Margaret (Peg) Allen, MLS-AHIPHmong Health Education Network Coordinator

Presentation will be available at Hmonghealth.org, linked from News

Community Analysis Principles

• Know the Healthcare Consumer– Cultural history; health needs

• Know the Healthcare Environment– Access issues; potential partners

Baker, L. M., & Manbeck, V. (2002). Consumer health information for public librarians. Lanham, Maryland and London: Scarecrow Press.

Project History

• 2001 Hmong Health Information Promotion NLM Subcontract awarded to Northern Wisconsin AHEC

• 2003 – 2004 Hmong Health Education Network funding from NLM Office of Special Populations

• Wausau Community Health Foundation funding for STD Prevention video produced by UW Family Health with distribution support from network

• Wausau Area Hmong Mutual Association (WAHMA) emerged as key partner

Leadership and support from Hmong association critical to credibility with the Hmong community

Wausau Area Hmong Mutual Association & Health (WAHMA)

• Wausau 2000 Needs Assessment– Bridge Community Health Clinic, 1995– Marathon County Director of Minority Affairs:

Thomas Lee

• Office of Minority Health grants 1993 – 1995 English-Hmong Medical Anatomy & Phrase Book/

Aaskiv-Hmoob Tib Neeg Lub Cev & Tshuaj Kho – Included anatomy and medical terminology training

for Hmong medical interpreters

• Presentations to health & social service providers

• Key informant for 2001 proposal

Project Partners, 2001 to date

• Wausau Area Hmong Mutual Association• American Cancer Society • American Red Cross – Marathon County Chapter• AmeriCorps Team - Greater Wausau Area• Aspirus Wausau Hospital• Bridge Community Health Clinic • Children’s Service Society of Wisconsin• Marathon County Health Department• Marathon County Public Library• Marshfield Clinic• Ministry Health Care/Saint Clare's Hospital • The Neighbor’s Place• NorthCentral Technical College• Northern Wisconsin Area Health Education Center• UW-Center for Tobacco Research and Intervention• UW Eau Claire School of Nursing• UW Wausau Family Practice • UW Marathon County & UW Extension• UW Stevens Point • Wausau Family Planning/Health Promotion/WIC• Wausau School District & DPI Early Identification Program• Wausau churches, including First Presbyterian

• Hmong Health Care Professionals Coalition, St. Paul/Minneapolis

• Aurora Health Care – Eastern WI• Gundersen Lutheran Medical Center, La

Crosse• La Crosse County Health Department• WI Department of Workforce

Development • WI Division of Public Health • Wisconsin Literacy• Wisconsin United Coalition of Mutual

Assistance Organizations (WUCMAA)• Hmong National Development • NLM & NN/LM• Refugee Health Information Network

October 2004 to date

• NLM continuation award via Refugee Health Information Network, www.rhin.org

• Health Navigator Program 2005 to date, funded by Ministry Health and Alexander Judd Foundations

• WUCMAA Health Education funding 2005 – 2006 • National Network/Libraries of Medicine Consumer Health &

Exhibit Awards, 2006• NN/LM Health Disparities Subcontract, November 1, 2006 to

June 30, 2008: Website enhancement & multimedia • RHIN funding, July 1, 2008 to June 30, 2009: Hmong Health Education Network: Promoting Hmong Health Literacy

– Hmong Family Health Guide, online and in print– Marketing network and resources

Key Project Staff: Fall 2008

• Peter Yang, Executive Director, Wausau Area Hmong Mutual Association (WAHMA)

• Shu Blong Her & Karl Thoj, Translators,WAHMA• Bao Lee, Web Assistant, WAHMA (AmeriCorps worker & UW

Marathon County student)• Xa Xiong, DC, MD, volunteer Medical Consultant, Aurora Health

Care• Jeff Allen, Technical Consultant, Fossil Designs LLC• Community Health Workers: Pang Moua, Marathon Co. and Mor

Lor, WAHMA• Babs Zehren, Office Manager and Mai Yia Yang, Receptionist,

and all other WAHMA & WNRB staff

Focus on Collaboration

“We need to understand how Western medicine works. And the doctors need to understand our culture.” (Blong Moua, Wausau Daily Herald, July 2, 2003)

Mission The Hmong Health Education Network will develop health information

resources, services and model programs to improve Hmong patient-health professional communication, by focusing on the health literacy of the Hmong population and providers’ understanding of traditional Hmong health beliefs and practices. Our target audiences include providers and interpreters, as well as Hmong leaders and consumers. We will use technology as a tool that can deliver information in formats that can be utilized by all Hmong – not just those with Internet access or reading skills.

Community Analysis:Who are the Hmong?

• Migration from China to Laos – oral traditions, writing new

• Fought for U.S. in Viet Nam War; 34,000 lives lost

• Refugee status Thai camps, 1974 – 2005• Emigration to U.S., Australia & Europe,

1979 – (mostly as refugees)• 15,000 new refugees, 2004 + • Many still trying to leave – ongoing

political issues abroad and in U.S.• Culture clash• Current focus on integration

Relationships, Language & Health

• Extended families– Both parents work, often multiple jobs – In traditional agrarian society, children worked alongside

parents– Hmong speaking grandparents often caregivers for young

children (language at home)

• Elders in clans must be consulted for significant medical decisions– 18 Clans Council

• Health education needs extend beyond patient• Cultural brokering roles

Traditional Healing

• Shamanism• Herbs & traditional

healing practices• Pregnancy practices• Funeral: guiding

souls to afterlife

Partner goal: Balance between Western and Traditional practices

Project Planning & Development

• Hmong Health Steering Committee

• Teams for specific projects

• Virtual communication– Email– Hmong Health listserv– Telephone

Unique Challenges

• Relatively few Hmong/English bilingual resources • Hmong vocabulary does not include many Western foods

or medical concepts• Some resources not appropriate

– Reading level; literal translation– Not culturally relevant

• Lack of appropriate resources to translate/adapt– Reading level– Not culturally relevant; images all non-Asian

• Need to develop our own resources• Very few Hmong providers or health profession students • New generation does not read or write Hmong

Hmong Language (Moob/Hmoob)

Two main dialects:• White• Green (or Blue)

Reference: The Hmong Language by Nachee S. Lee, 2000 www.hmongcenter.org/hmonglanguage2.html

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Key Needs for Health Information

• Bilingual resources• Audiovisual • Prefer English subtitles;

find written Hmong confusing

• Culturally appropriate • Relevant to current

Hmong health Issues

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http://www.unitedhealthfoundation.com/

United Health Foundation campaign: the more you know, the healthier you'll be

1. Ask questions

2. Educate yourself

3. Network with others

Health Literacy Important for ALL

Library Resources needed for Hmong health education

• Portal for finding online and in libraries

• Bilingual resources• Audiovisual – graphics!• Culturally appropriate • Relevant to current Hmong

health issues• Support health education:

clinic, classes, health fairs...

Hmong Health Website

• Website developed with extensive input from Hmong team members

Original embroidery concept rejected –

photos preferred

Quick tour: www.hmonghealth.org

Content Management System (CMS)

Resource goal from 2001: Develop culturally and linguistically appropriate health information resources

• Bilingual model – see poster & www.hmonghealth.org

• Permission to use WAHMA book, but not anatomy drawings

• Challenge to find appropriate resources to translate

• White or Green Hmong?• Are written resources needed?

Appropriate?

Hmong Health Video Resources Team

• Assess needs:– Available videos

– Prioritize topics

• Support video production

STD Prevention Video

• Highest priority topic• Controversial• Translation challenge• Digital production• $10,000 local grant to UW

Wausau Family Practice• In first two years, distributed

114+ videos and 68+ CD-ROMs to more than 80 organizations in 17 states

• NLM funding to convert to DVD & use sections individually

Health Crosses a CultureCancer DVD – 8 parts

• ACS health educator worked with Hmong association and area providers

• Debut: Hmong Language workshop: Finding Cancer Early can Save Your Life, April 26, 2006

Serving size comparison

Heart Health Multi Media

• Goal from first connection with Dr. Gillespie

• First English modules put on HRM site with project funds

• Early photo project

• Scripts culturally adapted

• English on slides

Hmong Family Health Guide

Phau Ntawv Moob Qha Txug Kev Noj Qaab Haus Huv

• Online and print – goal from 2004

• 2008 decision: Both dialects

• Dr. Xa Xiong reviewing translation

• Online in progress; print 2009 by April 3-5 Hmong National Development Conference, Appleton, WI

• Adapted resources, some already translated

• Original anatomy drawings – also in Health illustrations

• Glossary/index as basis for online dictionary

Lessons Learned

• Audience includes Hmong consumers, interpreters and health & social service providers

• Bilingual resources are critical • Culturally appropriate graphics • Internet most appropriate for delivery of resources that can

be downloaded as well as used online• Finding tools are needed – must include resources not

online (books, pamphlets, videos)• NLM, RHIN and partner support vital to success • Time and funding needed for continuing success: Don’t

attempt too much at once

Future Plans

• Match needs with funding organizations - develop proposals with potential partners

• Continue to evaluate all activities• Act local – think global• Collaborative Hmong Health Education Network

– Local Hmong Health Steering Committee on hiatus – Consider relationships with other Hmong organizations:

Hmong National Development Wisconsin United Coalition of Mutual Assistance Organizations

(WUCMAA)

– Virtual network?

Questions?

• Contact pegallen@verizon.net or pegallen67@yahoo.com

• Join Hmong health listserv or others

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