Evaluation of a Pilot Spanish Language Program for Student Pharmacists.

OBJECTIVE: To present findings from an evaluation of the Spanish Language Track (SLT) for student pharmacists, which assessed student outcomes and feedback. METHODS: A mixed-methods program evaluation was conducted with the first cohort of the SLT members (N = 10). Participants completed pre/post-surveys and focus groups. Quantitative data analysis employed descriptive and frequency analysis, while qualitative data was thematically analyzed. RESULTS: With a focus on qualitative themes, quantitative results support themes one, two, and three based on findings from the self-assessment of participants' ability to speak and use the Spanish Language. Five themes were identified: (1) initial involvement and motivation to engage; (2) language skill development; (3) health-focused language immersion; (4) strong relationships within the SLT cohort; and (5) opportunities for improvement. CONCLUSION: Findings demonstrate students' active engagement with SLT while enhancing language skills through immersive experiences. Their connections with other cohort members, SLT team members, Colombian pharmacists, and bi-weekly patient appointment simulations were key contributors to learning outcomes while offering suggestions for programming. The SLT provides a foundational model for health professional programs to offer students opportunities to understand and practice language-concordant healthcare delivery to promote improved health outcomes in Spanish-speaking populations.

Analysis of Spanish-Language News Reports on Schizophrenia and Psychosis.

OBJECTIVE: Stigma toward individuals with schizophrenia and psychosis has been widely studied in the general population, but research on Spanish-language news media coverage of these mental disorders in the Latinx population is limited. The authors aimed to examine how schizophrenia and psychosis are commonly presented in U.S. Spanish-language news media, focusing on stigmatizing stereotypes, recovery themes, and the use of best practices for reporting on mental health issues. METHODS: A content analysis was conducted of reports from two leading U.S. Spanish-language news outlets, Univision and Telemundo, and from the newspaper database U.S. Hispanic Newsstream. The searches included articles published from August 1, 2012, to August 1, 2022, and included keywords related to schizophrenia and psychosis. RESULTS: In total, 108 news articles were identified and coded. Several types of stigmatizing stereotypes were observed, including portraying a person with schizophrenia or psychosis as violent, suicidal, incompetent, or weak. Only 20 news articles included at least one recovery theme, with educational information about schizophrenia or psychosis being the most common. Most articles used person-first language when referring to people with these conditions, but few articles included information about treatment options or where and how to seek mental health care. CONCLUSIONS: More studies should emphasize the importance of U.S. Spanish-language news outlets offering linguistically and culturally appropriate information on treatment options and where and how to access mental health care. Studies focusing on recovery and treatment for schizophrenia and psychosis are needed to combat public mental health stigma in the Latinx population.

A pilot randomized controlled trial of text messages to improve well-child visit attendance after no-show.

OBJECTIVE: Evaluate the effectiveness of text messages to systematically engage parents/guardians ("caregivers") to reschedule a well-child visit (WCV) that was missed ("no-show") and attend that rescheduled WCV visits. METHODS: Patients <18 years in one of five pediatrics or family medicine clinics, in one health system in the Southeast U.S., were eligible. Patients without a rescheduled WCV after a no-show were randomized into intervention (text messages) or care-as-usual comparison, stratified by language (English/Spanish). Enrollment occurred May-July 2022. Up to three text messages were sent to caregivers one week apart via REDCap and Twilio, advising how to reschedule the missed appointment by phone or health portal. Primary outcomes were (1) rescheduling a WCV within 6 weeks of no-show and (2) completing a rescheduled WCV within 6 weeks. Risk differences (RD) and odds ratios (OR) were used to evaluate the effect of text messages. RESULTS: 720 patients were randomized and analyzed (texts: 361, comparison: 359). The proportion rescheduling WCV after text versus usual care was English: 18.85% vs. 15.02%, respectively, and Spanish: 5.94% vs. 8.14%, with overall RD +1.98% (95% CI: -1.85, 5.81) and OR 1.21 (95% CI: 0.79, 1.84; p-value 0.38). Completed WCV rates in text or usual care were English: 13.08% vs. 6.59%, and Spanish: 5.81% vs. 5.94% with texts associated with RD +2.83% (95% CI: 1.66, 4.00) and OR 1.86 (95% CI: 1.09, 3.19). CONCLUSION: Text message follow-up after a no-show WCV may positively impact attendance at WCVs rescheduled in the subsequent 6 weeks. TRIAL REGISTRATION: ClinicalTrials.gov NCT05086237.

A comparative analysis of Spanish Clinical encoder-based models on NER and classification tasks.

OBJECTIVES: This comparative analysis aims to assess the efficacy of encoder Language Models for clinical tasks in the Spanish language. The primary goal is to identify the most effective resources within this context. IMPORTANCE: This study highlights a critical gap in NLP resources for the Spanish language, particularly in the clinical sector. Given the vast number of Spanish speakers globally and the increasing reliance on electronic health records, developing effective Spanish language models is crucial for both clinical research and healthcare delivery. Our work underscores the urgent need for specialized encoder models in Spanish that can handle clinical data with high accuracy, thus paving the way for advancements in healthcare services and biomedical research for Spanish-speaking populations. MATERIALS AND METHODS: We examined 17 distinct corpora with a focus on clinical tasks. Our evaluation centered on Spanish Language Models and Spanish Clinical Language models (both encoder-based). To ascertain performance, we meticulously benchmarked these models across a curated subset of the corpora. This extensive study involved fine-tuning over 3000 models. RESULTS: Our analysis revealed that the best models are not clinical models, but general-purpose models. Also, the biggest models are not always the best ones. The best-performing model, RigoBERTa 2, obtained an average F1 score of 0.880 across all tasks. DISCUSSION: Our study demonstrates the advantages of dedicated encoder-based Spanish Clinical Language models over generative models. However, the scarcity of diverse corpora, mostly focused on NER tasks, underscores the need for further research. The limited availability of high-performing models emphasizes the urgency for development in this area. CONCLUSION: Through systematic evaluation, we identified the current landscape of encoder Language Models for clinical tasks in the Spanish language. While challenges remain, the availability of curated corpora and models offers a foundation for advancing Spanish Clinical Language models. Future efforts in refining these models are essential to elevate their effectiveness in clinical NLP.

Changes in Cancer Screening Knowledge Among a Prospective Cohort of Spanish-Speaking Hispanic Community Outreach Event Participants in Florida and Puerto Rico.

The current study examined cancer prevention and early detection awareness (pre-workshop) and changes in knowledge (from pre- to post-workshop) among Hispanic/Latino (H/L) community members who participated in Spanish-language educational outreach events in Puerto Rico (PR) and Florida (FL). Spanish-language educational outreach events were comprised of an educational session lasting approximately 45-60 min and were delivered to groups in rural and urban community settings by a single trained community health educator (CHE). The research team assessed sociodemographic characteristics, personal and familial cancer health history, as well as awareness and knowledge (pre-test) of a range of cancer prevention and screening topics. Following the presentation, participants completed a post-test knowledge survey which also measured likelihood of engaging in cancer screening, cancer preventive behaviors, and cancer research as a result of information presented during the session. Change in the average knowledge score was evaluated using a paired samples t-test. Post-session likelihood of completing cancer screening and preventive behaviors and engaging in cancer research were examined using descriptive statistics and group/site comparisons. The percentage reporting awareness of screening procedures ranged from 33% (PSA test) to 79% (mammogram). H/L in PR reported higher percentage of stool blood test awareness when compared to H/L in FL (χ2(1)= 19.20, p<.001). The average knowledge score increased from 5.97 at pre-test to 7.09 at post-test (Cohen's d=0.69). The increase was significant across all participants (t(315)= 12.4, p<.001), as well as within the FL site (t(124)= 6.66, p<.001, d=0.59) and the PR site (t(190)=10.66, p<.001, d=0.77). Results from this study suggest that educational outreach events delivered to H/L community members by a CHE are valuable strategies to address challenges regarding cancer screening knowledge and engagement in multiple behaviors.

Establishing a Spanish-Focused Advance Care Planning Educational Session for Latina Breast Cancer Survivors.

Minoritized groups including Latinos are less engaged in awareness and discussion of advance care planning (ACP) due to the United States English-dominated healthcare system that contributes to systemic inequities related to language and cultural barriers. Explicit interventions, such as a sole Spanish-speaking educational session, may begin discussions of ACP among Latina breast cancer survivors. However, what constitutes a culturally sensitive Spanish-language ACP educational session is currently unknown. To address this need, this current project (1) presented a nurse-led ACP educational session and (2) held a focus group to assess the acceptability of the Spanish-focused ACP educational session to a Spanish-speaking group of Latina breast cancer survivors. Thematic analysis revealed four themes: (1) familial involvement, (2) need for advance care planning education, (3) addressing language and cultural barriers, and (4) culturally sensitive and informative resources. Features of a culturally sensitive Spanish-focused ACP educational session were identified and found to reduce current barriers that hinder ACP conversations in Latina breast cancer survivors.

Spanish Adaptation of the Mentalization Questionnaire (MZQ) in Community Adolescents and Adults / Adaptación Española del Cuestionario de Mentalización (MentalizationQuestionnaire; MZQ) para Adolescentes y Adultos de Población General

Background: Despite the role of mentalization in mental health outcomes and prevention, psychometrically-evaluated screening measures for mentalization remain sparse. One widely-used mentalization questionnaire is the Mentalization Questionnaire (MZQ; Hausberg et al., 2012), which we aimed to adapt and validate for use in Spanish. Method: We adapted the MZQ to European Spanish and evaluated its psychometric properties in both adolescent (n = 389, ages 12-19, M = 14.5) and adult community samples (n = 382, M = 48). Results: Confirmatory factor analysis resulted in a unidimensional structure including all items. This model had better goodness of fit than the original and other adaptations. Invariance analysis showed the same structure in adolescents compared by sex and age, and additionally in the adult versus adolescent samples. Evidence for convergent and discriminant validity was found. Internal consistency values in both adolescents and parents were fair and in the adolescent sample the MZQ scores remained moderately stable after re-test. Conclusions: The Spanish adaptation of the MZQ presents similar evidence of reliability and validity in the adolescent and adult samples. The results support this being a suitable version for evaluating mentalization in the general population.(AU)

Antecedentes: A pesar del creciente reconocimiento de la mentalización como factor en el desarrollo de la salud mental y la prevención, las medidas de cribado validadas psicométricamente siguen siendo escasas. El Cuestionario de Mentalización (MZQ; Hausberg et al., 2012) es uno de los más utilizados. El objetivo es adaptar y validar su uso al español. Método: Adaptamos el MZQ al español europeo en muestras comunitarias de adolescentes (n = 389, edades 12-19, M = 14,5) y de adultos (n = 382, M = 48). Resultados: Se realizó un análisis factorial confirmatorio que expuso una estructura unifactorial para ambas muestras. Este modelo presentó mejores índices de ajuste que los modelos presentados en la versión original y en las adaptaciones. El estudio de invariancia mostró la misma estructura en la muestra de adolescentes cuando se compararon por sexo y edad, y también en la muestra de adultos comparada con la muestra de adolescentes. Se encontraron evidencias de validez convergente y discriminante. Conclusiones: La adaptación del MZQ al español presenta evidencias de validez y fiabilidad similares en la muestra de adolescentes y en la de adultos. Los resultados apoyan que se trata de una versión apta para evaluar la mentalización en población general.(AU)

The role of language in mammography orders among low-income Latinas over a 10-year period.

INTRODUCTION: Latinas in the United States have higher mortality from breast cancer, but longitudinal studies of mammography ordering (a crucial initial step towards screening) in primary care are lacking. METHODS: We conducted an analysis of mammography order rates in Latinas (by language preference) and non-Latina white women (N = 181,755) over a > 10 year period in a multi-state network of community health centers (CHCs). We evaluated two outcomes (ever having a mammogram order and annual rate of mammography orders) using generalized estimating equation modeling. RESULTS: Approximately one-third of all patients had ever had a mammogram order. Among those receiving mammogram orders, English-preferring Latinas had lower mammogram order rates than non-Hispanic white women (RR = 0.92, 95% CI = 0.89-0.95). Spanish-preferring Latinas had higher odds of ever having a mammogram ordered than non-Hispanic whites (odds ratio = 2.12, 95% CI = 2.06-2.18) and, if ever ordered, had a higher rate of annual mammogram orders (rate ratio = 1.53, 95% CI = 1.50-1.56). CONCLUSION: These findings suggest that breast cancer detection barriers in low-income Latinas may not stem from a lack of orders in primary care, but in the subsequent accessibility of receiving ordered services.

Latin American and Caribbean Health Resources: The VHL Regional Portal.

This column provides an overview of the Virtual Health Library (VHL) Regional Portal, a resource provided by Pan American Health Organization and others with the purpose of communicating and exchanging health experiences and information for Latin American and Caribbean countries. The content is organized in four sub-portals: the VHL Model, which describes health information and knowledge management to structures and guides; LILACS, the Latin American and Caribbean Index Health Science Literature; DeCS, Descriptors Health Sciences, a controlled vocabulary; and Training, which gathers and organizes information for librarians, developers, and users who are interested in construction and use of VHL methodologies. An overview of the resource and sample search is discussed.

Healthcare experiences of patients with Down syndrome from primarily Spanish-speaking households.

We report on the health care experiences of individuals with Down syndrome (DS) from families who are primarily Spanish-speaking. Data were collected through three methods: (1) a nationally distributed, 20-item survey, (2) two focus groups with seven family caregivers of individuals with DS who self-identified as living in primarily Spanish speaking households, and (3) 20 interviews with primary care providers (PCPs) who care for patients who are underrepresented minorities. Standard summary statistics were used to analyze the quantitative survey results. Focus group and interview transcripts, as well as an open-ended response question in the survey, were analyzed using qualitative coding methods to identify key themes. Both caregivers and PCPs described how language barriers make giving and receiving quality care difficult. Caregivers additionally described condescending, discriminatory treatment within the medical system and shared feelings of caregiver stress and social isolation. Challenges to care experienced by families of individuals with DS are compounded for Spanish-speaking families, where the ability to build trust with providers and in the health care system may be compromised by cultural and language differences, systemic issues (lack of time or inability to craft more nuanced schedules so that patients with higher needs are offered more time), mistrust, and sometimes, overt racism. Building this trust is critical to improve access to information, care options, and research opportunities, especially for this community that depends on their clinicians and nonprofit groups as trusted messengers. More study is needed to understand how to better reach out to these communities through primary care clinician networks and nonprofit organizations.

The Effect of Language Concordance on Health Care Relationship Trust Score.

INTRODUCTION: Various barriers exist for Limited English Proficient (LEP) patients in the United States healthcare system, including language barriers. To address language access, interpreters have been used as well as physicians who speak the same language (language concordance), with unknown effect. By studying the strength of patient-physician relationships under different communication parameters, such as the use of a variety of language services, we can better understand healthcare interactions and move toward optimizing patient care and health outcomes. This study investigates the importance of language-concordant care in LEP populations to build trusting patient-physician relationships. OBJECTIVE: To determine whether Spanish-speaking patients who receive health care from language-concordant (in this study, Spanish-speaking) physicians have higher total trust scores on the Health Care Relationship (HCR) Trust scale than patients who use professional or ad hoc interpreters. METHODS: This is a prospective survey conducted on Spanish-speaking adult patients coming to family and internal medicine outpatient clinics in the Phoenix, AZ, metro area. Of 214 recruited subjects, 176 completed the survey. Primary outcomes of the study: measured total mean Health Care Relationship (HCR) trust score among three groups (language concordant, professional interpreter, ad hoc interpreter). Secondary outcomes of the study: variance of trust scores among three groups for individual survey items.  Results: The group with language concordant providers had a mean trust score of 48.73, significantly higher than the mean for the group with ad hoc interpreters with a mean of 45.53 (p = 0.0090). Patients with a professional interpreter also had a higher mean trust score of 48.27 than the ad hoc interpreters (p = 0.0119). There were several individual questions where the professional language groups had statistically significantly higher HCR trust scores than the ad hoc interpreter group in terms of their trust in specific instances, i.e., involving the patient in discussing treatment options, making the patient feel worthy of the doctor's time, and their doctor telling them the whole truth. There were no differences in overall mean scores or individual scores for the two professional language groups (language concordant providers and professional interpreters). CONCLUSIONS: The results reinforce the current understanding that professionally acknowledged and trained speakers of a second language in the medical setting allow for the formation of stronger patient-physician relationships, specifically in terms of a patient's trust in their physician. In addition to continuing to increase the availability of high-quality interpreters, the same effort should be placed on increasing the diversity of languages spoken by physicians to foster trusting patient-physician relationship formation.

The utility of limited Spanish proficiency in interpreted genetic counseling sessions.

Professional interpreters are an integral component of healthcare for Spanish-speaking individuals with limited English proficiency (LEP). Research has demonstrated that errors in interpretation are common and can contribute to poor outcomes for Spanish-speaking clients. Providers with some Spanish proficiency may be able to detect clinically significant interpretation errors, potentially limiting negative clinical outcomes and helping to reduce health disparities for clients with LEP. This study aimed to identify the level of Spanish proficiency necessary for genetic counselors to be able to detect a majority of clinically significant errors made by a professional interpreter during a reproductive genetic counseling session. Practicing genetic counselors and genetic counseling graduate students were surveyed regarding their Spanish language background, experience working with interpreters, and self-rated Spanish proficiency. Participants then watched short video clips from three simulated reproductive genetic counseling sessions conducted with a professional interpreter and were tasked with identifying clinically significant interpretation errors. Survey responses were analyzed from 118 participants who met eligibility criteria. Participants who reported "basic" and "fair" Spanish proficiency detected an average of 36.5% and 67% of clinically significant errors, respectively. Those reporting "good" proficiency or higher detected more than 80% of errors. Overall self-rated Spanish proficiency was positively correlated with years of Spanish language education and individual measures of speaking, listening, and reading proficiency, indicating that self-report may be a reasonable measure of proficiency when the goal is error detection in an interpreted session. Genetic counselors with even minimal Spanish proficiency can detect clinically significant interpretation errors, allowing for the correction of these errors during the session. Genetic counselors with "basic" and "fair" may consider genetic counseling-specific Spanish language classes to increase their proficiency to be able to detect a majority of interpretation errors and thereby improve the quality of care and reduce health disparities for Spanish-speaking clients.

Perspectives on Spanish language concordant cancer genetic counseling sessions from the Spanish-speaking population.

Genetic counselors (GCs) provide risk assessment, education, and counseling about the genetic contribution to disease. To do so, they must effectively communicate, build rapport, and help patients make the best decisions for themselves and their families. Language barriers add a complex layer to this patient-provider dynamic. While interpreters serve as a primary solution when a patient and GC speak different languages, issues have been documented with these sessions, such as misinterpreted genetic terminology (Gutierrez et al., 2017). Having a GC with concordant language skills may help address these barriers. The purpose of this study was to assess Spanish-speaking patients' perspectives on communication, decision-making, and the interpersonal relationship developed with a bilingual GC in language concordant cancer genetic counseling sessions. Spanish-speaking patients, ages 18 or older, seen by a Spanish-speaking GC at a California public, safety-net hospital were eligible to participate in this study. Nine participants were interviewed via telephone by the bilingual researcher using a semi-structured interview guide to assess three domains: communication, decision-making, and interpersonal relationship. Analyses of interview transcripts identified themes within these three areas of focus: (1) participants felt all explanations were clear and they were not afraid to ask questions in the session, (2) participants experienced preference-concordant decision making, and (3) participants felt empowered and supported by the GC. Participants suggested that GCs working with Spanish-speaking patients in the future should consider group counseling sessions, engaging in outreach efforts to educate the Spanish-speaking community about genetics, and increasing the number of GCs who speak Spanish. These results demonstrate the positive experiences of Spanish-speaking patients in language concordant cancer genetic counseling sessions and further support the need for recruitment of Spanish-speaking individuals into the profession. Future research should further assess the experience of Spanish-speaking patients in language concordant sessions and address the role of cultural concordance in sessions.

Research on Papua, a digital tool with artificial intelligence in favor of learning and linguistic attitudes towards the learning of the English language in students of Spanish language as L1.

This study examines learners' perceptions of the linguistic and learning potential of an AI-based English language learning app called Papua. The study took a quasi-experimental approach in which 128 students of the degree in Primary Education at the University of Huelva, Spain, gained experience of using the app over a six-week period, and then answered a questionnaire. This was of a quantitative design, and included the following components: attitudes towards learning English; attitudes towards learning oral and written skills, and towards opportunities for interacting in English; and attitudes towards the motivation provided by the app. These attitudes were contrasted according to the variables memory and self-evaluation. The results of the study showed that oral skills were perceived as the most improved skill. Participants also foregrounded the enhancement of memorization of vocabulary, and positively evaluated the self-evaluation feature included in the app.

Training and intrinsic evaluation of lightweight word embeddings for the clinical domain in Spanish.

Resources for Natural Language Processing (NLP) are less numerous for languages different from English. In the clinical domain, where these resources are vital for obtaining new knowledge about human health and diseases, creating new resources for the Spanish language is imperative. One of the most common approaches in NLP is word embeddings, which are dense vector representations of a word, considering the word's context. This vector representation is usually the first step in various NLP tasks, such as text classification or information extraction. Therefore, in order to enrich Spanish language NLP tools, we built a Spanish clinical corpus from waiting list diagnostic suspicions, a biomedical corpus from medical journals, and term sequences sampled from the Unified Medical Language System (UMLS). These three corpora can be used to compute word embeddings models from scratch using Word2vec and fastText algorithms. Furthermore, to validate the quality of the calculated embeddings, we adapted several evaluation datasets in English, including some tests that have not been used in Spanish to the best of our knowledge. These translations were validated by two bilingual clinicians following an ad hoc validation standard for the translation. Even though contextualized word embeddings nowadays receive enormous attention, their calculation and deployment require specialized hardware and giant training corpora. Our static embeddings can be used in clinical applications with limited computational resources. The validation of the intrinsic test we present here can help groups working on static and contextualized word embeddings. We are releasing the training corpus and the embeddings within this publication.

Mexican-Origin Newsmakers: Utilizing Health in La Opinión Microfilm for Data Collecting and Methodology.

The Spanish-language newspaper La Opinión, in microfilm format from the 1960s, shows how the margins of archival repositories are filled with the voices of marginalized communities. Archival data about the Mexican-origin population has proven scarce throughout the twentieth century; not until 1980 was the term "Hispanic" added to the census and the group categorized in governmental repositories. This paper takes the reader on a journey through the depths of the Los Angeles County Library, into the fourth-floor basement where the entirety of La Opinión is stowed away in reels. This paper covers the challenges and rewards of archival research as well as the process of conducting archival research. Equipped with lived experiences in Mexican enclaves in Los Angeles, the researcher recognizes the voice of the community in ads, announcements, political cartoons, and throughout the margins of the newspaper. This article also offers an analysis of the opinions from the community about health care and raises questions of whether health-care services sufficiently met the needs of the community.

El periódico en español La Opinión en formato de microfilm de la década de 1960 muestra cómo los márgenes de los depósitos archivísticos están repletos de las voces de comunidades marginalizadas. Los datos de archivo sobre la población de origen mexicano han resultado ser escasos durante el siglo veinte; no es hasta 1980 que se añadió el término "hispano" al censo y que el grupo fue categorizado en los depósitos gubernamentales. Este trabajo lleva al lector en un viaje por las profundidades de la Biblioteca del Condado de Los Ángeles, en específico el sótano de cuarto piso donde se guarda la totalidad del periódico La Opinión en carretes de microfilm. Este trabajo trata los retos y las recompensas de la investigación archivística así como el proceso de llevarla a cabo. Provisto de experiencias vividas en los enclaves mexicanos de Los Ángeles, la investigadora reconoce la voz de la comunidad en anuncios, declaraciones, caricaturas políticas y en los márgenes del periódico. Este artículo presenta un análisis de las opiniones de la comunidad sobre los servicios médicos y plantea dudas sobre si dichos servicios satisfacían las necesidades de la comunidad.

Delays in autism diagnosis for U.S. Spanish-speaking families: The contribution of appointment availability.

Promoting equity in health services requires an understanding of the mechanisms that produce disparities. Utilizing a sequential, mixed-methods, explanatory study design, we analyzed child-, family-, and organizational-level factors and their association with wait times for an ASD diagnostic evaluation among 353 families scheduled for English and Spanish language appointments (27% Spanish language). A subset of parents and caregivers participated in English and Spanish language focus groups to provide their perspectives on the diagnostic process. Spanish language was associated with greater completion of, and time to evaluations than English language. The only variable found to mediate associations with time-to-evaluation was appointment availability - an organizational factor. Qualitative results elucidate potential explanations for greater Spanish language evaluation completion (e.g., fewer community-based diagnostic options). Results serve as a case study to support the utility and importance of analyzing the influence of organizational-level factors on delays and disparities for childhood health and mental health services. We discuss our findings in relation to strategies that can be widely applied to support equitable services access for childhood diagnostic and intervention services.

Downward National Trends in Mental Health Treatment Offered in Spanish: State Differences by Proportion of Hispanic Residents.

Objective: This study aimed to determine how the prevalence of mental health treatment facilities that offer services in Spanish has changed over time in the United States. Methods: Data from the National Mental Health Services Survey conducted in 2014 (N=13,015 facilities) and 2019 (N=12,345 facilities) were used to measure changes in the proportions of facilities that offered treatment in Spanish overall and by year, state, and proportion of Hispanic residents. Descriptive statistics were used to illustrate state-level changes in services offered in Spanish. Results: Between 2014 and 2019, the national Hispanic population increased by 4.5%, or 5.2 million people. During the same period, the proportion of facilities that offered treatment in Spanish declined by 17.8%, or a loss of 1,163 Spanish-speaking mental health facilities. Overall, 44 states saw a decline in the availability of services in Spanish, despite growth in Hispanic populations across all states. Among states with the fastest Hispanic population growth, several also experienced the greatest reduction in Spanish-language services. Conclusions: The findings indicate that availability of Spanish-language mental health services decreased in most U.S. states during 2014­2019. Promoting mental health service delivery in Spanish is critical for reducing barriers to treatment and ensuring health equity across populations.

Online Health Information Seeking and eHealth Literacy Among Spanish Language-Dominant Latino Adults Receiving Care in a Community Clinic: Secondary Analysis of Pilot Randomized Controlled Trial Data.

BACKGROUND: eHealth literacy is the ability to seek, obtain, and decipher online health information (OHI) for health and disease management. Rapid developments in eHealth (eg, health care services and online information) place increased demands on patients to have high eHealth literacy levels. Yet, greater emphasis on eHealth may disproportionately affect groups with limited eHealth literacy. Cultural background, language, and eHealth literacy are influential considerations affecting health care and information access, health care use, and successful eHealth resource use, and they may influence OHI seeking for behavioral change toward cancer prevention. OBJECTIVE: This study aimed to characterize the extent of OHI seeking and eHealth literacy among Spanish-dominant (SD) Latino adults aged 50 to 75 years. Further, we aimed to examine potential associations between sociodemographic characteristics, Preventive Health Model (PHM) constructs, OHI-seeking behaviors, and eHealth literacy, separately. METHODS: Participants (N=76) self-identified as Latino, were enrolled in a colorectal cancer (CRC) screening intervention, were aged 50 to 75 years, were at average risk for CRC, were not up to date with CRC screening, and preferred receiving health information in Spanish. We describe participants' sociodemographic characteristics, PHM constructs, OHI-seeking behaviors, and eHealth literacy-among those seeking OHI-assessed at enrollment. Descriptive analyses were first performed for all variables. Next, primary univariate logistic analyses explored possible associations with OHI seeking. Finally, using data from those seeking OHI, exploratory univariate analyses sought possible associations with eHealth literacy. RESULTS: A majority (51/76, 67%) of the participants were female, 62% (47/76) reported not having graduated high school, and 41% (31/76) reported being unemployed or having an annual income of less than US $10,000. Additionally, 75% (57/76) of the participants reported not having health insurance. In total, 71% (54/76) of the participants reported not having sought OHI for themselves or others. Univariate logistic regression suggested that higher educational attainment was significantly associated with an increased likelihood of having sought OHI (odds ratio 17.4, 95% CI 2.0-150.7; P=.009). Among those seeking OHI (22/76, 29%), 27% (6/22) were at risk of having low eHealth literacy based on an eHealth Literacy Scale score of less than 26. Among OHI seekers (22/76, 29%), an examination of associations found that higher eHealth literacy was associated with greater self-efficacy for screening with the fecal immunochemical test (ß=1.20, 95% CI 0.14-2.26; P=.02). CONCLUSIONS: Most SD Latino participants had not sought OHI for themselves or others (eg, family or friends), thus potentially limiting access to beneficial online resources. Preliminary findings convey that higher eHealth literacy occurs among those with higher self-efficacy for CRC screening. Findings inform areas of focus for future larger-scale investigations, including further exploration of reasons for not seeking OHI among SD Latino adults and an in-depth look at eHealth literacy and cancer screening behaviors. TRIAL REGISTRATION: ClinicalTrials.gov NCT03078361; https://clinicaltrials.gov/ct2/show/NCT03078361.

A multilevel, low literacy dual language intervention to promote colorectal cancer screening in community clinics in Florida: A randomized controlled trial.

One of the largest disparities in cancer mortality in the United States occurs with colorectal cancer (CRC). The objectives of this multilevel two-arm intervention trial were to compare the efficacy of two interventions to promote CRC screening (CRCS) with fecal immunochemical test (FIT) and examine sociodemographic and psychosocial predictors of FIT screening. Individuals ages 50-75 (n = 326) who were not up-to-date with CRCS, could understand English or Spanish, and were at average CRC risk were recruited from two federally qualified health centers (FQHCs) in Florida. Prior to intervention, CRCS rates in the FQHCs were 27.1% and 32.9%, respectively. Study enrollment occurred April 2018-November 2019. System-level intervention components included leveraging electronic medical record (EMR) systems and delivering patient reminders. Participants were randomized to C-CARES (education+FIT) or C-CARES Plus (C-CARES+personalized coaching [for those not completing FIT within 90 days]). Primary outcome was completed FIT returned <1 year. Primary outcome analyses were performed using logistic regression. 225 participants completed FIT (69.0% [95% CI: 64.0-74.0%]), with no significant difference in FIT uptake by intervention arm (67.3% C-CARES Plus vs. 70.8% C-CARES; p = .49). FIT uptake was significantly higher among patients who received intervention materials in Spanish (77.2%) compared to those who received materials in English (63.2%, p < .01). The personalized coaching in the C-CARES Plus arm did not appear to provide added benefit beyond the C-CARES intervention. Multilevel approaches that include EMR prompts, reminders, FIT access, and provision of low-literacy, language-concordant education can support efforts to improved community clinics' CRCS rates. Future efforts should focus on repeat FIT screening. Trial registration: The trial was registered at ClinicalTrials.gov (NCT03906110).