Multilingual Eye Health Patient Education Videos

As they say, there is always a first time for everything... so here goes my very first blog and blog post... the prep-work of putting this together has been very exciting and rewarding, and I hope anyone who happens to come across this will also share the same excitement about this project idea as I and our growing team of volunteers, without whom this project would not be possible (see acknowledgement at the end).  Thank you SO MUCH for taking time out of your busy schedule to read about this exciting and hopefully beneficial project.  So here goes... 

Background

According to the Canadian National Institute for the Blind:

• only 1/3 of working-age Canadians with vision loss are employed,
• seniors with vision loss are 3X more likely than those with good vision to experience clinical depression, and
• people with vision loss are at high risk of social isolation, reduced community participation, falls and associated morbidity and mortality such as hip fractures and death

Vision loss can lead to other major losses in life, including job, relationships, driver’s license, and independence.  Hence, preserving vision and eye health is not only important to each individual, but to society overall. 

Anecdotally, I have noticed many patients who speak limited English present with end-stage blinding eye disease.  I am of Chinese ethnic background and am fluent in Cantonese and Mandarin.  Through speaking to those Chinese patients who present with end-stage eye disease, it seems that this is either because they do not know how to navigate our healthcare system or do not know what symptoms to look for.  Unfortunately, some end-stage eye diseases are not salvageable, and for others, treating advanced disease is often associated with poor outcomes as a result of higher treatment risks and complication rates, longer recovery time for the patient, and higher costs to our healthcare system.

Objective evidence is also consistent with these anecdotal findings.  Health Canada reports that language barrier is a major hindrance to access to healthcare in Canada, may provide limitation to the quality of care and patient satisfaction, and is associated with higher costs to our healthcare system (H. C. Government of Canada, 2003). 

The need

Canada is highly multicultural.  According to the 2011 census (S. C. Government of Canada, 2012):

• Nearly 6.6 million people or 20.0% of Canada's population reported speaking a language other than English or French at home.          
• 9 out of 10 of these individuals reside in a metropolitan area: Toronto, Montreal, Vancouver, Calgary, Edmonton and Ottawa. 

Greater Toronto Area (GTA) is the most multicultural:

• 1.8 million of these people live in the GTA
• 1/3 of these people in GTA speak one of Cantonese, Punjabi, Mandarin, Urdu and Tamil.  
• Other frequently spoken languages include: Tagalog, Spanish, Italian, Farsi, Portuguese, Russian

Majority of the public education materials available are in one of our official languages, English or French. 

Economic analysis

According to The Cost of Vision Loss in Canada report published in 2009 by the CNIB and Canadian Ophthalmological Society,

• The real financial cost of vision loss in Canada is estimated to be $15.8 billion for 2007, or 1.19% of Canada’s gross domestic product.

o    This breaks down to $500 for every Canadian or $19,370 for every Canadian with vision loss in 2007.

o    The real financial cost consists of:

§  Indirect costs (lost productivity, care and rehabilitation, and others) of vision loss of $7.2 billion

§  Direct costs (health-related) of $8.6 billion

• The net cost of suffering (also known as the burden of disease) due to vision loss, over and above financial costs, is estimated to be a further $11.7 billion in 2007.
• Vision loss has the highest health care costs (direct costs) of any disease category in Canada, costing Canadians much more than diabetes, all cancers or cardiovascular disease.

So who pays for the costs of vision loss?  The financial costs breakdown is as follows (CNIB & Canadian Ophthalmological Society, 2009):

• Individuals with vision loss ($3.5 billion)
• Family and friends ($474 million)
• Federal government ($2.4 billion)
• Provincial and territorial governments ($6.3 billion)
• Employers ($141 million)
• Society and others ($3.0 billion)

In essence, the largest financial costs come from taxpayers, as federal and provincial governments bear 55.3% of the costs, and all of society bears a further 18.7%.

Based on a rapidly aging population in Canada and the fact that the top three causes of blindness are all age-related, in the next 25 years, the number of Canadians with vision loss is projected to double (CNIB & Canadian Ophthalmological Society, 2009).  With increase in immigration, any intervention will also need to be culturally sensitive and offered in multiple languages.  Hence, it is more important than ever to place eye health as an important public health issue with culturally-appropriate health promotion in multiple languages. 

The proposed program

The multilingual eye health public education videos (MEHPEV) project consists of producing a series of eye health patient education videos in the top several non-official languages spoken in Canada, as well as in English and French.  Videos will be hosted on the University of Toronto Department of Ophthalmology and Vision Sciences (DOVS) YouTube channel and will be available on the DOVS website as education tools especially aimed for those who speak limited English.  Awareness of the videos will be promoted through various ethnic media (TV, radio, newspaper, websites), public and private immigrant organizations, and through healthcare professionals. 

Target population

The target audience, to which the MEHPEV will be promoted, is a vulnerable population consisting of those who speak one of the top non-official languages in the GTA.  The number of languages to be included will depend on the funding amount raised for the program, starting with the top spoken languages.  The target population may be expanded to the rest of Canada starting with the other metropolitan cities if the project is proven to be successful locally and a transferability evaluation deems it to be useful. 

Video content

For each language, the topics for the videos will start with the top 3 causes of blindness (cataracts, glaucoma, and age-related macular degeneration) and 2 common eye conditions (dry eyes and floaters).  If there is sufficient funding, additional topics will be added in the future. 

Format

Online videos were selected as the media of choice for a few reasons. 

1. Video was chosen over printed material as those with eye diseases may not have good vision and can rely on the voice component of the videos.  This also has the added benefit of reaching those who are illiterate as well. 
2. Online format was chosen over one time or intermittent TV or radio broadcasts to allow for long term availability and ease of access. 
3. Online video format is more cost efficient compared to broadcasting educational videos of several minute duration on TV or radio. 

There are limitations to online video format, as some elderly individuals may not be familiar with internet usage, but it is hoped that some of them will have family or friends who can assist them with access and that some of the ethnic community organizations who we are partnering for the video dissemination will have human or technical resources to facilitate access to the videos.  Hopefully these and other mitigating measures will help to allow the online videos format to strike a balance between cost, program longevity and ease of access. 

Why is this proposed program of interest to me?

The MEHPEV program started as a personal project.  Each time I see a patient who presents with end-stage eye disease, my heart sinks.  As many of these patients are elderly and speak limited English, they remind me of my grandparents.  I wish I could have helped them earlier, prevented them from losing their vision or having to go through difficult treatment course with higher risks, and I am sure their own children, grandchildren, and family would have wished that for them too. 

I entered medicine with the goal of helping society in the clinical setting and beyond.  I have always had a passion for education.  I am currently actively involved in medical education and am looking to expand my volunteer interests to help the general population.  I think that international outreach is highly needed, valuable and encouraged.  I myself am involved with international work.  However, I see a huge need locally right at home.  Even though we have one of the best healthcare systems in the world and we are so fortunate to live in a first-world country, I see many cases of third-world end-stage eye diseases in my practice in GTA.  Hence, I feel very strongly that we should help ourselves right at home and started this program.   

I envisioned this program to require 3 components/stages:

1. Funding
2. Video production
3. Dissemination

Project goals

The goals of this project are to:

1. Reduce the number of patients who speak one of the major non-official languages in GTA presenting with end-stage eye disease (secondary prevention)
2. Promote healthy lifestyle and eye disease risk reduction (primary prevention)
3. Save healthcare spending costs through prevention, early detection and early treatment

How will this program be achieved?

•       Funding

•       Application to governments and granting agencies

•       Seeking individual donations

•       Seeking corporate sponsorships

•       Dissemination

•       Media: multilingual TV, radio, newspaper, websites

•       Toronto Public Health

•       Community groups

•       Physician groups (ophthalmology, family medicine)

Donations

For anyone or organization interested in donating to this project, tax receipts will be issued and your generous gift will be recognized. 
- Please make donation cheques to: University of Toronto
- Please indicate in the memo part of the cheque: multilingual eye video fund
- Please mail cheque to: 

Department of Ophthalmology and Vision Sciences
University of Toronto
340 College Street, Suite #400
Toronto, Ontario  M5T 3A9
Canada
Att: Elizabeth den Hartog

Sample videos

These videos were produced unscripted without rehearsal for Yee Hong Centre for Geriatric Care with volunteer efforts from Ms. Wendy Wu, Mr. William Leung, and Mr. Albert Au (videographer).  The goal for MEHPEV project will be to produce a standard script which will be translated to various languages and the videos will also include computer animation of eye anatomy and surgery.  

https://www.youtube.com/watch?v=MapvrOXJ1Eg (English)

https://www.youtube.com/watch?v=QFZJGbm-ooc (Mandarin)
https://www.youtube.com/watch?v=gzoAG5g8C_A (Cantonese)

Questions/Comments/Suggestions/Potential Collaborators or Volunteers

Please email: eyehealthvideo@gmail.com

References

Canadian National Institute for the Blind. (n.d.). Fast Facts about Vision Loss. Retrieved from http://www.cnib.ca/en/about/media/vision-loss/pages/default.aspx

Government of Canada, H. C. (2003). Language Barriers in Access to Health Care [Health Canada, 2001] (report). Retrieved from http://www.hc-sc.gc.ca/hcs-sss/pubs/acces/2001-lang-acces/index-eng.php

Government of Canada, S. C. (2012, October 24). Census: Language. Retrieved October 18, 2015, from http://www5.statcan.gc.ca/olc-cel/olc.action?ObjId=98-314-X2011001&ObjType=46&lang=en&limit=0

Acknowledgements (the list will be continuously updated)

Huge thanks to all involved in this project!!  Let's try to help by saving one patient's vision at a time...

Contributors/Collaborators/Advisors:

Dr. Sherif El-Defrawy, DOVS

Dr. Agnes Wong, DOVS

Dr. Wai-Ching Lam, DOVS
Dr. David Wong, DOVS

Dr. Ian Johnson, Public Health Ontario

Miss Jessica Cao

Dr. Raj Rathee, North York General Hospital

Dr. El-Karim Rhemtulla, Niagara Health System
Dr. Pierre Trottier, Quebec

Mr. Muhammad Tariq

Ms. Nida Tariq

Mr. Edward Yun

Ms. Lily Liu

Ms. Rosalind O’Connell, Canadian Ophthalmological Society

Ms. Elizabeth McCarthy, North York General Hospital

Dr. Beate Sander, Public Health Ontario

Mr. Sachin Malik

Ms. Wendy Wu

Mr. William Leung, Yee Hong Centre for Geriatric Care

Mr. Albert Au

Mr. Chad Liu

Donors:

Mrs. Elly Li Cairns

Ms. Sara Mok

Mr. Alex Wong

Mr. Hongyu Wang

Ms. Yi Yang

Ms. Jia Liu