Infant mortality serve as a mode to measure the health in a population. Indiana ranks 45th in the nation for rates of infant mortality in a country that ranks 167th in the world. This public health issue is evident in Hispanic/Latino(a) children in Indiana who are disproportionately at risk. In 2010, Indiana ranked last (33rd of 33) among reporting states for infant mortality among Hispanics. Then, in 2014 the number of Hispanic/Latino(a) children in Indiana who died before age 1 (7.2 infant deaths per 1000 live births) is higher than the national rate (6.1) and the Healthy People 2020 target (6.0). These statistics highlight that the percentage of Hispanic/Latino(a) children in Indiana who died before the age of is significantly higher than those in most U.S. States.
Some of the leading causes of infant deaths among Hispanics are birth defects, followed by preterm birth and low birth weight, accidents, newborn complications and bacterial blood infections. To help mitigate these risks, stakeholders need to effectively communicate proper health education material to it target audience. However the problem is that there is little information known about how to communicate the health education in a way that appropriately resonates with minority (Hispanic) populations. Since there is little knowledge on this topic, this research study collected qualitative data to learn how the Hispanic/Latino(a) community perceives the causes of infant mortality, generated candidate messages to address the holes in understand of this topic in the target audience, then tested candidate messages through rigorous evaluation, and provided an evidence-based video to communicate with the Hispanic/Latino public on interconception, prenatal, and infant health and safety.
A strategic frame analysis was used for this study, which is an evidenced-based strategy that involves a process to map how the public currently thinks about an issues, identifies gaps in the public’s understanding that need reframing, and develops an effective messaging strategy. The study methods for this study were separated into two parts; a descriptive phase and a prescriptive phase. The descriptive phase purpose was to map the values, beleifs and behaviors that comprise the Hispanic/Latino(a) community’s conceptual model of infant mortality. This was done by conducting in-depth qualitative interviews with 10 members of the Hispanic/Latino(a) community. The interviews resulted in identifying the strengths and limitations in the community’s understanding of infant mortality and helped outline areas that need strengthening or clarification. This allowed the research team to generate three possible “explanatory metaphors” that aimed to “quickly and effectively” explain the process of achieving a healthy pregnancy and healthy baby that is culturally relevant and appropriate to the Hispanic/Latino(a) audience.
The prescriptive phase purpose was to develop and test candidate explanatory metaphors among the Hispanic/Latino(a) population to determine which metaphor would accurately and convincingly communicate about the process of achieving a healthy pregnancy and healthy baby. The prescriptive phase entailed two focus groups, a Spanish-English focus group and a Spanish-only focus group. Each group explored perceptions on infant mortality and had discussions on the metaphors and how they relate to healthy pregnancies and healthy babies. The metaphor of the seed was enthusiastically well received in both focus groups. Thus the research group moved forward with the seed metaphor.
The findings from the descriptive phase helped map the values, beliefs, and behaviors of the Hispanic/Latino(a) community on infant mortality. An analysis from the in-depth interviews showed a connection between infant mortality and child abuse. In other words, when the words “infant morality” were mentioned, participants often linked the concept with child abuse. Then, because of underlying belief that infant mortality has something to do with child abuse, participants focused on the role of responsibility in parenting. For example, participants would suggest that keeping children away from external threat, such as open stairwells, and acting quickly if a medical illness or emergency arises, are ways to prevent infant mortality. Prevention of infant mortality was linked to responsibility, readiness to be a parent, and attentiveness. Although responsibility was a strong theme in caring for an infant, there was a failure to connect prenatal health with postpartum outcomes. Majority of the participants did not mention indicators like full-term birth and birth weight as important indicators to healthy pregnancies, even though they are the top contributors to infant mortality among the Hispanic/Latino(a) population.
The goal of this study was to “proactively establish a productive frame for the general public” because “the impact of the communications that follow will be enhanced”. To do so we recommend using the seed metaphor to frame messaging around interconception, prenatal and infant health and safety. The education videos produced to communicate the seed metaphor highlights the following points:
- Care for the soil by maintaining a healthy weight prior to becoming pregnant.
- Don’t plant prior to planting season, meaning use protection when having sex, except when wanting to get pregnant
- Plant in a sunny area by cultivating happy relationships
- Make sure your seed is fertilized by taking prenatal vitamins
- Water the seed by leading a healthy lifestyle
- Tend the garden by meeting with a doctor for prenatal care visits throughout pregnancy
- Protect the plant by using the safety precautions
It is recommended to use this metaphor when discussing interconception, prenatal and infant health and safety and distribute widely. The goal is to broadly disseminate the metaphor so it becomes a common way of thinking and talking about these topics. Ways to do that are as follows:
- Have a plant in patient exam rooms so providers can use this metaphor while discussing the plant as an “object lesson”
- Have the video playing in provider waiting rooms and exam rooms
- Share on social media
- Use in billboards, flyers, and other informational media
- Share on websites
- Record a short version for radio ads (30 seconds)
Other important points to consider when discussing infant mortality with the Hispanic/Latino(a) population are as follows:
- Define infant mortality as the number of children who die before the age of one. The term is not commonly understood, so failure to provide a definition may cause confusion.
- Be explicit that infant mortality does not mean a child has been abused.
- Be explicit about the health indicators most likely to reduce rates of infant mortality among the Hispanic/Latino population: preterm birth, low birth weight, and teenage pregnancy.
- Emphasize the values of love, responsibility and readiness and tie those values to the continum of interconception, prenatal and infant health and safety.
- Try to reduce the stigma of pregnancy or infant loss by indicating that miscarriage and stillbirth still happen, just as bad weather and natural disasters can harm a seed or plant.
- Always include messaging in Spanish.