Abstract:

Introduction:
Lack of understanding of one’s health condition and/or medications and how to take them is associated with poor medication adherence, which can lead to poor health outcomes. As linguistic minorities, Spanish-dominant Hispanics (SDH) in the United States (US) face challenges such as difficulties in obtaining and understanding accurate information about their conditions and its treatment. Traditional health educational methods (e.g., pamphlets, talking) may not be as effective as delivering through alternate venues. Moreover, medical staff and pharmacists may not be bilingual and written materials may not be available in languages other than English. Technology-based health information interventions that are linguistically and culturally appropriate have the potential for being readily available on desktop computers or over the Internet. Our experience in translating HIV interventions in this population provides insight into the process of cultural adaptations and address the new scientific emphasis on ecological validity.

Purpose:
The purpose of this report is to discuss our findings from our previous exploratory study and explicate our methods used to adapt a computer health education application (initially developed for English-speaking persons) that will provide linguistically and culturally appropriate health education for patients with limited English skills using Internet and computer-based applications.

Methods:
An iterative process involving forward and backward translation and a cultural linguistic committee was used to modify interventions. We present strategies used to ensure fidelity in implementing the efficacious core components of evidence based interventions for reducing HIV transmission and drug use behaviors and the challenges posed by making cultural adaptation for participants with low literacy. This experience demonstrates the importance of integrating culturally relevant material in the translation process with intense focus on language and nuance. The process must ensure that the level of intervention is appropriate for the educational level of participants.

Results:
Using findings from our mixed methods study of twenty-five adult patients from a clinic serving the indigent/non-insured Hispanics in South Florida, US, we used the four major themes within cultural contexts relevant to understanding factors related to adherence (i.e., HIV stigma, the role of familia [family], social support, and depression) to develop a culturally and linguistically adapted a tailored intervention. The application provides information about HIV infection, treatment, and medication related problem solving skills that can be delivered using touch-screen computers, tablets, and smartphones.

Discussion:
Culture-specific psychosocial factors and linguistic appropriateness in addition to provision of disease and medication information may favorably affect patient outcomes, particularly with regard to medication adherence. Internet-based eHealth education interventions in that builds on knowledge and also targets core cultural determinants of medication management may prove a highly effective approach to improve health outcomes and medication decision-making in this group. This adaption method can be applied to eHealth health education computer applications designed for non-English language dominant persons living with chronic illness that requires medication management to improve health outcomes.

Keywords:

EHealth, Computer Educational Applications, Linguistic and Cultural adaptation, medication adherence, chronic illness, Health Literacy, Translational Research.