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Entertainment – Education? A Fotonovela? A new strategy to I

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on 24 September 2014

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Transcript of Entertainment – Education? A Fotonovela? A new strategy to I

High risk for depression among immigrant Latinas and under-utilization of needed treatment among these women during the acculturation process.

- acculturation level
- legal status
- lack of bilingual or culturally sensitive services
- not knowing how or where to access services
- lack of health insurance
- stigma
- a need to prioritize basic life needs
- conflicting time commitments
- lack of child care

- low health literacy

Highly effective
depression-relates knowledge,
self- efficacy to identify the need for treatment
reduced stigma towards antidepressant medication.
What is the health literacy and why it’s so important?
- poor understanding of verbal and written materials and instruction
- difficulties with providing accurate health histories
- low self-efficacy to manage health problems
- mistrust of health care providers

Approach: Entertainment – Education (E-E)

E-E refers to the placement of educational content within entertainment massages in efforts to increase knowledge and create behavioral and social change

One of the example of E-E is a fotonovela

The need of applying multifaceted and culturally component intervention

In many cases, the relevant health information do not reach to Latinos.

The solution is found in health educators’ ability to become part of ethnic community’s storytelling network composed of residents, non-profits, and media.

Designing culturally sensitive and appropriate community programs.

The best programs are developed in collaboration with members of the local culture and community

Distinction proposed by Resnicow:

Surface structure vs Deep structure

Theoretical framework
The application of E-E to depression literacy is guided by two models of health behavioral change:

1. Social Cognitive Theory
- Modeling Theory and Social Learning (A. Bandura, 1977)

2. Model of Culture-Centric Narratives in Health Promotion (Larkey and Hecht,2010)

Purpose of study

Evaluation of the fotonovela’s effectiveness with immigrant Latinas in a community-based setting in which promotoras, trained by local community-based clinic, conduct health education activities.

1. Exposure to the fotonovela will increase knowledge of depression and its treatment in immigrant Latinas.
2. Exposure to the fotonovela will reduce the stigma towards depression treatment among immigrant Latinas.
3. Self-efficacy to identify the need for treatment will increase after exposure to the fotonovela.
4. The intention to seek depression treatment will increase after exposure to the fotonovela.

- Study Design

- Participants

- Analysis of Data:

- hypothesis testing

- participant demographics

142 adult Latina women, (18–55 years old)

Participants were enrolled in:

- Educational classes (health or parenting) offered regularly by the study site’s promotoras

- Recruited by the first author and the promotoras at community events and other local services (e.g., Head Start) where such women are typically recruited for ongoing health educational classes.

Analysis of Data
Hypothesis Testing: To test all hypotheses were created to calculate the mean difference between the pretest and posttest scores for all outcomes variables, for both the experimental and control groups.
- Depression Knowledge

- Stigma toward mental health treatment

- Self-Efficacy to Identify the need for treatment

- Intent to seek treatment.
Hypothesis Testing:
* Depression Knowledge: The first hypothesis was supported by greater increases in pre to post mean depression knowledge scores among the experimental group There is a significant difference between the experimental and the control groups’ mean increase in depression knowledge.

* Stigma Towards Mental Health Treatment: Several missing values were found in response to the two stigma scales: while 85 % of participants responded to the SCMHC, only 69 % responded to LSAS. During the administration of the SCMHC and LSAS several participants, from both groups, requested assistance in the completion and comprehension of the scales. indicated a statistically significant difference between the experimental groups’ mean decrease in LSAS scores. Thus, Hypothesis 2 was partially supported.

* Self-Efficacy to Identify the Need for Treatment: The third hypothesis was validated by mean pre to post self-efficacy to identify the need for treatment scores indicating a greater increase for the experimental group in comparison to the control group confirmed that the experimental group’s mean increase in self-efficacy from pretest to posttest is significantly greater than the mean increase for the control group.

* Intent to Seek Treatment: The fourth hypothesis was found to be marginally significant. statistically significant difference, between the experimental and control groups’ mean increase in intent to seek treatment marginally significant in favor of greater intention to seek treatment on the part of experimental participants exposed to the fotonovela.

The fotonovela was flexibly implemented in conjunction with other culturally competent approaches.

1. Use of the multiservice study site allowed for collaboration with promoters’ who assisted in the successful outreach and recruitment of often hard to reach Latina immigrants.

2.Childcare was offered to all participants.

3.Consistent with the promoters’ typical delivery of health education

*Highly generalizable to different Latino populations and community settings, where in can be flexibly implemented alongside health education classes offered by promotoras.

*Individuals reporting low literacy could still participate in the study.

*The fotonovela can be delivered by multiple providers to educate, engage and retain clients in services.

*Once diagnosed with depression, the fotonovela may help women better understand their condition and treatment options.

Entertainment – Education? A Fotonovela? A new strategy to Improve Depression Literacy and Help-Seeking Behaviors in At-Risk Immigrant Latinas
Definition of Acculturation process and Berry’s model of psychological acculturation

Designing culturally sensitive or appropriate community programs:

Promotoras competences:

1. Knowledge and respects for the characteristics, experiences, beliefs, values and norms of the cultural group

2. Interpersonal – behavioral skills for working within the culture

3. Supportive relationships within the culture with whom one is working and one’s own culture

4. Awareness of one’s limited knowledge and commitment to learn

5. Awareness of how one’s own culture and experiences have shaped one’s worldview

6. A viewpoint that developing of cultural competence is an ongoing process, not an achievement

Balcazar, Suarez- Balcazar and colleagues:

Training model for supporting cultural competence

1. desire to engage - individual’s willingness to participate and learn about human diversity

2. development of critical awareness of personal bases towards others who are different in any dimension of cultural diversity

3. knowledge of the multiple factors that can influence diversity and familiarization with selected characteristics, histories, values, beliefs etc.

4. development of practice of skills

5. the degree of organizational support

“Cultural competence is a complex process that requires both individual and organizational willingness and commitment to change.”

(Taylor-Ritzler, 2008)

Surface structure
– involves observable aspects of program: race, ethnicity, and gender of its staff; language etc.

Deep structure
– involves core cultural beliefs, values, and practices. This requires historical, psychological and social knowledge of the culture.
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