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Picture Stories for Adult ESL Health LiteracayCreated by Kate Singleton The picture stories are:
What groups of students are the picture stories suitable for? The stories "Emergency," "A Doctor's Appointment," and "Stressed Out" are suitable for most classes, as the topics are common and uncontroversial. "What Should She Do?," however, should be used with discretion, as its topic of domestic violence may evoke strong reactions and discomfort, especially if a class member has experienced domestic violence personally or knows someone who has. How can the stories be used in class? The Language Experience Approach (LEA) is an effective way to use the picture stories with beginners. Benefits of LEA:
Suggested LEA procedure:
Are there any other considerations? In using picture stories, teachers should carefully consider the images that they choose to use. Cartoons or similar drawings or illustrations that incorporate figures of isolated body parts may not be recognizable or comprehensible to all English language learners. This may be especially true for learners with limited literacy in their native languages. Drawings of people or body parts may even be offensive to some groups. Teachers need to be aware of these issues and be prepared to use alternative resources such as photographs, videos, or gestures.
Picture Story 1: Emergency!
Health literacy issues:
The basic story: A man feels pain symptoms in June, but ignores them because he doesn't have insurance and feels he can't afford medical care without it. A female acquaintance suggests that he see a doctor, but he repeatedly refuses to because of his concern about the cost. Six months after his pain starts, he is taken to the emergency room by ambulance because his condition has worsened. A month later, he is still in bed, faced with a large hospital bill which he doesn't know how he will pay. Background information:
Suggested questions for prompting discussion while eliciting the story:
With the sixth frame the opportunity arises for particularly valuable discussion on students' health care options and responsibilities:
Additional Useful Information The following information can be helpful for your students. Language is simplified, but you can decide how to present it, how much to present and what specific information suits the interest and needs of your students. The information may be used for teacher reference, or it may be modified for the level of your students to make an informational handout or other activity. Paying for health care if you do not have insurance
Picture Story Two: A Doctor's Appointment
Health literacy issues:
The basic story: A man feels a pain and goes to the doctor. The doctor examines him, asks questions about the symptoms and gives him a lot of information. The man pretends he understands, but he doesn't speak much English and doesn't know what the doctor is saying. The doctor gives him a chance to ask questions, but the man doesn't ask any. He gets some new prescriptions but doesn't understand how to take them. At home one of his family members asks what the doctor said, and the man reports that he doesn't know. He is frustrated and confused. Background information:
Suggested questions for prompting discussion while eliciting the story:
With the eighth frame the opportunity arises for particularly valuable discussion on language barriers in health care and what communication is expected of the patient in the U.S. health care system.
Additional Information More advice for talking with doctors about your medicines
General advice for patients in the doctor's office/hospital
Picture Story Three: Stressed Out!
Health literacy issues:
Basic Story: A woman wakes up in the middle of the night to feed her baby. Her family (her husband and 2 older children) is waiting for her to cook them breakfast at 7AM. She arrives late to work, and her supervisor is angry with her. On her way home from work, she is in a fender bender. Later that night, she looks at her bills and worries about money. After that, she feels completely stressed out from all the stressors of her day. Background Information:
Suggested questions for prompting discussion while eliciting the story:
With the sixth frame the opportunity arises for particularly valuable discussion on stress reduction and stress management.
Picture Story Four: What Should She Do?
Health literacy issue:
IMPORTANT: "What Should She Do?" should be used with discretion, as its topic of domestic violence may evoke strong reactions and discomfort, especially if a class member has experienced domestic violence personally or knows someone who has. It is the author's experience that students who feel comfortable in a class sometimes ask their teacher for information about the rights of domestic violence victims in the U.S. as well as services that can provide refuge from abuse. Such students may indicate that they know a friend of a friend who is in an abusive situation. The picture story can be a safe catalyst for discussion of the law and dissemination of accurate information on services for victims. The timeline: Times of events are shown in the story simply to indicate the passage of time for a learner to follow. They do not indicate a standard timeline of a domestic violence situation. Each situation in real life is different, and events should not be discounted as domestic violence because they are far apart or intense periods of violence are followed by fewer episodes. The basic story: A woman and man fall in love. They live peacefully together and start a family. One day, the man drinks too much. He gets angry and hits the woman. The woman has a black eye. The children see what happens and become upset. Later the man apologizes to the woman, tells her he loves her and gives her flowers. She is confused, but she hopes things will be better. The man drinks again, and he beats the woman again. Now the woman is very confused. She doesn't know if she should stay with the man, who says he loves her, but keeps getting drunk and beating her. She doesn't know what she should do to protect her children. She thinks about calling 911, but she isn't sure what will happen if she does. Background information:
Suggested questions for prompting discussion while eliciting the story:
With the eighth frame the opportunity arises for particularly valuable discussion on the problems a victim of abuse faces and sources of help available in the community.
Picture Story Five: Depressed
To print picture as a handout, use the pdf version of the file. Health literacy issues:
The basic story: In January, a woman is having an active, happy life. She is busy with work, friends, family, school, exercise and parties. In February she starts to feel sad. In March she feels worse. She cries a lot. In April she is still sad, and she doesn't want to eat. In May she feels very tired and stays in bed all day while other people are busy outside. In June she decides to ask for help. Background information: Depression is a very common illness worldwide, affecting an estimated 9.9 million adults in the U.S. alone annually. It is believed to be in part caused by environmental factors and in part caused by biological factors. Nearly twice as many women as men experience major depression. Depression can occur at any age to people from all ethnic, racial and socioeconomic groups. Depression is highly treatable with counseling, antidepressant medication, or a combination of the two. Many people from other countries don't know about treatment, in part because of a low presence of mental health care in many parts of the world. The World Health Organization reports that:
Many people come to the United States to escape situations of war and torture, which may have left them traumatized and depressed. Others may experience socioeconomic hardship or other challenges of cultural adjustment which make them more vulnerable to depression. Often immigrants don't seek care because they are unaware of mental health care options, feel stigma around the issue of mental health, or feel they can't afford care. Many communities in the United States provide sliding scale mental health services. These services may be found via county or municipal health departments or community service boards. Increasingly, services are being offered in languages other than English from government and other non-profit mental health care providers. Major depression (sometimes called clinical or chronic depression) is believed to have a biological basis that can respond to triggers in life. Neurotransmitters in the brain are out of balance. The term major depression is used when a person has some of the following symptoms for more than 2 weeks and the symptoms don't get better. Possible symptoms:
Suggested questions for prompting discussion while eliciting the story: Go over the title, "Depressed," with students. Ask if anyone knows what depression means. Ask if they know what symptoms a person has if they are depressed. Ask what a person can do if they are depressed. Preteach vocabulary as needed: symptoms (problems you have when you are not healthy, like sneezing and a runny nose for a cold), treatment (something to help you get better, like medicine; you go to the doctor for treatment), energy (pantomime the difference between having energy and having no energy). First frame: What do you see in the picture? What is the woman's name? What month is it in the picture? How is she? (busy) Why is she busy? What does she do? (You can emphasize that she is busy and happy in her life. She does many different things and she has friends and family in her life.) Second frame: When is it now? How is the woman now? Is she very depressed, or just a little depressed? Do you know why she is sad? (Tell students that we don't know why she is sad. Sometimes people get depressed because something bad happened in their life. Sometimes people get depressed without something bad happening in their life.) Third frame: Now what month is it? How is she in March? Is one month a long time to be sad, or a little time? Fourth frame: When is it now? How does she feel now? Does she want to eat the food? Why not? (Explain that being sad for a long time and having no appetite are symptoms of depression.) Fifth frame: When is it now? Where is she now? How is she feeling? (You might want to elicit words like very depressed, no energy, very tired. You can explain that having no energy and being tired all the time are symptoms of depression.) What's happening outside? (It's sunny. People are busy/playing/walking, etc.) What time do you think it is? Do you think she feels lonely? (Explain that feeling lonely and not wanting to do activities that you liked before are symptoms of depression.) Sixth frame: Now what month is it? Where is she now? What is she doing? Who do you think she is calling? (Maybe a friend, family member, person from her church, counselor, or doctor.) Why do you think the woman waited until June to get help? (e.g., stigma, no information about help, thought she might get better on her own.) With the sixth frame the opportunity arises to talk with students about cultural differences and options for treating depression in the United States. You can ask if there is treatment available for depression in their native countries.
World Health Organization (WHO). (2001). Mental health policy project policy and service guidance package. Executive summary. Geneva: WHO. National Alliance for the Mentally Ill website at http://www.nami.org. Click on "Education." National Mental Health Association at http://www.nmha.org. Click on "Mental Health Information." Picture Story Six: The Right Dose
To print picture as a handout, use the pdf version of the file. Health literacy issues:
The basic story: One medicine label says that children should take 2 teaspoons of the medicine every 2 hours. A mother gives the medicine to her son. She confuses the teaspoon and tablespoon. She gives her son 2 tablespoons of the medicine at 7 AM. It is too much medicine. At 11:30 her son is very sleepy. The mother shouts, "WAKE UP!!!" She is worried. Another medicine label has one dose for adults and one dose for children. A father reads the label wrong. At 7:00 AM, he gives his little daughter the adult dose by accident. He should give her 2 pills, but he gives her 4. At 12:00 PM his daughter is very sleepy. The father shouts, "WAKE UP!!!" He is worried Background information: Medication errors are a big problem in the United States. It is important to understand all the information on the medicine label, and to ask your health care provider questions about medication for yourself and your children. If reading skills are limited, asking questions about medication directions is essential. Mistakes can include taking the wrong dose, taking the wrong medicine, or taking a medicine you are allergic to. Adult ESL learners often report to their teachers that they have difficulty understanding medication labels to decide the correct dose to take themselves or to give their children. People make medication mistakes in their homes and hospitals also make mistakes. An estimated 7,000 people die each year in the United States from medication errors. Common suggestions for medication safety:
Suggested questions for prompting discussion while eliciting the story: Go over the title, "The Right Dose." What does "dose" mean? (How much medicine to take at one time.) What does "the right dose" mean? (Taking the correct dose, not too much, not too little.) Preteach vocabulary, as needed: Dose (How much medicine to take at one time.), label (the writing on the medicine that tells you the medicine's name and dose), teaspoon (the small sized spoon; bring in example), tablespoon (the large sized spoon; bring in example), directions/instructions (the words that say how much medicine and when to take the medicine), adults (older people, not children; like mother, father, etc.), children (young people, like babies, kids, etc.), every (as in every 4 hours; give examples), too much (make sure students understand that "too much" does not equal "a lot." Too much means you have a problem, like "Too much ice cream can make you sick.") First frame: What do you see in the picture? What are the directions on the medicine label? What is the name of the little spoon? What is the name of the big spoon? What spoon do you use for this medicine? Second frame: What do you see in the picture? What time is it? What spoon is the mother using for the child, a teaspoon or a tablespoon? Is that correct? What will happen to the child? Third frame: What time is it now? What happened to the boy? (He fell asleep/He is sleepy, etc.) Why? (He had too much medicine.) What is the mother saying? How does she feel? (She feels nervous, worried, etc. You might want to clarify that if she cannot wake the boy up, she should call 911.) Fourth frame: Now here is a different medicine. What are the directions for adults for the medicine? How many pills can an adult take at one time? (You might want to ask students some questions, like "If I take 4 pills at 6 pm, what time do I take the next 4 pills?, etc.") What are the directions for children? How many pills can a child take at one time? (Again, you might want to quiz students on what times they can take the pills.) Fifth frame: What's happening in this picture? What time is it? How many pills is the father giving his daughter? (4, the adult dose) Is that correct? What will happen to the child? Sixth frame: What time is it now? What happened to the girl? (She fell asleep/She is sleepy, etc.) Why? (She had too much medicine.) What is the father saying? How does he feel? (He feels nervous, worried, etc. You might want to explain that if he cannot wake the girl up, he should call 911.) Agency for Healthcare Research and Quality, "Your Medicine: Play it Safe." at http://www.ahrq.gov/consumer/safemeds/safemeds.htm. American Pharmacists Association Web site at http://www.pharmacyandyou.org/ . Click on "About your Medicine" for extensive information on medication safety. U.S. Food and Drug Administration, "FDA's Tips for Taking Medicine" at http://www.fda.gov/fdac/reprints/medtips.html. Picture Story Seven: What Happened to My Body?
To print picture as a handout, use the pdf version of the file. Health literacy issues: The basic story: In his native country, the man was very active and ate fresh, nutritious food every day. When he came to the United States he got a job as a taxi driver. He didn't get much exercise. He ate a lot of fast food. For breakfast, he ate at McDonalds (note golden arches behind taxi cab in the second frame). For lunch he ate pizza. For dinner he ate food he could microwave quickly. After dinner he ate snacks of ice cream and potato chips while watching TV. After one year, he had gained a lot of weight. He couldn't breathe while going up some stairs. His body had changed a lot in one year! He was not healthy! Background information: Learners from different countries often report to their teachers that they have gained weight since they came to the United States, or that they have less energy. Often their diets in their native countries were lower in fat and sugar than the food they eat here, and their daily routine contained more physical activity. They may not have had much education in nutrition or preventive health practices in the past to help them make better food and exercise choices in their new home. Being overweight increases health risks like type 2 diabetes (also known as adult onset diabetes) and heart disease (cardiovascular disease, high blood pressure, coronary heart disease). Risk for both diabetes and heart disease can usually be decreased with: Some ethnic groups are at greater risk for diabetes and cardiovascular disease than others. Type 2 diabetes is especially common among certain ethnic groups, including Hispanics, some Asian and Pacific Islander groups, African Americans and Native Americans. Complications from type 2 diabetes can include: Treatment for type 2 diabetes generally involves changes to diet, regular exercise, and medication. Diet changes generally involve: Suggested questions for prompting discussion while eliciting the story: Go over the title, "What Happened to My Body?" Ask what students think it means. What will the story be about? Pre-teach vocabulary as needed. Vocabulary might include: nutrition/ nutritious (knowing what food that is good for your body, like foods that don't have too much fat, sugar, and salt, or foods that have a lot of vitamins), fresh (new food, not old), healthy (good for your body), fast food (food that you can buy quickly, like McDonalds, Wendy's, KFC; many times it has a lot of fat, salt and sugar.), junk food (food that is not nutritious, like chips, soda, and french fries; it has a lot of fat, salt, or sugar), microwave (a machine for cooking food fast), exercise (moving your body to make your body strong and healthy; e.g., running, swimming, walking, playing sports), fat (bring in examples of high fat foods like butter and oil, or pictures of cakes, ice cream, etc. Pantomime your stomach getting bigger as you are eating them) and gain weight or get fat (the latter might be easier for lower level learners to remember; pantomime for students to understand), and breathe (pantomime). First frame: Where is the man? What is his name? What do you see in the picture? What do you think the man eats every day in his native country? Is the food good for him/ nutritious/ healthy? (You can draw attention, if necessary, to the fact that the food is fresh and nutritious.) Second frame: Now where is the man? (Point out the arches if necessary.) What do you think he eats for breakfast in the U.S.A.? What is his job? Do you think he gets much exercise in his job? Third frame: Now where is the man? What does he eat for lunch every day? What does he drink? Are pizza and soda nutritious? Fourth frame: What does the man eat for dinner every day? Is it nutritious? (You can point out that some foods that you buy for microwaving are healthy, but others have a lot of fat and salt. It's important to look at what is in the foods. You can bring in boxes and talk about ingredients if your learners are up to it.) Fifth frame: Now what is the man doing? What is he eating? (ice cream cone and chips.) Are ice cream and chips nutritious? Is he doing any exercise? (Only the finger on the remote exercise!). Does he get much exercise in the day? Sixth frame: When is this picture? Is the man different? What is happening? What's the problem? Why is it difficult for the man to go up the stairs? What can the man do to be more healthy? (Your students will probably be able to come up with specific examples, but in general solutions include weight loss, change in diet [if your students are up to handling the details, this includes controlling carbohydrates, and reducing fat and calories in the diet], stress reduction, and increased exercise). With the sixth frame the opportunity arises to talk with students about the health risks that increase with weight gain and inactivity and possible solutions. Resources:: American Diabetes Association Web site at http://www.diabetes.org. Information on types of diabetes, prevention, and management. American Heart Association Web site at http://www.americanheart.org. Information on heart-related diseases, their prevention and treatment. U.S. Food and Nutrition Information Center Web site at http://www.nal.usda.gov/fnic/Fpyr/pyramid.html. Has a variety of Food Guide Pyramids which print out clearly, including ethnic and culturally-based pyramids. Picture Story Eight: Snack Attack
To print picture as a handout, use the pdf version of the file. Health literacy issues: The basic story: In summer, the boy in the story is active and healthy. He plays soccer, basketball, and baseball, and goes swimming, so he has a lot of exercise. In September he does not exercise much. He eats snacks of chips and soda after school while he sits in front of the T.V. In October, he eats ice cream while he sits at the computer. In November, he eats cookies while he watches T.V. He weighs a little more. In December, he eats French fries while he sits at the computer again. He has gained a lot of weight. He is not healthy anymore like in the summer. Background information: Childhood obesity is considered to be a major health problem in the United States today. The rate of childhood obesity in this country is believed to have tripled in the past 15 years. There is debate over the causes. Too much TV, Nintendo, and computer time? Working parents not around to monitor kids' eating and activity level after school? Too much access to junk and fast food? However, the basic facts that many children are not getting enough physical activity and they are eating too much fat and sugar to be healthy are widely accepted. More children are showing signs of high blood pressure and type 2 diabetes (also called adult onset diabetes), conditions that usually show up much later in life. (For more information on heart disease and diabetes, see Background Information for the story "What Happened to My Body?") Suggested questions for prompting discussion while eliciting the story: Go over the title, "Snack Attack." What is a snack? (eating food between meals.) What does "attack" mean? (something hurts you or hits you strongly.) Ask what students think the title means. Pre-teach vocabulary as needed. Vocabulary might include: nutrition/ nutritious (knowing what food that is good for your body, like foods that don't have too much fat, sugar, and salt, or foods that have a lot of vitamins), healthy (good for your body), fast food (food that you can buy quickly, like McDonalds, Wendy's, KFC; many times it has a lot of fat, salt and sugar.), junk food (food that is not nutritious, like chips, soda, and french fries; it has a lot of fat, salt, or sugar), exercise (moving your body to make your body strong and healthy; e.g., running, swimming, walking, playing sports), fat (bring in examples of high fat foods like butter and oil, or pictures of cakes, ice cream, etc. Pantomime your stomach getting bigger as you are eating them) and gain weight or get fat( the latter might be easier for lower level learners to remember; pantomime for students to understand). First frame: What is the boy's name? When is it? What does the boy do in summer? How is the boy? Is he healthy? Second frame: Now when is it? What is the boy doing? What is he eating? Are chips and soda healthy (or nutritious)? Third frame: Now when is it? What is he doing? (He's using the computer.) What is he eating? (An ice cream cone.) Is an ice cream cone healthy (or nutritious)? Fourth frame,: Now when is it? What is he doing? What is he eating? (Cookies.) Are cookies healthy (or nutritious)? Fifth frame: Now when is it? What is he doing? (He's using the computer.) What is he eating? (French fries.) Are French fries healthy (or nutritious)? Sixth frame: With the sixth frame arises the opportunity to talk about health problems related with being overweight, and possible solutions for the child and his parents. What happened to the boy? (He gained weight/got fat.). Is he very healthy now? (No.) What can he do to be more healthy? (Exercise more, eat healthy foods, not junk food or fast food.) What can his parents do to help him? See what suggestions for parents your students can come up with. Here are some ideas: The following questions can help generate discussion on the longer term risks of obesity for children: Resources: American Diabetes Association Web site at http://www.diabetes.org. Information on types of diabetes, prevention, and management. American Heart Association Web site at http://www.americanheart.org . Information on heart-related diseases, their prevention and treatment. KidsHealth Web site at http://kidshealth.org/ . Has 3 sections, one for parents about their kids, one for teens, and one for younger kids. Each section has articles with important nutrition and fitness information for that group to know. U.S. Food and Nutrition Information Center Web site at http://www.nal.usda.gov/fnic/Fpyr/pyramid.html. Has a variety of Food Guide Pyramids which print out clearly, including ethnic and culturally-based pyramids and a pyramid for young children. |
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