Hi Marty-
Teaching with stories is our oldest form of education and is used in
cultures throughout the world. However, the scholarly research on the
process and specifically on photonovellas I believe is still pretty sparse
at this point. Hopefully discussions like we are having now can stimulate
some interest in this area. As a doctoral student myself, I appreciate the
importance of research that can make a meaningful contribution to
scholarship as well as practice. There are lots of opportunities for
exploration related to their design, development, use, and efficacy.
 
A study by Elder et al. (2006) comes to mind that may provide some insight
into a possible intervention design for photonovellas. It may also provide
some helpful information regarding Bobbie Randall's idea about personalizing
diabetes information. 
 
In the study entitled, Long-term effects of a communication intervention for
Spanish-dominant Latinas, they examined the 1-year impact of two innovative
behavior-change approaches (use of promotoras (a.k.a. lay educators) and
tailored print materials) to reduce dietary fat and increase fiber. 
 
Here are the abstract details:
Study Design: Three-group randomized controlled trial: (1) personalized
dietary counseling via lay health educators plus tailored print materials
delivered via the mail, (2) tailored mailed print materials only, and (3)
targeted mailed 'off-the-shelf' materials.
 
Results:  Earlier work reported that at immediate post-intervention the
promotora group achieved significantly lower levels of total fat grams, and
lower levels of energy intake, total saturated fat, total carbohydrates,
glucose, and fructose than the targeted group. However, the present
longitudinal analyses suggest that the effects achieved by the promotoras
dissipated over the 12-month follow-up period while the effects of the
tailored group concurrently improved.
 
Conclusions: The high interactivity (i.e., calls, visits) of the promotora
condition may have been the most salient reinforcer and may have led to
further tailoring, making this type of intervention more effective than the
comparison groups in the short term. Further research should explore whether
booster sessions involving promotoras help to maintain the impact over time.
 
Reference:  Elder, J.P., Ayala, G.X., Campbell, N.R., Arredondo, E.M.,
Slymen, D.J., Baquero, B., Zive, M., Ganiats, T.G., & Engelberg, M. (2006)
Long-term effects of a Communication Intervention for Spanish-Dominant
Latinas. Journal of Preventive Medicine. 31: 159-166.
 
In this case, 'tailored print materials' included a series of 12 tailored
newsletters and homework assignments that were created using baseline data
provided by the participant. Perhaps an interesting study would be to
compare this type of tailored material (including a person's photo on it?)
to a photonovella series (developed through a participatory process) and to
the photonovella series used with the TWS method. 
 
Another suggestion to consider for a public health intervention is to
explore what data is already being collected in your system or organization.
For example, in the demonstration project at the Neighborhood Health Plan of
Rhode Island (NHPRI), as a medicaid managed care organization, they
routinely collect Healthcare Effectiveness Data and Information Set (HEDIS)
data to measure their performance and monitor their quality of care. For
details, see the National Committee for Quality
Assurance.http://www.ncqa.org/    I understand that HEDIS has a standardized
compliation of indicators that constitute 'optimal prenatal care.' So NHPRI
was able to compare that data for the participants who had the
Teach-with-Stories intervention with photonovellas to, in this case, those
that received  'usual-care.'   The results- 90% received optimal prenatal
care compared to 65%.  NHPRI also conducted a participant pre and post test
and follow up focus group with participants about their experience and
perceptions (I believe 3 months after), and a debriefing with staff (via a
meeting and self-assessment form) re: their experience and perceptions. 
 
If others have conducted or know of other studies or have developed
evaluation instruments specifically for use with photonovellas, please let
us know.  Are there specific research questions you would like to see
addressed regarding photonovellas?
 
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 Marty Romney
Sent: Wednesday, November 19, 2008 7:32 PM
To: The Health and Literacy Discussion List
Subject: [HealthLiteracy 2486] Re: Teach-With-Stories method for using
photonovellas


Susan,

Thank you for all you have shared (and others as well). This discussion
about different facets of photonovellas has been extraordinarily informative
as well as exciting.

I would appreciate insights and recommendations on appropriate, validated,
reliable (etc.) evaluation instruments that have been used to assess and
confirm the effectiveness of interventions utilizing photonovellas.  Are you
aware of any evaluation instruments that have been developed specifically
for photonovellas?  

How would you recommend someone planning a public health intervention
determine what and how to measure the outcomes?

Are you are aware of any published reports documenting appropriate
evaluation tools and analyses to measure the outcomes and success of using
photonovellas? I have looked but not found anything specific to evaluation.

Thanks again to everyone.

Kind regards,

Marty



On 11/19/08 1:26 PM, "Susan Auger" <sauger at mindspring.com> wrote:



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: auger at augercommunications.com <mailto: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

 




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