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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.

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