Short Film for Hispanic/Latinx MS Patients Found to Improve Perceptions, Attitudes

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by Steve Bryson, PhD |

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A short film produced for Hispanic/Latinx people who live with multiple sclerosis (MS) improved patients’ understanding of the condition and the effectiveness of treatment, a study found. 

“Health communication interventions, like film, have been shown to be effective tools in promoting positive attitudes and health literacy,” the investigators said.

“Our results provide support that a short narrative film of MS in Hispanics/Latinx is a feasible intervention to change perceptions of MS to a more positive view,” they wrote.

The study, “Effectiveness of film as a health communication tool to improve perceptions and attitudes in multiple sclerosis,” was published in MS Journal — Experimental, Translational and Clinical.

MS is characterized by various unpredictable symptoms, severity, and progression, all of which impact the quality of life. Patients’ perceptions of the disease may be influenced by their own beliefs, which can be shaped by cultural background. These perceptions, in turn, can affect treatment, disease management, and the recovery of function.

Studies suggest that people of Hispanic/Latinx ethnicity who have been diagnosed with MS are more likely to believe the disease is the result of stress and other cultural-specific factors. Meanwhile, research shows MS is caused by the immune system mistakenly attacking the myelin sheath, which is the protective protein coat around nerve fibers.

Many barriers Hispanics/Latinx people experience, including language and cultural differences, can lead to misunderstandings and less access to programs that provide low-cost assessments or medications. Furthermore, undocumented immigrants may fear deportation if they seek medical help.

“The use of audio-video technologies to promote self-care and improve outcomes has been well accepted among underrepresented communities,” including those of Hispanic/Latinx patient populations, according to the researchers.

Film has been found to be especially effective in improving self-care and outcomes. Unlike printed materials and educational videos, films can be tailored to a specific population’s social norms and values, using cultural-specific messaging with relevant characters that reflect varying concerns and diverse beliefs. 

The purpose of this study was to test the impact of a short film developed and directed by researchers at the University of Southern California (USC) to improve understanding and perceptions of MS in Hispanics/Latinx adults who live in the U.S. 

The 13-minute film — Dentro De Mí, which used English and Spanish with corresponding subtitles — portrayed non-fiction stories of Hispanics/Latinx people of different ethnic backgrounds who are affected by MS.

The film is based on cognitive-behavioral theory, which focuses on how thoughts (cognition) influence behavior, emphasizing cultural-specific perceptions, language, and ideas about MS and treatment.

A total of 236 adults who self-identified as Hispanic/Latinx and were able to read or speak English and/or Spanish were included in the study. MS patients with serious cognitive impairments were excluded. The participants — 72.8% of whom were women — had a mean age of 40, and primarily had relapsing MS. 

To test the film’s effectiveness, the researchers showed it to 130 of the participants (55%); the remaining 106 did not see the film. Both groups were assessed at the start of the study, and then again at one month, and after three months.

The Brief Illness Perception Questionnaire (Brief IPQ) measured illness perception using five cognitive domains or areas of study. These included consequences, or the impact of MS on a patient’s life, expected disease duration or timeline, and personal control — a patient’s perceived control over the disease. Treatment control, meaning the efficacy of different therapies, and identity — the severity and extent of MS — were the other two domains.

Two emotional domains, concern and emotional response, also were measured, as well as one domain that assesses understanding of the illness. Higher scores indicated a more positive perception of illness. Also, an MS self-efficacy scale (MSSE) assessed function and control of various aspects of each patient’s condition.

Before the film, those assigned for viewing it had a lesser understanding of their illness and higher MSSE scores for functional status compared with those not assigned to see the film.

Those who saw the film had a significant positive change in understanding MS at one month and at three months. A significant change also was seen in the perception of treatment effectiveness, particularly at one month. 

A change in participants’ expectations of disease duration (timeline) — knowing that MS is long-lasting — was noted by the investigators. Higher self-efficacy functional scores based on MSSE at one month also were observed.

To provide additional insights into patient perspectives on living with MS, the investigators convened focus groups, chaired by a public health researcher and two neurologists. The discussion was recorded and transcribed. 

The most important perceived cause of MS was environmental factors, including lifestyle factors, such as being overweight, work-related stress, and unhealthy eating habits. Other suspected causes, as expressed by participants, were sociocultural such as psychological and emotional, and biological factors, including family history.  

Disease prognosis (concern), education and awareness (understanding), and cultural and family support (consequences) were three dimensions of disease perception repeatedly mentioned to be relevant to attitudes.

“We found that Hispanics/Latinx with MS who were exposed to film construed more favorable positive perceptions,” the investigators wrote, noting the study’s results showed that the short narrative film was “a feasible means to change perceptions of MS related understanding and treatment of MS, particularly in those with a shorter disease duration.”

The researchers said the study’s results support increased use of film as a tool for reaching Hispanic/Latinx patients with MS.

“These findings … confirmed that film can foster lasting effects making it a practical clinical tool to promote positive perceptions in disease,” they concluded.