La Clínica del Pueblo: A Model of Collaboration Between a Private Media Broadcasting Corporation and an Academic Medical Center for Health Education for North Carolina Latinos
La Clínica del Pueblo, a health education collaboration between the Maya Angelou Center for Health Equity at Wake Forest University School of Medicine and Qué Pasa Media, Inc., disseminates culturally appropriate health information to the North Carolina (NC) Latino community. The program includes a weekly radio show and corresponding newspaper column addressing four areas: childhood health, adult health, safety, and utilization. The radio show format includes a didactic presentation followed by a call-in question and answer period. Over 200 consecutive weeks of programming have been completed, averaging 11 calls per show. A Latino healthcare resource guide and hotline also provide resource information. Participant demographic information indicates that 50% of the target population comes from Mexico, 60% are women, and 70% of the community is younger than 38 years. There was an increase in the use of the media as a source of health information over the course of the project, from an initial 33% of respondents to 58% in the last survey. Listenership to La Clínica del Pueblo displayed a pronounced increase (18% initial survey to 55% in last survey, P < 0.05). We also observed a statistically significant increase in medical knowledge from initial survey to the last survey (P < 0.001). By multiple regression analysis, we identified 4 predictors of medical knowledge: order of surveys (1 < 3, P < 0.001), education level (P < 0.0001), female gender (P < 0.01) and radio listenership (P < 0.05). The first three variables predicted higher scores; however, radio listening recognition of our radio program was more common among individuals who had lower scores. In conclusion, La Clínica del Pueblo is a model for a novel approach that can reach the Latino community to improve medical knowledge and possibly affect health behaviors in a positive manner.
KeywordsLatino Media Health education Health promotion Survey North Carolina
Migration from Latin America into the United States (US) has increased in recent years. The Census  showed that the Latino population increased more than 50% between 1990 and 2000, comprising 12.5% of the population, and is expected to double by 2050 . In North Carolina (NC), the Latino population increased by more than 500% in the last decade, accounting for 6.3% of the NC population , and is the fastest growing ethnic group in the state .
Latino immigrants face significant challenges related to navigating the US healthcare system. Even those with functional English proficiency have lower health literacy rates  and a greater degree of difficulty communicating with their physicians  than their non-Latino counterparts. These barriers complicate the provision of effective health care and health education.
Latinos in the US also face a variety of health-related concerns. Latinos have a higher prevalence of diabetes  and are more likely to have hypertension and to be obese, regardless of gender , all of which are significant predictors of heart disease. Safety is an important health concern for this population as well; in 2005, 21.2% of all Latino deaths in the state resulted from motor vehicle injuries, many of which were alcohol-related .
All of the above indicate the need of unique, non-traditional programs for health education that are sensitive to the cultural and linguistic needs of this population. Since large numbers of Latino immigrants are undocumented, providing health information through private clinics often reaches only a small segment of the Latino population. Mass media provides an outlet for health education that could reach millions of people in their own homes, cars, or workplaces.
Research demonstrates that health information can be distributed effectively to Latino communities, once considered a “hard to reach” population, via mass media. Gombeski et al.  found that Latinos living in Texas obtain medical information from doctors and from TV and radio. Hu et al.  discovered that Latinos in Baltimore acquire knowledge about HIV from television (42.6%) and radio (19.9%). The 2004 report from the National Council of La Raza’s Institute for Latino Health confirms that, while Latinos get health information by word of mouth, Spanish-language media is one of the best methods to reach them . The “¡Salud!” campaign used radio, television, and print to circulate information to Latino families about the benefits of folic acid with positive outcomes .
In Seattle, Washington, half of those queried preferred radio messages to the television , and listeners of radio-based “Salsa and Salud” indicated that the messages were beneficial and culturally appropriate . It is therefore not surprising that the Director of the Office for Substance Abuse Prevention made a plea to use the broadcast media for prevention of alcohol and drug abuse among Latinos more extensively .
“La Clínica del Pueblo” arose in 2004 as a collaboration between the Maya Angelou Center for Health Equity of Wake Forest University School of Medicine (MACHE) and Que Pasa! Media, Inc., to test the hypothesis that the use of media (radio and newspaper) will increase health knowledge and promote healthy lifestyle choices among Latinos in NC. We used an approach based on the theory of social marketing . The basic premise is that the “packaging” of the product (medical information) with a blend of proper language (Spanish) and a professional communicator (physician) through an accepted vehicle (Que Pasa) would encourage acceptance and hence promote acquisition of the information. The objective of this paper is to describe “La Clínica Del Pueblo” (LCDP) and our findings pertaining to medical knowledge and radio listening among Latinos in NC.
The framework for LCDP is the Social marketing theory, which comprises the design, implementation and control of programs that aim at increasing the acceptability of a social idea or practice in a target group . The underpinning of Social Marketing theory is that people in the target group (the NC Latino community, for LCDP) will adopt new behaviors or ideas if they feel that something of value is exchanged between him/her and the “marketer,” which in this case is the team of investigators. Thus, one of the goals of a social marketer is to meet consumer needs and wants, which can be products (i.e., health education articles, radio show) or ideas (i.e., need to control diabetes) or both. For our project, the assumption is that the social marketing theory can successfully and efficiently be applied to advance a medical cause, which in our project was the acquisition of medical knowledge to enable NC Latinos to lead healthier lifestyles.
Target cities for implementation of LCDP (Greensboro, Winston-Salem, Raleigh, and Durham) were selected according to Latino population density and radio and newspaper reach. A 5-month pre-implementation marketing campaign was employed to raise awareness about the upcoming radio program, including a recognizable logo; advertisements on billboards; flyers in Latino churches, schools, recreational facilities, community centers, and clinics; and inserts in local newspapers.
Sample Program schedule for La Clínica del Pueblo
Adults and Pediatrics
HIV: what now? After diagnosis
Seat belt safety
Adults and Pediatrics
Cardiovascular disease risk factors
Adults and Pediatrics
Prostate cancer—testing and diagnosis
Adults and Pediatrics
Protection from sun and heat
When to use the emergency room
HPV vaccine/cervical cancer
Adults and Pediatrics
Eating healthy on a budget
Substance abuse (alcohol, illicit drugs, Rx drugs, OTC medications)
Adults and Pediatrics
The Radio Program
LCDP radio program is a live, one hour broadcast, with commercial breaks every 13 min. A 10- to 15-min didactic section begins the show, introducing the audience to the weekly topic, followed by a question and answer period of 30–45 min. Live, on-air listener questions are filtered by a bilingual member of the research team (SL), who selects commentaries and questions that are in consonance with the topic of the day. All questions or comments that are not related to the topic of the day are answered post-program by the host.
The program’s host is a bilingual physician (JCE), and many health care professionals, representatives of community agencies, and community members have served as guest hosts. For years 1 and 2 of the project, a bilingual nurse (E. G) served as a co-host on the radio program.
The Newspaper Article
The same day of each broadcast, a corresponding newspaper column is published in Que Pasa newspaper; this article is prepared by healthcare professionals. The PI (JCE) reviews all articles to ensure they are medically suitable, culturally sensitive, and appropriate for the community. All articles are published in Spanish using colloquial language.
Surveys were conducted in Winston-Salem, Greensboro, Raleigh, and Durham in person, in Spanish, among convenience samples of the Latino community by a trained Latina interviewer at 9, 18, and 32 months. The convenience samples were recruited via one-on-one conversations between the interviewer and the community members at their places of work, play, and worship, which helped build trust in this difficult to reach population. The list of specific locations for recruitment was developed by the research team, the interviewer and community members. The methodology used to create and validate the survey has been presented elsewhere . Those surveyed were Latino, greater than 18 years of age, and fluent in Spanish. At the outset of the first interval of survey administration, each participant was requested to provide informed consent. However, data collection efforts proved difficult, demonstrating a 60% refusal rate, since a large segment of those approached did not trust the consent form out of fear of providing identifying data. The project protocol was amended to use a waiver of consent for the second and third intervals of the survey. Results presented in this manuscript pertain to the radio program reach and medical knowledge in the community. Data for healthcare resource utilization and interaction with the healthcare system will be presented in another manuscript.
Complementing the radio and newspaper components, a toll-free hotline allows community members to access health-related resource information (location of free and low-cost clinics in their local area, free preventive healthcare screenings, domestic violence centers, shelters, free dental clinics, and other resources). Study personnel answer the calls during business hours; after-hours, callers can leave a message, which is promptly returned.
Data Collection and Analysis
For the radio show, detailed documentation of program content; names of guest presenters; and number of calls received, nature of questions, and caller demographics are collected. Feedback regarding the newspaper columns and calls to the toll-free hotline are also monitored.
Survey data were coded and compiled in Microsoft Excel (Microsoft Corporation, 2007). Medical knowledge (16 questions) was composed into an aggregate score (number of right answers with a range of 0 to 16). Questions reflected the main areas of health care covered by the radio program and the newspaper articles.
Quantitative survey data were analyzed by a study co-investigator (JH) using SAS Version 9.1 (SAS Institute, 2003). First, univariate analyses using PROC FREQ and chi-square statistics were conducted to measure significance and directionality of relationships between variables. Next, all variables were included in a multiple regression model using PROC REG. The dependent variable in the model was the medical knowledge score; independent variables included age, gender, listenership to LCDP, number of years in the US, education level, and survey year. A p value of less than 0.05 was considered statistically significant.
The Institutional Review Board at Wake Forest University School of Medicine approved this project and provided regulatory oversight.
The first interval of surveys was completed in May 2005 (n = 148), the second in June 2006 (n = 150), and the third in June–July 2007 (n = 150). Because of inconsistencies with data collection and loss of contact with the Survey #2 interviewer, co-investigators deemed data from Survey #2 unusable; hence, all results presented are from Surveys #1 and #3.
Survey Participant Demographics (Table 2)
Demographic characteristics of survey participants
Country of origin
24% El Salvador, Guatemala, Honduras (8% each)
18% Costa Rica and Cuba (9% each)
8% other Latin American countries
60% women, 40% men
70% ≤38 years old
33% <9th grade education, an additional 33% <high school education, 33% >high school
Time in US
70% ≤6 years
Time in NC
78% ≤6 years
22% single, 55% married, 11% divorced, 11% living together
# of adults and children in the home
50% have ≥2 adults in the home, 52% have ≤1 child in the home
Program Reach (Media Utilization)
There was a clear trend demonstrating increased community utilization of the media as a source of health information over the course of the project. In the first survey, 33% of respondents strongly agreed that Spanish language radio and television helped them learn how to take care of their own health and their family’s health. This number rose to 58% in the last survey. Other popular vehicles through which people receive health information were family members (38%), billboards (28%), and hospital or clinic brochures (77%). While overall listenership to Que Pasa Radio itself has remained steady between the first and last surveys (71% Survey #1, versus 69% in Survey #3, P > 0.1), the LCDP radio program listenership displayed a pronounced increase (18% Survey #1, versus 55% in Survey #3, P < 0.05).
Medical Knowledge (Fig. 3)
Predictors of medical knowledge among Latinos in NC from multiple regression analysis
Years at the USA
Traditionally, Spanish-speaking communities have been regarded as “hard to reach” due to several barriers: language, socio-economical disadvantages, low level of education, suspicions of figures of authority, fears of deportation, etc. Moreover, journalism in Mexico (origin of the largest contingent of Hispanic immigrants) has been found to be inconsistent and to oversimplify medical issues, which adds to the distrust of the Latino community in regards to medical information obtained via the mass media .
However, recent publications support the use of mass media for dissemination of appropriate medical information in Spanish, which may have a positive effect on communities for prevention of chronic diseases [10, 11, 16, 20]. The Hispanic Health Media Project supports the findings described in these papers and demonstrates that an academic medical center can effectively disseminate health information by establishing a partnership with a trusted community entity. An indicator of this acceptance is the continuous stream of phone calls that we receive during the radio program and to the hotline.
Our project aimed to increase medical knowledge among members of the NC Hispanic community using social marketing theory , by targeting the perceived needs and values of our audience. Moreover, throughout the years of the program, the topics have been changed by direct consultation with radio listeners and taking into account the questions and messages received. Our survey also helped us glean feedback.
The survey data revealed a substantial increase in the aggregate scores for medical knowledge from the inception and initial implementation to-date. Although it is tempting to attribute the increase to our efforts, the explanation for this increase is not clear. The acquisition of medical knowledge could reflect a secular trend in the target areas and could also be a reflection of exposure to the US healthcare system. However, if this were the case, we would have expected length of residency in the US to have had a demonstrable statistical relation to the scores. Changes in the admixture of migratory populations can occur very rapidly, and it is possible that an influx of more educated Hispanic immigrants to NC could explain the trend in medical knowledge documented by our surveys. Our survey was not designed to capture shifts in population admixture, so this possibility requires further research.
Finally, it is possible that some selection bias influenced the results, given that participants from Survey #1 had to provide informed consent and those from Survey #3 did not. It is possible that a different demographic of individuals were willing to provide consent, thus skewing the results. Our survey did not collect sufficient information to test for this potential bias.
The increased number of phone calls each year during the LCDP program indicates growing name recognition of the program and possible acceptance among the NC Latino community. Thus, it is tempting to speculate that our program has had a contribution to the increase in medical knowledge documented in the surveys. Unfortunately, the surveys were not designed to establish a cause-effect relationship, and future research will be necessary to understand whether the mass media can be used successfully to affect the level of medical knowledge of the NC Hispanic community.
By design, our program reaches a specific target population—that is, individuals who  are able to read the newspaper, and/or  have access to Que Pasa radio. Ideally, however, health information will further be disseminated to friends and family members of the program audience through word-of-mouth. Person-to-person interactions have been demonstrated to be successful in spreading health information in Latino communities [21, 22, 23], as personal contact is largely valued by this culture. Unfortunately, this mode of transmission of medical information cannot be captured with the survey instruments utilized by our project.
We acknowledge some other limitations in our study. All participants lived in a single geographic area (NC), and therefore may not be representative of individuals living in other parts of the US. However, our survey was community-based, which suggests that it reached a broader spectrum of individuals than would be the case if the survey had been clinic-based. Some individuals experienced difficulty understanding several questions, although the interviewer read each one out loud and attempted to explain what the question meant. This process ensured comprehension if the participant was unable to read. Despite these limitations, this is the first community-based survey to assess community knowledge of healthcare utilization for NC Latinos in their own language.
Future directions for expanding this project might include developing a more structured survey that would measure the impact of the radio program specifically on program listeners and measure the resulting increase in health knowledge and health literacy among the NC Latino population as a whole. Moreover, the project could be expanded to other media outlets, such as television, to increase the audience receiving these targeted messages.
New Contribution to the Literature
The Hispanic Health Media Project demonstrated the feasibility and success of a partnership among an academic institution, a private media corporation, and the Latino community for dissemination of health information. The Latino community has adopted LCDP as a trusted resource, as demonstrated by the increasing number of calls during live broadcast, off the air, and to the hotline. Moreover, LCDP radio listenership has increased over the course of the project.
There are many lessons learned and implications for practice that arose from this study. First of all, Latinos in Forsyth County have a reasonable level of general health knowledge, contrary to prevailing stereotypes. Perhaps most importantly, the Spanish-language media plays a critical role in disseminating health information; however, it is seldom used by health care providers. Our data, as well as data collected by others [10, 11, 16, 20] demonstrate that the radio is accepted by the Latino community and can be utilized for purposes of community education. Because of what we have learned, other organizations will be able to adopt our model to benefit Latinos and other vulnerable communities across the nation.
The study was funded by the Kate B. Reynolds Charitable Trust Health Care Division and the Fannie E. Rippel Foundation. The team wishes to thank Dr. Alain Bertoni for extending his statistical expertise to provide oversight for the quantitative data analysis.
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