Hi Len and CeCi-
When we first created our photonovelas on prenatal care, we had that
possibility in mind (using photonovelas to teach and lead discussions with),
however, health professionals didn't seem interested or didn't know where to
start. The questions you posed are what prompted our exploration and
development of a method of teaching with stories. We wanted to make sure
that our method would work in practice so all the development work was done
in conditions as close to 'real-life' as possible. 
 
We used a community-based participatory approach and Deming's
(plan-do-study-act) PDSA methodology. With everyone's input and experience,
we slowly refined and improved the process. It all started out quite
intuitively. We had the women in the groups, myself, 2 intutive health
educators, the photonovelas, and Rick Arnold's 'Spiral Model' concept of an
empowerment-based process. We did 7 series (4-8 classes/groups per series)
in a 4 phase period, with a convenience sample of Latinas (n=122). We varied
settings (rural/urban, community health center/health department),
facilitators (a total of 10 with different skill sets and backgrounds),
frequency of classes (e.g. weekly and biweekly), and types of 'extra'
activities too. Using a PDSA methodology, we evolved our process for
training facilitators also. 
 
We boiled the process down to 6 steps which are outlined in an
easy-to-follow facilitator guide that goes with each photonovela. Each guide
contains specific suggestions on how to implement for that particular
photonovela. The guide also contains possible questions to ask, along with
space for the facilitator to record his/her own questions/ideas. The 6 steps
are:
1) Welcome, create a safe place
2) Review previous actions (e.g., practiced at home if this is a series)
3) Introduce new topic
4) Read and discuss story, foster critical thinking (as you suggest, we
recommend stopping at each page to 'chunk' the story)
5) Add depth, practice actions, review
6) Set stage- for next week or next steps - how will use or practice info,
etc.?
 
 It's simple, flexible and provides enough structure so that even educators
who have no training in participatory approaches can facilitate groups
effectively. (If they make the mental switch to a faciliator mindset. As I
mentioned, if they don't get that, even if they follow the steps, their
energy, tone of voice, and nonverbals can conflict and undermine the
process.)  The details of our study can be found in: 
Auger, S., DeCoster, M., & Colindres, M. (2008). Teach-With-Stories Method
for Prenatal Education: Using Photonovels and a Participatory Approach with
Latinos. In M. Dutta & H. Mohan (Eds.), Emerging perspectives in health
communication: Meaning, culture, and power (pp. 155-181).  New York, NY:
Routledge.

 
As Julie pointed out in a recent post, although more common in education, a
participatory, empowerment-based approach is a distinct skill set that is
not the norm in health education (that I am aware of). I would be very
curious to know how many schools of public health, nursing, medicine, etc,
actually offer this type of training. For instance, I know of only one
course offering at UNC in Chapel Hill (it's offered across discplines) that
is dedicated to teaching these types of approaches and skills. Many of my
friends and collegues who do use these types of approaches have often
developed and refined their skills and training through work or informal
educational opportunties (e.g. international work, workshops), not through
traditional academic programs.  Given our current healthcare challenges and
the movement towards a patient-centered model of care, I agree with Julie,
this is a critical gap. 
 
Since it is Thanksgiving, let me say thank you for all your work in this
area! I so appreciate the clarity and practical guidelines you have provided
in your book, Teaching Patients with Low Literacy Skills. I can only imagine
how many lives you have touched through all of us putting them into
practice.
 
Hope everyone has a wonderful Thanksgiving!
 
Susan
 

 
  _____  

From: healthliteracy-bounces at nifl.gov
[mailto:healthliteracy-bounces at nifl.gov] On Behalf Of Lendoak at aol.com
Sent: Tuesday, November 25, 2008 1:48 PM
To: healthliteracy at nifl.gov
Subject: [HealthLiteracy 2510] Re: Evidence-based? ... Literacy benefits?


Re/ Teaching with stories (TWS) and photonovela,
 
An important step in the health education process we've not seen addressed
is, "How do you teach using stories and photonovelas?"  What process do you
use to employ these media with other than those groups who created them?
 
Reason for the questions:  Some years ago, Marjorie Scharf, RD, and the
Philadelphia Health Dept. created the successful story booklets (and later
videos) of Healthy Food Healthy Baby,  and also, for weight loss, Your Best
Body. Clients, especially pregnant teens, participated in the designs.  But
other RNs and RDs were not sure of the best way to actually use these
wonderful, illustrated stories to teach their clients. Should they ,1) just
hand out the booklets?, 2) Should they read these to each client?, 3) Should
they assemble discussion groups, 4)how do you introduce this instruction?
Marjorie and others finally put out a supplemental instruction on ways to
best teach with these stories.  Is something like that also needed to teach
with photonovellas?  What has been users' experience?
 
People need time to adapt to new or "different than usual" media.  Some
years ago we had a Spanish language audio tape on hypertension made for a
doctor friend. She tried playing it while patients were waiting to see her
or while they were waiting in the examining room.  She found that, to get
the message, patients needed to hear the tape twice.  The first time to get
over the strangeness of an audio tape in the waiting room, and the second
time to get the message. Does this need for "adjustment" occur with TWS and
photonovelas?
 
Ceci and Len Doak
Palm Desert, CA.
 
 
 
 
 
In a message dated 11/25/2008 9:16:58 A.M. Pacific Standard Time,
julie_mcKinney at worlded.org writes:

Cristina, Susan and others,

Thanks for your thoughtful responses. You both touched on the element
that I find so exciting about photonovellas as a bridge between the
worlds of adult education and health care. 

Christina asked: "What do the texts we create...do to promote an active
engagement with concepts as much as the literal facts or 
information?" 

This shows a change in philosophy of teaching that adult educators have
been working with for years, and one that would do well to be adapted
for greater use in the health care world: a participatory approach that
allows a patient to engage with the concepts instead of simply absorbing
the facts. Adult educators (often) have the luxury of a classroom-based,
regular meeting time with the same group of students, a venue that is
rare in the health care world. This has allowed them to develop valuable
skills and experience in teaching with an engaging and participatory
approach.

Yet we see that health educators like Julie Smithwick-Leone and Mary
DeCosta do have this venue and have been using this approach with good
results. 

I wonder how much you all think this is a switch in philosophy for
health education strategies, and how much value you see in partnering
with adult educators who have extensive experience in participatory
learning? I know that I am implying a more didactic philosophy as the
main default in health education, and it may be way off, but from what I
see and hear, there is a strong perception of that.

This seems to parallel another change. Patients are now being asked to
engage in health decisions in a much more interactive way than they were
years ago. This must change the way health education needs to be
delivered, wouldn't you think?

I'd love to hear more from those of you in both (or other) fields!

Thanks,
Julie

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

>>> christina <zarcac01 at imail.mssm.edu> 11/25/08 10:27 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. Lev>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:

>[<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 

>settings, please go to 

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

ilman/listinfo/healthliteracy

>Email delivered to sauger at mindspring.com

>

>

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

>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 christina.zarcadoolas at mssm.edu



--

----------------------------------------------------
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 lendoak 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!
-------------- next part --------------
An HTML attachment was scrubbed...
URL: http://www.nifl.gov/pipermail/healthliteracy/attachments/20081125/6ba792b7/attachment.html