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
 
 



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