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Guest Discussion: ESL as Mechanism for Advancing Health Literacy

Hi Everyone,

I'm thrilled to introduce Maricel Santos as our guest this week! Maricel is a professor in the Teaching English to Speakers of Other Languages (TESOL) graduate program at SF State University, and is also a research scholar. Her recent publication is the culmination of a four-year project, done in collaboration with the California Diabetes Program, which explored how participation in adult ESL programs can affect immigrants' health, and also how adult ESL learners can serve as agents of change in health care. See below for a brief description and some excerpts.

In this discussion, we will hear from Maricel and other members of the project team, including partners in public health and adult ESL. We will talk about how the task force worked together to create the research design and the curriculum, how the ESL teachers incorporated the health content and skills into the existing curriculum, how they were able to address the social dimensions of health literacy, and the impact this had on the students and teachers. And most importantly, we will explore together how these findings can enhance our own program and classroom efforts.

Maricel will introduce herself soon and give us an overview of the study. (She's on West Coast time, so we'll all be patient with the timing! :)

In the meantime, who had a chance to take a look at the article? Does anyone have any impressions, questions or comments to share?

I'm looking forward to some rich discussion!



ESL Participation as a Mechanism for Advancing Health Literacy in Immigrant Communities

This research examined survey data from teachers and learners in the context of a 4-year collaboration between ESL teachers and the California Diabetes Program. The goals were to examine health literacy as a social practice rather than a set of functional skills, and to assess how this worked in the context of adult ESL classes. The results confirmed that teaching health literacy in this setting can effectively increase students’ functional health literacy skills and their ability to apply the knowledge to improve health behaviors. But the results go a step further and shed some light on how promoting literacy as a social practice can be a particularly effective method.

Some excerpts from the abstract:

The adult [ESL] system remains an untapped resource in the effort to address health literacy disparities among underserved immigrant populations…

The survey results...indicated that ESL teachers frequently model effective pedagogical practices that mediate social interaction around health content, the basis for acquiring new literacy skills and practices.

This study represents a first step in research efforts to account more fully for the mechanisms by which social interaction and social support facilitate health literacy outcomes in ESL contexts, which should complement what is already known about the development of health literacy as functional skill.

Maricel G. Santos teaches at San Francisco State University in the Teaching English to Speakers of Other Languages (TESOL) graduate program.  She teaches courses in second language acquisition, ESL methodology, community-based ESL, curriculum development/assessment, and immigrant literacies. From 2008-2013, she was a research scholar supported by a Research Infrastructure in Minority Institutions (RIMI) grant from the National Center for Minority Health and Health Disparities, to SF State. Her research explores adult ESL participation as a health-protective factor in transnational immigrant communities, as well as ways that adult ESL learners can serve as agents of change in health care. Read more…



Kat Bradley-Bennett's picture

This article was timely for our program because we offered health literacy for adult ESL Level 4 in a 6-week summer session. We used the New Readers Press Health Literacy textbook and diabetes was a large focus of nearly every lesson. Besides the reading & writing, there was a lot of discussion and role play. Students were asked to develop their own personal improvement plans to eat better, exercise, and see a doctor on a regular basis.  Knowing that the majority of our students are twice as likely to develop Type 2 diabetes adds another dimension to our curricula for next year: the risks (and myths about the risks) of developing diabetes in connection with literacy and poor health care.

Thank you!

Kat Bradley-Bennett
Longmont, CO

mgsantos's picture

Thanks, Kat, for sharing your thoughts. Based on our teacher survey, we found that the majority of teachers were interested in the integration of diabetes prevention content into their teaching, but a smaller proportion of teachers felt they knew where to look for reliable materials they could use in the classroom.  Did you need to augment the New Readers Press textbook with outside materials, and if so, what materials did you use?

And to others on the list, would you agree that there's a need to improve access to diabetes prevention materials for adult ESL/literacy teachers? What kinds of resources or materials would you like to have? And what's the best way to disseminate these materials?


Thomas Kennedy's picture

Maricel, when I was working on the project, the 2 things I wanted most were:

1) Materials with a) VERY simplified language and b) LOTS of pictures

2) Materials that portrayed the diabetes statistics, especially those that pertained to my students' specific demographics.

I wanted the second one in hopes that, if they saw the statistics, they'd come to realize the relevance/importance of the topic.

lagoratus's picture

ARC of NJ has good info for individuals with developmental disabilities in
English/Spanish at
Lauren Agoratus

Kat Bradley-Bennett's picture


I apologize for not seeing your comment and question. I'm not sure if our Level 4 teachers augmented the New Readers Press book very much in the unit on diabetes, but I will find out. I do know that they used a current newspaper article about the rise of diabetes in America to provide some authentic text.  I will let you know what else the teachers used.


Miriamb3's picture
One hundred

Dear Maricel, Julie, and all:

I looked over the resource, which can be downloaded for free, and have a question about the table on page 93 that lists the content, language skills, and social practice araound the risk factor for type 2 diabetes. The social practice for this topic is including activities in the ESL curriculum that explore

"How to talk about risk with peers, family members about risk factors [for diabetes 2]—who wants to get  screened, who does not, and why"

I would be very interested in knowing what sorts of language and activites could be practiced for talking with people who don't want to be screened. It seems the assumption in texts is often that you just talk about it and that' s it. Maricel, would you be willing to share an activity for that content?

Thanks in advance!  Miriam

mgsantos's picture

Thanks, Miriam, for your comment and question.  I'm glad you brought up the possibility that not all learners are going to feel comfortable assessing their own risk in ESL class. We adapted the risk assessment put out by the American Diabetes Association; we wanted learners to have the opportunity to take the risk assessment but did not force anyone to share his/her scores.  

In our lesson planning with the teachers, we spent considerable time talking about what kinds of activities would promote understanding of risk, promote sharing of questions about risk, without pressuring students to talk about their own personal risk profile.  We read a real-life short story of an ESL learner, Eugenia, who also was union organizer and the mother of 2 young boys. In her own words, Eugenia talks about her worries: Can I be a good organizer if I am sick? Will my boys get diabetes too? This activity, created by a colleague Alison Webber of Building Skills Partnership using Gail Weinstein's Learners' Lives as Curriculum framework, is able to (1) help learners develop language for talking about risk; and (2) help normalize the discussion of personal risk in a less threatening way.  Our teachers also developed an "imaginary profile" activity, which featured demographic profiles for Eugenia and 2-3 "imaginary" people:

For example:

Height: 5'0"
Weight: 135 pounds
Age: 77
Daily exercise: No
Baby weight: 6 pounds
Siblings have diabetes? Yes
Parents have diabetes? No

The learners practice calculating risk scores for each of the people featured on the worksheet.  (You probably already noticed that there's some interesting math involved in this lesson too). The learners could work in small groups and make up new "imaginary" profiles which could be then shared with other groups.  

Miriam's comment reminds us that, as teachers, we need to attend carefully to the nature of the conversations that learners are having around health content.  For me, I need to be able to keep in check my own excitement about/fascination with cultural perceptions of risk when developing lesson plans. I've learned how essential it is to attend to the nature of the learners' talk and interaction around the health content.  What content vocabulary about risk do they minimally need to react to Eugenia's story? What kinds of language can we teach so they are equipped to ask questions about risk? How can stories like Eugenia's serve as the template for telling their own stories about risk? (These are the kinds of questions inspired by Gail's Learners' Lives as Curriculum framework, which we have continued to use in our curricular planning).  Can I readily configure group work in the classroom so that learners have an opportunity to learn about risk from multiple learners in the room (e.g., older learners, younger learners, those who have been in the U.S. for many years versus a few months)?

More recently, I have been working with a colleague, David Olsher, at SF State who is a classroom discourse analyst. We are shifting our attention to the learners' social interactional patterns and language use during group work in diabetes-focused ESL classrooms.  We're still busy transcribing, but our sense is that learners appear to use an array of language practices that serve to personalize the health content in a meaningful way.  Examples of language practices include: clarifying task procedures, repeating new vocabulary, agreeing or disagreeing with an idea, giving advice, repeating a story, telling a new story...  Our idea is that health literacy is a kind of discursive reasoning which requires all of us (learners and non-learners!) to integrate health content with personal life experience. Even though our learners are not yet skilled users of English, their classroom learning has much to teach us about the importance of talk and engagement with others in our understanding of health literacy. 

Thanks, maricel

Julie McKinney's picture
One hundred


Your question about how to practice talking with people who don't want to be screened brings up one of the key challenges of addressing health literacy in this setting. We don't want to be saying "you must get screened", but we do ultimately want them to adopt some new behaviors --like this one-- on their own terms. And I think that the solution is exactly what Maricel's study highlights. The solution is a) going through the process of interacting socially around a question or decision, and b) using and valuing what the learners bring to the table. And this solution is one that is done naturally and well in an ESL classroom, but not so easily in a healthcare or public health education setting.

When we do things like open discussions, role plays, or "case study" stories, like the one about Eugenia, we are letting the learners come up with their own ways of talking about these things with their peers and making decisions about what they will do. I have heard that, according to studies, women are much better at advocating for others than they are at advocating for themselves. I can imagine a woman who learns about screenings in her ESL class but is resistant to get screened. She talks about it with others in class, looks at Eugenie's story and analyzes some "imaginary profiles". Then she goes home and shares what she learned and processed with her mother, and her husband and his sister. In this way, she is in the role of advocating for others, and may find herself trying to convince them of the very thing she is avoiding herself. 

Thanks, Maricel, for sharing that activity! Does anyone have others to share?

mgsantos's picture

Dear all --

Hello from San Francisco! Thank you to Julie McKinney and the LINCS team for making this week's discussion possible.
I look forward to this week's discussion, in hopes that our recently published article ESL Participation as a Mechanism for Advancing Health Literacy in Immigrant Communities sparks some discussion about the promise of health literacy work in ESL classrooms...
Several members of our project team -- representing both ESL and public health worlds -- will be joining the conversation at various points this week, so please feel free to share your reactions and questions. 
In case you haven't had a chance to read the article, please scroll down below for a recap....
To get things started, I'll go ahead and pose a question that has been on mind lately:
Our work has helped me appreciate that the impact of ESL-based health literacy interventions is a function of what the teacher and learner bring to the table, not merely the amount of health knowledge or skill the teacher is able to transmit to or cultivate in her learners. It should be possible to evaluate health literacy outcomes at the collective level – at the level of a classroom community, or a neighborhood ESL program, as we imagine that health literacy gains reflects gains in shared knowledge, gains in the strength of a social network around common health care concerns.  I would love to see adult ESL teachers be included in conversations about how we can be measuring health literacy outcomes with this expanded social view in mind.  What opportunities do we have to do so? 

Best, Maricel Santos


Recap of ESL Participation as a Mechanism for Advancing Health Literacy in Immigrant Communities (Santos, Handley, Omark, & Schillinger, 2014)


Our central guiding questions:
How can health literacy research in adult ESL classroom help us appreciate the social dimensions of health literacy, not only health literacy as an achievement of cognitive skill? In what ways are adult ESL program uniquely poised for health literacy interventions, in particular related to diabetes prevention?

Conceptual framework:
We are interested in the social dimensions of health literacy as defined by (a) adult literacy learners’ prior and increasing engagement in everyday literacy practices associated with health care tasks (e.g., reading nutrition labels); and (b) the range of pedagogical approaches (e.g., whole-group, pair-work, project-based teams) used to assist learners in the development of new knowledge and practices. An exploration of these two domains demonstrates that health literacy development is not merely a matter of cognitive skill development but also of shared social practices.

 Research context:
Our study included two parts:  a survey of 144 adult ESL teachers throughout California, and a study of learner engagement in 5 ESL classrooms focused on diabetes prevention content (116 ESL learners, in total). The ESL programs were based in the San Francisco Bay Area.

Study highlights:

  • Based on the statewide survey, we found that the majority of ESL teachers are highly motivated in reaching out to public health professionals and organizations and integrating diabetes prevention content into classroom instruction. Many teachers also expressed interest in partnership with health organizations to pursue funding in support of these kinds of health literacy activities.
  • The classroom pilot data revealed the positive impact of the ESL instruction on learners’ functional health literacy skills: the majority of the learners, despite varying proficiency levels, were able to acquire knowledge of Type 2 diabetes risks and prevention strategies, and apply this knowledge to the affirmation of healthy everyday behaviors, or the planned revision of unhealthy ones.
  • Social interaction also appears to be an important dimension of ESL learner health literacy gains, as evidenced in the attention the ESL teachers gave to the classroom social arrangements which mediated the learning of new language skills (vocabulary, grammar) as well as Type 2 diabetes content.
  • The majority of ESL learners reported sharing health information from the class with others (other classmates, spouses, elderly parents, children, friends, coworkers). This finding suggests that the social practices of preventive health knowledge sharing and diffusion in class often can extend to contexts outside of school, in the home and community.

Some key take-aways

  • The adult ESL system provides a rich context for (a) understanding the mechanisms by which social context facilitates the acquisition of new health literacy skills in immigrant communities and (b) leveraging the power of social relationships and social supports that are already a part of immigrant adults’ everyday lives. Adult literacy practitioners are “strategic intermediaries in the world of immigrant health care”, but their efforts will be hampered without the appropriate investment of time and resources in partnership development, teacher training, and curriculum development.
  • From a social view, the impact of an ESL-based intervention might best be understood at the collective level, in other words, that the achievement of health literacy gains is shared across individuals – among groups of learners, within classroom communities.  Future research should more closely examine the mechanisms by which classroom interactions and relationships (learner-learner, teacher-learner) facilitate health literacy development.
Margaret Handley's picture

Having worked with Maricel in this arena, I too have noticed the incredible 'spill over' of collective health literacy skill development in ESL classrooms and welcome further conversation about how to best characterize the "achievement of health literacy gains that is shared across individuals".  


In the public health field, while there is much said about collective impact and there is a real desire to develop community-level measures of impact, there are few examples that can help explore mechanisms and facilitators of health literacy skill development. Indeed, this is an area where ESL communities could help advance this area of health literacy scholarship and practice. 

Julie McKinney's picture
One hundred

I would love to further explore the teaching methods that address health literacy as a social practice. These are some questions for Maricel and the teachers who worked on this project, and also for everyone!

  1. Please share other examples of these methods.
  2. How do learners engage with these methods in comparison to skills-based methods? (How well do they like them? How easily do they throw themselves in? Any resistance or shyness?)
  3. How do you balance the social practice work with the skills-based work?
  4. How well do these social practice methods (and the health topic itself) mesh with your required goals of improving English and literacy proficiency?
Thomas Kennedy's picture

Gosh, when we were working on this project, the framing of functional literacy vs. social practice wasn't as clear to me as it is in the paper.  But Maricel definitely encouraged the teachers to move beyond information transmission and to get students to question.  And I gather that's part of teaching literacy as social practice.

Here are a couple of examples to illustrate how I accomplished this in a low beginning level ESL class.  Contrasting the two may show the difference between functional literacy and literacy as social practice.  The content is exercise; the grammar is simple present tense.

I hope the links work.  Sorry the document formatting gets messed up in the uploading process.

Exercise half page

With this handout, students learn vocabulary for different types of exercise.  They also reinforce their recently-learned knowledge of the simple present tense by asking each other, in pairs, "What does he do for exercise?" "He runs," etc.

Exercise or Not half page

With this handout, students learn more vocabulary for activities, of which some are obviously NOT exercise, and others may or may not be exercise, depending on the speakers' viewpoint.  Pairs asked each other, "Is this exercise?" the response being either, "Yes, it is," or "No, it isn't."

The activity was designed to get my students thinking about what kinds of activity in their daily lives may constitute exercise -- a theme that's expanded upon later in the unit.  I also hoped it would generate some difference of opinion to, in turn, at this very beginning level, promote some discussion.  And it did.  For example, we had male/female difference of opinion about whether cleaning house and making beds is exercise.  And it surprised ME that my students overwhelmingly said that working construction (as opposed to, say, lifting boxes) is NOT exercise.  (My guess is that the workers in the picture I used look like they have good union jobs my students are envious of.)

Julie McKinney's picture
One hundred

Thanks, Thomas, for sharing these specific activities. They show how the two types of instruction work symbiotically! You need the vocabulary lesson to give people the skills to participate in the the social practice activity, which in turn gives people the opportunity and motivation to practice the new skills (vocabulary and present tense).

I would imagine that social practice activities would be a challenge for low beginners because these activities require discussion in English. But your example shows how it can still work when you have a simple and clear framework for asking and answering the questions.

I suppose for this level the greater part of their social practice work around the health issue may happen at home and in their communities when they can discuss these questions in their native languages. How much is it part of your efforts to make sure this happens? And what kind of feedback do you get about their social practice at home?

Thomas Kennedy's picture

I can't say that I had that as a specific goal in my curriculum or activities, Julie.  Other teachers did have activities designed to encourage "expanding the circle", as I'm interpreting what you're saying.  Camilla Bixler's students wrote role-plays and presented them to another class, for example.  Perhaps others who included activities more specifically designed to encourage spreading the word outside of class will chime in. 

Julie McKinney's picture
One hundred

Thanks, Thomas. Yes, I'd love it if others could chime in about what the students did at home and in their communities as a result of the intervention. And perhaps Maricel could speak to this?

As she says in the article, part of promoting "engagement around type 2 diabetes prevention" was "leveraging the power of social relationships and social supports that are already a part of immigrant adults' everyday lives."

mgsantos's picture

Thanks, Tom and Julie, for expanding this conversation about the social dimensions of health literacy learning and health literacy outcomes.

Through the feedback we gathered from learners towards the end of the lesson cycles, we found that learners, indeed, were going home after ESL class and talking about what they heard/learned in class with friends, co-workers, and family members.  For some learners, the information wasn't "new" per se, but their discussions in class helped to re-affirm what they already knew about living healthy or diabetes prevention.  The discussions in the ESL classroom, thus, seemed to help affirm that the learners were already knowledgeable;  I observed, particularly among parents with school-age children, that they derived a sense of confidence from knowing they could talk about diabetes prevention in their native language AND English. 

I can appreciate the value of Tom's classroom activity about exercise, on many levels.  We immediately recognize the skill-building around the grammar/vocabulary needed for question-formation.  But we also can appreciate that the learner engagement around the central question -- what is exercise? -- is a powerful act of interpretation of public health messages. For those practitioners/policymakers who have not spent much time in adult literacy classrooms, the learners' yes/no questioning strategies may seem to have little in common with the public health discussions in the "real-world" which tackle the nuances of what constitutes "exercise" or what "active living" means.  However, by documenting interaction around health literacy activities in ESL classrooms, we are better poised to appreciate that active interpretation of public health messages is fundamental to health literacy development.  I also think it's important to monitor how the mixture of pair-work and whole-class discussion contributes to the sense of group ownership
of the "what is exercise" question. Might this kind of exchange foster a kind of group identity about the challenges of exercising "enough", reducing the potential stigma that learners may feel if they aren't very active or don't exercise in a socially endorsed way (e.g., joining a gym)? We definitely need more rigorous research in ESL classroom to capture these kinds of processes, but an expanded view of literacy opens the door. 

Thanks again, Maricel



Miriamb3's picture
One hundred

Thanks, Maricel, for your wise and generous response to my request for activities and suggestions for addressing the issue of what to do when someone doesn't want to talk about their own risk factors. I definitely think that starting by evaluating a  hypothetical person is the way to go. And I agree about pair work.This might very well be a situation where students choose their own partners  to work with on this!

I still remember as a child in elementary school getting weighed in front of the whole class and the nurse stating my weight out loud to an assistant or the teacher or someone who wrote it down. (Yes, it was the late fifties or early 60s, but still!) The thing was, the whole class could hear everyone's weight. Those of us not lithe and light suffered a thousand deaths.  I think we need to be sensitive to issues around these topics and make sure we are not embarrassing our adult students. And I definitely agree with getting the message out that exercise doesn't have to mean looking good in spandex and joining an expensive gym, as Maricel points out above. It can start with friends walking together around the block at breaks or after class if that works.

Miriam Burt

mgsantos's picture

Thanks, Miriam, for your thoughtful response -- your subject line was a great attention grabber!!!

Individual risk profiles are definitely something people have to discuss with a trained medical professional.  I don't think ESL teachers needs to burden themselves with the task of interpreting a particular person's risk profile.  But we have a very vital role in facilitating engagement around risk themes.  This is also an area where health-education collaborations are invaluable so that learners have access to engaging learning environments AND content knowledge about risk.

Best, Maricel

Ana De Carolis's picture

Hi Julie and everyone!

I am one of the teachers who worked with Maricel on this project. I teach at a community-based organization created by and for Latina immigrant women, whose programs are built on the idea that immigrants themselves are uniquely equipped to find solutions to the issues that affect them. The health literacy as social practice model is a great fit for my organization, as opposed to a model where experts from outside the community would just transmit information on diabetes to the students.   

In my class, the starting point for our discussion on diabetes was the story of Claudia, one of our members. She is the President of the Board of Directors of our organization, and was a domestic worker at the time. The story describes her busy schedule as a domestic worker and single mom, and how her busy life prevented her from exercising and eating well. After being told by her doctor that she was at risk for gestational diabetes, she dramatically changed her lifestyle, started eating healthier food, exercising, losing weight and feeling better.

This story was a gateway for discussion, as most women in my class felt identified with Claudia, and several of them revealed that they were also diagnosed with pre-diabetes or diabetes, or that the disease runs in their families. The story allowed us to do language work mostly around idioms, verbs in the present tense and interrogative sentences.

Students prepared questions to ask Claudia as well as Diana, a health practitioner from UCSF who specializes in gestational diabetes and is bilingual in English and Spanish. The project ended with a bilingual Q&A session between Claudia, Diana and the class participants. By the end of the project, participants had collectively come up with self-care strategies, brainstormed ways to incorporate self-care activities into their busy lives and shared resources on eating well and exercising. 

mgsantos's picture

Thanks, Ana, for sharing a description of the work you did with the women at Las Mujeres Unidas. I remember how invested the classroom of learners were in learning more about Claudia's personal story.... and supporting her in making changes.  

Julie McKinney's picture
One hundred

This study and its emphasis on social practice reminds me of another study done in 2007-8. Marcia Hohn and Lorna Rivera found that the group of adult learners were developing what they called "collective efficacy", which helped them to engage with the health information and start changing some behaviors. 

Take a look at this short overview of their study:

And here is an excerpt:

In the focus groups in the second cycle, students began talking about the importance of learning about healthy eating in a group in a trusting environment with trusted staff and how that helped them make some important changes in their eating. We as researchers saw that collective efficacy (where the group enhances feelings of power and control to be more effective) might be in the early stages of generation. This led to a deliberate effort in the third cycle to develop action projects to increase the group’s solidarity and deepen engagement with the learning. These action projects culminated in sharing across all the programs in the local “Adult Literacy Coalition Week”. One program provided a cookout with revised “healthy recipes” and another program brought their student-made posters and informational handouts. The third program developed a powerpoint “teach back” based on what they had learned from the university nutrition program. Beginning analysis indicates that this action approach deepened engagement with the learning and supported greater degrees of action around healthy eating. We think that the potential of generating collective efficacy is an exciting area for further exploration. 

Maricel and others, what do you know about collective efficacy in this context?

mgsantos's picture

Thanks, Julie, for bringing in collective efficacy here. While we have not referred to this particular concept in our work thus far, it's a highly relevant concept for understanding one possible mechanism by which health literacy instruction in ESL classrooms can have a positive impact on a learners' health literacy skills/practice, their preventive health behaviors, and ultimately, their health and well-being. The concept enables us to appreciate the possibility that health literacy instruction in ESL may benefit learners by giving them a greater sense of control over the direction of their health care and well-being. As part of pre/post surveys, we asked learners Do you have plans to change your eating (exercise) habits? and If yes, how confident are you that you will make this change? Accounting for changes in confidence represents one way we accounted for changes in perceived control.  Over 90% of the learners who said they had plans to change their eating/exercise habits reported feeling confident to very confident about doing so.  But please note that "Many learners indicated they already had healthy nutrition and exercise habits at baseline, suggesting the ESL lessons reinforced health habits in addition to supplanting less healthy ones" (p. 99).  

Building on Marcia Hohn's study, it's exciting to imagine how we -- through our curriculum development and classroom-based research -- might be able to demonstrate that "collective efficacy" is a key factor that links ESL participation and health outcomes.  Such evidence would build the argument that ESL participation can be viewed as a health-protective factor in immigrant communities.  This reminds me of a 2000 study that was conducted by two public health researchers Deborah Bender and Dina Castro entitled "Explaining the birth weight paradox: Latina Immigrants' perceptions of resilience and risk".  The researchers explored the perceptions of resilience among Latina women who had recently immigrated to the U.S., and the possible links between sources of resilience and health.  They found that ESL participation was an important source of resilience for the women:

Several of the [women] did talk about the importance of learning English. For these women, not only were ESL lessons helpful, but the Americans who worked with them were identified as a helpful and highly valued resource in making sense of and managing the dominant U.S. culture. Asking for assistance with studying for a driver’s license, help with adjustments to bills, and understanding which and why certain forms were necessary for completion of a particular application were among the tasks for which the Latina women had requested assistance. Although the ESL training itself helped respondents to adapt to their new surroundings, the support offered by the ESL volunteers seems to offer at least some of the ‘‘emotional support outside the family’’ and the ‘‘encouragement of autonomy’’ that is thought to promote resilience in stressful circumstances. (p. 172)

I imagine Bender & Castro's findings will not surprise anyone who has worked in ESL/adult literacy.  The value placed on classroom community is a strength of many ESL classrooms.  I'd love to hear how others have thought about the promotion of collective efficacy or the promotion of resilience in our ESL classrooms. Best, Maricel


Kim Bullock's picture

Collective efficacy is a great extension to self-efficacy. The addition of group treatment as part of disease management is currently taking hold by physicians who handle chronic disease management ( DM/HTN/CAD-Coronary Artery Disease). Group sessions where a certain number of patients regularly get together and discuss their experiences with treatment and disease self-management creates an almost "group think" environment, and the opportunity for collective efficacy. This encourages and activates the participants to strengthen their locus of control, improve their condition and empower their lives individually and collectively.

Julie McKinney's picture
One hundred

Thanks, Kim, for bringing up the group visits that some practices and clinics are using. We had a discussion on this topic back in 2011 on this list. The list at the time was in a different format. If you want to read some of it, go to this link:

Scroll down to post #6313 and read on from there. The subject line is Group Dynamic in Health: Shared Medical Appointments.

Here are some of the resources we shared to prepare for that discussion:

mgsantos's picture

Dear all --

I would like to thank Julie McKinney, the LINCS staff, and all the folks who contributed to last week's discussion in response to the article "ESL as Mechanism for Advancing Health Literacy".  Even though the formal discussion period is over, this thread remains open, and anyone can add to the discussion anytime. So, if you didn't get a chance to comment last week, no worries -- you can still do so, and one of us will respond!

In the spirit of the Thanksgiving holiday, I am feeling very grateful that this community of practice exists through LINCS.  It's always great to find others with similar interests, and it strengthens our shared knowledge base about the promise of ESL contexts in health literacy interventions... (but I think you all already knew this!)

Best wishes for a safe and peaceful Thanksgiving holiday.

Best, Maricel

Julie McKinney's picture
One hundred

Hi Everyone,

Thanks for participating in this discussion! I appreciate the group effort to explore and promote this research done by Maricel and her team from SF State and the California Diabetes Program. I hope that you will all share what we've talked about with your colleagues!

I think this is an important topic to pursue. I believe, as the article says, that ESL programs (and ABE programs) are a valuable and largely untapped resource for health promotion efforts. Clinics and health centers have limited access to the populations that most need their help in reducing chronic disease and maintaining health.  And when they do have access, there are challenges in communication, cultural integration and trust that make it hard to bring about changes in behavior. The ESL model can diffuse all of these challenges, and as we see here can be very effective.

Another important example that this study offers is the partnership between adult education programs and local health programs. I would love to see these partnerships develop in every community! I know there are challenges, but perhaps we could work through them here. What makes it hard to develop these partnerships, and how can we help to encourage more of them? As Maricel said, this thread will stay open and I hope we can keep talking!

Finally, I'd like to give a big "Thank You!" to Maricel for taking the time to discuss this with us here. Also thanks to the teachers, who shared their insights.

So carry on, and have a great Thanksgiving!

All the Best,