[NIFL-HEALTH:4684] RE: Research on the use of Photonovellas?

From: William Smith (BSMITH@smtp.aed.org)
Date: Tue Mar 08 2005 - 08:50:23 EST


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From: "William Smith" <BSMITH@smtp.aed.org>
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Subject: [NIFL-HEALTH:4684] RE: Research on the use of Photonovellas?
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Evaluating fotonovelas. What would you evaluate and how would you do it?
 FotoN are like radio programs - they are a channel of communication. 
Some radio programs fail and others succeed, but radio doesn't succeed
or fail.  I have never seen anyone waste  money on a case control study
of fotonovelas, whioch be the gold standard.  You would have to take one
fotonovella, compare it against another  fotonovel and then compare it
against some other alternative format to determine what?....in a given
population at a given moment fotonovella A was better(read more widely,
understood?) than B or not as good as alternative C?  What would that
tell you that could generalize to different audience, subjects and
times? 

I will check some international sources that do research on
entertainment media - but I am very skeptical of finding any evaluation
of fotonovells as stand alone, or as simple evaluations that would not
really show you much becasue they were so case specific.  

What is it that you wopuld want an evaluation to tell you? 

I think what we know about communication suggests that your focus on
formative research makes a great deal of sense for a channel like this.
Obiviously a program would need to demonstrate that the  reach and
frequency of a footonovella was sufficient for a given population.    In
a given setting who reads fotonovelas?  How often?  What do they get out
of them?  And most important what part are they playing in a much
broader strategy to accomplish a public health objective.   

Once you decide  they are a viable channel for a specific audience -
what content do you put through it (what are people going to learn from
a fotonovel - facts, positioning, branding ?)  

We did a series of fotonovels in Ecuador to help fight the racism
against rural Indians.  The novel featured a  super hero Indian who
solved real problems with great street smarts.  It was critical that the
problems were perceived to be real and that he was not fighting aliens
from outer space. Manual Santi was his name and he had to  solve things
like water rights problems to be credible.

Manual Santi became a symbol of the smart savvy Indian that we used in
a dozen other channels to address the existing stereotypes.  We used
photos and the lead character made personal appearances around the
country. 

In another case we needed to get very specific information about how to
mix a rehydration solution to mothers of newborns.  There, the accuracy
of the information was important and we knew that just reading the
fotonovel would not be enough.  We designed it as a school project. 
Kids got the fotonovel in school, read it in class and then took it
home. It  was the story of how a school kid had saved his baby sister's
life by mixing oral rehydration properly.  The kids took the fotonovel
home---read it to his parents as a school assignment -- and had mom
answer four test questions about ORS which the kid brought back to
school as homework.  The fotonovel became a reminder in the home of the
mixing formula. The plot line was dramatic - with the child becoming
more and more dehydrated etc.  

This was part of a much larger program that reduce infant mortality due
to diarrhea by some 37% I think.  But you could not say the fotonovel
was the only reason.  It was part of a broader strategy. 

The key evaluation issues  are really formative.  In designing a
fotonovella you test whether it is compelling - whether the story is
clear and NOT considered "learning".  If they think it is a textbook it
will loose its unique power.  You want to test the drawings individually
- actually we use photos in both caseas above because we found drawings
too difficult to identify for our audience.  We were targeting women age
18-35.  Young boys loved the drawings better, but they were not our
audience. This was an audience specific finding, not realy
generalizable. 

There is a large literature on entertainment media and social change. 
The key motion ios to embed call for action and information within an
entertainment format.   My experience is that too many people test only
whether people "liked it" and not did it have the intended behavioral
effect. 

We have so little dollars for evaluation I always try to suggest using
it during the format process.  

What I think experience shows is that fotonolas can be an effective
channel for communication on topics that have an emotional appeal.  They
can be targeted to specific audiences through their distribution
channels.  We used traveling herbalists to sell our fotonovelas because
that's where our mothers bought things like that.  Putting them in
stores would have gone no where.  

The final thing I will share is that the production quality of a
fotonovel matters.  We tested various formats with our audiences and
found that unless it looked professional it was not taken seriously.
Again this was all part of the formative testing.  

I know this does not answer the science question....do fotonvoleas
work?  But then do we have an answer to the question...does surgery
work?....not to cure a cold it doesn't and not if it is done by a
plummer.
Surgery is a procedure with practice standards and fotonovelas are a
channel with practice standards.  Has anyone ever submitted surgery to a
case control trial?  Why not?  Don't we need to know if it works?  
Even in the face of documented medical errors we don't submit surgery
to case control trials. 
 
>>> CBaur@OSOPHS.DHHS.GOV 3/7/2005 3:31:26 PM >>>
Bill,

Bill,

Would you mind posting some specific references to evaluation studies
of
fotonovelas? The original inquiry related to efficacy. The listserv
responses have focused on formative research and production processes.
The
Healthy People 2010 objective 11-3 encourages both formative research,
which
is what most people have discussed, and evaluation research. 

Cynthia Baur
HHS

-----Original Message-----
From: nifl-health@nifl.gov [mailto:nifl-health@nifl.gov] On Behalf Of
William Smith
Sent: Monday, March 07, 2005 3:20 PM
To: Multiple recipients of list
Subject: [NIFL-HEALTH:4680] RE: Research on the use of Photonovellas?

I spent a good deal of my early life developing photonovels in Latin
America.

I'd be glad to offer that experience if people want specific guidence.
I'm pretty  fluent in Spanish if that helps. 

Wm. Smith
Executive Vice President
Academy for Educational Development
1825 Connecticut Ave., NW
Washington, D.C. 20009

A little change hurts a lot.
A lot of change doesn't hurt that much more.
Phone: 202-884-8750
Fax: 202-884-8752
e-mail: bsmith@aed.org 

Wm. Smith
Executive Vice President
Academy for Educational Development
1825 Connecticut Ave., NW
Washington, D.C. 20009

A little change hurts a lot.
A lot of change doesn't hurt that much more.
Phone: 202-884-8750
Fax: 202-884-8752
e-mail: bsmith@aed.org

>>> rrudd@hsph.harvard.edu 3/7/2005 12:30:23 PM >>>
Hello,
It is good to see discussions about this topic. I'd like to make a
brief note 
about photonovels. As you all now, this form of wrting material is
very

popular in Central and South America. The format is set like a comic
book. 
However, photos are used instead of comics. The story line is carried
by 
dialogue bubbles and aided by a brief note on top of a new page [e.g.
the next 
day...]. The dialogue bubbles must be very brief and this helps with
literacy 
related issues.
However, as you examine a wide variety of photonovels developed to
address an 
array of health issues..... do look into the development process. In
some 
cases the photonovel was developed by experts. It will be important
for
you to 
consider the rigor with which it was developed, piloted, and revised
by

members of the intended audience. In some cases the photonovel was
developed 
by members of the intended audience through a process facilitated by
an

outside or inside expert. Here too, be sure to consider the rigor of
the 
process. 
Debra Roter, John Comings and I [Rudd] wrote about this participatory
approach 
and indicated the importance of authentic voice. 
Also -- for those of you thinking about developing such material, you
will 
find a how-to approach on the following website: 
www.hsph.harvard.edu/healthliteracy. 
We've found this to be a rich experience, a lot fun, and a worthwhile 
endeavor. Participatory materials development enables members of the
intended 
audience to share a story of their own about critical topics. The
power
of 
this story, told visually and in words that are the participants',
captures 
the attention of readers and most often speaks to them in 'plain'
everyday 
terms.
Rima Rudd


>===== Original Message From nifl-health@nifl.gov =====
>Hi-
>I just started working on an article related to our use of the
photonovels
>we developed for prenatal care.  (We've discussed the De Madre A
Madre/From
>Mother to Mother bilingual photonovels on this listserv previously.)
>Although the article is not published yet, you might be interested in
our
>work.
>
>After developing the photonovels (a hybrid design- combining a
traditional
>photonovel format with a literacy component) we received several
small
>grants to develop a method to teach prenatal education classes using
the
>photonovels.  We've developed a simple 6 step process.  Over a period
of
>about 4 years, we have tested the 'Teach-With-Stories' (TWS) method
in
>several sites across North Carolina with pregnant Latino women with
low
>literacy skills in English and/or Spanish.  The facilitators also had
>different skill and literacy levels. Each class they would read and
discuss
>a story together.  Group members took the photonovels home.  They
reported
>keeping them, rereading and sharing them with friends and other
family
>members.
>
>The TWS method addresses health literacy, health empowerment, and
health
>education needs. While our focus was on refining the method and
learning how
>to train facilitators in the process, we did some informal
qualitative
>evaluation. The results and stories were fairly consistent across
sites.
>Many of our findings are similar to the published findings in studies
on the
>efficacy of patient-centered care. Both clients and clinic staff
benefit.
>Note:  A great summary of these studies is in the Institute of
Medicine's
>Health Professions Education: A Bridge to Quality report (2003).
>
>At the core of the TWS method is a 'power-sharing' way of relating
and
>educating (i.e., educator as facilitator rather than expert).  In
addition,
>we have tried to build on your work, Dr. Rudd's work and the work of
Rick
>Arnold (who developed the 'Spiral Model'- an educational empowerment
>process).
>
>Just recently, the TWS method was selected as a national
demonstration
>project and will be more formally evaluated.  We are looking at how
to
>evaluate its impact on the group members' health literacy (and also
the
>impact on the group itself).  We are especially interested in how to
>evaluate change in levels/types of social support and how it relates
to
>health literacy of individuals and the group.)  If anyone has any
>suggestions about this, please let me know!
>
>If you would like additional information, feel free to contact me
directly.
>
>Hope this helpful-
>
>Susan Auger
>Executive Director
>Auger Communications/Aprendo Press
>sauger@mindspring.com 
>tel: 919-361-1857
>
>-----Original Message-----
>From: nifl-health@nifl.gov [mailto:nifl-health@nifl.gov] On Behalf Of
>Lendoak@aol.com 
>Sent: Monday, February 21, 2005 12:05 PM
>To: Multiple recipients of list
>Subject: [NIFL-HEALTH:4657] Research on the use of Photonovellas?
>
>Several of us are preparing a paper on the efficacy of visuals in
patient
>education.  Our question is:  What research or practice has been
published
>on the
>use of Photonovellas?
>
>We would appreciate any information.
>
>Len and Ceci Doak
>Patient Learning Assoc.
>4 Chilham Ct.
>Potomac, Md. 20854

Rima E. Rudd, MSPH, Sc.D.
Department of Society, Human Development,and Health
Harvard School of Public Health
677 Huntington Avenue
Boston, MA 02115
Phone: 617-432-1135
fax:   617-432-3123
Note new listings on our Health Literacy Web Site:
www.hsph.harvard.edu/healthliteracy 



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