Project background

Consider these facts:

• Latinos now constitute the largest minority population in the U.S.
• In North Carolina this population increased 400% from 1990-2000—the largest percentage increase in the nation.

Source: U.S. Department of State (January 23, 2003)

Few health care providers speak Spanish, have access to interpreters, or are familiar with Latino cultural norms. These factors undermine the quality of health care services available to this growing immigrant population.

Acutely aware of the communication gap between Latino immigrants and their health care providers, the Office of the Provost at the University of North Carolina at Chapel Hill (UNC-Chapel Hill) set out in January of 2000 to better understand the challenges facing health care providers throughout the state.

Consequently, the Office of the Provost convened an interdisciplinary committee of faculty and staff (Interdisciplinary Development Committee) and charged this group with 1) assessing the need and interest for Spanish language instruction among students in the health professions and practicing health professionals and 2) determining the availability of Spanish language distance learning courses.

To guage the need and interest for Spanish language instruction among UNC-Chapel Hill students, the Committee surveyed over 500 on-campus and distance-degree students in six health science and social work schools (see Spanish for Health Professionals Survey). An overwhelming 92% of these students reported the need and interest for instruction to improve their ability to communicate with Spanish-speaking clients. To assess the need and interest for Spanish language instruction among practicing health professionals, the Committee relied on data collected in 1998 from a questionnaire developed and administered by the Duke Endowment/AHEC Spanish for Health Professionals group to approximately 400 health service providers at hospitals, health departments and community health centers. The results (based on a 20% response rate) indicated a substantial perceived need for Spanish language training for health professionals.

The Committee began searching for existing Spanish language distance learning courses offered at other institutions of higher learning. The Committee discovered several general and discipline-specific Spanish language courses (e.g., Medical Spanish, Business Spanish). One program that repeatedly surfaced was Destinos, a highly popular video-based program used in both classroom settings and for self-paced, individual study. Destinos teaches general Spanish and is designed for beginning- and intermediate-level high school and college students. Very few of the courses the Committee learned about, however, targeted intermediate-level students, had health content, or focused on the Spanish and culture of the recently-arrived Latino immigrant.

A needs assessment (see Executive Summary of the Report on the Development of an Interdisciplinary Distance Course in Spanish Language and Culture for Students in the Health Professions) documenting the Committee's findings was submitted to the Office of the Provost in July of 2000.

Based on these findings, the Committee recommended the development of a distance learning program to teach Spanish language skills and promote cultural awareness within a health context. Given the target audience, the distance learning format offered the most flexible approach to accomodate the hectic schedules of on-campus and distance-degree students and practicing health professionals. The Committee made a determination early-on in the development process that video, comparable to the high-quality video and engaging storyline used in Destinos, would become the centerpiece of the ¡A su salud! program. Whereas Destinos is aimed at a general, beginner-level audience, the ¡A su salud! program focuses specifically on health-related tasks and situations and intermediate-level students.

With initial funding from the Office of the Provost, including distance education funds appropriated by the N.C. General Assembly, and a subsequent $470,000 grant from the Fund for the Improvement of Postsecondary Education (FIPSE), U.S. Department of Education, the ¡A su salud! project has been moving forward on an established timeline. WrayMedia, a production company from Columbia, SC, was contracted to produce the video and program the DVD-based instructional content. The ¡A su salud! program has been evaluated in two pilots and two courses at UNC-Chapel Hill and is scheduled for publication in Fall 2004 by Yale University Press.