Developing Visually Based, Low-Literacy Health Education Tools for African Americans with Psychotic Disorders and Their Families

Abstract

Schizophrenia presents particular challenges to health literacy, partly due to associated neurocognitive deficits. In order to develop engaging, recovery-oriented, visually based psychoeducational tools pertaining to psychotic disorders, thirty-nine individuals, consisting of mental health service users with serious mental illnesses, family members, and mental health professionals, participated in informal discussions. Using suggestions from these groups, the first two psychoeducational booklets of a planned series were developed in collaboration with a graphic designer and visual artist. Content of the booklets was developed addressing four components: knowledge, self-efficacy/self-management, incorporating a workbook format, and planning/contracting. In a follow-up discussion group, mental health service users provided positive feedback on the completed booklets. The finished booklets are practical, accessible, engaging, and low-literacy. These and other innovative approaches are needed to enhance mental health care, promote self-efficacy/empowerment, and encourage communication between service users, family members, and providers, especially in light of limited health literacy, illness-related neurocognitive impairments, and stigma.

Health Literacy in African-American Communities: Barriers and Strategies

“…Culturally tailored and interactive approaches such as storytelling and culturally appropriate graphics have been reported to improve health literacy related to diverse health conditions in African-American samples (Bertera, 2014;Broussard et al, 2014;Rikard et al, 2012;Ross et al, 2010). For instance, oral storytelling slideshows on diabetes and hypertension that featured community members' voices and photographs were developed and administered to a group of predominantly older African-American women (Bertera, 2014).…”

“…While adopting universal precautions of health literacy simplifies health communication and information processing for all consumers ( DeWalt et al, 2010 ; 2011 ), studies suggest that reaching African Americans with LHL more effectively also relies on adopting culturally tailored, interactive, and community-engaged health literacy approaches ( Bertera, 2014 ; Broussard, Radkins, & Compton, 2014 ; Rikard, Thompson, Head, McNeil, & White., 2012 ; Ross, Ashford, Bleechington, Dark, & Erwin, 2010 ). This is based on the premise that health information is processed through multiple lenses; thus, the interpretation of health-related concepts and images varies across cultures and other social markers (e.g., language, generations) ( Kindig et al, 2004 ; Scrimshaw, 2019 ).…”

“…Exposure to these slideshows produced significant pre-post increases in diabetes (8.8%, p < .000) and hypertension (5.6 %, p < .001) knowledge and self-efficacy (11.3% and 13.2% respectively; p < .000) in the intervention group, with the greatest effects among those with LHL (measured by a Veteran's Administration instrument) ( Bertera, 2014 ). Print materials containing real-life stories, culturally appropriate concepts and images, and practical, action-oriented steps have also been well received in African-American samples with LHL ( Broussard et al, 2014 ; Rikard et al, 2012 ).…”

“…Community members perceived the toolkit as acceptable, easy to use, and effective in raising awareness and dialogue on HIV ( Rikard et al, 2012 ). In another study, two interactive low-literacy educational workbooks were developed for African Americans with psychotic disorders in collaboration with service users, providers, and graphic designers ( Broussard et al, 2014 ). These workbooks were written at the fifth-grade level and contained storylines with comic-strip illustrations featuring African-American characters, which service users and providers found useful and understandable ( Broussard et al, 2014 ).…”

“…In another study, two interactive low-literacy educational workbooks were developed for African Americans with psychotic disorders in collaboration with service users, providers, and graphic designers ( Broussard et al, 2014 ). These workbooks were written at the fifth-grade level and contained storylines with comic-strip illustrations featuring African-American characters, which service users and providers found useful and understandable ( Broussard et al, 2014 ). Similarly, over a 2-year period, our team used Boot Camp Translation, a novel community-based participatory research (CBPR) tool, to engage community members, academics, and health professionals in a predominantly African-American community facing extensive health and social inequities.…”