I appreciate the emphasis on the importance of the participatory process. I
think this is central to health literacy's objectives related to being able
use and apply health information in a person's daily life as suggested by
Chris Zarcadoolas' 'gold standard.'  

What's also important is a person's readiness for change. According to the
'stages of change' theory (aka transtheoretical model) developed by
Prochaska, DiClemente and others, behavior change is not an event, it is a
process with distinct stages (i.e. precontemplation, contemplation, action,
maintenance).  The information a person seeks and finds relevant is often
influenced by what 'stage of change' a person is. This theory informs my
work developing photonovels and is an intergral part of the TWS method.

For example, when we began the development of the gestational diabetes
photonovel, there were many possible 'action steps' to focus on. When we
studied the flow in a high-risk clinic system, we found that one of the
problems was that the women were getting identified in local clinics and
referred to the regional high-risk clinics, however, many women never
followed through. We looked into this situation in more depth. We found a
variety reasons, however, one stood out that seemed particularly suited for
a photonovel story- the overwhelming emotions many women felt when first
learned they had gestational diabetes. Their fear, misconceptions and sense
of hopelessness were further compounded by misinformation in their families,
community, etc. As one reviewer (a diabetes educator) put it, 'Thank you for
addressing this issue. I have so many things to teach the women about what
to do to manage their diabetes except they are so distraught, some almost
paralyzed by the news, that I have to put all that aside. I just sit and
talk with them about their feelings. Until they are emotionally ready, they
just can't take in anything else.'

In groups, you will naturally have a mix of people in various stages of
change. We found that the TWS method with the photonovels is an effective
way to tap into the power of group dynamics and turn that diversity into a
strength. By asking questions and through the natural flow of dialog, women
support each other through the stages of change. For example, you can ask
the women who are ready for change about what motivates them (this can give
those in precontemplation or contemplation mode things to think about). You
can ask about hesitations or challenges and let the group members respond
re: how they overcame them and/or how they think about those issues, e.g.
for possible ways to reframe. With the group members actively participating,
the information is much more likely to be relevant and culturally
appropriate. Members can also help 'translate' what a health professional
shares if needed. 

If resources and time are limited, participatory groups offer an intriguing
and powerful complement to the traditional one-on-one visit. On a related
note, there is a growing body of research on the efficacy and cost
effectiveness of group models of care (with education and medical
components).  To further health literacy aims, I think group care &
education ought to be on our radar too.

Susan


-----Original Message-----
From: healthliteracy-bounces at nifl.gov
[mailto:healthliteracy-bounces at nifl.gov] On Behalf Of Laura Nimmon
Sent: Wednesday, November 26, 2008 2:23 PM
To: The Health and Literacy Discussion List; The Health and Literacy
Discussion List
Subject: [HealthLiteracy 2518] Re: Evidence-based? ... Literacy benefits?

I second this.  It is more about the participatory process, not the product.

Again, this is reiterated in the findings of James et al. (2005) who found
that photonovels proved to be an effective strategy to prepare South African
youth for adequate preventive behaviours. The study, however,  identified
the need to combine photonovels with other planned theory-based
interventions to initiate preventive behaviour with respect to sexually
transmitted infections.
Laura

--
Laura Nimmon
Ph.D Student
Social Sciences & Humanities Research Council of Canada Doctoral Fellow
Michael Smith Foundation for Health Research Senior Graduate Trainee
www.photonovel.ca

Language and Literacy Education
University of British Columbia
2125 Main Mall
Vancouver, BC
Canada V6T 1Z4


-----Original Message-----


> Date: Wed Nov 26 06:13:04 PST 2008

> From: "Rima Rudd" <rrudd at hsph.harvard.edu>

> Subject: [HealthLiteracy 2516]   Re: Evidence-based? ... Literacy

benefits?

> To: "The Health and Literacy Discussion List" 

> <healthliteracy at nifl.gov>

>

> Hello [and Happy Thanksgiving]

> I write, as a fan of Cris Zarcadoolas who always manages to cut to the

chase. There are indeed two dangers hidden in our enthusiasm. The first is
the easy temptation to reach into our pocket for our favorite tool with the
intent to use it for all situations. The second is to forget that materials
[even exciting materials such as the photonovels] serve only as a support
for a well designed program -- they do not and should not constitute the
program as a whole.

> The participatory processes underlying the focus on photonovels in  public

health/education efforts should be at the center. The photonovel serves as
an example. We need to look at other participatory processes [e.g.
photovoice] and be sure that our attention is on the process and not the
product.  

> Rima

> 

> 

> Rima E. Rudd, ScD, MSPH

> Department of Society, Human Development & Health Harvard School of 

> Public Health

> 677 Huntington Avenue

> Boston MA 02115

> Phone: 617 432 1135

> fax:     617 432 3123

> web:    www.hsph.harvard.edu/healthliteracy

> www.hsph.harvard.edu/sisterstogether

> 

> >>> christina <zarcac01 at imail.mssm.edu> 11/25/2008 9:37 AM >>>

> Julie, Susan, ...

> 

> I think of photonovellas the way I do about any text.  And as Susan so 

> rightly put it - is is one

> of many texts - verbal, visual, print,   that 

> contribute to advancing a person's engagement and understanding.

> Therefore "evidence based" is so medical and narrow a standard - in 

> some ways setting the bar too low.

> If a text has meaning for someone it will give voice, empower, and 

> democratize what is too often the rarified, closed codes of science ( 

> or other technology). Not all of these powerful things can be 

> accomodated in our "evidence based" tool kit.

> 

> What tempers my enthusiasim for novellas ( or any one kind of text) is 

> that I see too often that "it" becomes the default.  Therefore instead 

> of struggling with the messiness of true collaboration to see what the 

> text is/might need to be, we decide it will be a novella for X 

> community, for y subset of the population. We can become wooed into 

> thinking that is the one true answer.

> 

> Another concern with text formats that "work" is that we have to learn 

> more about what they work at.  Can they convey more than the 

> information given.  The gold standard for me is, can the text convey 

> the information in a way that is productive - allows the user to use 

> something of the information in a new way, in a new context.

> 

> What prompted me to post today is there is some breaking news on the 

> all the morning

> Study: Do breast tumors go away on their own?

> http://www.usatoday.com/news/health/2008-11-24-breast-cancer_N.htm?csp

> =34

> 

> Perhaps not totally on the topic of novellas - but a text  question in 

> its own rightŠ.

> 

> What do the texts we create ( alone or with our

> collaborates) do to promote an active engagement with concepts as much 

> as the literal facts or information?

> 

> Thanks for a stimulating discussion this past week.

> 

> Happy Thanksgiving to you all,

> Chris

> 

> Christina Zarcadoolas, PhD.

> Health and Environmental Literacy Initiative Dept. of Community and 

> Preventive Medicine Mount Sinai School of Medicine One Gustave L. Levy 

> Place Box 1057 New York, NY 10029

> 212-824-7061

> 

> Visit my blog     www.zarcbark.blogspot.com 

> 

> 

> 

> >Hi Julie-

> >It's nice to finally be back on-line!

> >

> >The question are photonovellas an

> >"evidence-based" strategy made me pause. 

> >Empirical studies could help us arrive at a 'yes' or 'no' answer. 

> >However, given the level of variability in design, development, 

> >populations, objectives, and usage, the generalizability of the 

> >findings would be quite limited (which I think is what you were 

> >getting at when you suggested it's not an easy yes or no). This makes 

> >me wonder if it would be more helpful to ask how empirical research 

> >and different cultures of inquiry can help inform our development and 

> >use of photonovellas to achieve our stated objectives. An 

> >interdisciplinary approach seems ideal, drawing from fields such as 

> >medicine, public health, education, communications, and social 

> >psychology (I'm sure there are others).

> >

> >As I reflected on the question, 'evidence of what?' my thinking came 

> >full circle, back to Dr.

> >Chris Zarcadoolas's comments last year about the problems that can 

> >stem from defining health literacy in terms too narrow, or from not 

> >incorporating our powerful creative abilities as human beings to use 

> >language to make meaning and change in our worlds. Evaluating the 

> >photonovella challenges us in this regard because, as many of the 

> >shared experiences reflect, we must consider not only the results of 

> >the creative process but also the mystery of creation, the intuitive, 

> >spontaneous elements.

> >As Laura Nimmon's mentioned in her most recent post, that she trusts 

> >the creative potential of the participants and that in and of itself 

> >is a means to restore human agency. The experiences of John Comings, 

> >Rima Rudd and others suggest that it is possible to help a community 

> >in this way also.

> >

> >Thanks to the pioneering efforts of many members on this discussion 

> >list, the health literacy movement is growing and evolving. 

> >Evaluation of programs and approaches to improve the health literacy 

> >of individuals and communities is a critical part of that proces. I 

> >appreciate and am encouraged by the interest expressed in developing, 

> >using, and evaluating photonovellas.

> >I look forward to continuing the dialog as we move forward!

> >

> >To clarify the difference between using a photonovella and using the 

> >Teach-With-Stories

> >(TWS) Method:

> >

> >You can use a photonovella in different ways:

> >    --develop a photonovella as the intervention (like Laura and John 

> >discussed) and then, for example, the group can use it to teach 

> >others in their community

> >    --use it for information dissemination (distribute at health 

> >fairs, clinics, home visits, etc.),

> >    --use it to reinforce health information provided in a different 

> >format (e.g., we provided radio health program then had same info in 

> >a novela available in local businesses)

> >    --use to spark group dialog and provide education. The 

> >photonovella provides the 'curriculum' structure for both health and 

> >participatory literacy instruction.

> >

> >The Teach-With-Stories Method is a 6 step participatory group 

> >facilitation process. This method of facilitation can be used with 

> >any 'spark' (e.g. photonovella, video, plays, article, current event)

> >

> >We developed the method to assist educators in making the shift from 

> >a traditional, didactic approach (that typically relies heavily on 

> >written communication) to a culturally appropriate, participatory 

> >approach that builds on oral traditions (like creating a play and 

> >keeping the focus on dialog).

> >

> >Our website is currently being renovated but should be up in the next 

> >couple of weeks. We will have additional details about the TWS 

> >facilitation training and training materials for the De Madre A Madre 

> >prenatal program. Also, we will be posting the findings from our TWS 

> >study

> >re: Lay Educator Prenatal Outreach Program for Latinas. I will let 

> >you know when it's up and running.

> >

> >Susan

> >

> >-----Original Message-----

> >From: healthliteracy-bounces at nifl.gov 

>

>[<mailto:healthliteracy-bounces at nifl.gov>mailto:healthliteracy-bounces at nifl

.gov] 

> >On Behalf Of Julie McKinney

> >Sent: Thursday, November 20, 2008 2:30 PM

> >To: healthliteracy at nifl.gov 

> >Subject: [HealthLiteracy 2494] Evidence-based? ... Literacy benefits?

> >

> >I'm glad that Marty brought up evaluation! 

> >So...John, Susan and others, can we call 

> >phonovellas an "evidence-based" strategy? For 

> >public health?

> >How about for literacy teaching?  (My guess is it's not an easy yes or

> >no!)

> >

> >We have not heard from many adult literacy 

> >teachers: for you all, what benefits do you see 

> >in literacy gains using photonovellas vs. other 

> >authentic materials?

> >

> >And one question for Susan: what is the 

> >difference between using a phonotovella and 

> >using the TWS (teach with stories)method?

> >

> >Thanks to all for great questions and answers!

> >

> >Julie

> >

> >Julie McKinney

> >Health Literacy List Moderator

> >World Education

> >jmckinney at worlded.org 

> >----------------------------------------------------

> >National Institute for Literacy

> >Health and Literacy mailing list

> >HealthLiteracy at nifl.gov 

> >To unsubscribe or change your subscription 

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>

><http://www.nifl.gov/mailman/listinfo/healthliteracy>http://www.nifl.gov/ma

ilman/listinfo/healthliteracy 

> >Email delivered to sauger at mindspring.com 

> >

> >

> >----------------------------------------------------

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> >Email delivered to christina.zarcadoolas at mssm.edu 

> 

> 

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--
Laura Nimmon 
Ph.D Student
Social Sciences & Humanities Research Council of Canada Doctoral Fellow
Michael Smith Foundation for Health Research Senior Graduate Trainee 
www.photonovel.ca

Language and Literacy Education
University of British Columbia
2125 Main Mall
Vancouver, BC
Canada V6T 1Z4

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