Environmental Health Education in Underserved Hispanic Communities

The focus of this study was to use environmental health education to improve topic-specific health literacy in two underserved Hispanic communities, Webb County and San Antonio. Hispanic communities may have disparities in income, health care, pesticide use, and access to health information when compared to non-Hispanic communities. The education intervention topics, pesticides and nutrition, were topics of relevance to participants in these communities. Promotoras delivered the health education interventions and assessments. Assessments of knowledge, attitudes, and behaviors were given to participants prior to, immediately after, and several months after the health education intervention. These repeated measures assessed change and persistence of change following the message. Paired t-tests, McNemar’s chi square, and Wilcoxon sign rank test were used to assess significance of change in the repeated measures. Between-community differences were assessed with Wilcoxon rank sum tests. One community, San Antonio, was in an urban setting, while the other community in Webb County was functionally rural despite the location near Laredo. The demographics of the participants from the two study communities were very similar in gender, country of origin, education status, employment status of self and spouse, and language. Participants in the two study communities reported similar pests, household pesticide use, continuing pest problems, planned household pesticide use, and past use of illegal pesticides. In Webb County, the mean summed pesticide knowledge pre-test score was 13.68 (98.33% CI: 13.24, 14.13). The summed knowledge scores for the knowledge assessment after the module were 15.92 (98.33% CI: 15.58, 16.25) in Webb County and 15.36 (98.33% CI: 14.90, 15.82) in San Antonio. There were also statistically significant changes in some attitudes and behaviors regarding pesticides in both communities; however, the communities had different baseline attitudes and behaviors. For the nutrition intervention in San Antonio there was an increase of 0.92 (98.33% CI: 0.28, 1.56) points between the pre-test and immediate post-test, an almost 10% increase in the mean participant score following the module. Between the pre-test and three month post-test, there was a 0.54 (98.33%CI: -0.21, 1.28) point increase in mean knowledge score on the three month post-test when compared to the pre-test. The results suggest that pesticide health education can change attitudes and behaviors regarding pesticides. The nutrition module resulted in significant immediate changes in knowledge, but not in the long-term. However, there were long-term changes in some attitudes and behaviors following the nutrition module. Additionally, the Webb County pesticide intervention results suggest that even with linguistically and culturally appropriate promotora driven interventions, evaluation and education modules should be developed taking into account the baseline knowledge, attitudes, and behaviors of the community