By NANCY FRAZIER O'BRIEN
For those without a medical home and a familiar health care provider, a visit to the doctor can be a daunting experience.
At a time when hundreds of thousands of Californians may have new health insurance coverage because of the Affordable Care Act and related Medicaid expansion, St. Francis Medical Center in Lynwood, Calif., is helping those in its predominantly Latino community to navigate the health system and better utilize the resources available to them.
The hospital, part of the Daughters of Charity Health System, has about 2,500 participants enrolled in its Vida Sana (Spanish for healthy living) community wellness program, with 840 of them in the patient empowerment module called Health Options for Patient Empowerment and increased enrollment planned for later this year.
"Our community has high rates of uninsured, high poverty and a lot of medical misinformation going around," said Celia Ventura, a nurse educator for the Healthy Community Initiatives program at St. Francis Medical Center.
The 12-week Vida Sana program asks participants to come to one of seven sites in the community — usually a local Catholic church — three times a week, if possible, for an hour of education and an hour of Zumba or another exercise program. Some participants continue with the exercise program even when they have completed the educational segment.
Ventura said the biggest local health problems are "rapidly increasing diabetes" and high blood pressure. Exercise can be a crucial component in staving off or controlling diabetes, she said.
Write it down
But the educational module — developed by the Anthem Blue Cross Foundation and provided to St. Francis Medical Center free of charge — is at the heart of the medical literacy campaign.
Participants receive work sheets to help them prepare for a doctor's visit and are encouraged to write down their questions ahead of time and take notes during the visit. They see reenactments of helpful and unhelpful conversations with a physician. They get guidance about when to consult a primary care provider and when a specialist, community health center, urgent care center or emergency room might be the better choice.
Ana Valdes, a 21-year-old from South Gate, Calif., who recently completed the Vida Sana program but continues to come for the Zumba classes, said she has become more open with people and better able to communicate clearly with her doctor.
"I think the way it explains how to ask questions properly and the idea of writing questions down before you go into the doctor's office is really helpful," she said.
With diabetes on both sides of her family tree, Valdes wants to keep the good health she has and also to help other family members to make the most of their doctor visits.
"Most of them are asking questions, and they don't really understand the answers," she said.
Clear communications
Ventura said many clients have told her that preparing for their appointments ahead of time really helped improve communication with their doctors.
She recalled one woman with diabetes who had been taking her diabetes medications faithfully but had been unable to make clear to her health care providers how she was feeling after taking them. She even changed doctors twice, but only after the medical literacy class was the doctor able to pinpoint that she was experiencing low blood sugar and adjust her medications accordingly.
Although the program is offered in both English and Spanish, 88 percent of the participants are Latino, according to Eduardo Herrara, data coordinator at St. Francis Medical Center.
Vida Sana also helps the Spanish-
speaking clientele to overcome certain cultural beliefs that might be interfering with their medical visits, Ventura said.
"A lot of Hispanic patients believe that asking questions of authority figures is disrespectful," she said, so there is a discussion in class about differences in cultural values. Class attendees who do not feel comfortable with medical terminology in English might need to be reminded to ask in advance that an interpreter be available at their appointment, so that a child or other relative is not put in the inappropriate position of having to translate.
Insurance options
The final step in empowering medical consumers is making sure they understand their health insurance options.
"Some of the clients will be able to qualify for government assistance under the Affordable Care Act," Ventura said.
A health care navigator has come to some classes to assist attendees. Other class participants get information about their health insurance options through the Health Benefits Resource Centers that provide a one-stop information and referral service at St. Francis Medical Center and three other Daughters of Charity Health System hospitals.
Gilda Acosta, director of Healthy Community Initiatives and the Vida Sana program at St. Francis Medical Center, said she hopes the information given to program participants will spread throughout the community.
"We've found that when participants receive understandable and useful information, they share what they've learned with family and friends," she said. "We anticipate that, once learned, managing your own health and your family's health will be a lifelong practice."