal agent of the Refugee Health Information Network.

Participants at the meeting included:

  • Coordinators of immigrant/refugee health divisions of state and county health departments in Minnesota, Utah, Massachusetts, Texas, California, Florida and New York
  • Professionals in language interpretation
  • Web site development specialists
  • Immigrant and refugee health care providers
  • Disaster relief experts.

During the meeting, work groups met to discuss progress on creating a usable, high-quality, easily searchable Web site.

In addition, the project technical manager at Georgetown demonstrated the prototype Web site.

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RECOMMENDATIONS

In a report following the first meeting, Scott, the project director, conveyed participants' recommendations about how to improve the availability of and access to culturally and linguistically appropriate health information. These were:

  • Establish a central repository of culturally and linguistically appropriate health information. Participants endorsed the concept of a national, Web-based database of the materials with a coordinating/managing agency.
  • Create standards for translation and assessing and developing multilingual and multicultural materials.
  • Coordinate efforts to develop appropriate health information for refugees and immigrants to avoid duplication of efforts and ensure high-quality materials.
  • Reach out to health care providers, community organizations and refugees and immigrants so they are aware of available information.
  • Develop an infrastructure to sustain funding and support for continued development and dissemination of culturally and linguistically appropriate health information.

In his final project report, Scott summarized recommendations from participants of the second meeting on how to further develop and sustain the Web-based database:

  • Ensure that the Refugee Health Information Network will be sustained.
    • Expand network partnerships, particularly with state health departments.
    • Prepare a strategic/business plan.
    • Secure funding through sources possibly including the U.S. departments of Defense and Homeland Security.
  • Create a user-friendly Web site.
    • Identify the Web site's audience, possibly to include both providers and consumers via different sections of the site.
    • Design the Web site to be easy to use, including a clear and attractive home page, easy pathways for searching and easily retrievable and readable documents.
    • Create a means for Web site users to interact with one another, particularly for the purpose of providing comments to developers of materials.
    • Expand the "Frequently Asked Questions" section of the Web site.
  • Maintain a high quality of information on the Web site.
    • Ensure the selection of high-quality resources through development of criteria for selecting materials and determining quality.
    • Ensure that Web site resources are kept current by developing indicators for what materials need to be updated and when. Include dates when materials were last reviewed or updated.
    • Promote the development of high-quality resources and offer tools to help develop such materials. Identify best practices/standards/criteria for developing resources.
    • Include easily accessible English translations.
    • Provide information on the Web site about how each resource was developed and evaluated.
    • Include information on the Web site about copyrights. Consider seeking attorney advice on copyright issues.

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AFTER THE GRANT

Lockheed Martin, a private firm with an existing Web-site development contract with the National Library of Medicine, took over continued design and development of the Web site after the grant to Georgetown ended. RHIN® continues to be managed by the Center for Public Service Communications.

Beginning April 2, 2007, interested users can visit RHIN's fully operational Web site.

The National Library of Medicine will continue to support the Web site, and the steering committee will continue to seek funding from additional sources to maintain, improve and expand RHIN services.

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GRANT DETAILS & CONTACT INFORMATION

Project

Refugee Health Information Network

Grantee

Center for Public Service Communications (Arlington,  VA)

  • Symposium on the Availability of Culturally and Linguistically Appropriate Health Services for Refugees and Immigrants
    Amount: $ 53,157
    Dates: April 2003 to July 2003
    ID#:  048340

Grantee

Health-Equity.Org (Arlington,  VA)

  • Convening a Diverse Set of Health Professionals to Review and Provide Guidance to the Refugee Health Information Network
    Amount: $ 66,599
    Dates: August 2005 to January 2006
    ID#:  053555

Contact

John C. Scott, M.S.
(703) 536-5642
jcscott@cpsc.com

Web Site

http://www.rhin.org

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BIBLIOGRAPHY

(Current as of date of this report; as provided by grantee organization; not verified by RWJF; items not available from RWJF.)

World Wide Web Sites

www.rhin.org. The Web site of the Refugee Health Information Network. Includes health information for refugee and immigrant communities and their health care providers.

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Report prepared by: Janet Heroux
Reviewed by: Richard Camer
Reviewed by: Molly McKaughan
Program Officer: Wendy L. Yallowitz

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