• by Beatriz Mallory , Columnist, October 10, 2017

We weren’t prepared for tears in this routine focus group, testing a television campaign for a health care system. Seven Spanish-speaking Los Angeles residents were just introducing themselves, when one broke down crying. She shared being undocumented after 24 years in the U.S. The others in the group squirmed uncomfortably. The moderator moved to the next participant, but the uneasiness lingered. 

Anxiety about deportation is having significant negative effects on immigrants' health and health care use. The Trump administration's more aggressive policy of detaining and deporting undocumented immigrants is posing new challenges for health care providers serving immigrant communities. Thus, long-planned advertising campaigns targeting the less-acculturated Hispanic consumer may not perform to plan.

Clinics serving immigrants report a downturn in appointments since the crackdown. Two-thirds of respondents in a recent national poll of providers by Migrant Clinicians Network said they had seen reluctance among patients to seek health care.

It is time to recognize that marketing and communications designed to change Hispanic immigrants’ health behaviors face a new environment. Messaging and tactics need to directly reassure and inform these skittish consumers, actively encouraging them to remain within the continuum of care. 

Immigrant patients were making fewer appointments and avoiding follow-up visits just months after the signing of Executive Order 13768. Community health center leaders and hospital emergency physicians attribute this to heightened patient fears of leaving home and risking detention and deportation by Immigration and Customs Enforcement (ICE) agents. This means chronic conditions could worsen and infectious diseases might go untreated.

ICE officials have traditionally defined medical centers as “sensitive locations,” like schools and places of worship, which federal agents usually would not enter except in “exigent circumstances.” Regardless, there are few efforts to make these concepts clear to immigrants, so they still fear going to the doctor.

In one week in Santa Rosa, Calif., twice as many patients as normal canceled their appointments at the Alliance Medical Center because they feared a raid by ICE agents, according to CEO Alex Armstrong. 

In February in Brooklyn, N.Y., rumors of ICE agents prowling the halls of the Kings County Hospital led patients to cancel appointments. 

These stories and other recent reports bring home the magnitude of the fear dominating the Hispanic immigrant community, its adverse impacts on the patients served, and the need for Hispanic health care marketers to recognize its potential impact on strategy and execution. 

How do we address these growing concerns? 

Here are six ideas that may support a more immediately relevant, reassuring, and more precisely targeted messaging.

1. Identify, catalog and empathize with the direct impacts on health. How are individuals and families coping with this uncertainty? Are they coping at all? How is stress affecting their lives and relationships? Answers can come from ongoing ethnographic research and developing and consulting consumer advisory boards.

2. Pay attention to access. Understand the realities of the target consumers’ access to health care, resources that reinforce positive health behaviors like supermarkets within walking distance or private transportation that limits exposure at bus stops.

3. Get help from the community. Map and leverage influencers. Communicate and partner with organizations and resources used by Hispanic immigrants — churches, ethnic grocery stores and restaurants, nonprofits, social service agencies, etc.

4. Take steps to reassure participants in Hispanic patient and caregiver research. The consumer’s trust in the overall system may be eroding. The designs of research focusing on immigrants may benefit from providing additional safeguards beyond the usual human participants' protection. 

Consider going through the step of obtaining a National Institutes of Health Certificate of Confidentiality. That would protect data from subpoena, ensuring the confidentiality of participants regardless of their immigration status. This could help allay fear of divulging information to government entities. 

5. Integrate therapeutic-area specific messaging. Preventive care, prenatal care, and chronic disease management are the most acute treatment areas driving the industry’s concern related to immigrant Hispanic patients. 

Marketing strategists and campaign planners may want to upgrade the urgency and immediacy of messaging to pinpoint specific disease states and providers’ areas of concern.

6. Test more digital and hyper-local channels of communication. Hispanic families staying home and missing appointments are likely consuming more media in home — especially digital channels. Out-of-home media like transit, may not reach vulnerable immigrants. It may pay to test incremental digital, social and earned media channels, as well as hyper-local neighborhood OOH options. 

Hispanic consumers of all ages suffer more acutely from chronic illness, and are far less likely to access preventive care. The atmosphere of fear in Hispanic immigrant communities is yet another layer of complication for those serving this already-vulnerable population. Hispanic health care marketers who support providers treating immigrant communities will benefit from reshaping strategies to get them and keep them in care.