e-HEALTH SUMMER TRAINING INSTITUTE
APPLICATION FORM
Team Leader Name: ______Silvia Martinez______
Title/Position: ______Assistant Professor______
Department: __Communication Sciences and Disorders______
University/Organization: ____Howard University______
Address: ______525 Bryant St. NW Suite _243______
City: Washington______State: _____DC______Zip Code: _20059_
Work Phone: __202-806-9310__ Home Phone: _202-723-9474______
Fax Number: __202-806-4046_____ E-mail: ______
Team Members Brief Description of Work Responsibilities
1. Silvia Martinez, Ed. D. CCC/SLPTeam Leader, develop and
produce speech pathology materials,
Spanish materials, manage website, collect and analyze data
2. Janice Trent, MA, CCC/ATeam member, develop and
produce audiology materials, manage
website, implement program, collect and analyze data
3. Margarita Vigas, MA, CCC/SLPTeam member, develop and
produce materials, Spanish
materials, implement program,
collect and analyze data
Talking Fotonovelas© for Low Literacy Hispanic and African American Populations
e-Health Summer Training Institute
ThomasJeffersonUniversity
Proposal
Silvia Martinez, Ed. D.
Assistant Professor
HowardUniversity
Department of Communication Sciences and Disorders
Table of Contents
Proposal…………………………………………………..……1
Description of underserved populations……………….…...2
Description of health program………………………….…..2
Overview……………………………….…………...…..2
Specific Aims…………………………………....……...3
Plan for the Program…………..………………………...3
- Needs Assessment……………..….………….3
- Materials Production………….….…………..3
- Implementation……………….….…………..4
- Evaluation……………………..……………..4
How program will make a difference in this community
and dissemination plans……………………….…….…..4
Team expectations……………………….……………,…...5
Biosketches……………..…………………………………...…6
Appendices…………………………………………………….8
- Sample fotonovela……………………………………….……...9
- Letters of support……………………………………………..….11
Talking Fotonovelas© for Low Literacy Hispanic and African American Populations
Proposal
Description of underserved populations
This interdisciplinary project is aimed at increasing health literacy of the disciplines of Speech and Language Pathology, and Audiology in Hispanics and African Americans with low literacy levels in English and/or Spanish. This project will address the needs of clients being served by two clinics offering Speech Pathology and Audiology services to children and adults in Washington, D.C.: Scottish Rite Center for Childhood Language Disorder and Howard University Speech and Hearing Clinic.
Washington, DC is comprised of 63% Blacks and 7% Hispanics[1]. Even though the centers’ communities (Ward 1) include 45.7% Blacks and 24.7% Hispanics[2], they do attract a larger percentage of minority clients. For example, the profile of minorities served at the Scottish Rite Center comprises 70% Hispanics and 25% Blacks (from a total of 600 clients)[3]. Similarly, the population seen at the HowardUniversity site comprises 95% Blacks and 5% Hispanics (from a total of 225 clients)[4].
The Center for Health Care Strategies has estimated that minorities and immigrants (50% Hispanics and 40% Blacks) have disproportionate literacy problems which increase their health risks[5]. In Washington, D. C., adult education levels in the site communities are the second lowest. Only 68.4% report having a High School education.[6] Nevertheless, it is safe to assume that the percentage of clients with only High School education or less is higher. Most Hispanics served are Central American immigrants who do not have English literacy competencies necessary to successfully navigate English literature. Furthermore, because they come from poor rural sectors, Spanish language literacy skills are also low. Filling out simple clinical case history and insurance forms in either language requires individual attention from clinical staff. This experience runs in concert with a report on functional health literacyof the Council of Scientific Affairs of the American Medical Association (1999). As reported by the National Library of Medicine (NLM), this study states that “one-third of English-speaking patients at two public hospitals were unable to read basic health materials.” NLM also reports a Medicare finding that “34% of the English speaking and 54% of the Spanish speaking patients had inadequate or marginal health literacy.”[7]
Description of health program
Overview. This program proposes to establish a web-based site containing Talking Fotonovelas© to be accessed by different service delivery sites. The web-based culturally and linguistically appropriate Talking Fotonovelas© will be designed to complement Speech and Language Pathology, and Audiology services. They will offer low literacy clients the opportunity to receive clinical instructions and health information in a format that will increase their understanding of: a) service procedures, b) the nature of speech and language pathologies and hearing problems, and c) clinical recommendations. Fotonovelas are similar to comic books, contain photographs and simple dialogue bubbles, which address the needs of cultures with low literacy rates and oral traditions. This project will be innovative in that it will present the fotonovelas with voice-overs.
Offering alternative methods of communication to English and/or Spanish low literacy Hispanics and African Americans will address the Healthy People 2010 overarching goal of eliminating health disparities. One of the leading health indicators is Access to Health Care[8]. For minorities, financial, structural and personal barriers prevent access. This project will address the latter two barriers. A structural barrier includes the lack of service providers to meet the needs of clients. The American-Speech-Language and Hearing Association (ASHA) has identified the lack of professionals as a problem, particularly with respect to limited English proficient speaking clients. Only 2.5% of Speech-Language Pathologists and 1.8% of Audiologists identify their ethnicity as Hispanic, and not all Hispanic professionals are Spanish proficient.[9] Furthermore, the time demands of service providers, and particularly of those serving bilingual populations preclude them from entirely meeting all of their clients’ individual needs. Personal barriers include among others, language barriers and lack of knowledge about health procedures[10]. Two language barriers are of interest to this project. First, language barriers caused by low literacy rates in immigrant Hispanics and African Americans because of inadequate education attainment in Spanish and/or English. Second, language barriers faced with Hispanics because of their limited oral English proficiencies or limited Spanish proficiencies in service providers.
The Institute for Healthcare Advancement summarized from research that written health materials usually appear at the 10th grade level or higher (above average abilities), that they include too much information and no explanation of uncommon words, and that treatments are accompanied by complex instructions.[11] They recommend that appropriate materials be developed. The materials that will be developed in this project will be culturally and linguistically appropriate. They will have appropriate readability levels, and will contain photographs and voice-overs. A fototonovela format proven to be effective with low-literate immigrant populations will be used.
Specific Aims. This project will reduce structural and language barriers by developing culturally and linguistically appropriate web-based materials to:
- Increase the knowledge of African Americans and Hispanic populations about speech and language pathology, and audiology issues and services.
- Meet the needs of health providers by offering materials to complement and enhance their services.
- Carry out research activities to probe the effectiveness of using web-based materials with low literacy and limited English proficient clients.
Plan for the Program.
A. Needs Assessment. A needs assessment will be carried out to gather information about materials needed by the service providers in both sites. Service providers will be asked to list and prioritize content areas and describe how materials will be used. Areas will address speech and language pathologies, swallowing, hearing problems, normal speech and language development and use, and normal hearing development and use. They will also be asked to specify if the materials will be used for: a) prevention (i.e. normal language development in children, proper care of voice, protection from noise), b) service delivery (i.e. hearing screening instructions and demonstrations, steps of an articulation evaluation), or c) remediation (i.e. proper care of the hearing aid, caring for a family member with swallowing problems).
B.Materials Production. With the above, teams will use research-based information to elaborate story boards for the Talking Fotonovelas©. The fotonovela uses stories to convey a message similar to comic books. They relate a story using photographs and dialogue boxes or bubbles containing simple language. Appendix A presents a sample of a hard copy by the Farm Worker Eye Network addressing eye care and injury prevention[12]. The fotonovela format takes advantage of the strong oral traditions of both African Americans and Hispanics. Fotonovelas and stories have been used successfully internationally and in the United States for health education [13],[14],[15],[16]. In this project, the photographs will also be accompanied by voice-overs in English and in Spanish separately. While video-streaming would seem the preferred mode, the Talking Fotonovelas© will be produced using PowerPoint software since it is a program that is readily available and does not impose memory, speed and storage demands on computers[17]. Furthermore, hardcopies may be printed for clients.
C.Implementation. The Talking Fotonovelas© will be produced and linked to a web site. Training will be provided in the different service delivery uses of the fotonovelas. For example, a fotonovela giving instructions in Spanish about an audiological evaluation may be made available to the client while waiting for services, or simultaneously when the audiologist is giving the instructions. These materials may also be used by parents while they are waiting for a child being evaluated so they better understand the procedures. Since the materials can be reproduced, clients may also take hard-copies home.
D.Evaluation. This project will carry out a research program that will be used for summative and formative evaluation purposes. First, service providers and clients will be asked questions regarding facility of use and satisfaction. Second, health knowledge retention will be gauged by offering one set of clients traditional brochures, a second set of clients traditional brochures and asking them to read and respond to questions, and a third set of clients Talking Fotonovelas© web-based materials and asking them to respond to questions. After 30 days, all clients will be interviewed and their recall will be compared to their previous performance and to that of other clients.
How program will make a difference in this community and plans for disseminating success of program
Impact. This interdisciplinary program between speech and language pathologists, and audiologists will address immigrant Hispanics who are limited English proficient and who have low literacy levels in English and/or Spanish, and African Americans with low literacy levels. It is expected that presenting culturally and linguistically appropriate materials will increase understanding and retention of information that will enhance prevention, procedural, and treatment goals and activities. It is also expected that sites without enough bilingual personnel will enhance their service delivery practices.
Dissemination. Papers and demonstrations will be presented in professional organizations of both professions such as ASHA, AmericanAcademy of Audiologists, the National Black Association of Speech, Language and Hearing, and the Council for Exceptional Children. Furthermore, presentations may be made before professional organizations addressing health literacy in minority populations. Because this program will have materials that are web-based, professionals in other states and countries may readily access them through website links to professional organizations or HowardUniversity.
Team expectations from the Institute
The team hopes to obtain information about the characteristics that make an e-Health program effective. This might be achieved by offering examples of successful programs. Another expectation is to obtain technical information written or delivered with regard to technical aspects, such as how to establish links. Finally, information about funding sources would be welcomed.
Biosketches
Silvia Martinez, Assistant Professor, HowardUniversity
Degrees: BA Psychology; MS Speech and Language Pathology; CAS Administration, Planning and Social Policy; Ed. D. Applied Psycholinguistics
Significant accomplishments: As Director of Multicultural Education and Practices for ASHA prepared workshops, materials and products supporting the appropriate service delivery to culturally and linguistically diverse individuals. Have worked in the area of service delivery to inner city multicultural populations for more than 24 years. Certificate of Distance Education from TexasA&MUniversity.
Publications and Presentations:ASHA publications: Issues in Telepractices that Affect our Profession: Professional Practices and Access. In Telepractices and ASHA: Report of the Telepractices Team (2001); Guide to Speech and Language Multicultural/Multilingual Assessment Tools (2000); When Your Student’s Parent Speaks Portuguese or any other language. In School-Based Employment: A Resource for Speech-Language Pathologists (2000); Second Language Learners: ASHA Readings(Ed. 2000 with A. Grice);Clinical Issues When Assessing African American Children: ASHA Readings (Ed. 2000 with A. Grice); Manual. Infórmese Brochures (1999).
Other work: Worked with Hispanics and other minorities in inner city schools; trained bilingual teachers and speech-language pathologists at various universities; performed advocacy roles in behalf of bilingual students and parents; produced cable programs to educate Hispanic parents about education and special education; legislative education reform liaison to the community
Janice R. Trent, Chief Clinical Supervisor/Lecturer, HowardUniversity
Degrees: MA Speech-Language Pathology
Significant accomplishments: Provided Intervention and Prevention services to community churches and agencies in the District of Columbia.
Presentations: Workshop on “Coping with Hearing Loss” for individuals who are deaf or hard of hearing and their caregivers.
Service to the community: Health Fair screenings at numerous churches in the D.C. Metropolitan community; The Howard University Speech and Hearing Clinic and The Hospital For Sick Children Daycare Speech and Hearing Screening Program; The Advisory Board for The Universal Infant Hearing Program in the District of Columbia.
Margarita Bautista-Vigas, Speech-Language Pathologist, ScottishRiteCenter for Childhood Language Disorder at ChildrenNationalMedicalCenter
Speech-Language Pathologist, ScottishRiteLanguageDevelopmentCenter
Degrees: BA speech-Language Therapy; MA Speech-Language Pathology
Significant accomplishments: Worked for 6 years with multicultural population serving children with disorders. Worked with parents with strategies to improve communication. Worked with pediatricians, social workers, teachers, parents and community serving as a bridge to expedite the process of educaiton of chidren and parents. Identified mothers at risk of delivering chidlren with communication disorders, worked with stimulaiton in uterus and early intervention of newborns. Other work: WhiteMemorialHospital, Los Angeles, Hospital Universitario de Caracas, Venezuela, and school systems in Venezuela and U.S.
Publications and Presentations: Participated on the design of programming and research for government of Caracas; Social pragmatic language and communication articles in newspaper (1975, 1983, 1994); ASHA reviewer for brochures El Niño y el Bilingualismo and The Learning of Two Languages (2003). Community Help Experiences: Volunteer for Saint Anne Maternity Center and the Women of the Organization of the American States.
Appendices
Apendix A: Sample fotonovela. Para poder ver el futuro. Rural Women’s Health Project. 1999
Appendix B: Letters of support
[1] Kayser Family Foundation,
[2] Office of Planning, Washington, DC government. 2000 Population by Single Race and Hispanic by Ward.
[3] Personal communication with center director, Dr. Tommie Robinson, January, 2004.
[4] Personal communication with center director, Ms. Janice Trent, January, 2004.
[5] Doak CC, Doak LG, Root Jh. The literacy problem. In: Teaching Patients with Low Literacy Skills. 2nd ed. Philadelphia: J. B. Lippincott Co; 1996: 1-9.
[6] Office of Planning, Washington, DC government. 2000 Population by Single Race and Hispanic by Ward.
[7]
[8] Office of Disease Prevention and Health Promotion. Healthy People 2010. people.gov/About/hpfact.htm
[9] 2003.
[10] Office of Disease Prevention and Health Promotion. Healthy People 2010.
[11]Health Literacy: An Overview and Research-Supported Solutions
[12]Para poder ver el futuro. Rural Women’s Health Project. 1999.
[13]Cortes, DE. Diabetes Health Education for Latinos through Innovative Informational Materials. Harvard Schold of Public Health: health Literacy Website. 2003.
[14] Participatory Materials Development: How-To Guides.
[15] Cain, BJ & Comings, JP. The Participatory Process: Producing Photo-Literature. Amherst, MA: Center for International Education, U. Mass.
[16]Texas Cancer Council. Practical Guidelines for the Development of Printed Cancer Education Materials for African Americans.College Station, TX: TexasA&MUniversity, 1996.
[17] As more clinics acquire technology with more capacities, these talking fotonovelas may be delivered using video streaming and touchscreen technologies.