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Strengthen the Evidence for Maternal and Child Health Programs

Evidence Tools
MCHbest. NPM 14.1: Smoking in Pregnancy

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Strategy. Culturally Adapted Healthcare

Approach. Support the development of multi-language educational materials about secondhand smoke exposure risk.

Source. Robert Wood Johnson Foundation's What Works for Health (WWFH) Database

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Overview. Culturally adapted health care tailors care to patients’ norms, beliefs, values, language, and literacy skills (Pottie 2013*, Hodge 2010*). Care may delve more deeply into cultural considerations such as social, psychological, and economic factors (Hodge 2010*). Culturally adapted care can include: matching specialists to patients by race or ethnicity (Chowdhary 2014); adapting patient materials to reflect patients’ culture, language, or literacy skills (Pottie 2013*); offering education via community-based health advocates (Cochrane-Attridge 2014*); incorporating norms about faith, food, family, or self-image into patient care; and implementing patient involvement strategies (Kong 2014).

Evidence. Scientifically Supported. There is strong evidence that culturally adapted health care improves health outcomes and health-related knowledge (Cochrane-McCallum 2017*, Cochrane-Attridge 2014*, Pottie 2013*, Hawthorne 2010, Howie-Esquivel 2014) for culturally and linguistically diverse (CALD) patients. There are many types of culturally adapted care, with approaches such as culturally appropriate health education programs (Cochrane-McCallum 2017*, Cochrane-Attridge 2014*), culturally tailored life style interventions (Nierkens 2013, Pottie 2013*), and culturally trained or bilingual health workers (Truong 2014, Pottie 2013*) appearing especially effective. Telephone-based cessation counseling adapted to patients’ linguistic and cultural needs increases smoking cessation more than standard telephone counseling (Nierkens 2013). Interventions that include more counselor contacts and address familial influences can yield stronger effects than less intense interventions (Nierkens 2013). Read more in the WWFH database report. Read more about WWFH's evidence ratings. (*Links to citations can be accessed through the WWFH database).

Target Audience. System.

Outcome. A) Percent of women who smoke during pregnancy; B) Percent of children, ages 0 through 17, who live in households where someone smokes.

Examples from the Field. Access descriptions of ESMs that use this strategy directly or intervention components that align with this strategy. You can use these ESMs to see how other Title V agencies are addressing the NPM.

Sample ESMs. Using the approach “Support the development of multi-language educational materials about secondhand smoke exposure risk,” here are sample ESMs you can use as a model for your own measures using the Results-Based Accountability framework (for suggestions on how to develop programs to support this strategy, see The Role of Title V in Adapting Strategies):

Quadrant 1:
Measuring Quantity of Effort
("What/how much did we do?")

  • Number of Spanish Language fliers about risk of secondhand smoke exposure distributed to parents of newborns.

Quadrant 2:
Measuring Quality of Effort
("How well did we do it?")

  • Percent of Spanish Language fliers about risk of secondhand smoke exposure distributed to parents of newborns.

Quadrant 3:
Measuring Quantity of Effect
("Is anyone better off?")

  • Number of parents of newborns who report increased knowledge of secondhand smoke exposure after receiving Spanish Language flier.

Quadrant 4:
Measuring Quality of Effect
("How are they better off?")

  • Percent of parents of newborns who report smoking cessation after receiving Spanish lanugage educational materials.

Note. When looking at your ESMs, SPMs, or other strategies: (1) move from measuring quantity to quality; (2) move from measuring effort to effect; (3) Quadrant 1 strategies should be used sparingly, when no other data exists; and (4) the most effective measurement combines strategies in all levels, with most in Quadrants 2 and 4.

Learn More. Read how to create stronger ESMs and how to measure ESM impact more meaningfully through Results-Based Accountability.


 

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U02MC31613, MCH Advanced Education Policy, $3.5 M. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.