Julie- 
I appreciate the points you make very much. In fact when I first began my
research into this area, World Education's H.E.A.L. adult health education
literacy project,including the booklet on how to use a photonovella, proved
to be excellent model and guide! Another great resource was Mary Norton and
Pat Campbell's work with low income women described in their manual
"Learning for our health: A Resource for participatory literacy and health
education" at The Learning Centre in Edmonton, Canada (it went out of print
but I understand they may make an electronic version available). Their
application of the 'Spiral Model' (developed by Rick Arnold et al.) for
group facilitation gave me the idea of how to adopt a participatory approach
to teaching prenatal education using photonovellas. 

Two other resources for participatory education manuals and reference books
probably more well-known in the literacy world are: Peppercorn Books & Press
and also Delta Publishing Company.

Regarding your observation about medical culture's different mode of passing
on information and different power dynamic. Absolutely critical to talk
about and make explicit when thinking about adopting a participatory
approach. They are two fundamentally different paradigms of relating, which
lead to different communication dynamics and consequently, different
outcomes. One is a 'power over' hierarchical way of relating, the other is
based on a 'power sharing' paradigm. Sharing power is central to cultural
competency and empowerment-based approaches.

We noticed something interesting in our Teach-With-Stories facilitator
training process. Even if a person followed the 'six-step method' correctly,
if she did not also shift her thinking to a facilitator mindset (i.e., and
stayed mentally in the role of 'expert'), the energy of the group was flat,
there was no sense of flow, or connection. So in our training, we use
experiential exercises, modeling and practice to help people understand and
feel the spirit of this approach for all the reasons Mark alluded to in an
earlier post. It's same reason I use an experiential, skills-based approach
to cultural competency training. It's one thing to talk about it, it's
another thing to practice it.  

Regrarding challenges...I was so heartened to see this issue addressed
directly in the Institute of Medicine's 2003 and 2004 reports (on bridging
the quality chasm and health literacy). They call for a shift from a
clinician-centered to a patient-centered model of care. In essence, to put
the IOM's recommendations to transform our healthcare system into practice,
we must make this paradigm shift to a power-sharing way of relating and
communicating. If we are to become culturally competent and proficient in
our actions and systems, we must adopt cultural humility as an attitude and
spirit of relating.  

This is easier said than done, especially when the design of our healthcare
systems, funding policies, and ways of training professionals perpetuate and
reinforce a clinician-centered model. And given the increasing complexity of
needs, sheer volume of demand, coupled with resource shortages, making any
kind of change can feel overwhelming. Specifically in the area of preantal
care, through an NIH study, we are looking at factors that faciliate and
hinder the use of group education and lay educators. I'll keep you posted on
those results when we have them.

For others, especially the participatory literacy educators on the list, how
do you typically teach these types of skills and approaches? Are there
things you may do differently when teaching health professionals versus
literacy educators? 

For health professionals involved in education, what are your thoughts or
impressions about adopting a participatory approach in your program or
clinic?

Susan




-----Original Message-----
From: healthliteracy-bounces at nifl.gov
[mailto:healthliteracy-bounces at nifl.gov] On Behalf Of Julie McKinney
Sent: Wednesday, November 19, 2008 3:30 PM
To: healthliteracy at nifl.gov
Subject: [HealthLiteracy 2484] Re: Teach-With-Stories methodfor
usingphotonovellas

Thanks, Susan. Your comments reinforce how this method matches well with the
needs of health and literacy educators, but also brings up some interesting
issues about their respective methods of delivering information. (Or, at
least our perception of their respective
methods...)

Adult education has for a long time promoted the effectiveness of a
participatory approach, and is known for supportive group environments where
the verbal and written sharing of each student's views, experience and
culture are thought to enhance the process of language and literacy
learning. Indeed, when you are aiming for language and literacy skills
aquisition, it seems clear (and is supported by evidence) that practicing
speaking and writing about a topic that is meaningful to you will help you
to learn the skills.

The medical community, traditionally, seems to have a different culture of
passing on information and skills. The medical provider/patient relationship
seems to have a different power dynamic than what we usually see in adult
education classrooms. (I like to back this up with the documented "white
coat syndrome", where a patient's blood pressure has been shown to go up
when someone wearing a white coat enters the
room.) 

Granted, health education venues, like Julie and Mary described are
different than the clinical encounter. But is this issue something we need
to consider when encouraging the health community to embrace a highly
participatory method like photonovellas? What challenges do health programs
find in using a method like this? Is this an area where a literacy
program/health program partnership would help? 

Julie

Julie McKinney
Health Literacy List Moderator
World Education
jmckinney at worlded.org

>>> "Susan Auger" <sauger at mindspring.com> 11/19/08 1:32 PM >>>

I wanted to share some background info to help clarify how I came to develop
and use photonovellas differently...

In the early 1990's I 'discovered' photonovellas while conducting a national
search for culturally appropriate bilingual educational materials for NC
health departments.  As the State Training Coordinator for women's health at
the time, I was responsible for conducting statewide training needs
assessments, as well as developing and coordinating training for health
professionals in maternity and family planning.

Serving the growing Hispanic population posed many challenges, e.g., lack of
bilingual, bicultural staff, interpreters, and bilingual materials. It was
common for women to come into prenatal care late or just show up in the
emergency room at the time of delivery. Issues voiced by providers included
problems with no-shows, 'non-compliance,' and perceptions that Latinos were
'difficult to reach,' and 'didn't like groups.' The more I learned about
literacy and cultural competency, I realized that this probably had more to
do with our lack of cultural competency (individually and
organizationally)
and ineffective service delivery strategies, than simply a lack of
appropriate written materials and problem patients. 

Similar to John and Laura, Paolo Friere, along with Malcom Knowles' work
(adult learning theory), were also inspirational to me.  From a systems
perspective, I saw the need to transform how we were teaching mandated
prenatal education- from a teacher or clinician-centered model to a learner,
patient or cultured-centered model.  To me, the photonovella was a perfect
tool to assist providers and educators who wanted to adopt a participatory,
empowerment-based approach. 

Using a collaborative development process, we wove together key content
taught in traditional prenatal education curricula, actual experiences of
Latino families and providers who serve them to create the De Madre A Madre
photonovellas.  Embedded in the stories are discussion 'sparks' related to
common issues and concerns (mental, emotional, social, spiritual)
experienced by women during and after pregnancy.  

As Julie and Mary mentioned, the women read the novella out loud like a play
(so those who can't read can still participate). While key health messages
are automatically addressed while reading the story, the dialog focuses on
the priorities, experiences, and questions of the group members.  So they in
effect tailor the session to their unique needs and interests. This
structure shifts the dynamics from a passive, lecture style to an active,
participatory one where everyone truly is a teacher and a learner. 

The group process, what we now call the Teach-With-Stories(TWS) method,
fosters critical thinking, behavior change, and social support- all key
elements of health literacy.  Julie touched on its simplicity and
flexibility. It takes no more time than a traditional class and you can
weave in other activities or use it to supplement an exisiting curriculum.
And as Julie also mentioned, the photonovellas can still be used for
information dissemination and in one-on-one education.

As Mark suggests, the dynamics in making change in one' life or one's family
are complex and can be complicated to explain. We need to create 'space ' in
our systems of care to address these types of needs and realities.  It is at
the heart of true health literacy. I think using photonovellas with a
participatory, group approach, like our TWS method, gives providers and
educators a practical and easy way to do this.

Susan
 
Auger Communications, Inc.
PO Box 51392
Durham, North Carolina 27717
tel:  919.361.1857
fax: 919.361.2284
email:  <mailto:auger at augercommunications.com>
auger at augercommunications.com
 

  _____  

From: healthliteracy-bounces at nifl.gov
[mailto:healthliteracy-bounces at nifl.gov] On Behalf Of MarkH38514 at aol.com
Sent: Wednesday, November 19, 2008 10:55 AM
To: healthliteracy at nifl.gov
Subject: [HealthLiteracy 2481] Re: Treatment refusal and verbal abilitiesand
phot...


Susan: 
 
This sounds promising. From my own experiences as a Psychologist and a
patient...
 
Because so much information about medical treatments and research is focused
on the patient,  health care providers don't always realize that every
disease is a family disease. 
 
Physicians are often frustrated by "non-compliant" patients (a description I
despise) who don't do what they're told--losing weight, for example. But
losing weight means you have to change what you eat and that decision alone
can create profound spousal, family, cultural and religious conflicts. 
 
Plus, successful weight loss can be psychologically threatening to other
family members who can't or don't want to lose weight, or feel that their
spouse's weight loss will threaten the marriage because the spouse may now
be more attractive to the opposite sex. Sometimes family members can
sabotage one's best efforts to lose weight and keep it off. Obviously
there's more to weight loss than telling patients to lose weight and giving
them nutritional handouts. 
 
If you can find patients willing to talk honestly about these issues, you
may be able to identify possible barriers to healthy behavior and provide
some possible solutions in a format that's more meaningful than just another
medical handout. 
 
Mark
 
Mark Hochhauser, Ph.D.
Readability Consultant
3344 Scott Avenue North
Golden Valley, MN  55422
Phone: 763-521-4672
Fax: 763-521-5069    
Cell: 612-281-1517
email: MarkH38514 at aol.com
 
 



  _____  

One site has it all. Your email accounts, your social networks, and the
things you love. Try the new AOL.com
<http://pr.atwola.com/promoclk/100000075x1212962939x1200825291/aol?redir=htt
p://www.aol.com/?optin=new-dp%26icid=aolcom40vanity%26ncid=emlcntaolcom00000
001>  today!

----------------------------------------------------
National Institute for Literacy
Health and Literacy mailing list
HealthLiteracy at nifl.gov
To unsubscribe or change your subscription settings, please go to
http://www.nifl.gov/mailman/listinfo/healthliteracy
Email delivered to sauger at mindspring.com