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 funded by NHLBI
Grant Number: 1R21HL091820-01A2
Principal Investigator:
Francisco G Soto Mas, MD
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:
1) the rapid growth of the Hispanic population
2) the low health literacy levels of the Hispanic population
3) the high participation of Hispanics in ESL instruction.
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.
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:
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community issues,
problems,
aspirations,
skills,
cultures,
languages
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.
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.
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
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
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
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:
1.
2.
3.
4.
5.
6.
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.
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).
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.
SAMPLE UNIT (Cont.)
– Duration
• 3 hours
– Materials
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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
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.
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.
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.
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.