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Russian–American health care: Bridging the communication gap between physicians and patients Inna Shpilko * Queens College, City University of New York (CUNY), Benjamin Rosenthal Library, 65-30 Kissena Blvd, Flushing, NY 11367, United States Received 3 October 2005; received in revised form 27 February 2006; accepted 25 March 2006 Abstract Objectives: The objectives of this article are two-fold: (1) to gather in one place reliable information about Russian–Americans’ past medical practices and their current outlook on health care and to provide health care professionals with an overview of the major afflictions suffered by this ethnic group; and (2) to educate Russian-speaking patients about the American heath care system and social services geared towards immigrants by locating and evaluating free, culturally appropriate patient education Web sites available in Russian. Methods: In order to draw data on specific diseases and conditions affecting the Russian-speaking population, the author searched various scholarly health-related electronic databases. A number of well-established U.S. government consumer-health Web sites were searched to locate patient education resources that can be utilized by recent Russian immigrants. Results: The author provides an overview of the major health problems encountered by the Russian-speaking population before emigration and potential health concerns for Russian immigrant communities. In addition, the author provides a scholarly exploration of patient education materials available in Russian. Conclusion: In this increasingly diverse society, physicians are faced with the challenge of providing culturally sensitive health care. Multicultural Web-based health resources can serve as a valuable tool for reducing communication barriers between patients and health care providers, thus improving the delivery of quality health care services. Recommendations for further research are indicated. Practice implications: The author offers recommendations for practitioners serving Russian-speaking immigrants. Suggestions on utilization of Web resources are also provided. # 2006 Elsevier Ireland Ltd. All rights reserved. Keywords: Russians; Former Soviet Union; Russian-speaking immigrants; Health care; Patient-provider communication; Information services; Patient education 1. Introduction 1.1. Russian immigrant communities in the United States: health aspects and issues of concern In the past several decades there has been a dramatic increase in the number of Russian-speaking people immi- grating to the United States from the former Soviet Union. According to the U.S. Census Bureau, the number of Russian speakers living in the United States for five years or more has increased from 241,798 in 1990 to 706,242 in 2000, thus representing a significant portion of patients that are seen by physicians in the major U.S. cities. Of the 706, 242 Russian speakers, 148,671 reported limited English-language ability (‘‘not well’’), and 43,623 did not speak English at all [1]. Since this population is beginning to rise drastically in the United States, attention to their health care needs is warranted. 1.1.1. Cross-cultural communication: implications for health care Communication between physicians and patients is crucial to quality health care. It has been found that understanding patients’ perspectives and cultural values enables physicians to tailor treatment plans more effectively in accordance with their patient’s particular needs [2,3]. The lack of a common language between patients and health care professionals has long been identified as a central barrier to health care for many www.elsevier.com/locate/pateducou Patient Education and Counseling 64 (2006) 331–341 * Tel.: +1 718 997 3676; fax: +1 718 997 3753. E-mail address: [email protected]. 0738-3991/$ – see front matter # 2006 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.pec.2006.03.014

Russian–American health care: Bridging the communication gap between physicians and patients

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Page 1: Russian–American health care: Bridging the communication gap between physicians and patients

www.elsevier.com/locate/pateducou

Patient Education and Counseling 64 (2006) 331–341

Russian–American health care: Bridging the communication

gap between physicians and patients

Inna Shpilko *

Queens College, City University of New York (CUNY), Benjamin Rosenthal Library, 65-30 Kissena Blvd, Flushing, NY 11367, United States

Received 3 October 2005; received in revised form 27 February 2006; accepted 25 March 2006

Abstract

Objectives: The objectives of this article are two-fold: (1) to gather in one place reliable information about Russian–Americans’ past medical

practices and their current outlook on health care and to provide health care professionals with an overview of the major afflictions suffered by

this ethnic group; and (2) to educate Russian-speaking patients about the American heath care system and social services geared towards

immigrants by locating and evaluating free, culturally appropriate patient education Web sites available in Russian.

Methods: In order to draw data on specific diseases and conditions affecting the Russian-speaking population, the author searched various

scholarly health-related electronic databases. A number of well-established U.S. government consumer-health Web sites were searched to

locate patient education resources that can be utilized by recent Russian immigrants.

Results: The author provides an overview of the major health problems encountered by the Russian-speaking population before emigration

and potential health concerns for Russian immigrant communities. In addition, the author provides a scholarly exploration of patient

education materials available in Russian.

Conclusion: In this increasingly diverse society, physicians are faced with the challenge of providing culturally sensitive health care.

Multicultural Web-based health resources can serve as a valuable tool for reducing communication barriers between patients and health care

providers, thus improving the delivery of quality health care services. Recommendations for further research are indicated.

Practice implications: The author offers recommendations for practitioners serving Russian-speaking immigrants. Suggestions on utilization

of Web resources are also provided.

# 2006 Elsevier Ireland Ltd. All rights reserved.

Keywords: Russians; Former Soviet Union; Russian-speaking immigrants; Health care; Patient-provider communication; Information services; Patient

education

1. Introduction

1.1. Russian immigrant communities in the United

States: health aspects and issues of concern

In the past several decades there has been a dramatic

increase in the number of Russian-speaking people immi-

grating to the United States from the former Soviet Union.

According to the U.S. Census Bureau, the number of Russian

speakers living in the United States for five years or more has

increased from 241,798 in 1990 to 706,242 in 2000, thus

representing a significant portion of patients that are seen by

* Tel.: +1 718 997 3676; fax: +1 718 997 3753.

E-mail address: [email protected].

0738-3991/$ – see front matter # 2006 Elsevier Ireland Ltd. All rights reserved

doi:10.1016/j.pec.2006.03.014

physicians in the major U.S. cities. Of the 706, 242 Russian

speakers, 148,671 reported limited English-language ability

(‘‘not well’’), and 43,623 did not speak English at all [1]. Since

this population is beginning to rise drastically in the United

States, attention to their health care needs is warranted.

1.1.1. Cross-cultural communication: implications for

health care

Communication between physicians and patients is crucial

to quality health care. It has been found that understanding

patients’ perspectives and cultural values enables physicians

to tailor treatment plans more effectively in accordance with

their patient’s particular needs [2,3]. The lack of a common

language between patients and health care professionals has

long been identified as a central barrier to health care for many

.

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I. Shpilko / Patient Education and Counseling 64 (2006) 331–341332

ethnic populations [2–5]. According to a study of former

Soviet Union refugees in Northern California (1997), for

many foreign-born patients, ‘‘the U.S. health care system

remains confusing, largely because of cultural and language

differences’’ [2]. The National Conference of State Legis-

latures’ reports that, according to the Department of Health

and Human Services, people with limited language skills

often cannot understand the basics of how to apply for

programs for which they may be eligible, including Medicaid,

the Title XXI State Children’s Health Insurance Program, and

other social services and welfare programs [3].

This growing communication barrier between patients

and their physicians in hospitals and other health care

organizations has been discussed at different levels,

including government health agencies and professional

organizations [3,4]. The use of interpreters or bilingual

health professionals has helped to improve the situation, but

this has not always proven entirely effective. Interpreters are

often family members, usually the children or grandchildren

of an elderly patient. It is not uncommon for the patient to

feel uncomfortable discussing private matters in their

presence. Bilingual health professionals or trained inter-

preters demonstrate great potential for help, but their

services can be costly for employers [2,3]. A few initiatives

have been proposed to reduce communication barriers and

help physicians provide culturally competent care [6,7].

Acculturation of new immigrants is influenced by

individual demographic and health status factors, as well

as health and social services provided for them in their

country of immigration [8]. Therefore, physicians serving

diverse populations ‘‘should be aware of the prevalence of

diseases in the country of origin (including diseases caused

by the social disruption that occurs with immigration), of

public policy issues that create barriers to appropriate care,

and of the potential for cross-cultural misunderstanding

between provider and patient’’ [9].

While awareness of the need for culturally sensitive

health care exists among practitioners, insufficient research

has been conducted with the Russian-speaking population,

and there is still room for improving the delivery of quality

health care services [10,11]. In general, many aspects of

Russian culture and the Russian attitude towards medicine

are foreign to American health care providers. The purpose

of this article is to provide U.S. health care practitioners with

additional information on specific diseases and disorders

common among Russian-speaking patients and explain their

past medical practices as well as their current outlook on

health care.

1.2. The Internet as a tool for reducing cross-cultural

communication barriers between physicians and

patients

Constructive physician–patient dialogue requires pre-

paration by both parties, including educating non-native

patients about the American health care system.

One of the most rewarding achievements of the Internet is

the wealth of consumer-health information now available to

the public. Many users turn to the Internet to obtain

information about their diagnosis or particular disease. Their

research may include investigating new therapies, selecting a

physician or hospital, or reviewing new studies published in

medical journals. The availability of accurate and compre-

hensive information allows online users to make educated

decisions about the most advantageous treatment plans and

facilitates informed discussions with their health care

providers. However, it can be a time-consuming and

frustrating process to look for such information when the

user does not know where to start. Certainly, this task becomes

more daunting for those whose English is imperfect.

Having recognized these concerns and the importance of

providing multilingual and multicultural consumer-health

information, a number of multilingual Web-based resources

were introduced [12,13]. Many of these Web sites were

developed by librarians. Currently, various Web sites are

available to educate patients about different health topics

and assist them in getting appropriate care. Although studies

with other ethnic groups around the world were conducted,

little was done to target the Russian-speaking population

base. Thus, the second goal of this article is to educate recent

Russian immigrants by providing a gateway to free Web-

based patient education resources available in Russian.

2. Methods

In order to gather information on specific diseases and

disorders common among Russian speakers and explain their

past medical practices and current outlook on health care, the

author searched a variety of scholarly health-related

databases, including MEDLINE; CINAHL; Health & Well-

ness Resource Center; Health Reference Center-Academic;

Health Source: Nursing/Academic Edition; and Elsevier

Science Direct. The author used various combinations of

keywords, including ‘‘Russian immigrants’’ and ‘‘health’’, or

‘‘Soviet’’ and ‘‘health care, or ‘‘Russian’’ and ‘‘diabetes’’, or

‘‘Russian-speaking’’ and ‘‘hepatitis’’.

Locating high-quality patient education Web sites on

specific diseases and conditions for a particular ethnic

population is complex. Not all Internet sources contain

accurate, peer-reviewed and/or up-to-date information; there-

fore, it is crucial to evaluate the quality of the online

information found. It is also important to take into

consideration the changing nature of existing Web resources

— one of the major drawbacks of the Internet. Web sites on

specific medical topics maintained by government health

agencies, not-for-profit organizations/professional societies,

and universities are among the most trustworthy. To

accomplish the second objective of this study, the author

searched a number of well-established and highly regarded

U.S. government consumer-health Web sites, including

MedlinePlus (National Library of Medicine) <http://medli-

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I. Shpilko / Patient Education and Counseling 64 (2006) 331–341 333

neplus.gov/>, National Network of Libraries of Medicine

South Central Region <http://nnlm.gov/scr/>, U.S. Depart-

ment of Health and Human Services <http://www.os.dhhs.-

gov/>, New York Online Access to Health (NOAH)<http://

www.noah-health.org/>, and others, using the above-men-

tioned combinations of keywords or concepts. The quality of

information found was carefully evaluated based on the

National Network of Libraries of Medicine (South Central

Region) criteria for evaluating health-related information on

the Internet<http://nnlm.gov/scr/conhlth/evalsite.htm> [14].

Criteria for inclusion were the following: authority, currency,

amount of information provided, and backup documentation

(bibliographies, references, and feedback offered). Web sites

free of charge that had either Russian version or selected

materials available in Russian were included.

3. Results

3.1. Medical care in the former Soviet Union and

current health risk factors

A number of studies have depicted health care problems

in the former Soviet Union [2,15–17]. Summarized findings

of these studies indicate that there have been both positive

and negative aspects of the health care system in the former

Soviet republics.

Soviet socialized medicine was the government’s

responsibility. Although it was advantageous to have free

access to specialists and unlimited diagnostic tests, the

downside included inadequate government funding, lack of

medical equipment and supplies, long length of hospital

stay, the misuse of medical services (use medical services

for social and psychological problems), and the lack of

support groups for those diagnosed with specific conditions.

A report, published by the Centers for Disease Control

and Prevention’s (CDC) National Center for Health

Statistics and the Ministry of Health of the Russian

Federation, notes further deterioration of the health care

system and a decline in the level of care provided in the

Russian Federation in the 1990s [15]. According to the

report, Russia’s mortality rate is one of the highest in the

world (it is 1.7 times higher than the birth rate). The main

reasons for the mortality rate’s growth could be attributed to

‘‘worsening of socioeconomic living conditions of the

majority of population, exposure to stress, and growing

alcohol abuse’’. Although the overall life expectancy from

1990 to 1994 was 64.0 years, the life expectancy for men

was 57.6 years. Cardiovascular diseases, infectious diseases,

cancer, stress and depression, alcoholism, and malnutrition

were reported among other risk factors [15].

3.1.1. Infectious diseases

Currently, three groups of infectious diseases represent

emerging health problems in Russia: HIV/AIDS, tubercu-

losis and hepatitis [15,18–23].

3.1.1.1. HIV/AIDS. In late 2004, there were 300,000

officially reported cases of HIV, affecting mostly people

15–29 years old in the former Soviet Union. Though the

number of official cases reported is 300,000, Murray

Feshbach, a demographer at the Woodrow Wilson Interna-

tional Center for Scholars in Washington, DC, has concluded

that there could actually be as many as 900,000 Russians

infected [18]. Vadim Pokrovsky, director of the Health

Ministry’s AIDS Prevention and Treatment Center, agrees

with Feshbach and believes that the unreliable data should

be attributed to physicians’ lack of familiarity with the

symptoms of AIDS and to families who do not wish to reveal

AIDS as the cause of death [18]. Organizations like

Feshbach’s are advocating extensive drug therapy for AIDS

patients and prevention education for their citizens. Many

stereotypes and misconceptions about this disease exist

because HIV/AIDS is still considered a taboo topic by the

Russian public. As a result, many infected people are either

too ignorant or ashamed to seek the proper treatment, greatly

increasing the epidemic.

A comparative study investigating knowledge and

attitudes about HIV/AIDS among the American and Russian

public revealed that ‘‘on all but one of the HIV/AIDS

knowledge questions, American participants were signifi-

cantly more likely than Russian participants to answer

correctly’’ [19]. As the results indicate, Americans in

general are more exposed to HIV/AIDS-education issues via

television, radio, and school programs than their Russian

counterparts.

3.1.1.2. Tuberculosis. The growing HIV/AIDS epidemic

has coincided with a severe rise in tuberculosis (TB) cases.

The cruel irony is that the two diseases are often spread

together, since people afflicted with HIV are more prone to

catching TB [20]. According to the Bulletin of the World

Health Organization, ‘‘the Russian Federation has the 11th

highest tuberculosis burden in the world in terms of the total

estimated number of new cases that occur each year’’ [21].

The number of TB cases in Russia has grown significantly,

from 45,000 (34 cases per 100,000 population) in 1991 to

124,000 (85 cases per 100,000) in 1999 [22].

3.1.1.3. Hepatitis. Hepatitis is a rapidly growing health

concern in Russia. Sergey Netesov, from the State Research

Center of Virology and Biotechnology Vector, Russia, and

Conrad, medical epidemiologist, USA, indicated that,

although in Russia ‘‘the rates of hepatitis A decreased

during the1990s, the rates of hepatitis B and hepatitis C

increased steadily’’ [23]. The major reasons for this increase

include intravenous drug use with unclean needles, lack of

adequate hygiene, and high-risk sexual behavior.

3.1.2. Alcoholism

Alcoholism is a major health concern in the former Soviet

republics. It is reported to be among the leading causes of

death [15]. The problems resulting from the collapse of the

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I. Shpilko / Patient Education and Counseling 64 (2006) 331–341334

Soviet Union have only served to increase the prevalence of

the disease. However, it should be noted that Russian-

speaking immigrants generally do not suffer from this

syndrome [24–26]. The major reason being that immigrants

hope to survive and thrive in the United States, and

alcoholism takes away both hope and vitality [24]. Although

alcoholism is not a reported problem among Russian–

American patients, indirect psychological effects of this

illness may nonetheless remain.

3.1.3. Diabetes

In 2000, the Russian Federation was ranked seventh among

the top 10 countries with the highest incidence of diabetes

[27]. It is currently estimated that approximately 9 million

people are suffering from this illness in Russia. This grim

figure is, unfortunately, an underestimate, since many people

who have diabetes have not reported their condition. Further,

more than 50% of cases are undiagnosed [28]. Undoubtedly,

many are left vulnerable to severe diabetes-related complica-

tions, such as eye disease and foot amputations. A lack of

information regarding the symptoms of diabetes and methods

of managing this condition is largely to blame. In fact, Karel

Bakker, Chair of the International Working Group on the

Diabetic Foot, has stated that ‘‘it is estimated that up to 85% of

amputations can be prevented with well-organized diabetic

foot care, good diabetes control, education and well-informed

self care’’ [28].

3.1.4. Nutrition

There is a direct link between proper nutrition and health

[29]. Malnutrition occurs when a diet is lacking in adequate

amounts of protein, vitamins, and minerals. The lack of

availability and consumption of vegetables and fruits in the

former Soviet Union is one of the major concerns and

grounds for this condition [15,29]. The traditional diet was

high in saturated fat content [30]. According to the journal

Science, one of the reasons for the high death rate of young

and middle-aged Russian men can be attributed to poor

nutrition [31]. In the Russian Federation, ‘‘the diet of all

population groups, including children, contains an inade-

quate amount of B group vitamins, particular B2 (60–80% of

the recommended amount), and of ascorbic acid. The

minerals lacking in the diet are ‘‘calcium salts and the more

readily absorbed forms of iron’’ [32].

3.1.5. Alternative treatments

Traditionally, the Russian-speaking publicpreferred to turn

to alternative therapies prior to seeking allopathic (conven-

tional) care for their conditions. Many of their traditional

therapies, considered alternative in the United States, were

officially utilized in the former Soviet Union [30,33]. The

reason for the confidence in alternative therapy over

pharmaceutical drugs among the public was their belief that

‘‘too much of any medicine can be poisonous’’ [30]. With the

collapse of the former Soviet Union and the ban that

previously existed on using the preferred complementary

medicine lifted, the use of alternative therapies is rising. In

1996, the eight most popular branches of complementary

medicine officially recognized by the Russian Ministry of

Health included reflexology, chiropractic, massage, homeop-

athy, and the ‘‘Buteiko breathing method’’ [34]. In some

countries, including Russia, use of alternative and comple-

mentarymedicine by thegeneralpopulation reaches60%[35].

3.2. Russian immigrants in the United States: potential

diseases, health attitudes and lifestyle preferences

3.2.1. Specific diseases and conditions

According to a number of studies, cancer, hypertension,

cardiovascular diseases, diabetes, arthritis, and gastrointest-

inal diseases have been reported as the prevailing health

concerns for adult Russian immigrants [26,30,36].

3.2.1.1. Cancer. In Russia, a diagnosis of cancer was never

outright mentioned to patients, since it was customary for

the physician to inform the family members first [30,36].

This is not meant to deceive or misinform the patient.

Simply, the family feels that it is their obligation to take on

the burden of truth. Many people have held on to this

concept, and it is therefore, still customary for the family to

either conceal a grave diagnosis or hold back from informing

the patient of their condition in the doctor’s office or

hospital. It is common that the patient be told of his/her

illness at home surrounded by family and/or friends, who

can offer the necessary support. This is in sharp contrast to

the autonomy and independence valued in American society

[4,36]. Consequently, this attitude can be problematic for

both Russian-speaking immigrants and American physi-

cians. American health care professionals consider it their

job to tell the patient both their diagnosis and prognosis,

while Russian patients may feel that a lack of respect for

their values and traditions is being shown.

There are also differences in expectations when it comes

to cancer screening. The findings from a study conducted

with women from all age groups who have emigrated from

the former Soviet Union countries of Belarus, Russia and

Ukraine, illustrate that these women relied on their

physicians to refer them for cancer-preventive tests, as well

as providing them with needed health care information [10].

It was found that these women went for regular preventive

exams in their native country because their physicians would

continually remind them to keep up with such tests.

However, the women in this study who were asked about

such preventive measures as Pap smears and mammograms

reported that they did not receive the same push from their

current providers in the United States, and therefore, did not

participate in these procedures regularly.

3.2.1.2. Hypertension and cardiovascular diseases. Var-

ious studies demonstrate that there is a high rate of

hypertension and cardiovascular disease among the Russian-

speaking population [5,24,25]. For instance, the results of

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I. Shpilko / Patient Education and Counseling 64 (2006) 331–341 335

the assessment performed with Russian immigrants living in

the Denver area, showed that as compared with the U.S.

population, Russian people had a significantly higher rate of

hypertension and hyperlipidemia (total serum cholesterol

greater than or equal 200 mg/dl) in the 55–64 age category.

Further, Russian participants in 20–34 and 65–74 age

categories had a higher incidence of hypertension than their

American counterparts [25].

The notion of lifestyle changes as a first-line of defense

against diabetes and hypertension was not well known and

exercise was generally not recommended by the physicians

of the former Soviet Union [16]. Screening for cholesterol

and blood pressure was also quite limited, according to a

study performed on Russian and Ukrainian immigrants in

Virginia [11].

3.2.1.3. Mental disorders. Russian-speaking patients wit-

nessed the social chaos that resulted from the fall of the

Soviet Union. It is no wonder that a people who have

experienced a complete restructuring in their political and

economic sectors would suffer from feelings of depression

and anxiety, especially the elderly, for whom change is

always difficult. Immigrating to America, another major

life-altering event, often compounds the problem. Some

findings from the assessment of Russian speakers showed

that ‘‘loss of country, work and status cause many Russian-

speaking newcomers to feel depression and stress’’ [37]. In

addition to undergoing a transformation in their lifestyle and

living in radically different surroundings, they also face

isolation and loneliness due to their lack of English skills

and separation from relatives and friends left behind [16].

This sadness and poor mental state are definitely felt, though

rarely expressed, by Russian-speaking patients [17]. This is

because a diagnosis of mental illness would have resulted in

major social consequences in their former homeland.

Anyone participating in activities not approved by the

Soviet government might have been labeled as insane,

placed in a psychiatric hospital, and punished with

psychiatric drugs [11]. Due to the lingering and persistent

fear of discrimination and persecution that accompanied

admitting such illnesses in the former Soviet Union,

Russian-speaking patients often do not provide answers

regarding any family history of psychiatric illness or past

psychiatric treatments when questioned by their health care

providers.

3.2.2. Self-care practices (use of ‘‘Russian

medications’’)

A study with a group of elderly Russian immigrants in the

55–64 age group showed that the high cost of drugs

prescribed by physicians in the United States, language

barrier, and a lack of relevant health information were

grounds to use European and Russian medications brought

by visitors [10]. A number of participants (mean age—60

years; mean stay in the United States—4.7 years) in another

study mentioned that they prefer medicines imported from

the former Soviet Union because ‘‘they know what they are

and how to use them’’ [2]. Patients’ reliance on their

country-of-origin medications was also noted in Israel [38].

These drugs, brought to the United States from Russia either

by friends/family members or sold by peddlers on the streets,

are potentially dangerous because they may either interact

with medications prescribed by American physicians, or

may no longer be effective (no expiration date) [39].

Many Russian-speaking immigrants continue their use of

various types of alternative medicine in addition to

prescribed drugs, such as massage therapy, herbal/home

remedies, spiritual healing, hydrotherapy, and others, in the

United States [2,30,37].

3.3. Providing guidance in finding consumer-health/

patient education resources in Russian

The author has identified, evaluated, and compiled a

listing of selected culturally appropriate, free consumer-

health/patient education Web-based resources available in

Russian. Table 1 provides a list of resources, which have

either a Russian-language version or selected documents

available in Russian. Several comprehensive Web sites offer

reliable information for clinicians who work with non-

English speaking patients. Patient education Web sites offer

consumer-oriented information on specific diseases and

conditions, including HIV/AIDS, tuberculosis, hepatitis,

and diabetes translated into Russian. They also provide

immunization and vaccination updates, food safety guide-

lines, etc. Health and social services resources offer practical

information on a variety of topics, including helping recent

immigrants in their adjustment to living in the United States.

Selected documents available in Russian are listed in

Appendix A.

4. Discussion and conclusion

4.1. Discussion

As we have seen, the Russian health care system differs in

many ways from its American counterpart, one of which is

that medicine, though limited, was free in the former Soviet

Union. Therefore, recent Russian immigrants may have

trouble understanding such concepts as health insurance,

malpractice, private pay, and Health Maintenance Organiza-

tions (HMOs). Consequently, they are in need of resources

that can acquaint them with the American health care system

and the various social services available to them. In addition,

a thorough understanding and explanation of their particular

conditions is necessary in their native language, as foreign

medical terminology may prove difficult to grasp quickly.

Several research studies cited in this article have

demonstrated that culture or ethnic background can affect

the quality of health care and health-related outcomes. In

this increasingly diverse society it can be challenging for

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I. Shpilko / Patient Education and Counseling 64 (2006) 331–341336

Table 1

Selected free, consumer-health/patient education Web-based resources for patients and practitioners available in Russian

Internet resources Web site producer Scope

Comprehensive resources forpatients and practitionersMedInfoRus http://medinforus.

homestead.com/medline.html

Three Russian-speaking

medical librarians

This site provides links to special

health topics, dictionaries, and

online journals. The most

significant contribution of the

three librarians was the

development of a Guide for

searching PubMed in Russian [40]

EurasiaHealth knowledge network

http://www.eurasiahealth.org/index.jsp?&lng=en

American International

Health Alliance

This service is geared mostly

towards Russian speakers living

in Central and Eastern Europe

and in the former Soviet Union.

It contains links to health care

organizations, educational

institutions, and research

projects. The Network has

two English–Russian glossaries:

the Entire Glossary (2243 terms)

and the HIV/AIDS Glossary

(687 terms)

The NSW multicultural health communication

service http://mhcs.health.nsw.gov.au

New South Wales (NSW)

Department of Health in Australia

This Web site provides information

and services to assist health care

practitioners in communicating

with non-English speaking

populations throughout New

South Wales. The NSW

Department of Health produces

multicultural health materials

based on its guidelines and policies

The combined health information database

(CHID) http://chid.nih.gov/detail/detail.html

U.S. government health-related agencies This database offers bibliographic

information on various topics,

including AIDS, sexually

transmitted diseases (STDs),

tuberculosis, Alzheimer’s disease,

complementary and alternative

medicine, diabetes, digestive

diseases, etc. Users can locate

health information and

educational resources in various

formats, such as brochures

and leaflets

Health care quality glossary

http://www.ahcpr.gov/qual/hcqgloss.pdf [41]

The Ministry of Health of the Russian

Federation’s Institute of Public Health;

U.S. Department of Health And Human

Services, Agency for Health Care Policy

and Research; and the Quality Assurance

Project of the University Research Co.,

LLC, and Center for Human Services

The glossary, in English,

describes numerous concepts,

terms, and ideas pertaining to

health care, which are then

translated into Russian

Selected diseases and conditionsTuberculosis

Tuberculosis education training resource guide

http://www.cdcnpin.org/Guides/tbguide.pdf [42]

The Centers for Disease Control and

Prevention’s National Prevention

Information Network (CDC NPIN)

and CDC Division

of Tuberculosis Elimination

Provides general TB information

and training materials. Each entry

in the ‘‘Educational materials’’

section contains the document

title; annotated description of

the material; list of target

audience; type and length of

material; language in which the

materials are available; link to

HTML or PDF version; and the

distributor’s contact information

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I. Shpilko / Patient Education and Counseling 64 (2006) 331–341 337

Table 1 (Continued )

Internet resources Web site producer Scope

Vaccine information statements (VIS)

http://www.cdc.gov/nip/publications/VIS/#languages

The National Immunization Program

of the CDC

VIS offers patient education

materials, explaining the benefits

and risks of specific vaccines.

This site provides immunization

updates and federal guidelines

Hepatitis

Infectious disease information index

http://www.cdc.gov/ncidod/index.htm

The National Center for Infectious

Diseases (NCID) of the CDC

Provides links to educational

and training materials regarding

the different strains of hepatitis

(A–D). Documents are frequently

updated and revised based on

newly available information

Fact sheets on hepatitis A, B and C

http://www.mass.gov/dph/cdc/masshepc/russian.htm

Massachusetts Department of Public Health,

Commonwealth of Massachusetts

Diabetes

DiaNet http://www.diabet.ru/ Alexander Dreval Therapeutic Endocrinology

Department, Moscow Regional Scientific

Clinical Institute, Russia

This resource is of use to both

patients and clinical practitioners.

It offers information on various

topics related to diabetes, such

as treatment, diagnosis,

complications, prevention and

control. Legal documents on

patients’ rights and discussion

groups are also available

Bilingual diabetes handouts

http://monarch.gsu.edu/multiculturalhealth/handouts/russian/

Georgia State University Department of

Anthropology and Geography

The set of Russian-language

diabetes handouts contains the

following information: what is

diabetes? Food pyramid; better

health begins with you; good

food for kids; better nutrition

for mature adults; better health

for mother and baby

Food, nutrition, and dietary supplementsCFSAN http://vm.cfsan.fda.gov/list.html The Food and Drug Administration,

Center for Safety and Applied

Nutrition (CFSAN)

Offers documents concerning

food safety, food additives,

FDA regulations, FDA import

procedures, food-borne pathogens,

etc. Available Russian language

documents are listed in

Appendix A

International bibliographic information on dietary

supplements (IBIS) http://grande.nal.usda.gov/ibids/index.php

National Institutes of Health, Office of

Dietary Supplements; Food & Nutrition

Information Center, National Agricultural

Library, U.S. Department of Agriculture

This database allows users to

search for international scientific

literature on dietary supplements

Health and Social-ServicesThe diverse Washington: one state, many languages

http://www1.dshs.wa.gov/fl/russian.html

Department of Social and Health Services,

Washington State

Offers documents on aging and

disability services, child and

family support, medical

assistance, Medicaid, home

care agencies, nursing homes, etc.

Eldercare locator http://www.eldercare.gov/

eldercare/Public/Home.asp

U.S. Administration on Aging Fact sheets that address a variety

of topics, including adult day

care, assisted living, assistive

technology, government-assisted

housing, home health care,

and hospice

Social Security online: multilanguage gateway

http://www.ssa.gov/multilanguage/Russian/russian.htmoffers

U.S. Social Security Administration This site provides a link to

documents on various SSA

topics. Available Russian

documents are listed in

Appendix A

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Table 1 (Continued )

Internet resources Web site producer Scope

The food stamps program http://www.fns.usda.gov/

fsp/outreach/translations.htm

U.S. Department of Agriculture, Food and

Nutrition Service (FNS)

These materials are intended

for distribution to consumers

who may be eligible for the Food

Stamp Program. Documents

available in Russian are listed in

Appendix A

Welcome to the United States: a guide for new immigrants

[43] http://uscis.gov/graphics/citizenship/welcomeguide/index.htm

U.S. Citizen and Immigration Service Contains ‘‘practical information

to help immigrants settle into life

in the United States’’

physicians to provide culturally sensitive health care. Glenn

Flores, from the Boston University School of Medicine, has

stated that failure to provide culturally competent health care

may result in a variety of unfavorable outcomes, including

decreased satisfaction with care, less preventive screening,

miscommunication, decreased access to care, use of delayed

immunizations, and others [44]. Therefore, there is a need

for educating health care and social services providers on the

attitudes and approaches of the multicultural community

that they treat. Findings of this article have provided details

about those needs.

4.2. Conclusion

The Internet provides new opportunities for both

practitioners and their patients. Multilingual Web-based

health resources can serve as valuable tools for reducing

cross-cultural communication barriers between patients and

health care providers, and thus improving the delivery of

quality health care services. Web sites listed above should be

of interest to health care providers, but together with the

documents in Appendix A, should be invaluable to their

potential or active patients. In addition, resources related to

various health topics could be utilized by clinicians and

patients wherever Russian-speaking immigrants have

arrived. Collaboration among different groups of health

care professionals, social workers, librarians, web specialists

and others is helpful to identify and make available high-

quality cross-cultural Web sites [7].

With immigration from the former Soviet Union growing

worldwide, further research is needed to investigate how

different environments and acculturation affect the quality

of life, as well as the use of health and social services in other

countries where Russian immigrants have settled. In

addition, future research is needed to identify and evaluate

Web-based resources on cultural-awareness training for

health care practitioners.

4.3. Practice implications

4.3.1. Practical recommendations for health care

professionals serving Russian-speaking patients

Based on the findings listed above, the author offers the

following recommendations for health care practitioners to

improve the quality of health care for Russian immigrants:

1. I

t is very important to monitor Russian-speaking

patients presenting any signs of TB and thoroughly

explain all treatment options that they may not have

known were available.

2. H

ealth care providers should be aware that if their

Russian-speaking patients acquire infectious diseases,

they may not be open to discussing neither their

exposure nor treatment, due to the fear of receiving

negative responses from their community. Any discus-

sions regarding infectious diseases should be handled

with patience and sensitivity.

3. R

ussian-speaking patients are in need of information

about preventive measures against infectious diseases

and treatment options. The health care provider may be

the first and only reliable source of information for the

Russian patient.

4. H

ealth professionals may consider discussing the

beneficial techniques for coping with anxiety and

depression with their Russian-speaking patients, who

have seen vast numbers of people turn to alcohol for

stress management.

5. P

ractitioners should be aware that the underlying cause

of their patients’ multiple physical complaints may be a

psychological condition and screen for mental dis-

orders. They should specifically check for depression,

the most common psychological ailment among the

Russian-speaking population. In addition, they should

provide support for depression and loneliness associated

with immigration [17].

6. I

t is important that health care providers educate their

Russian patients on proper management of diabetes,

since it should not be assumed that they have received

this information earlier.

7. T

here is a need for educating Russian-speaking

immigrants to utilize cancer-preventive measures, such

as breast self-examinations, Pap smears, mammograms,

prostate examinations, etc. [11].

8. H

ealth professionals should instruct Russian immi-

grants about the significance of strictly following the

drug regimen prescribed [25]. The importance of dietary

modification, weight control, and exercise in preventing

the onset of heart disease should be emphasized.

9. H

ealth care providers should be aware that since their

Russian-speaking patients may have suffered from

malnutrition for many years prior to emigrating, long-

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I. Shpilko / Patient Education and Counseling 64 (2006) 331–341 339

term complications may result. Many may retain their

food preferences for potatoes and bread and may be in

need of nutritional guidelines and educational resources

regarding healthy eating [29,35].

10. T

he acknowledgement of alternative medicine by

physicians instills trust in their Russian-speaking

patients. As a result, patients will be more willing to

discuss their practices with their providers and potential

side effects from conflicting medications can be

avoided. However, if hostility or resentment towards

complementary medicine is perceived by the Russian

patient from their health care providers, they may

conceal their use of these therapies, thereby creating a

possibly unhealthy situation.

4.3.2. Utilization of Web sites by patients and health

care providers

The author has identified selected health and social

service resources that are currently available on the Web and

can be utilized by newly arrived Russian immigrants. It is

especially important to bring these resources to the attention

of the Russian-speaking community at large. One of the

recommended solutions includes disseminating this infor-

mation among various social service agencies dealing with

emigration from the former Soviet Union, such as the New

York Association for New Americans (NYANA) <http://

www.nyana.org/>, Hebrew Immigrant Aid Society (HIAS)

<http://www.hias.org/>, and others.

Public, medical, and academic librarians serving multi-

ethnic communities are in the ideal position of providing

vital consumer-health information to both patients and

health professionals. Many public and hospital libraries

possess reliable consumer-health collections. It would be

useful to deliver the above-mentioned information to such

libraries as well. consumer-health librarians can issue

brochures or fact sheets in Russian, post such information on

their Web sites, and provide direct links to needed

information. Thus, Russian-speaking immigrants, visiting

different types of health-related or social service institutions

or searching their Web sites, will be able to obtain needed

documents available in their native language.

Appendix A. Appendix

The following documents are available in Russian:

A.1. U.S. Food and Drug Administration, Center for

Safety and Applied Nutrition <http://vm.cfsan.fda.gov/

list.html>

� FDA actions on new bioterrorism legislation;

� R

egulatory requirements for marketing cosmetics in the

U.S.;

� O

rganisms that can bug you;

� E

veryone can fight BAC!

� F

ood labeling background;

� H

azard analysis and critical control point (HACCP)

principles for food production;

� B

ackgrounder on FDA and imports;

� F

DA import procedures;

� L

ow acid canned and acidified foods — the FDA

importers guide;

� F

DA report on pesticides;

� O

verview of the seafood program;

� H

ow to obtain printed copies of the Federal Register and

the code of Federal Regulations.

A.2. Social Security Administration <http://

www.ssa.gov/multilanguage/Russian/russian.htm>

� New Medicare prescription drug coverage — who can

help me apply and enroll? (CMS-11125);

� I

ntroducing Medicare’s new coverage for prescription

drugs the Centers for Medicare and Medicaid Services

Fact Sheet (CMS-11103);

� Q

uick Facts about Medicare’s new coverage for

prescription drugs for people with Medicare and

Medicaid, and Medicaid now pays for their prescription

drugs (CMS-11106);

� N

ew Medicare prescription drug coverage: a message for

people who care for someone with Medicare (CMS-

11126);

� Q

uick facts about Medicare’s new coverage for prescrip-

tion drugs for people with a Medicare Health Plan with

prescription drug coverage (CMS-11135);

� I

nterpreter services;

� A

snapshot of Social Security (SSA Pub 05-10006);

� U

pdate 2004 (SSA Pub 05-10003);

� S

ocial Security Numbers for non-citizens (SSA Pub

10096);

� S

ocial Security Numbers for children (SSA Pub 05-10023);

� N

ew numbers for domestic violence victims (SSA Pub 05-

10093);

� I

dentity theft and your Social Security Number (SSA Pub

05-10064);

� H

ow to earn credits (SSA Pub 05-10072);

� H

ow to correct your Social Security Earnings Record

(SSA Pub 05-10081);

� R

etirement and survivors benefits (SSA Pub 05-10700-

EN);

� H

ow work affects your benefits (SSA Pub 05-10069);

� W

hen you retire from your own business: what social

security needs to know (SSA Pub 05-10038);

� S

pecial payments after retirement (SSA Pub O5-10063);

� D

isability benefits (SSA Pub 05-10701-EN);

� A

uthorization to disclose information to the Social

Security Administration (SSA-827);

� H

ow we decide if you are still disabled (SSA Pub 05-

10053);

� W

hat you need to know: reviewing your disability (SSA

Pub 05-10068);

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I. Shpilko / Patient Education and Counseling 64 (2006) 331–341340

� S

upplemental security income (SSA Pub 05-10702-EN);

� S

upplemental security income for non-citizens (SSA Pub

11051);

� S

SI rights and responsibilities;

� S

upplemental security income benefits in California (SSA

Pub 05-11125);

� T

he appeals process (SSA Pub-10041);

� I

f you are self-employed (SSA Pub 10022);

� B

enefits for children (SSA Pub-10085);

� A

pplication for help with Medicare prescription drug plan

costs (Form SSA-1020-INST).

A.3. U.S. Department of Agriculture, Food and

Nutrition Service <http://www.fns.usda.gov/fsp>

� Questions and answers about getting and using food

stamps, FNS-313;

� P

ublic charge;

� I

mmigrant eligibility questions and answers;

� D

ocuments needed to apply;

� F

act sheet on eligibility (for seniors and disabled persons).

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