Fusing health literacy education to Teaching English as

Fusing health literacy education to Teaching English as a Second Language (TESOL): Health literacy as social practice in a TESOL class. Pam Howard San Francisco State University i. Fusions, Medical Library Association May 19, 2009 May 14, 2009 Pam Howard 1

Presentation outline • Introduction & Synopsis • Theory and the literature • Story – Protagonists: who, what, when – Plot line: library, librarian & instruction – Subplots: student generated project proposals – Epilog: what we learned May 14, 2009 Pam Howard 2

Health Literacy: Back Story • Governmental policy/definitions • Adult Learner Literature – New Literacy Studies • Public Health/Medical Literature – Clinical risk – Health Asset • Academia: Information Literacy May 14, 2009 Pam Howard 3

Health literacy as governmental policy • Healthy People 2010, 2000 – 1979, revised - 1990, revised - 1999 – Revolves around ‘functional’ literacy • World Health Organization – Health Promotion Glossary – 1986, revised - 1997 – “critical to empowerment” • Institute of Medicine – 2004 – Social activity, shared, takes place anywhere May 14, 2009 Pam Howard 4

May 14, 2009 Pam Howard Photo © Jon 6 Crispin

Adult Learner Literature • Pedagogy of reading & writing • New Literacy Studies – Sociology of Knowledge – Ethnography of Communication • New Literacy Studies: Literacy events – What are they – Who does them – Where do they take place – Why May 14, 2009 Pam Howard 7

Public Health/Medical Literature • Clinical risk – lack of functional skills – Reading/writing – Forms, labels • Health asset – self efficacy • Transactional – Speaking/listening – Quality of communication • Social practice • Societal benefit – Self care – Compliance May 14, 2009 Pam Howard 8

Academia: Information Literacy • Academic College & Research Libraries – – Functional: Skill set • Know – makes a question, information formats • Access – searching for information • Evaluate – critically appraises information for use in context • Use – applies the information to the need in context • Ethical/legal – use of sources – Interactive Research Process "Standards Step-by-Step, " American Library Association, August 29, 2006. http: //www. ala. org/ala/mgrps/divs/acrl/issues/infolitstandards/stepbystep 1/stepbystep. cfm (Accessed April 03, 2009) May 14, 2009 Pam Howard 9

AUTONOMOUS: IDEOLOGICAL: Functional literacy Interactive or critical literacy Adult Literacy Education Concepts Health Literacy Matrix Quality of Health -Communication: Text Speaking/listening -Access to ‘health’ Transactional Decoding skills -Writing/reading skills: labels forms -Numeracy -Patient/clinician interaction Functional CLINICAL RISK May 14, 2009 Social Practice -Participation in health -Empowerment in health decisions -Life styles and living conditions Relational - Social benefit Self Care - Disease management -Compliance Self efficacy HEALTH ASSET Public Health Concepts Pam Howard 11

The stage is set - May 14, 2009 Pam Howard http: //farm 3. static. flickr. com/2330/2416100250_aa 478 b 3496. jpg 12

SF State and Health Literacy • Long standing programs with City college – Project SHINE (Students Helping in the Naturalization of Elders) & Project SAIL (Students Assisting with Immigrant Literacies ) • Certificate – CIRCLE (Center for Immigrant & Refugee Community Literacy Education) • Health Literacy gatherings – Health Literacy Forum http: //www. sfsu. edu/~forum/ – Health Literacy Summit http: //literacyworks. org/hls/ May 14, 2009 Pam Howard 13

NLM Outreach Express Award • Las Vegas regional MLA meeting. Feb 7, 2008 • Dr. Santos & budget impacts for summer 2008 TESOL class • Heidi Sandstrom, Assoc. Dir. PSR NN/LM, at the Health Literacy Summit. Feb 28, 2008 • Lobby library to become member of NN/LM • Write the grant, late April 2008 – NLM formats – University hoops • Accepted, June 2008 • http: //nnlm. gov/psr/funding/eoa/ May 14, 2009 Pam Howard 14

May 14, 2009 Pam Howard 15

Pre-test of typical library and information concepts Questions 1 -3: catalog, boolean concepts Questions 4 -8: citation typology of sources Questions 9 -11: Internet health behavior Questions 12 -15: Patient scenario & the need for information • Questions 16 -18: Self report of information skills and comfort levels • Questions 19 -23: Student demographics • • May 14, 2009 Pam Howard 16

Pre-test, Student demographics Questions Survey Responses Currently enrolled in ENG 432: 8. 3% ENG 832: 50% Open U, ENG 432: 25% Background TESOL: 75% Nursing: 25% Public Health: 8% Computer at home Laptop<2 yrs old: 25% Laptop>2 yrs old: 42% Desktop<2 yrs old: 8% Broadband @ home Yes: 67% No: 33% Gender Female: 75% Male: 25% May 14, 2009 Pam Howard Open U ENG 832: 17% Desktop>2 yrs old: 25% 17

Pre-test, Scenario: Culture and the concept of self care Self care is a central pillar of American health care systems. Failure to care for one-self is common in cultures that emphasize family over the individual. An Anglo-American tenet is our high value placed on independence. For other cultures the emphasis maybe shifted from the individual to family interdependence. The importance of self-care is not as highly prized. An older Korean man was hospitalized for stroke. Self-care in stroke victims is an important part of therapy. He and his wife listened to the nurse’s instructions on self-care, but made little progress. His family would feed him, shave him and dress him. This frustrated the nursing staff. It was perceived that the family was hindering his progress in relearning his self-care skills. During physical therapy and occupational therapy he made good progress. He relearned self-care skills and gained strength. But when the family was present he would regress and family members would take over the self-care activities. The nursing staff was frustrated by his dependency on his family. Galanti, G. -A. (1991). Caring for patients from different cultures: case studies from American hospitals. Philadelphia: University of Pennsylvania Press. May 14, 2009 Pam Howard 19

Post-test of typical library and information concepts • Question 1: boolean concept • Questions 2 -8: familiarity with introduced resources • Questions 9 -10: comfort levels • Questions 11 -12: future health info seeking • Questions 13 -16: scenario • Questions 17 -18: self report of information skills • Questions 19 -21: Student demographics May 14, 2009 Pam Howard 23

Post-test, similar to the pre-test questions about health resource searching Survey Question Survey responses In the future if you need health information, will you use the NLM databases? Yes: 93% For whom? Family: 100% What type of health Information? Medical condition: Drug 80% information: 40% May 14, 2009 No: 7% Friends: Work: 62% 77% Pam Howard School: 77% Support Group: 40% 24

Post-test: Self report of information skills (%) strongly agree When searching for information, I can 1) find books and materials in the library online catalog, such as Investi. Gator. 2) find appropriate databases to use for specific questions. 3) find journal articles and periodical literature using indexes and databases from the Library website. 4) use the library Web resources to find research information more than I use Internet search engines (e. g. , Google). 5) when evaluating health related information on the web it is important to know the source and 'authority' of the information, and to look for the date associated with that information. May 14, 2009 agree disagree strongly disagree 54 (33) 46 (58) 0 (8) 0 36 64 0 0 36 (17) 57 (67) 7 (17) 0 43 (17) 36 (42) 21(42) 0 71 21 7 0 Pam Howard (Pre-test response, %) 25

Post-test: Knowledgebase question, example Medline. Plus is a consumer friendly database. Which are parts of Medline. Plus, check all that apply. An online encyclopedia An online dictionary Videos of surgeries Tutorials on many medical subjects A database inclusive of alternative medicine and supplements Response Percent 80% 93% 73% 93% 67% Comments: This information alone was worth the price of the class! I think that the NLM resources are a real contender for services like e. Pocrates, Sky. Scape, etc. for basic references. May 14, 2009 Pam Howard 26

Subplots: Student proposals for community-based projects 1. Fair Care: Empowering In-home Caregivers with the Language and Skills to Negotiate Workplace Rights 2. Connecting Asian Indian Immigrant Elders to Health Care Resources through Community Partnerships 3. FROM PLOT TO PLATE: A Community Partnership 4. Tenderloin Community ALERT (Alemany Emergency Readiness Training) 5. Mozart to Miles Music Foundation 6. Empowering Immigrant Parents through Public School Participation May 14, 2009 Pam Howard 27

Recap of the presentation • Protagonists, Convergence of ability and need • Back story, the literature • Plot, Collaborative presentation of health literacy, TESOL & immigrant populations • Subplots, Student proposals for communitybased projects May 14, 2009 Pam Howard 28

Epilog: What did we learn… • Learned from class – Not really long enough in the summer – People don’t understand the connection between health and literacy/culture • Some proposed projects bore fruit – – Monterey county Oaxaca community and lead poisoning – City college disaster preparedness fair May 14, 2009 Pam Howard 29

Questions? Contact: Pam Howard pjhoward@sfsu. edu Grant #60207100 May 14, 2009 Pam Howard 30