Picture Postcard Worth a Thousand Words as Multicultural Health Literacy Tool
Cigna's Multicultural Communications Workgroup teamed with case management nurses and Cigna's Health Disparity Council to create a pictorial postcard campaign which is successfully helping Cigna's Haitian customers get the full benefit of their health insurance and improve health outcomes. Michele Wolff-Poitevien, tri-lingual case management nurse for Cigna in Orlando, FL has a large number of Haitian customers. When those customers experienced a serious medical issue or hospitalization, she found it difficult to connect with them by phone for medical follow-up. When this occurs, the usual approach is to send a follow-up letter—written in English. Frustrated and concerned that this approach wasn't working; Wolff-Poitevien highlighted the communications issue with Cigna's Multicultural Communications Workgroup lead, Crystal Duran.
Wolff-Poitevien, Duran and other members of Cigna's Health Disparity Council researched the issue. Their findings uncovered that their Haitian customers often do not understand what case management is and why it's important. Research also showed this population will not answer a call from an unknown caller like an 800 number. In addition they learned these customers often can't read print communications, in any language. Other challenges found included preference for Creole or French communications; stigma for receiving care; decision making role not held by the patient; limited understanding of health plan covered benefits and services; very low preventive care use and high use of the emergency room and hospital services.
Determined to overcome these barriers creating a problematic health disparity for the Haitian customer base, the team employed health literacy tactics to create a culturally-tailored, pictorial postcard campaign asking customers to call a Cigna nurse case manager.
"The pictures convey the simple call to action relying on the graphic image, a picture of a nurse with a telephone, to convey the message. Also, a very short message is written on the back of the postcard in three languages--French, Creole and English. The postcard is also visually appealing and doesn't require opening an envelope. The case manager mails the card whenever a customer cannot be reached through phone contact," explains Duran.
Duran and Wolff-Poitevien worked with a translator to ensure the word choices were culturally appropriate for each language. Significant care was given to selecting culturally tailored colors, words and images. Interestingly, the traditional nurse's cap image used on the postcard, considered an outdated image of a nurse in the U.S. today, is still prevalent in Haiti. This image resonates with this specific Haitian audience. Finally, the postcard format was selected because it's readily visible in their preferred language without the barrier of an envelope.
The objectives of the project, which was first addressed in 2010, implemented in 2011 and ongoing today are to:
1) Increase the number of Haitian customers who are contacted by the case manager.
2) Improve the Haitian customer's experience and awareness of health plan services available to them.
3) Improve the customer's ability to manage his/her health condition which initiated the need for case management.
While longer-term use measurements will be studied, initial results show success with all three objectives and savings in health care costs.
Editor's Note: October marks Health Literacy month. Health literacy is one of four key focus areas of Cigna Connects, our new corporate responsibility initiative and is a 24/7/365 effort at Cigna. Find more information on Cigna's health literacy work in the “Let's Be Clear—Your Real World Guide to Health Insurance” section of our website: http://newsroom.cigna.com/letsbeclear
Cigna Corporation (NYSE: CI) is a global health service company dedicated to helping people improve their health, well-being and sense of security. All products and services are provided by or through operating subsidiaries of Cigna Corporation, including Connecticut General Life Insurance Company, Cigna Health and Life Insurance Company, Life Insurance Company of North America and Cigna Life Insurance Company of New York. Such products and services include an integrated suite of health services, such as medical, dental, behavioral health, pharmacy, vision, supplemental benefits, and other related products including group life, accident and disability insurance. Cigna maintains sales capability in 30 countries and jurisdictions, and has approximately 71 million customer relationships throughout the world. To learn more about Cigna®, including links to follow us on Facebook or Twitter, visit www.cigna.com.