Developing Effective
Messages and Materials
for Hispanic/Latino Audiences
Special thanks to Amelie G. Ramirez,
Dr.P.H., and Miguel Baraona, major contributors to the writing of
this document.
Hispanics/Latinos in the United States are a heterogeneous,
complex population with rich internal diversity. They constitute
a multicultural community that is the product of an ongoing
process of simultaneous migration from many different countries,
including Mexico, Cuba, Puerto Rico, and Spain as well as Central
American and other Spanish-speaking Latin American nations. This
process of migration, which has lasted for decades, presumably
will last for decades more.
As indicated by the 1990 Census, the Hispanic/Latino community
is experiencing a fast demographic expansionsix times faster than
the general U.S. population. It is not only the fastest growing
ethnic population in the United States but also the youngest. By
the year 2000, Hispanics/Latinos will make up nearly 11 percent
of the population, with an increasingly large segment of youth.
Rapid demographic growth has been accompanied by positive
educational and economic achievements as well as by a surge in
social problems affecting the Hispanic/Latino community.
Numerous studies indicate that substance use among
Hispanics/Latinos in the United States is increasing,
particularly among youth. This presents new challenges and needs
for prevention of substance abuse problems among a rapidly
growing, changing, and diverse population.
Creative and innovative communication materials and strategies
are needed. How can substance abuse prevention education and
public information initiatives be developed to accommodate the
numerous internal distinctions that exist within the
Hispanic/Latino community? How can effective communication occur
within a community that is neither linguistically nor culturally
homogeneous? How can specific strategies and approaches be
identified to reach a population that includes subgroups with
cultural, racial, religious, ethnic, linguistic, and
socioeconomic differences?
This bulletin provides information to help program planners
meet the challenges of communicating effectively with
Hispanic/Latino audiences.
U.S. Hispanics/Latinos at a Glance
Population: At 24 million, this is the fastest growing
population sector in the United States. Hispanics/Latinos are
estimated to become the country's largest minority group by the
year 2000.
Age: Hispanics/Latinos are younger than the national
average with one in three presently under age 15. In the general
population, this proportion is one in five.
Citizenship: Approximately 60 percent of
Hispanics/Latinos living in this country are U.S. citizens.
Income: More than 70 percent of Hispanic/Latino
families live above the poverty line, although 4 of every 10
Hispanic/Latino children remain impoverished.
Health insurance: Hispanics/Latinos constitute the most
highly employed minority. Almost two-thirds of Hispanic/Latinos
are covered by health insurance, but more than one-third are
without basic coverage.
Education: Hispanics/Latinos are making progress in
educational attainment yet remain the population segment with the
lowest average educational level.
Language: Nearly 95 percent of Hispanics/Latinos
consider it very important to maintain their language and
culture. Almost 70 percent of Hispanics/Latinos over age 5 still
speak Spanish at home.
Health status: The Hispanic/Latino population has a
life expectancy approximately 3 years longer than the total
population (79.1 for Hispanics/Latinos; 75.4 for the total
population in 1990). Health status trends indicate improvements
in infant mortality rates among certain Hispanic/Latino
subgroups, lower smoking prevalence rates among adults, and
increases in breast and cervical cancer screenings among women.
Key areas of health concern for Hispanics/Latinos include
preventing diabetes, adolescent pregnancy, tuberculosis, HIV
infection, violence, and obesity as well as increasing access to
primary health care services.
Sources: 1990 U.S. Census; U.S. DHHS's 1992 and 1993 National
Household Surveys on Drug Abuse; TODOS's 1993, Recommendations
to the Surgeon General To Improve Hispanic/Latino Health.
Follow the Health Communication Process
It is important that any communication programs and materials
designed to reach Hispanic/Latino audiences with substance abuse
problem prevention messages are based on proven health
communication principles, reflect and respond to cultural
diversity, and attain cultural competence. These principles are
embodied in the six-stages of the health communication process:
planning and strategy selection, selecting messages, materials,
and channels, developing materials and pretesting,
implementation, assessing effectiveness, and feedback to refine
the program. Cycling and recycling through the stages will also
help ensure cultural competence through the application of
academic and interpersonal skills that allow for an increased
understanding and appreciation of cultural differences and
similarities within, among, and between groups. Note that
achieving cultural competence requires a willingness and ability
to draw on community-based values and traditions, and to work
with knowledgeable persons from the targeted community or
population in developing strategies, messages, and materials.
The Health Communication Process
1. Planning and Strategy Selection
2. Selecting Messages, Materials, and Channels
3. Developing Materials
and Pretesting
4. Implementation
5. Assessing Effectiveness
6. Feedback To Refine Program
Research the Problem
Begin the health communication planning process with research
to ensure that efforts to reach the target population have an
impact on the substance abuse problems that are addressed.
Gather information about the Hispanic/Latino population from
many sources. Review the literature on the target audience.
Identify national, regional, and local studies that can help
explain the health, social, and other risk factors related to the
substance abuse problems in the Hispanic/Latino community.
Identify any gaps in information. If necessary, gather new data
about the segment of the population that the prevention messages
are intended to reach.
Involve prevention experts, opinion leaders, and other
influential individuals in the Hispanic/Latino community to help
identify the problem and the target audience segments for the
prevention program. Talk with members of the target audience.
Involve them in discussions about substance-abuse-related
concerns, needs, and issues. Ask them how they obtain
information, what they see as the barriers to communicating about
substance abuse problem prevention, and what factors make
receiving and acting on prevention messages easier.
Define the Audience
When program planners simply target "the Hispanic/Latino
community," their efforts may fail. Instead their research
should make it possible to target specific segments of this
community for prevention messages. Remember that the more
specific the segment of the community targeted, the more
successfully the target audience can be reached.
To develop a profile of the target audience, consider
factors such as:
Age and gender
Geographic location
Educational attainment
Socioeconomic level
Health status
Religious practices
Knowledge, attitudes, beliefs, and behaviors related to
substance abuse
Cultural norms and values
Channels of communication
Reasons for immigration and immigration status
Degree of acculturation
Intergenerational issues
Literacy levels.
There are many ways of segmenting the Hispanic/Latino
community. For example, a substance abuse problem prevention
program could be targeted to:
Hispanic/Latino community leaders or Spanish-language
news media
Hispanic/Latino subgroups (e.g., recent, Mexican American
immigrants, Cuban American adolescent males)
Low-income Hispanic/Latino women, 18 to 25 years old, at
risk for substance abuse
Hispanic/Latino youth ages 9 to 13, and their families
(an audience that has achieved even greater importance
with today's rapidly changing youth culture)
Spanish-speaking migrant farmworker populations.
Four Communication Programs Targeting Hispanics/Latinos*
1. The Inside Story Project
University of New Mexico School of Medicine, Albuquerque, NM
Target audience: Low-income, Hispanic/Latino women, 18
to 25 years old, at risk for substance use
Project focus: Discourages the use of alcohol, tobacco,
and drugs during pregnancy through audio and visual prevention
materials.
2. La Esperanza del Valle Project
University of Washington, Yakima Valley, Granger, WA
Target audience: Mexican American migrant farmworkers
Project focus: Promotes substance abuse education and
prevention through telenovelas, radionovelas, and fotonovelas
(soap operas for television, radio, and print media).
3. The Substance Abuse and Media Project
University of Arizona Rural Health Office, Somerton and
Nogales, AZ
Target audience: Young people
Project focus: Teaches students skills they need to
prepare messages on drug use prevention for other youth like
themselves.
4. The ¡Mirame! Look at Me! Project
University of Texas Health Science Center, San Antonio, TX
Target audience: Young Hispanics/Latinos ages 9 to 13
Project focus: Teaches young people the life skills
they need to avoid alcohol, tobacco, and drugs, through use of a
video-based curriculum.
*Funded by the Center for Substance Abuse Prevention,
Substance Abuse and Mental Health Services Administration, U.S.
Department of Health and Human Services
Develop a Relevant Message
To reach and have a significant impact on Hispanic/Latino
audiences, develop an appropriate and culturally relevant message
that is based on thorough knowledge and understanding of the
audience and the community. Given the diversity of the
Hispanic/Latino community, regional and local research is
essential to the development of prevention messages.
Work With Community Leaders
Community gatekeepers (e.g., health care providers, chamber of
commerce members, public personalities, leaders in daily contact
with the community) can help explain local conditions and issues,
which can vary widely depending on local problems, perceptions,
assets, and resources. They can also help develop messages and
materials that will be successful in reaching specific segments
of the Hispanic/Latino community. Research and direct
consultation with members of the target audiences and with those
who can reach and influence them are necessary to establish the
content of messages and the form of materials.
Involve the Target Audience
Testing assumptions and ideas for specific prevention
messages, formats, and languages to use by involving members of
the target audience in discussions is essential. Obtain their
reactions to ideas, sketches, scripts, and other materials in
development. Coordinate with local projects and agencies that are
producing materials for the Hispanic/Latino community. Close
cooperation and an exchange of materials and experiences can
improve understanding of the audience and result in more targeted
and effective prevention messages and materials.
In addition to developing targeted and relevant messages that
appeal to specific segments of the Hispanic/Latino community,
producing prevention materials that express basic messages using
global images and icons that have meaning for all
Hispanics/Latinos is also important. Efforts to discover
commonalities linking the daily life experiences of
Hispanic/Latino people living in different geographical areas and
under different local conditions may broaden the reach of
prevention messages. Such efforts may also be cost-effective.
Lessons Learned from National Programs
The following recommendations reflect lessons learned from
national campaigns and communication programs that have targeted
Hispanics/Latinos:
Always avoid stereotypes.
Promote respect for elders and promote interest in
disappearing traditions.
Listen to and respect youth and promote this attitude
among Hispanic/Latino parents.
Facilitate sharing and discussion of experiences.
Build on the strengths of the Hispanic/Latino community
and its cultural values.
Promote the importance of extended kinship (grandparents,
uncles, aunts, cousins) in family relations. Also promote
nonfamily forms of close integration between individuals,
such as "compadrazgo" (a person who supports
you as a friend; could be similar to a child's
godparents) and friendship.
Promote communal values and neighborly attitudes such as
"barrio"(specific area in the community
and/or neighborhood) fiestas and traditions; and in
general support all forms of extended social networking
that are central to Hispanic/Latino culture.
Encourage general civic values, but also support all
practices and events that promote ethnic cultural pride
and higher self-esteem among Hispanics/Latinos.
Praise and use as role models particular contemporary and
historical heroes and figures who are of specific
significance for each Hispanic/Latino subgroup.
Highlight Hispanic/Latino contributions in the
development of the American nation and in the emergence
of world civilization.
Determine the Form Materials Should Take
Even if a message is developed and has a target population
well motivated and interested in the type of material and
information to be disseminated, this alone may not be
sufficiently powerful to ensure success. Always keep in mind:
Form should not be considered secondary to
content. If the message is not presented in a
form (style, vocabulary, voice, story line) that is clear
and attractive, the content (concepts, values,
perspective) of the materials may be misunderstood or
simply disregarded. An appealing form enhances the
content of messages.
Materials should be informative as well as
appealing. If materials are simply attractive
and entertaining without being truly educational, they
will not help to achieve program goals.
Modern culture is increasingly influenced by
television and other visual media. Visual images
also offer a good opportunity to reverse stereotypes.
Identify appropriate visual images and cultural
symbols. During developmental stages and before
launching visual materials, use working groups as well as
focus groups to pretest the materials.
Good humor and jokes can be used successfully in
visual images to communicate serious messages.
In fact, cartoons are often a powerful form for
delivering prevention messages. But care must be taken to
use humor in a way that is appropriate and sensitive to
the cultural context.
Use Appropriate Language
Because Hispanics/Latinos constitute an essentially bilingual
community, issues of linguistic competence and language use are
of prime importance for those involved in prevention aimed at
this sector of the U.S. population.
All English, All Spanish, or Bilingual?
There is no universal answer. Some communicators feel that all
documents should be bilingual. Others argue that strategic market
segmentation is a more effective strategy for distribution. Here
are some guidelines:
Adapt materials to better fit the needs and specificities
of Hispanics/Latinos. Develop and write the text in both
English and Spanish for bilingual materials. Do not rely
on translations of the English text.
Consider providing both English and Spanish texts in one
document. Cut the length of written English materials by
half so that there is room to write it in both languages.
Look for alternatives to print materials; use oral
messages in both languages whenever possible.
Write messages in English clearly and simply for readers
who are just learning the language.
Remember that the language level of new immigrants is usually
unknown, which makes it difficult to know how best to target this
population. Research in this area is needed to establish more
realistic programs with regard to the use of Spanish and English
in materials for Hispanics/Latinos.
Readability
What should be done if audience members speak mainly Spanish
but do not read it? What if they read both English and Spanish
but are truly literate in neither? Here are some strategies for
enhancing readability:
Use readability formulas, such as the SMOG formula or
Gunning's Fog default.
Develop materials at the appropriate literacy level of
the audience.
Make written materials as brief and clear as possible.
Keep the use of technical jargon to a minimum.
Accompany written material with good visual material.
Ideally, the reader should be able to draw meaning from
every picture.
Explore images and symbols that communicate
pan-Hispanic/Latino concepts. Some of these can be global
cultural icons derived from nature, food, and
celebrations.
Use a type size large enough to be easily read.
Hispanic or Latino?
When is it appropriate to use which term, and when should both
be used? For national materials, such as this bulletin, the
combination "Hispanic/Latino" is probably the most
appropriate and acceptable term. But realize that this practice
may not be as effective at the local level. If materials are
aimed at a local audience, carry out research locally to
determine with which identity, which term, people feel more
comfortable. Another viable way of referring to people is by the
language they speak (e.g., Spanish-speaking people,
Navajo-speaking people). A good working principle: Be as specific
as possible to reach the majority of the target audience.
Colloquialisms
In general, many factors determine the different contexts in
which either colloquialisms or formal Spanish may be used. If a
targeted group constitutes a very wide audience (State and
national levels), Spanish messages should be more formal and
standard.
Although there seems to be no consensus on whether
colloquialisms should be used, many professionals oppose their
use, both in written and oral materials. Common voices are
difficult to achieve given the wide variety of Spanish
colloquialisms used among Hispanics/Latinos. Common wisdom
suggests that it is best to approach each case separately without
attempting to apply a formula mechanically. Ask members of the
target group about specific local or regional dialect expressions
that may be used in more informal conversations.
Careful use of certain colloquialisms makes verbal
messages more realistic and thus more credible.
Certain colloquialisms, such as terms of endearment, may
be more universal/or useful.
Colloquialisms can be more freely used when they are part
of a local message intended for a local audience.
Reasons to avoid using colloquialisms:
Many Hispanic/Latino audiences consider colloquial
language derogatory.
Colloquialisms tend to stress differences among
Hispanics/Latinos rather than emphasize linguistic and
cultural commonalties.
When using colloquialisms, be careful not to use them in
a way that reinforces stereotypes sometimes used in the
mainstream media to depict Hispanics/Latinos.
Plan Ways To Put Materials Into the Community
To get messages across and to promote and distribute materials
successfully, choose appropriate channels of communication and
methods of outreach to the target audience. Strategies for
planning successful outreach activities to Hispanic/Latino groups
include the following:
Plan and design the outreach process carefully, making
sure local leaders and gatekeepers are involved.
Promote and make good use of the positive family and
communal values that are central to traditional
Hispanic/Latino culture.
Respect local and generational charac-teristics, but
place special emphasis on promoting those basic
historical and cultural foundations that unite all
Hispanics/Latinos. Take advantage of the links that bind
the individual to the family, the family to the
community, and the community to the country.
Appropriate Methods of Outreach
Outreach methods and procedures should be tailored to cultural
and generational differences. To ensure that messages get out to
the Hispanic/Latino audience
Learn who the real leaders and gate-keepers of
the community are, gain their support, and get
them to work collabor-atively. Then, let local leaders
and gatekeepers speak for and to their local communities.
Use creative strategies to involve local leaders
and target audiences. For example, in certain
cases, men can be the channel for reaching women, other
relatives, and peers.
Work with organizations/institutions with
programs that focus on family in implementing the
outreach process. For example, clinics, day care
centers, and women's organizations can be of great value
for outreach purposes.
Consider seriously organizations used by the
general population, such as churches and hospitals.
However, churches and hospitals are not always good
inter-mediaries. It depends on local conditions that can
vary greatly from one location or community to another.
Include viable intermediaries and gatekeepers
such as teachers, pharmacies, recreation and civic
associations, fiestas, coaches, sport teams,
corporate leaders, the media, health care providers, lay
folk healers "curanderos," and Hispanic/Latino
elected officials.
Use mass communication media, including
television, radio, VCRs, CDs, newspapers, and
magazines.
Use community access television and
interactive technology as an outreach tool.
Work with "promotoras."
These are active members of a Hispanic/Latino community
who work in close and direct contact with the target
population in promoting values and preventive measures.
"Promotoras" are lay people who receive
instruction in the art and ways of promoting safe and
successful attitudes toward the more immediate and
pervasive health challenges and dangers faced by the
Hispanic/Latino community. They work at the grassroots
level and are probably the most effective type of
intermediary. Several Latin American countries have
successfully experimented with this type of intermediary
action.
Media Channels for Reaching Hispanic/Latino Groups
Mass media channels offer many opportunities for reaching
Hispanic/Latino audiences.
For effective delivery of messages, consider the following:
Videos in Spanish seem particularly viable. Recent
studies indicate that most Hispanic/Latino households in
the United States have VCRs. The U.S. market for videos
in Spanish is also rapidly expanding.
Novelas (soap operas) are of paramount importance in
modern Hispanic/Latino culture. An effort should be made
to incorporate implicit prevention messages in novelas.
Talk shows are becoming popular among Hispanic/Latino
audiences.
Because repetition of a message is essential for
reinforcement, ensuring that the audience receives long-term
exposure to materials assumes strategic importance. But the high
cost of developing materials for distribution and of their
repeated exposure through mass media, especially television,
should be considered before deciding to reach Hispanic/Latino
audiences through such channels. Distribution and marketing of
Hispanic/Latino media materials have yet to be well defined and
improved.
Evaluate the Effectiveness of Messages and Materials
The ability to pique the target population's interest is not
proof that the materials are successful. To be effective,
products not only must be appealing, but they must also be
understood. Above all, they have to elicit some kind of action.
In testing whether the materials meet these
objectives, methodologies based on social marketing approaches
can be of great value:
Conduct preliminary formative research to determine the
needs of the target population and the best means to
reach this audience.
Develop and pretest the appropriate message and
materials.
After disseminating and promoting the materials, conduct
an evaluation to determine the results or outcomes of the
prevention messages.
To assess the impact of the materials on people's
daily lives and the value and relevancy of the materials to
individuals and their families, ask:
Who is using the material? Are they a part of the target
group?
How is the material being used? Is this the way it was
intended to be used?
Is the effort prompting the target audience to do
anything different? If so, what? If not, why not?
Even when resources are limited, it is possible to incorporate
into the evaluation plan collecting data, pretesting with focus
groups, and monitoring implementation of program goals and
objectives.
The evaluation methods and process selected depend not only on
the resources available but also on cultural considerations. Care
should be taken to build in appropriate resources for evaluation.
But even greater care should be taken to select and apply
evaluation methods and tools that are sensitive to cultural and
other factors specific to the Hispanic/Latino community. For
example, designing a survey instrument that requires written
responses may not be useful or effective in evaluating the
results of prevention messages with recent Hispanic/Latino
immigrant groups with low levels of literacy. It may also
indicate a lack of cultural sensitivity by the evaluator.
Evaluation results will enable the reassessment and refinement
of ongoing health communication planning efforts to ensure that
the substance abuse problem prevention messages and materials
developed for Hispanic/Latino audiences are increasingly relevant
and more effective.
Reference/Resources
Center for Substance Abuse Prevention (CSAP). Hispanic
Americans Prevention Resource Guide, 1992. Available from the
National Clearinghouse for Alcohol and Drug Information (NCADI).
Center for Substance Abuse Prevention. Technical Assistance
Bulletins. The following titles in the series are especially
relevant and are available from NCADI:
Identifying the Target Audience, 1997.
A Key Step In Developing Prevention Materials Is To Obtain
Expert and Gatekeeper Reviews, 1994.
Pretesting Is Essential; You Can Choose From Various
Methods, 1994.
You Can Avoid Common Errors As You Develop Prevention
Materials, 1994.
You Can Prepare Easy-To-Read Materials, 1994. Provides
information on how to apply the SMOG readability formula.
You Can Use Communications Principles To Create Culturally
Sensitive and Effective Materials, 1994.
Center for Substance Abuse Prevention. Cultural Competence
Series. The Challenge of Participatory Research: Preventing
Alcohol-Related Problems in Ethnic Communities, 1995.
Available from NCADI.
Center for Substance Abuse Prevention. Cultural Competence
Series. A Hispanic/Latino Family Approach to Substance Abuse
Prevention, 1995. Available from NCADI.
Center for Substance Abuse Prevention. Hispanic/Latino
Natural Support Systems. Implementation Guide, 1995.
Available from NCADI.
Hernandez, S., Newman L. The choice of language when
advocating to Hispanics. Business Link 1990; Winter.
National Clearinghouse for Alcohol and Drug Information
(NCADI), P.O. Box 2345, Rockville, MD 20852, (301) 468-2600 or
(800) 729-6686, TDD (800) 487-4889. Internet World Wide Web
address: http://ncadi.samhsa.gov. Provides information on substance
abuse research literature, programs, and educational materials.
National Coalition of Hispanic Health and Human Services
Organizations (COSSMHO), 1030 15th Street, NW, Room 1053,
Washington, DC 20005, (202) 387-5000.
National Council of La Raza, 20 F Street, NW, 2nd Floor,
Washington, DC 20001, (202) 628-9600.
National Hispanic Families Against Drug Abuse, 1511 K Street,
NW, Suite 1026, Washington, DC 20007, (202) 393-5136.
Office of Cancer Communications, National Cancer Institute. Clear
and Simple: Developing Effective Print Materials for Low-Literate
Readers, 1994. To order contact NCI's Cancer Information
Service at 1-800-4-CANCER.
Office of Cancer Communications, National Cancer Institute. Making
Health Communication Programs Work: A Planners Guide, 1989.
Provides information on all aspects of health communications
including readability and pretesting. To order, call
1-800-4-CANCER.
Together Organized Diligently Offering Solidarity. Todos
Organizados Diligentemente Ofreciendo Solidaridad (TODOS). Recommendations
to the Surgeon General To Improve Hispanic/Latino Health, June
1993.
U.S. Department of Health and Human Services. National
Household Survey on Drug Abuse: Population Estimates 1992. Available
from NCADI.
U.S Department of Health and Human Services. National
Household Survey on Drug Abuse: Population Estimates 1993. Available
from NCADI.
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