Photonovel FAQs


What is a photonovel?

 A photonovel is a structured story with dialog bubbles, like a comic strip. Photographs are usually used instead of cartoons. 

Photonovels (fotonovelas) and other types of novelas, such as telenovelas and radionovelas, typically have dramatic plots like soap operas. They are extremely popular in Latin America. 

‘Storytelling’ is central to the development and use of photonovels.

When describing lessons learned from their health literacy research, Hohn (1998) observed, “Storytelling was a vitally important part of the process (for fostering empowerment in health education).  It brought the information back into the psychological-emotional realm so that meaning and connection could emerge...  

Even if health materials are written at appropriate literacy levels, they were insufficient by themselves in promoting active engagement with a health issue likely to result in behavior change.” 

“You can’t just tell people something and expect them to change as a result. You have to find ways to start with where people’s hearts are and connect to things that mean something to them.”  

                    Student Action Health Team Member

De Madre a Madre photonovels

What are the De Madre A Madre Prenatal Care Photonovels?

  • Seven, easy-to-read, bilingual stories about common experiences and concerns during pregnancy: 
  • Designed especially for and with Latino families
  • Based on real-life experiences of Latinas, photographed with community members as models
  • Extensively field-tested with diverse Latino communities and health professionals from multiple disciplines to ensure cultural and linguistic appropriateness and medical accuracy

Reach adults with limited literacy skills. Share prenatal information in a way that is clear, culturally appropriate, and motivating.

  • Improve client understanding of important health messages
  • Use valuable staff time and resources more effectively
  • Address The Joint Commission's Accreditation Requirements and Standards 


What makes these photonovels a versatile resource?

Our stories are designed to assist you in teaching in a way that truly reaches those you serve. Responding to the needs and issues identified during field-testing inspired many of the unique features.   

  • 'Bilingual Bubble' layout with numbers. Makes story easy to follow in Spanish & English.
  • Bilingual Glossary with Key Words in story. Cues to check comprehension.
  • Field-tested Glossary Definitions. Gives staff and interpreters a starting point for dialog. Add information as needed and appropriate.
  • Safety Information: When to call the clinic, when to call 911. 

These features allow the photonovels to be used in a variety of ways.

How can you use the De Madre a Madre Photonovels?

Teach-With-Stories Group Prenatal Education

Enhance Cultural and Linguistic Competency of Health Professionals

Reinforce Health Messages from the Prenatal Care team


  • The photonovels are designed to be used with the TWS Method.
  • Teaching points and health issues are embedded in the stories. These give the facilitator natural openings and ‘chispas,’ or sparks, to stop and discuss. 
  • The characters’ and the participants’ life experiences, feelings, and beliefs are a vital part of the group dialog.
  • Effective for all literacy levels. Those who cannot read can listen and participate in the discussion. Can be adapted for indigenous oral cultures.
  • Improve individual and group health literacy skills, including increasing confidence and understanding of how to access, interpret, and use health information and systems in daily life.
  • This participatory, learner-centered approach helps you meet educational and social support needs simultaneously, in a culturally and linguistically appropriate way.  

"You relax and eat, chat and learn. And then take a break and learn some more. The facilitators' attitude towards us is always special."

TWS Participant

"I feel like this program has helped me because I feel more sure of myself to ask questions. Because before they would...ask, 'Do you have any quetions?' and I'd say, 'No, it's fine.' And now if I see that my child has something, I ask, 'Why is this happening?' I ask them [so I can] be very well-informed."

TWS Participant

FIELD-TESTED FACILITATOR GUIDES to help you use the photonovels for groups.

Reinforce Health Messages from the Prenatal Care team

Enhance Cultural and Linguistic Competency of Health Professionals

Reinforce Health Messages from the Prenatal Care team


  • Give them to mothers after a clinic or home visit to reinforce important health messages you have shared. 
  • Effectively introduce and/or reinforce health messages presented in other prenatal education programs
  • Educate despite missed appointments and classes 

 “Of all the materials we have, these are the best! The photonovels are at a level the people understand.  The information is good, not too overwhelming. The pictures are great. The families read and relate to these the most…the ‘picture book’ format is something that they’re used to and find much more interesting than pamphlets or information sheets. I highly recommend them!”  
OB Hispanic Nurse Educator  
Raleigh, NC  

Enhance Cultural and Linguistic Competency of Health Professionals

Enhance Cultural and Linguistic Competency of Health Professionals

Enhance Cultural and Linguistic Competency of Health Professionals


  • Glossary of key words highlighted in the story alert staff to potential comprehension issues. When developing and field-testing the photonovels, these words were often not understood although they are commonly used during care.
  • Field-tested definitions in the glossary model simple, clear explanations for the prenatal team and interpreters. During the field-testing process, we discovered that many definitions offered by clinic staff were not understood by clients with low educational levels.

  "The attention to the cultural appropriateness of the material and the nuances of the Spanish language is remarkable. These photonovelas are universal and easily understood by those with lower educational levels." 
Tom Furtwangler
Former Director, Novela Health Education
University of Washington 

"There are many Latinas in my community. I know these materials will help them, especially with all the pictures. But what’s great is that they really help me with my Spanish!
Midwife, Livemore, California

“I am just learning Spanish...  I do home visits with many Spanish-speaking clients.  I feel so frustrated since we do not have enough Spanish-speaking staff.  I have started memorizing the photonovel dialog and phrases since they contain many of the important messages I have to communicate.  I know it’s not the best situation but at least I can communicate some of the essentials to these new mothers who need the information now.” 
Lactation Consultant, Raleigh, NC

Bridge Language Differences

Bridge Language Differences

Enhance Cultural and Linguistic Competency of Health Professionals


  • Unlike many brochures and pamphlets, the prenatal care photonovels are in a dialog format so the information is written the way a person speaks. This and the unique bilingual design can help bridge language differences.  

“These are excellent materials, easy to understand. The women love the stories and pictures of Hispanic women. They also like the Spanish/English layout…I know for sure they read them because they learn key words in English and use them to help explain problems at the clinic when I’m not here. These are definitely the ones that we keep in stock!” 
Hispanic Outreach Worker
 NC Davie County Health Dept. 

“I know very little Spanish and many of our clients speak very little English.  We use the side-by-side layout and the numbered dialog boxes to help us ‘read’ and communicate between English and Spanish. They have really helped me out of some difficult situations!”  

Public Health Social Worker 

Greenville, NC

Community Outreach

Bridge Language Differences

Literacy Instruction


  • The photonovels can be used as stand alone educational materials to raise awareness and convey important health messages without individual or group instruction.
  • Distribute them at health fairs, churches, stores where your clients may shop…just a few ideas!

"These are the first materials to go at my table when I put them out at community events. They catch people's eye and are engaging. It's not just the women, men and teens pick them up too."

Health Educator /Outreach Worker

 Chapel Hill, NC

Literacy Instruction

Bridge Language Differences

Literacy Instruction


  • The photonovels set the stage for many other types of related learning activities that can improve comprehension and participants’ literacy skills in Spanish and English.
  • Supports creative community partnerships. For example, the photonovels can be used in Spanish in TWS groups to discuss time-sensitive health information and used in English for literacy classes.

"When we first started out we learned from our needs assessment with Latinas in the community that they were most interested in learning English, not prenatal education. So we partnered with the local community college to provide English for Speakers of Other Languages (ESOL) classes after the prenatal groups. We had a lunch break in between which the women loved. It gave them a chance to socialize and spend time with their children." 

 Mélida Colindres, MPH  

Co-founder of the original De Madre a Madre program & TWS Study Team member

How do you create a photonovel?


A Continuum of Participatory Approaches

There are different ways to develop a photonovel.  How you define ‘community’ and the level of involvement of the community can and will vary depending on your timeframe and objectives (which are often driven by funding stipulations).  

Involving and getting buy-in of community and system leaders (e.g., healthcare, school system, local and state governments) up front can be critical for effective advocacy and community change efforts. 

The process of photonovel development by itself can be a powerful intervention with a group or specific community. 

A Particular Story

At one end of the participatory continuum, a photonovel is planned, written, designed, photographed, produced, and printed by community members. 

  • A primary goal is to capture and preserve the integrity of the voices, faces, and ‘codes’ of a particular community. 
  • Participation in the conception and creation of the photonovel is as important in the empowerment process as the actual product. 
  • ‘Outsiders,’ including health professionals, act in a technical advisory capacity only. 
  • Community capacity building to identify respected formal and informal leaders and stakeholders is important to the photonovel development process. For example, community leaders may possibly give their approval/blessing, help guide the project, adapt the process for the community, and select participants. 

          See Rudd and Comings for more info re: learner developed photonovels.

A Universal Story

In our development process, we define ‘community’ in a broader, more inclusive way. 

  • Our goal is to create health education photonovels that can be used across communities with the Teach-with-Stories Method.
  • These universal stories are then critically discussed in a facilitated group setting. Through the cycles of action and reflection, the dialog and issues that emerge naturally reflect the needs, concerns, feelings and beliefs particular to each group.

Steps in Development:

We gather extensive information from diverse perspectives and sources.

  • Everyone’s voice is valued, community members and health professionals alike. 
  • Our process involves focus groups, reviews of the literature, existing materials and programs, key informant interviews, and advisory board feedback with members from local, state, and national levels. 
  • To ensure the cultural and linguistic appropriateness of the photonovels, members of the intended audience participate in all aspects of the development and field-testing process: from concept and content development to design and production.
  • Materials are field-tested with health professionals from a wide range of disciplines to ensure that the information is accurate and, when appropriate, complies with state and federal program guidelines.