DOCUMENT RESUME ED 425 342 CE 077 721 AUTHOR Hohn, Marcia Drew TITLE Empowerment Health Education in Adult Literacy: A Guide for Public Health and Adult Literacy Practitioners, Policy Makers and Funders. Literacy Leaders Fellowship Program Reports, Volume III, Number 4, Part 1. INSTITUTION National Inst. for Literacy, Washington, DC. PUB DATE 1997-00-00 NOTE 155p.; For other reports in this monographic series, see ED 400 426, ED 402 444, and CE 077 717-720. AVAILABLE FROM ED Pubs, P.O. Box 1398, Jessup, MD 20794-1398; Tel: 877-433-7827 (Toll Free) ; Web site:http://www.nifl.gov/hohn/HOHN.HTM PUB TYPE Collected Works - Serials (022) Reports Research (143) JOURNAL CIT Literacy Leader Fellowship Program Reports; v3 n4A 1997 EDRS PRICE MF01/PC07 Plus Postage. DESCRIPTORS Adult Basic Education; *Adult Literacy; Adult Programs; Basic Skills; *Empowerment; *Health Education; *Health Promotion; *Integrated Curriculum; *Literacy Education; Models; Participatory Research; Program Development; Program Implementation ABSTRACT This report explores one avenue for health education and promotion for audiences with low literacy levels: embedding empowerment health education directly in adult literacy programs. This approach emerged through participatory action research (PAR) The four sections correspond to . the four questions around which the PAR process organizes the research. Intended audiences include public health and adult literacy practitioners, policy makers, and funders. Section I, "What is the problem?," provides multiple perspectives from public health, adult literacy education, and the target community. It cites literature supporting these concepts, summarizes research connecting literacy level and health status, and assesses social and political factors. Section II, "What are we going to do about the problem?," provides a description of how two major health education programs were carried out by a student action health team in adult literacy classrooms. Section III, "What did we learn from our action?," assesses what was learned in the programs, commonalities of findings, and how they merge to form a guiding model. The model is presented as a framework with fundamental components of empowerment health education in adult literacy. Section IV, "What do we need to share with others?," reviews research findings, implications for public health and adult literacy education policy, and recommendations for future funding. Finally, it includes suggestions for adult literacy teachers and public health educators for getting started. (Contains 140 references and instruments.) (YLE) ******************************************************************************** Reproductions supplied by EDRS are the best that can be made from the original document. ******************************************************************************** C\1 c,) kr) CV ii 'I- ak o ilk MI If: W o ID 11 41111 Mk U S DEPARTMENT OF EDUCATION Office of Educational Research and Improvement la o ,E /DUCATIONAL RESOURCES INFORMATION I lb A CENTER (ERIC) VThis document has been reproduced as received from the person or organization originating it 0 Minor changes have been made to improve reproduction quality Points of view or opinions stated in this document do not necessarily represent official OERI position or policy - 0 II 0 AIM A" - - 0 a 0 0 se - '" - -' ' II - D ... //a W 2 Empowerment Health Education in Adult Literacy: A Guide for Public Health and Adult Literacy Practitioners, Policy Makers and Funders by Marcia Drew Hohn, Ed. D. 1996-1997 NIFL Literacy Leader Fellow and Director of Northeast SABES System for Adult Basic Education Support at Northern Essex Community College 45 Franklin Street Lawrence, MA 01840 978-688-6089 mdrewhohn@aol. com With many thanks to the National Institute for Literacy for their fellowship support that allowed the creation of this report. The views expressed are those of the author and not necessarily those of the National Institute for Literacy. Li Empowerment Health Education in Adult Literacy: A Guide for Public Health and Adult Literacy Practitioners, Policy Makers and Funders. @Copyright 1998 by Marcia Drew Hohn. All rights reserved. These activities and other information contained in this project may be produced for educational purposes only, provided that the words "Created by Marcia Drew Hohn, MFL Literacy Leader Fellowship Project" appear on the documents so reproduced. No part of this document may be reproduced or utilized in any form for profit, without written permission of the author. 4 This report is Part A from a collaborative fellowship on connecting health and literacy education awarded to Marcia Drew Hohn and Beth Sauerhaft by The National Institute for Literacy. Part A is Marcia Drew Hohn's report of her project in Massachusetts. Beth Sauerhaft's project in Berkeley, California will be published as Part B and a special introduction will be developed linking the philosophy, processes and conclusions of the two reports. Dedication of the Student Action Health This report is dedicated to the members in a Participatory Action Research Team who worked with me for two years knowledge about health education for low Study to investigate and create literacy groups: Judy Berry Marie Deshommes Nguyet Nguyen Ana Reynoso Elsa Reynoso who continue to inspire me with ...and to adult literacy students everywhere and transformation in the face of their commitment to learning, growing frequently daunting circumstances. Bootstrap in Lynn, Many thanks to the staff of Operation and encouragement in Massachusetts, for their cooperation, support thanks also go to Vanda Ivaneko, Magali carrying out the research. Special Team in joined the Student Action Health Torres and Charlene Wigfall who project. year two of the research 6 Table of Contents Introduction Low Literacy and Poor Health 1 2 Organization of the Report 5 How to Use this Report 7 Definition of Key Terms Section I: What is the problem? 11 The Big Picture 11 Connections between Literacy Level and Health Status 12 Diagram- The Problem: Literacy Level and Health Status 13 Current Health Education and Promotion Practice 14 Public Health Perceptions of the Problems 15 New Perspectives in Public Health and Adult Literacy 16 Literacy Education Perspectives 18 Personal Perspectives and Background for the Study 18 Long Time Concern about Low-Literacy and Health Status 19 Personal Beliefs and Approaches 20 How I Came to Work with a Student Action Health Team 21 The Setting for the Study 23 Philosophy and Culture of Operation Bootstrap 24 History of the Team 27 What do we do? Diagram: The Student Action Health Team: Who are we? 28 Perspectives of Adult Literacy Students 28 First Level of Problem Identification 29 Students Diagram: What is the problem? Perceptions by Adult Literacy 30 Additional Levels of Problem Identification 30 The Participatory Action Research Cycle 31 Specific Areas of Health Work problem? Section II: What are we going to do about the 35 Getting Started with Participatory Action Research 35 Temn Process 37 Selecting New Membership 41 Diagram: What do we need to do about the problem? 7 Choosing the Health Topic 42 Diagram: How did we carry out a program 2 , 46 The Cancer Education Program: Early Detection of Breast, Cervical and Testicular Cancer 47 Learning about Early Detection of Breast and Cervical Cancer 47 Developing the Educational Program 49 Carrying Out the Educational Program 51 Evaluating the Program 54 Taking the Work to the Outside 58 The Family Violence Educational Program 60 Getting Started 60 A Three Part Program Evolves 62 Part One: The Child Street Safety Program 62 Part Two: Effects of Witnessing Violence in the Home 63 Part Three: Man-to-Woman Violence 64 Recruiting and Mentoring New Members 66 Evaluating the Program 67 Taking Our Learning to the Outside 68 Section III: What did we learn from our action? An Evolving Model 73 Diagram: The Model: Partnering for empowerment health education in adult literacy 74 Community Relationships and Processes that Create and Sustain Power Sharing 76 Creating Environments 76 Importance of Context 79 Recreating an Empowering Environment for Operation Bootstrap Students 80 The Team, the Work, and Funders 82 Learning within Community 84 Active Learning in the Physical, Psychological-Emotional, and Cognitive Realms 84 Learnings from the Cancer Education Program 85 Learnings from the Family Violence Education Program 89 Drama, Sensitive Issues, and Culture 90 Time Required 91 Voice, Changing Perceptions of Self and Self in Relationship to Others, and Action Insights from our Evaluation 92 Diagram: How information is diffused 96 Language and Literacy Learning Facilitates the Dialogue about Health & Health Catalyzes the Motivation for Language and Literacy Learning 98 Where are we now and where are we going? The Student Action Health Team-- A Summary 101 Section IV: What do we need to share with others? 107 Diagram: What did we learn from our action research 2 108 Conclusions 108 Empowerment 109 The Value of Empowerment Health Education Embedded in Adult Literacy The Value of Health as a Context for Language and Literacy Learning 111 112 Contribution and Limitations 113 Implications for Policy and Funding 114 Directions for Future Research Some Suggestions for Practitioners: Getting Started With Linking Health 116 and Literacy Education 116 For Adult Literacy Educators 116 For Public Health Educators 117 For Both Adult Literacy and Health Practitioners 119 References 129 Appendix A - Evaluation Survey in Cancer Program 133 Appendix B - Evaluation Survey Results in Cancer Program 149 Appendix C - Evaluation Interview Questions in Family Violence Program 151 Appendix D - Evaluation Interview Questions for Teachers 1 Introduction Low Literacy and Poor Health We are facing a serious social problem in this country that has critical implications for both public health and adult literacy education. Recent studies have established connections between literacy level and health status and have found extensive evidence that low literacy, poor health, and early death are inexorably linked. This looms as a crucial social problem because there are large numbers of people in the In this low literacy group, there are a United States with limited literacy. disproportionate number of people of color and whites of low socioeconomic status who have a documented higher risk of poor health than the overall population. In today's health care system, health education and promotion are key strategies for maintaining and improving health. However, health education and promotion are primarily carried out through print materials written at a tenth grade or higher reading level. Therefore, the group that needs health education and promotion the most is the group least likely to benefit from the current practice. The major problem, then, is to identify effective means of educating low literacy populations about health issues so that their health status is improved. This report explores one avenue for health education and promotion with low literacy audiences -- embedding health education directly in adult literacy programs. Based in a philosophy of empowerment, a two year participatory action research project was conducted in partnership with a student action health team. Together we identified Created by Marcia Drew Hohn, NIFL Literacy Leader Fellowship Project, 1996-1997 10