[MUSIC] In this next section, I'm going to give you several examples of the use of photonovellas, essentially demonstrating how storytelling health can be an effective strategy for communicating important health information, particularly to individuals with literacy deficits. The first of these is a series of photonovellas that were done in Baltimore with several different groups. They were a group of Chinese-speaking Americans, Korean-speaking Americans, and Vietnamese-speaking Americans drawn from Maryland communities. The storyline in each of these were somewhat different, targeting different characters and presenting somewhat different stories. But the effects of these were similarly positive in engaging and encouraging members of these communities to talk about hepatitis B prevention and also to inspire them to get screening. I'll mention those outcomes in a few minutes. This photonovella was done by a student in my health literacy class in conjunction with colleagues back in Tibet. And it's an illustration of a collaboration with villagers to promote the use of iodized rather than rock salt. And the story deals with resistance to using iodized salt because it's somewhat expensive, but then talks about the benefits in terms of brain function of children who might not then suffer from thyroid deficits because of lack of iodine. So you can read more of the dialogue in the slides. This next example is the embedding of photonovella type stories into a health education pamphlet. There's an image of an individual outside of an emergency room with a caption that says, what do I know about HIV testing that you don't? And there's a set up, much like a comic book, that talks about some specifics, giving place for instance, Baltimore, 5:30 PM. Latrice sprains her ankle, goes to the Urgent Care Clinic at Johns Hopkins, and while waiting, she agrees to take a rapid HIV test. She's nervous and she calls her friend Kia. So in contrast to what a typical informational brochure might be on the importance of HIV testing, the use of a photonovella approach immediately transforms this into a story. So that reader who might pick this up while in the walk-in clinic, the urgent care clinic, might be quite eager to open it up and see the rest of the story. It goes through talking to her friend on the phone. She's nervous, and then she starts talking about her relationships and why she may be at risk. And finally, she decides to in the future play it safe, get condoms, and be able to pass on what she's learned to others. And the last bottom panel of the brochure provides some information you may need to know if you want to get tested, if you want to talk with somebody, if you want to kick a habit. Next is another photonovella that I did many, many years ago working in collaboration with asbestos workers in the construction trades in Baltimore. We developed this photonovella together, raising a number of themes around exposure in the building trades. And the strong sense of family and responsibilities that older members of the construction trades feel in exposing their children, who they often see as wanting to come into this trade, the exposure for a health problem that may in fact be quite serious. The resolution in the story is that this exposure to asbestos is common among the construction trades. But there are a number of things that workers can do together to effectively address these risks by joining health and safety committees, and also diminish individual risks of smoking and things like that. So using these participatory approaches have practical and logistical benefits, participatory decision-making materials. Increased resources available to the group through the building of skills increases project success through client diffusion of ideas and materials. And decreased costs because these are not flashy, glossy materials, but those that people are able to produce locally and distribute locally. We found in a number of photonovella projects that I've done over the years and that my students have done is that participants are extremely proud of their product, the role that they play, the contribution that they're making to the health of others like them. And they take a very proactive role in disseminating the materials throughout the community. In the slide, there is a description of not photonovellas, but other kinds of graphic presentations, storytelling related to health. And as you can see, these are commonly in the area of cancer and quite popular. People like these because it's a way of reading a story that engages them and raises issues and fears that they may very much identify with and have themselves. So these are not participatory materials, but they are graphic and storytelling in a way that it is far more accessible to populations that have literacy deficits. This final illustration of the use of graphics is a poster that my colleagues and I did for a presentation at a communication conference. And the reason I show it is because it's not only people with literacy deficits that like a good story. Everybody likes a good story, even researchers and investigators. And we were able to tell a story about a study that we conducted in a way that people really enjoyed reading. I have to say that we won an award for best poster at an international conference, and it was fun. So the bottom line is stories are powerful. Photonovella studies, this is in the many that we've done, the majority of participants evaluate them positively. The people who work in producing particularly participatory photonovellas find it not only rewarding, but really fun. They think that the information when they read it as helpful. The story is written by people who are like them and who know the community. And the information is easy to understand. Photonovellas are favorably evaluated by readers and associated with positive intentions to perform, particularly the role-modeled behavior. So if you go back to the hepatitis B photonovella, the first one that I showed you, an outcome measure was intention for screening in the next five months. And those who read the photonovellas in any one of those three languages were far more likely to report having screening than those who had more traditional health education materials about hepatitis B. Or in the example of the construction workers, the reader's intention to join a health and safety committee was significantly higher for readers of that photonovella relative to readers of a more traditional National Cancer Institute, brochure on asbestos exposure in the construction trades. We also see that when stratified by level of education and income, positive intentions are strong along the lines of all readers, but particularly strong among those who are lower income and lower education groups. Well, thank you for listening, and I hope that you are interested and intrigued by the power of a story, the power of photonovellas, and that you're able to incorporate that in your future work and in your understanding of strategies to reach low literate audiences. Thanks a lot. [MUSIC]
