"Between Two Ferns" Had It Right

falseWho knew Zack Galifianakis would demonstrate the principles that can help enroll Latinos in the Affordable Care Act?

When The New York Times reported last month on California’s drive to bolster outreach to Latinos and boost enrollment numbers within those communities, a litany of obvious stumbling blocks emerged. And they have been the easiest to remedy: developing Spanish-language application forms, launching a Spanish-language website, hiring more Spanish-speaking voices to answer the phone. But these necessary and overdue steps are also far from sufficient. The more formidable obstacles to Latino enrollment are much more complex, both to understand and to overcome.

The best way to motivate and facilitate behavior change is to start by developing a deep understanding of audiences’ knowledge, attitudes, beliefs and behavior. True understanding can come only from asking the right questions, and listening, without judgment or preconception, to people’s concerns, hopes and fears while respecting their perceptions of what is desirable or possible. Assumptions about any of these are invitations to failure.

Often strategic listening will yield surprising answers. Some policymakers and pundits may believe that enrolling in health insurance is such a self-evidently good idea that simply making as many people aware of the new exchanges as possible is enough. But there are many reasons why someone may not have or want health insurance—costs, lack of access to culturally sensitive care (including the availability of providers, transportation, or time in a day), lack of trust in health care providers or in insurers or government, lack of perceived need, lack of understanding of what health insurance is and how it works, and concerns about immigration and legal status. And that is definitely not the whole list.

Clearly, we need to understand who isn’t enrolling and why. There are lots of barriers to overcome and lots of persuasion that needs to take place before many Latinos—and anyone else—will be motivated to go to a website or pick up the phone. They need to understand their options. They need to believe that the benefits outweigh the costs including money, time and perceived risk. Their fears need to be addressed and their questions answered. They need to trust the people delivering the messages. No small task, but it is possible—by crafting the right messages and having the right messengers deliver them at the right time through the right channels. 

The President’s interview on Between Two Ferns with Zack Galifianakis demonstrated some pretty important principles that work. Using the right channel, in this case a comedy website popular with the target audience, works. Messages addressing such issues as cost, ease of enrollment, and perceived lack of need for health insurance can be clear and engaging.  And having a popular figure, like the offbeat Galifianakis, repeat the message gets attention, and lends credibility.  Visits to Healthcare.gov jumped by 40 percent the day after the interview aired.

In the case of Latinos, messages shouldn’t simply be general information translated into Spanish. More and more ACA advocates are conducting outreach that respects differences in messaging and delivery for various audiences. Messages must be designed to inform—and at times startle—the complacent into awareness and the unsure into action. That means meeting community members where important life decisions are considered—where they live, work, play and pray. In bus and train terminals as they commute to work. At the playgrounds, parks, in the corner stores where they gather, and in their places of worship. Online, on blogs and websites that they read every day, in search engines where they seek out information, and on social networking sites where they chat. In person in neighborhoods and at community events to engage, inspire and spark conversation.

All of this is needed alongside popular traditional media, such as radio, television, newspapers and magazines.  Public health professionals learned long ago that these approaches and collaborating with community health centers, promotores, civic and religious leaders build credibility and local ties that can influence behavior.

In short, listening is the most important tool for enrolling Latinos in health care coverage. And then go find the right ferns.

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Julia Galdo is Managing Director for Health Communication and Social Marketing at AIR.