INTRODUCTION

Overview

These Guidelines were developed as part of a larger project, Educación de seguridad en el tránsito/Education in Traffic Safety (EST). The goal of the project was to foster the development of effective traffic safety educational materials to serve the growing Spanish-speaking population in the United States.

Guidelines for Developing Traffic Safety Educational Materials for Spanish-Speaking Audiences is designed for organizations seeking to create, or to help others create, culturally and linguistically appropriate traffic safety educational materials for Latinos.¹ The process outlined addresses primarily print materials such as brochures, posters, booklets, and fotonovelas.² It can also be used to develop videos, public service announcements, and other materials that promote safe driving, riding, walking, and biking.

These Guidelines cover the process of planning, creating, disseminating, and evaluating an educational material. They are designed to ensure that the final material meets three criteria:

• The traffic safety information presented is accurate.
• The target audience is appropriately addressed.
• Principles of effective health communication are used.

The nine steps in these Guidelines represent an ideal, comprehensive approach to developing a new material in Spanish. You should follow as many steps as your resources allow. This process requires more staff, time, and money than simply translating the text of an existing English material into Spanish. However, by following these steps you will produce a material that is more likely to resonate with your audience and to change your audience’s safety-related knowledge, attitudes, and behavior.

Because organizations have limited resources, you likely will need to decide which topic or topics are most important for you to address by creating a new material. It is not necessary for every organization to develop a Spanish-language material on every traffic safety topic. Instead, you can work with other groups, share materials, and adapt one another’s effective Spanish-language material for particular uses.

Ultimately, creating a few high-quality materials that resonate with the intended audience is likely to prove more effective than producing a greater number of low-quality materials.

Finally, realize that producing a brochure and putting it on a shelf or on your organization’s Web site is unlikely to make a widespread and lasting impact on the behavior of the people whom you’re trying to reach. The materials that you produce will be most effective if they are used as part of a broader and more sustained effort, by your organization and/or your community partners, to promote health and safety.

Although most of the demographic and cultural information in this document is specific to Latinos, the nine steps and much of the expert advice can be used to develop educational materials for other populations or materials that deal with other safety and health topics.

Why We Created These Guidelines

Motor vehicle crashes are the leading cause of death for Latinos between the ages of one and thirty-four (CDC 2005). Although Latinos have population-based traffic-related fatality rates similar to those of the general population, available data from travel surveys suggest that Latinos travel less than the general population, however, they experience greater risk when they travel. Baker (1998) reported this finding for Hispanic children and adolescents, and Braver (2003) reported similar findings for the adult men of Hispanic origin. Braver’s findings also pointed to lower socioeconomic status as an important risk factor for all races and ethnicities, and noted that socioeconomic status fully explained “the excess mortality risk among Hispanic men relative to whites” (2003). Other studies have found that Latino children are less likely to use bicycle helmets, child safety seats, and safety belts (The Traffic Safety Center Newsletter 2003; Womack 2001; Matteucci 1995). Latinos have higher per-capita pedestrian death rates than the U.S. population as a whole (CDC 2005), and a study in California found the pedestrian injury rate among Latino children to be twice that of non-Latino white children (Agran 1998). Several studies indicate that alcohol plays a role in a greater proportion of fatal crashes involving persons of Hispanic origin than in crashes involving non-Hispanic whites (Voas 1998; Voas 2000; NHTSA 2002; Harper et al. 2000).

Reducing the toll of traffic injury requires a comprehensive approach that includes the “three Es” of injury prevention: education, engineering, and environmental modifications (e.g., building safer pedestrian walkways, eliminating pavement edge drop-offs, etc.), and the enforcement of effective laws. It is widely recognized that public health-and-safety efforts have greater success when they are tailored to the cultural norms, preferences, history, and experiences of the specific groups that they seek to influence. Several studies specifically discuss the importance of cultural appropriateness in programs and materials that address traffic safety issues among Latinos (Schiff and Becker 1996; NHTSA 1995; Harper et al. 2000; Agran 1998). Although many materials are available in Spanish, at least one study has revealed deficiencies in the accuracy and cultural appropriateness of many of these materials (Ross, Gallagher, and Miara 2002).

Although educational materials are only one component of a comprehensive traffic safety program, they are an important element if they are accurate and effective. Consider the following scenario:

Pedro, a young child, gets his first bicycle and is excited to ride it. His parents are recent immigrants to a large city in the United States, and a local health center gives them a brochure in Spanish about preventing bike injuries. The material is hard for them to understand.

For example, comfort padding, the English technical term that describes the padding in a helmet, is translated into Spanish as acojinado de confort, but it is not explained. The type of Spanish used is unfamiliar to Pedro’s parents, and the brochure is written at a ninth-grade reading level, much too high given their limited literacy. The pages are filled with long paragraphs, and the printing is small. There are no pictures illustrating the proper way to use a helmet; the brochure’s only picture shows a child riding a bike in a community that looks nothing like Pedro’s urban environment. Finally, the information about how to adjust the helmet straps is incorrect.

In their home country, Pedro’s parents never saw children using helmets. They want to keep their son safe, but they don’t know what the information in the brochure means. As a result, Pedro rides his bicycle without a helmet, risking a head injury and violating his State’s helmet law.

This scenario illustrates the challenges inherent in developing materials for non-English speakers from other countries. If your materials are to influence attitudes and change behavior, they must consider cultural and linguistic factors, contain correct information, and employ principles of effective health communication.

Intended Audience for the Guidelines

The vast majority of traffic safety materials for Latinos are produced by English-speaking or bilingual (English-Spanish) staffs of State or national organizations. Therefore, the primary audience for these Guidelines is English-speaking or bilingual staffs of state or national organizations that wish to produce traffic safety educational materials for Spanish-speakers living in the United States. Most of the recommendations in the Guidelines relate to the development of new materials, but we also discuss how to modify existing English and/or Spanish materials.

Although local organizations are not the primary target audience of the Guidelines, such groups will also find them useful. Local organizations will learn how to ensure the accuracy and appropriateness of an item for their audience and how to modify for their particular community materials that were developed for a broader audience.

Critical Expertise You Need

Developing an effective material for a Latino audience requires knowledge of traffic safety, Latino communities, and health communication. If you are a traffic safety or injury prevention professional, make sure you have expertise in the area for which you want to develop a material (e.g., pedestrian safety or child passenger safety), and then find partners who have an understanding of the Latino audience and expertise in health communication. Similarly, if you are an expert on Latino issues but you or your organization does not have expertise in traffic safety or health communication, collaborate with specialists in these areas. Finally, if you are a health communication expert and you do not have specific expertise in traffic safety and/or Latino issues, work with experts in those areas.

How We Developed the Guidelines

Project staff took the following steps to develop and refine these Guidelines:

1. We collected existing Spanish-language traffic safety materials and conducted a telephone survey of the developers of those materials. This enabled us to identify positive examples of materials and to capture lessons learned by the developers.
   
   
2. We examined existing research and national guidelines on cultural competency, in particular those of the National Center for Cultural Competence and the Education Resources Information Center (ERIC) Clearinghouse on Elementary and Early Childhood Education.
   
   
3. We convened the EST National Work Group, a group of national experts in traffic safety, Latino issues, and health communication, and took advantage of their expertise throughout the development process. We also relied on a panel of expert reviewers (see appendix A).
   
   
4. We pilot-tested and subsequently refined the recommendations by convening a community advisory group (WEST) in one community and working with its members to create a model educational material following the steps in an earlier draft version of the Guidelines. The model material is in appendix E.

Organization of the Guidelines

The Guidelines are organized into three main sections: Research and Planning, Creating Materials, and Dissemination and Evaluation. Each section includes specific action steps and supplemental information. A fourth section, Adapting Existing Materials, provides guidance on adapting existing materials for different audiences and on updating or improving materials. We recommend reading the entire document before you begin to develop your material.

In the Guidelines you will find four different types of information, each denoted by its own icon:

	Basic steps: These are the nine steps you should follow in developing and disseminating a culturally and linguistically appropriate material for Latinos.
	Resources: These include Web sites, research articles, key reports and documents, and relevant organizations and contacts. They are located in the appendices.
	Quotes and advice: These are collected from several sources: Respondents to the EST telephone survey of developers of Spanish-language traffic safety materials (“EST Survey”). These developers were interviewed by EDC staff about the process they used to develop materials and the lessons they learned. Members of the EST National Work Group, who share their knowledge about the health-and-safety-related experiences, attitudes, and practices of Latinos. Staff from several national organizations and marketing firms who have experience working with community groups as part of the process of developing materials. These include EST staff who worked with the WEST group to develop a material. Researchers who have conducted focus groups and surveys related to traffic safety and injury prevention for the Latino community.
	Samples of actual materials: These exemplify the recommendations in the Creating Materials section of the Guidelines.

Definitions

Cultural appropriateness: “The ability to relate and communicate effectively when individuals involved in the interaction do not share the same culture, ethnicity, language, or other salient variables” (Santos and Reese 1999).

Latino: In these Guidelines, Latino is defined as people living in the United States who come from, or whose ancestors came from, Spanish-speaking regions of the world. The term Hispanic may be more familiar; however, based on advice from several sources, we use Latino in these Guidelines because it is considered to be more inclusive. Furthermore, many national and Federal initiatives refer to Latinos instead of Hispanics.

Debate: Hispanic or Latino?
There is no consensus in the United States about what term to use for people who come from Spanish-speaking countries or whose ancestors did. The following excerpts describe the debate.

The Tulane Hispanic Health Initiative states:

Today, the term Hispanic is used to include all kinds of persons from Spanish origin, [but] for some people in the United States, Hispanic is a more inclusive term because it does not [exclude people] who are from Spain or belong to countries whose language is not Spanish such as Brazil, Haiti, etc.; Hispanic is also a category used by the U.S. National Bureau of Census to refer to the different groups of Latinos living in the United States. Also, the National Institutes of Health prefers to use the term Hispanic origin more often than the Latino term. From this perspective the term Hispanic is widely used to write technical reports, and grants proposals; in other words, Hispanic is used as a more academic/technical term. On the other hand, Latino is probably the most popular term used by non-profit organizations, public health and medical professionals, newspapers, and popular magazines, to describe [Spanish-speaking] people living in the United States (Tulane Hispanic Health Initiative 2002).

In “Hispanic or Latino?” Lynet Uttal of the University of Wisconsin–Madison writes:

The term “Hispanic” has been widely criticized as a “government invention” that falsely homogenizes diverse groups of people. The major objection to this term is that it lumps together too many diverse groups, losing sight of distinctions between groups such as Mexican Americans, Puerto Ricans, and Cuban Americans. Another objection is that it emphasizes the European culture and ancestry and masks the African and indigenous cultures that are also part of the history of many of the groups included under this umbrella term. . . . Despite these objections, the term has become popularly used by individuals to self-identify. . . . [The] term “Latino” is the most apolitical, generally accepted term you can use. This use of “Latino” covers all the people from Central and South American countries plus Puerto Rico, Cuba, Costa Rica, Dominican Republic, but not Spain (Uttal n.d.).

Core Principles

EST staff and the Work Group agreed on a set of principles to steer the development of the Guidelines:

• To be most effective, developers should collaborate with appropriate partners and stakeholders throughout the process to ensure that the materials resonate with the audience, resulting in a change in behavior.
  
  
• Community input is essential in creating educational materials. Developers must collaborate with community-based partners throughout the entire process of development and dissemination. Developers must also solicit input from potential users of the material via focus groups, pilot testing, and other measures. Although Spanish-speaking professionals can provide useful guidance, the input of the actual audience is key. Professionals are likely to be more educated and acculturated than a typical member of the target audience; their preferred word choice, language, and style may not reflect those of the audience.
  
  
• Developers must be mindful that Latinos in the United States are a diverse group. Latinos come from many different places and have differing levels of education and literacy skills. Some Latinos live in homes where English is the primary language, others reside in Spanish-speaking households, and others use both languages at home. Religions, beliefs, length of time spent in the United States, and in some cases, legal status, also vary widely. Just as no single English educational material will be effective with all English-speakers, no single Spanish educational material will be effective with all Spanish-speakers.
  
  
• Acculturation to American norms occurs along a continuum. Individuals may be acculturated in some ways (English language ability, American dress, etc.) yet may prefer to receive health education information from within their own community. For example, some people who have lived in the United States for many years and appear to be very acculturated may get their news from Latino media sources rather than from mainstream American media.
  
  
• Whether creating new materials or adapting existing ones, developers must ensure that the materials use words that the audience can understand and must ensure that the materials are in tune with the audience’s values and culture. Creating original materials, in Spanish, for the specific audience, is the best way to ensure this.
  
  
• It is a waste of money, time, and other resources to create materials that do not resonate with the audience; this often occurs when an English-language material is translated into Spanish without seeking audience feedback or adapting the message for that particular audience. It is probably more cost-effective to create a few materials that are culturally and linguistically appropriate for the target audience. Developers should be selective in which topics they address, and collaborate and share materials with other developers.

¹ We use the term Latino to refer to all people living in the United States who come from, or whose ancestors came from, Spanish-speaking regions of the world. See pages 6–7 for more information.

² See page 38 for a definition of this term.