Acknowledgments

1. Understanding Health Literacy Through the Eyes of Immigrant Youth: A Photovoice Project Mandy Benson, Jennifer Kimbrough, Ali Phillips Center for Youth, Family & Community Partnerships, University of North Carolina at Greensboro Additional themes: There were several other less significant themes that emerged from the data. These included: -Nutrition -Education/teachers -Personal hygiene -Romantic relationships -Exercise -Spirituality -Sunscreen use -Nature -Friends and family -Substance use/abuse Conclusions Racism in schools against immigrant students negatively influences the mental health of ESOL students. In working with the ESOL students, it was obvious that they felt comfort and a sense of belonging within the ESOL classroom and among their peers that are also immigrants. Navigating the healthcare system is not a simple endeavor for immigrant students and their families for several reasons, including language barriers, the financial burden of healthcare costs, and lack of health insurance. When an interpreter is not available within the healthcare setting, frustration and embarrassment are commonplace for immigrant families. Utilization of the healthcare system seems to occur only when there is absolutely no other alternative. The findings of this study have future implications for educators and healthcare professionals alike. First and foremost, to educate American youth on the importance of helping immigrant youth assimilate into a new social context. Second, to increase healthcare professionals’ awareness of health literacy and cultural issues surrounding the immigrant communities. Introduction Health Literacy: What is it and why does it matter? Health literacy is the ability to obtain, understand, and use the information needed to make wise health choices (DHHS, 2000). Low health literacy can affect a patient’s ability to read consent forms, written medical information, and prescription labels. It can also inhibit a patient’s understanding of oral information from health care providers as well as compliance with medications and appointment schedules. Low health literacy impacts the overall health of our nation and costs the nation’s health system as much as $58 billion a year (DHHS 2000; Pawlak 2005). The consequences of low health literacy can affect anyone, regardless of age, race, education, or income. Some of the most vulnerable to the consequences of low health literacy are immigrants; a growing segment of the U.S. population, with approximately 26.3 million now living in the U.S. (Kimbrough, 2006). Photovoice: A picture is worth a thousand words The Photovoice methodology is a unique method of collecting qualitative data by which participants use photography to answer research questions. Photovoice allows participants to record and reflect local community issues, promotes in-depth group discussions around the photos taken, and provides a unique avenue for explaining issues to policy makers (Wang, 2005). Methods Setting and Participant Recruitment High School students from the English Speakers of Other Languages (ESOL) classes, located in Greensboro, North Carolina, were recruited to participate in the Photovoice project. Consent was obtained with parent signatures on a form describing the Photovoice project and requesting their child’s participation. Students over 18 years of age were allowed to sign the consent form themselves and students under 18 years of age completed an assent form in addition to the parental consent form. Consent forms were available in the family’s native language(s) when needed. Participants and their families were fully apprised of their rights and responsibilities as research subjects. Cultural Isolation: Students described their experiences as an immigrant and being new to the school as difficult, when trying to make friends. They were particularly attuned to racist attitudes among their classmates. Student Quote: “[Black kids] can make you hurt. They call you ‘African monkey’ but we have the same skin. They say ‘I know English,’ but I know English too.” Student Quote: “Gym classes are so segregated; the white people are on one side; black people on the other side. White and black people play basketball separate. If you go to their side, then they going to talk. I say why people being so racist. Why you guys so racist and people say ‘shut up.’ I say, if you see the truth, just tell the truth. I say why you guys so racist? Just be friends.” The idea of gangs as a place of social belonging was also significant to the cultural isolation theme. Student Quote: “There’s too many gangs all over the state. [Students] want to look cool. You have to do whatever they say to do. They look out for you” Healthcare providers/healthcare: Students described their experiences with the healthcare system and interactions with healthcare providers while interpreting for a family member. Student Quote: “[Healthcare providers] speak very fast sometimes. When I translate for family members at the doctor, they talk too fast and it’s hard.” Students also conveyed that a lack of insurance and costly healthcare fees restrict their families from accessing healthcare. Student Quote: “My mom, she moved here, she didn’t have medical insurance. She don’t want to pay much more. So she try to eat healthy, use vitamins so she doesn’t have to go to the doctor. She uses traditional medicine. She knows about medicines. The most important thing is to eat healthy and try not to get sick. If you really have to go just go [to the doctor] but if you don’t have paper, insurance, then it’s too much.” Environmental Conditions: Sub-standard living conditions and unclean surroundings were mentioned and discussed by the students. Student Quote: “Man you can’t tell [landlord]. Like in our room there’s a hole with water coming down. On our roof there is water dripping. The [landlord] doesn’t listen.” Data Collection Prior to the distribution of the cameras, an instructional session provided students with information on how to correctly use a camera and a reminder to ask permission before taking pictures of an individual. Participants were specifically requested not to take pictures depicting nudity or potentially illegal situations. Students were further engaged in a discussion about the different dimensions of health and how the environment, social class, living conditions, food, and other factors contribute to health. In addition to the researchers’ interaction with the students around aspects of health, the classroom teacher took up health literacy as a class topic for approximately a four week period. During this time, students spent the majority of their class time learning about health issues and completing a project on social understandings of health. Students received disposable cameras and a two-week period of time in which they were to use photography to answer the question, “What is it like to try to be healthy as an immigrant?” At the end of the two-week period, the cameras were collected and the photographs were developed. Four discussion groups, facilitated by the researchers, were held to show the students their photographs and give them the opportunity to discuss their pictures. Each discussion was conducted in the ESOL classroom, lasted approximately 50 minutes, and was recorded via handwritten notes by researchers. Handwritten notes were favored over audio or video tapes as many of the students spoke quietly and cultural tendencies for many people to speak at one time. Data Analysis The handwritten notes were typed and compiled into one document and then distributed to the research team for analysis and theme development. Each member of the research team read through the notes to become familiar with the content and then coding schemes were developed. Results The fourteen participants were representative of many countries, including six from African countries, three from Latin American countries, four from Asian countries, and one from Israel. Five participants were female and nine were male. The average age of participants was 16.7 years. Although many themes emerged from the data, there were primarily three significant themes: cultural isolation, healthcare providers/health care, and environmental conditions. Acknowledgments The study described was supported by the Center for Youth, Family & Community Partnerships at UNCG. Literature Cited Kimbrough, J. (2006, May). Health Literacy Matters, [report]. Greensboro: Center for Youth, Family, & Community Partnerships, University of North Carolina at Greensboro. Pawlak, R. (2005). Economic considerations of health literacy. Nursing Economic$, 23(4), 173-180. U.S. Department of Health and Human Services. (2000). Healthy People 2010: Understanding and improving health. Retrieved October 15, 2006, fromhttp://www.healthypeople.gov/publications Wang, C.C. (2005). Photovoice: Social change through photography. Retrieved November 11, 2006, from http://www.photovoice.com/index.html For further information Please contact jbkimbro@uncg.edu or mmbenson@uncg.edu