An integrated curriculum for improving health literacy among Hispanic adults

1. An integrated curriculum for improving health literacy among Hispanic adults Francisco Soto Mas, Brenda Fuentes, Erika Mein, Josefina Tinajero, Andrés Muro & The ESL-Health Literacy Team University of Texas at El Paso Project fundedby NHLBI Grant Number: 1R21HL091820-01A2 Principal Investigator: Francisco G Soto Mas, MD

2. BACKGROUND • Many approaches have been proposed to educate the public in three basic components of health literacy: prose, document, and numerical skills. • One approach that warrants further research is the use of English as a Second Language (ESL) instruction for improving health literacy. • This is an approach which has the potential for benefiting the Hispanic population in the U.S. for three reasons: • the rapid growth of the Hispanic population • the low health literacy levels of the Hispanic population • the high participation of Hispanics in ESL instruction.

3. PURPOSE • The purpose of this study was to develop a health literacy education component for Hispanic immigrants and integrate the component into an ESL curriculum. • This poster describes: • the theoretical framework that informed the methods and content of the curriculum, • the development process, • and provides specific examples for integrating ESL and health literacy content.

4. APPROACH • As is true for any aspect of health education, health literacy education must meet the cultural and social expectations of the intended audience . • Literacy education is understood in the context of adults' lives. • To create the basis for literacy work, as well as the tools to engage in it, these must be considered: • community issues, • problems, • aspirations, • skills, • cultures, • languages

5. APPROACH (Cont.) • ESL may represent one of the best approaches for literacy instruction among border populations for several reasons: • improving English proficiency is often desired or deemed necessary to function in U.S. society. • In the U.S. Hispanics are overrepresented in ESL programs.

6. THEORETICAL FRAMEWORK • The ESL/Health Literacy curriculum was informed by four key concepts related to literacy learning and second language acquisition for adults: • communicative competence; • the use of authentic texts; • multiple literacies; • and principles of adult learning.

7. THEORETICAL FRAMEWORK (Cont.) • Communicative competence (Hymes, 1971): • refers to the ability to use language appropriately and effectively in a given context • the goal is effectiveness in communication rather than correctness in communication

8. THEORETICAL FRAMEWORK (Cont.) • Multiple literacies (Barton, 1994; Street, 1995): • reading, writing, and communication are seen to be deeply embedded in and shaped by social interactions and social contexts • different kinds of literacy are used in different domains

9. THEORETICAL FRAMEWORK (Cont.) • Authentic texts(Duke, Purcell-Gates, Hall, & Tower, 2006): • promotes literacy learning so that students are more equipped to handle everyday literacy demands (as related to the domain of healthcare) • authentic texts include Medicaid forms, clinic brochures, medical history forms, prescriptions, and medicine labels • learning how to deconstruct and manage these texts in the ESL classroom setting will provide learners with the tools and confidence to effectively handle these kinds of texts in real-life situations

10. THEORETICAL FRAMEWORK (Cont.) • Adult learning theory (Knowles, 1984): • adults and children learn differently in part because of the different quality and quantity of their life experiences • six key principles of adult learning: • adults have a need to know why they should learn something; • adults tend to be self-directed; • adults bring rich, extensive prior knowledge to the learning situation; • adults learn better when they themselves perceive the need for learning (rather than the need being defined by an outsider); • adults tend to have a more problem-centered (or task-centered) approach to learning, with the goal of application rather than content mastery; • adults are driven by both intrinsic and extrinsic motivators to learn.

11. THE CURRICULUM • 12 units combining ESL/health literacy instruction • Intermediate proficiency level • Facilitated by a trained ESL teacher • Can be implemented over a 6 or 12 week period • Includes “Excellent English: Language Skills for Success” by Jan Forstrom, Mari Vargo, Marta Pitt & Shirley Velasco (McGraw Hill, 2008).

12. SAMPLE UNIT • CONSUMER SMARTS • Language Objectives. • Count and non-counts nouns: Statements and questions with • How much/How many • Health Literacy Objectives • Numeracy: Calculate percentages by reading food labels. • Prose: Read and interpret information about Nutrition Facts. • Texas Adult Education ESL Standards • List.2.2. Understand and respond to additional high-frequency grammar conventions used in speech, including simple verb tenses. • Speak. 4.5. Produce spontaneous comprehensible oral language independently with increasing control of pronunciation, rhythm, stress, and intonation. • Reading 2.2. Decode and recognize everyday words in short, simple text with assistance. • Writing 3.1. Convey information by writing some highly familiar words and phrases.

13. SAMPLE UNIT (Cont.) • Duration • 3 hours • Materials • Excellent Eng. Teacher Edition • Excellent Eng. Student book • English dictionary • English-Spanish dictionary • Writing paper • Pens/pencils/markers • Graphic organizer: Circle map • YHYL handouts: • -Read the Food Label to Choose Foods Lower in Saturated Fat, Trans Fat, and Cholesterol. • -Virginia’s Breakfast Choices • -Read the Food Label for Sodium • -Mariano’s Food Choices • -Read the Food Label for Sugar! • -Ana’s Food Choices

14. SAMPLE UNIT (Cont.) • VOCABULARY DEVELOPMENT (15 min.) • The teacher will write new vocabulary words (food labels, nutrition facts, serving per container, calories, daily values, ingredients, percentage, grams, cups, iron, calcium, packaged, choices, groceries, diet, beverages) on the board and read them. • As a whole group, the students will brainstorm the meaning of the above mentioned concepts. • The teacher will summarize the information to create and write a definition on the board.

15. SAMPLE UNIT (Cont.) • NUMERACY (10 min.) • The teacher will distribute photocopies of Read the Food Label to Choose Foods Lower in Saturated Fat, Trans Fat, and Cholesterol (YHYL pg. 145). • Students will scan the information to become familiar with the content. • The teacher will explain how to read nutrition labels while students follow along.

16. SAMPLE UNIT (Cont.) • WRITING (15min.) • Students will write a grocery list of commonly prepackaged foods they consume at home. • Students will write at least five items per food group using their food pyramid as a guide.

17. LEASSONS LEARNED • Avoid health literacy interventions that address specific health problems through traditional health education approaches facilitated by health providers in health care settings, particularly among Hispanic populations. • Health literacy cuts across education and health. Consider multidisciplinary education and health teams and approaches that use existing learning environments. • Successful multidisciplinary approaches are important to both adult educators and health care providers, given that literacy skills are critical in accessing and understanding health information and services. • Such approaches constitute a valuable resource for health initiatives aimed at addressing disparities in health status and access to health care among Hispanic adults.