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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
.
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-
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
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
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
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
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
I. Shpilko / Patient Education and Counseling 64 (2006) 331–341338
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-speakingpatients 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 theirRussian-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 informationabout 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 thebeneficial 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 causeof 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 theirRussian 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-speakingimmigrants 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 theirRussian-speaking patients may have suffered from
malnutrition for many years prior to emigrating, long-
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 byphysicians 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 theU.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 FDAimporters guide;
� F
DA report on pesticides;� O
verview of the seafood program;� H
ow to obtain printed copies of the Federal Register andthe 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 prescriptiondrugs the Centers for Medicare and Medicaid Services
Fact Sheet (CMS-11103);
� Q
uick Facts about Medicare’s new coverage forprescription 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 forpeople 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 Pub10096);
� 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 Pub05-10064);
� 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 socialsecurity 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 SocialSecurity 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 (SSAPub 05-10068);
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 Pub11051);
� S
SI rights and responsibilities;� S
upplemental security income benefits in California (SSAPub 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 plancosts (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).References
[1] Shin HB, Bruno R. Language use and English-speaking ability: 2000
Washington, DC: U.S. Census Bureau; 2003.
[2] Lipson JG, Weinstein HM, Gladstone EA, Sarnoff RH. Bosnian and
soviet refugees’ experiences with health care. West J Nurs Res
2003;25:854–71.
[3] Morse A. Language access: giving immigrants a hand in navigating the
health care system. Natl Conf State Legis State Health Notes
2002;23:381, http://www.ncsl.org/programs/immig/SHNarticle.htm.
[4] Searight HR, Gafford J. Cultural diversity at the end of life: issues and
guidelines for family physicians. Am Fam Phys 2005;71:515–22.
[5] Benisovich SV, King AC. Meaning and knowledge of health among
older adult immigrants from Russia: a phenomenological study. Health
Educ Res 2003;18:135–44.
[6] MacCarty LJ, Enslein JC, Kelley LS, Choi E, Tripp-Reimer T. Cross-
cultural health education: materials on the World Wide Web. J
Transcult Nurs 2002;13:54–60.
[7] De Ruiter H-P, Larsen KE. Developing a transcultural patient care
Web sites. J Transcult Nurs 2002;13:61–7.
[8] Miller AM, Gross R. Health and depression in women from the former
Soviet Union living in the United States and Israel. J Immigr Health
2004;6:187–96.
[9] Bigby J. Cross-cultural medicine Philadelphia: American College of
Physicians; 2003.
[10] Ivanov LL, Buck K. Health care utilization patterns of Russian-
speaking immigrant women across age groups. J Immigr Health
2002;4:17–27.
[11] Duncan L, Simmons M. Health practices among Russian and Ukrai-
nian immigrants. J Community Health Nurs 1996;13:129–37.
[12] Ford M. African–American health resources on the World Wide Web.
Collect Build 2000;19:45–55.
[13] Springston L, Sullivan M. Consumer health materials in Spanish.
Houston, TX: National Network of Libraries of Medicine, South
Central Region; 2004 (http://nnlm.gov/scr/conhlth/chspanish.htm).
[14] Liebermann, Jana. Evaluating health Web sites. South Central Region,
Texas: NN/LM; 2000 (http://nnlm.gov/scr/conhlth/evalsite.htm).
[15] Notzon FC, Komarov YM, Ermakov SP, et al. Vital and health
statistics: Russian Federation and United States, selected years
1985–2000 with an overview of Russian mortality in the 1990s.
National Center for Health Statistics. Vital Health Stat 2003;5:11,
http://www.cdc.gov/nchs.
[16] Grabber L. Understanding patients from the former Soviet Union. Fam
Med 2000;32:201–6.
[17] Aroian KJ, Khatutsky G, Tran TV, Balsam AL. Health and social
service utilization among elderly immigrants from the former Soviet
Union. J Nurs Scholar 2001;33:265–71.
[18] Webster P. Russia underestimates HIV/AIDS incidence. Can Med
Assoc J 2005;172:985.
[19] Benotsch EG, Pinkerton SD, Dyatlov RV, Difranceisco W, Smirnova
T, Swain G, Dudko V, Kozlova A. A comparison of HIV/AIDS
knowledge and attitudes of STD clinic clients in St. Petersburg,
Russia and Milwaukee, WI, USA. J Community Health 2004;29:
451–65.
[20] Land T. Russia reforms its health system to combat AIDS and TB.
Contemp Rev 2003;283:281–4.
[21] Atun RA, Samyshkin YA, Drobniewski F, Skuratova NM, Gusarova G,
Kuznetsov SI, Fedorin IM, Coker RJ. Barriers to sustainable tubercu-
losis control in the Russian Federation health system. Bull World
Health Organ 2005;83:217–23.
[22] Centers for Disease Control and Prevention (CDC). Tuberculosis
treatment interruptions — Ivanovo Oblast, Russian Federation,
1999. J Am Med 2001;285:1953–4.
[23] Netesov SV, Conrad JL. Emerging infectious diseases in Russia, 1990–
1999. Emerg Infect Dis 2001;7:1–5.
[24] Giger JN, Davidhizar RE. Transcultural nursing, 4th ed., Missouri:
Mosby; 2004.
[25] Mehler PS, Scott JY, Pines I, Gifford N, Biggerstaff S, Hiatt WR.
Russian immigrant cardiovascular risk assessment. J Health Care Poor
Underserved 2001;12:224–35.
[26] Smith L. New Russian immigrants: health problems, practices and
values. J Cult Divers 1996;3:68–73.
[27] Wild S, Roglic G, Green A, Sigree R, King H. Global prevalence of
diabetes: estimates for the year 2000 and projections for 2030.
Diabetes Care 2004;27:1047–53.
[28] International Diabetes Federation. Diabetes in Russia: millions of feet
at risk of amputations; 2005 (press release), http://www.idf.org/home/
index.cfm?node=1423.
[29] Robertson A. Food, nutrition and health in the Russian Federation
World Health Organization; 1998, http://www.who.dk/Document/Nut/
Russianpap1.pdf.
[30] Salimbene S. Providing culture-sensitive healthcare to emigres from
the former Soviet bloc countries of Russia, Bosnia, and Poland. In:
Salimbene S, editor. What language does your patient hurt in? A
practical guide to culturally competent patient care. Amherst, MA:
Diversity Resources; 2000. p. 146–90.
[31] Dye C. The science of social diseases. Science 2005;307:181.
[32] World Health Organization. Highlights on health in the Russian
Federation. World Health Organization; 1999, http://www.euro.-
who.int/healthinfo/highligts/20011015_1.
[33] McPartland JM, Sadigurski Y. Alternative therapies in Russia:
a clinical review of systems. Altern Therap Clin Pract 1997;4:
202–5.
[34] Goldbeck-Wood S, Dorozynski A, Lie LG, Lie LG, Yamauch M, Zinn
C, Josefson D, Ingram M. Complementary medicine is blooming
worldwide. Br Med J 1996;313:131–3.
[35] Jahns L, Baturin A, Popkin BM. Obesity, diet, and poverty: trends in
the Russian transition to market economy. Eur J Clin Nutr 2003;57:
1295–302.
[36] Sparks L, Mittapalli K. To know or not to know: the case of com-
munication by and with older adult Russians diagnosed with cancer. J
Cross Cult Gerontol 2004;19:383–403.
[37] Erwin P, Chappo LL. Russian-speaking newcomers in San Francisco: a
community assessment report; 2002. http://www.dph.sf.ca.usa/
reports/RussAssessNMap.pdf.
[38] Schwaber M. Outpatient clinic. Ann Intern Med 1996;124:1012–3.
I. Shpilko / Patient Education and Counseling 64 (2006) 331–341 341
[39] Holloway L. From Russian to little Odessa: illegal medicine trade
thrives. New York Times; Section 13; Page 10; Column 3; December
12; 1993.
[40] Friedman Y, Dolinsky L, Perelman R. MedInfoRus: access to medical
information in Russian. J Hosp Libr 2003;3:1–6.
[41] Russia–United States of America Joint Commission on Economic and
Technological Cooperation. Health care quality glossary; 1999. http://
www.ahcpr.gov/qual/hcqgloss.pdf.
[42] Centers for Diseases Control and Prevention National Prevention
Information Network. Tuberculosis education training resource guide;
2003. http://www.cdcnpin.org/Guides/tbguide.pdf.
[43] U.S. Citizen and Immigration Services (CIS). Welcome to the United
States: a guide for new immigrants. Washington, DC: CIS; 2005.
http://uscis.gov/graphics/citizenship/welcomeguide/index.htm.
[44] Flores G. Culture and the patient–physician relationship: achieving
cultural competency in health care. J Pediatr 2000;136:14–23.