Healthy eating for life: rationale and development of an English as a second language (ESL) curriculum for promoting healthy nutrition

Abstract

Low health literacy contributes significantly to cancer health disparities disadvantaging minorities and the medically underserved. Immigrants to the United States constitute a particularly vulnerable subgroup of the medically underserved, and because many are non-native English speakers, they are pre-disposed to encounter language and literacy barriers across the cancer continuum. Healthy Eating for Life (HE4L) is an English as a second language (ESL) curriculum designed to teach English language and health literacy while promoting fruit and vegetable consumption for cancer prevention. This article describes the rationale, design, and content of HE4L. HE4L is a content-based adult ESL curriculum grounded in the health action process approach to behavior change. The curriculum package includes a soap opera-like storyline, an interactive student workbook, a teacher's manual, and audio files. HE4L is the first teacheradministered, multimedia nutrition-education curriculum designed to reduce cancer risk among beginning-level ESL students. HE4L is unique because it combines adult ESL principles, health education content, and behavioral theory. HE4L provides a case study of how evidence-based, health promotion practices can be implemented into reallife settings and serves as a timely, useful, and accessible nutrition-education resource for health educators. KEYWORDSHealth literacy, Immigrants, Cancer health disparities, English as a second language, Intervention HEALTHY EATING FOR LIFE: RATIONALE AND DEVELOPMENT OF AN ENGLISH AS A SECOND LANGUAGE (ESL) CURRICULUM FOR PROMOTING HEALTHY NUTRITIONHealthy Eating for Life (HE4L) is a teacher-administered, English as a second language (ESL) curriculum intervention designed to promote healthy eating for cancer prevention while improving English language skills and health literacy. HE4L is designed for beginning-level ESL classrooms that serve predominantly medically underserved, limited literacy, immigrant populations. This article presents the background and rationale behind HE4L and describes the design and content of the curriculum. Our goal is to demonstrate how evidence-based practices can be incorporated into a real-life context where they have the potential to impact a population in need of effective cancer prevention interventions.Cancer health disparities Cancer health disparities are "differences in the incidence, prevalence, mortality, and burden of Implications Practice: Incorporating evidence-based, healthpromotion strategies into adult English as a second language curriculum can be a timely, useful, and accessible mean to impact a population in need of effective cancer prevention interventions.Policy: The information gleaned from testing the effectiveness of HE4L can be used to inform state-and national-level health education policies. Incorporating evidence-based health promotion strategies into pre-existing services, such as adult education, can ensure that important health information and behavioral skills are disseminated to at-risk populations.Res...

Blending Health Literacy With an English as a Second Language Curriculum: A Systematic Literature Review

“…Five curricula (Candelaria, Woodruff, & Elder, 1996;Martinez et al, 2013;Soto Mas, Mein, Fuentes, Thatcher, & Balcazar, 2013;Taylor, Cripe, et al, 2008) incorporated an interactive health literacy level-improving health knowledge, social skills, and health behaviors. Two curricula (Edwards et al, 1992;Handley, Santos, & McClelland, 2009) addressed the third and highest level-critical health literacy.…”

“…The curriculum developers collected assessment data using teacher observations (Candelaria et al, 1996), surveys (Edwards et al, 1992), interviews , or focus groups (Coronado, Taylor, Acorda, Do, & Thompson, 2005;Martinez et al, 2013;Taylor, Cripe, et al, 2008) in the ESL students' native languages. Another component of the formative studies was a review of literature on the topics of ESL populations' health status and contributing factors across age and cultural backgrounds (Edwards et al, 1992).…”

“…Five curricula took existing curricula as the foundation and followed national and local standards (e.g., Connecticut State Department of Education English Language Learner Framework, Texas Adult Education ESL standards) for English language education to develop their teaching materials (Candelaria et al, 1996;Edwards et al, 1992;Martinez et al, 2013;. For example, the Language for Health curriculum adapted materials from existing nutrition curricula and conformed to statewide ESL guidelines (Candelaria et al, 1996).…”

“…Four curricula used English exclusively for classroom activities (Candelaria et al, 1996;Martinez et al, 2013;Taylor, Cripe, et al, 2008); three curricula also included, in addition to English, students' native language (Spanish) during in-class activities (Edwards et al, 1992;Handley et al, 2009;. For example, students read both Spanish and English versions of the same text in the Familias Sin Plomo curriculum; students discussed their health experience in Spanish as the warm-up activity in the Health Literacy and ESL curriculum.…”

“…reviewed the previous lesson and the students discussed their health beliefs and behaviors (Candelaria et al, 1996;Martinez et al, 2013;Taylor, Cripe, et al, 2008). Other classroom activities included role playing, group discussion, and problem solving.…”