Latinas not only need information but they also need to have a sense of community and to feel empowered and respected …to feel that people are truly interested in their well-being.
Prenatal social support and less stress have been linked with improved patient satisfaction and prenatal attendance, fewer pregnancy complications, less postpartum depression, and improved birth outcomes.[1,2]
Although further research is needed, structural and functional (such as tangible and emotional) social support provided through community-based interventions have shown to be beneficial in overcoming limitations related to low health literacy of individuals and for improving the health status of individuals and the community.[3,4]
The central role women have in Latino culture with respect to the health of their families, along with their high fertility rates, make reaching and engaging Latinas a critical strategy in efforts to reduce disparities and improve health outcomes for adults and children in these communities. [5,6]
Currently at 11 million, over the next several decades the proportion of Latinas in their childbearing years is projected to increase 92%. This demographic shift will increase demand for reproductive care and magnify the healthcare challenges and potential adverse economic, social, and health impact of disparities experienced by Latina/os.[5,13]
Transforming our approaches and thinking about service delivery strategies today can help improve access and quality of care now and build our capacity of care for the future.
A FUN, Effective, Innovative Way to Provide Group Prenatal Education
An empowerment-based group approach can help Spanish-speaking staff use their time more effectively, while providing more comprehensive education in a culturally appropriate way.
Participants receive and provide social support during the group and have an opportunity to build relationships with other women for greater support in their community.
Improving the Quality of Prenatal Care for Hispanic Women
International 'Best Practice' Model
Selected by the Ludwig Boltzmann Institute for the Sociology of Health and Medicine, University of Vienna as a 'best practice' for incorporating health literacy and health empowerment principles in prenatal education.
One story is read each session. Group members volunteer to read the characters' parts, creating a play. Those that can't read, listen and participate in the discussion.
The TWS Method honors and builds on primary Latino values and norms as members move through a session.
Respect/Respeto: The group is founded on respect. Each group defines how to practice and show respect towards each other. This allows the members to tailor their communication guidelines to be culturally and linguistically appropriate to their unique needs and preferences.
Personal Connection & Kindness/ Personalismo & Simpatía: The TWS Method emphasizes and facilitates personal connections, in the spirit of simpatía. The steps make the learning process feel 'personal' easily and naturally. Kindness is the cornerstone of how the group members listen, share, challenge and learn from each other as they read the photonovels and tell their stories.
Present Time/Tiempo Presente: The participatory process helps keep the focus on group members' present realities, immediate needs, and priorities. Learning that is relevant and that can be applied immediately to one's life, is important not just from a Latino cultural perspective but also for women as adult learners and for those who live in a culture of poverty.
Communication/Comunicación: The facilitator training, room set-up, and TWS Method are designed to help ensure that different verbal and nonverbal communication styles and norms are accommodated.
Family/Familia: The TWS Method invites inclusion of family members in the learning process whenever possible.
Trust/Confianza: By following the five steps each session, trust among the facilitators and participants grows over time. It is reinforced by on-going respect, mutuality, caring and kindness. The bonds that develop often extend outside of the groups and last after the sessions are over.
These more nurturing, 'feminine' ways of knowing and learning, typically devalued or absent in traditional pedagogy, help validate and empower women learners.[14,15]
With proper training and assistance, lay health educators, also known as promotoras (or community health workers) can be valuable and effective partners on your team.
See the TWS LEARNING COMMUNITY for training resources.
In the TWS SBIR study, promotoras were trained and coached by a TWS program coordinator from a local Latino community-based organization. The TWS program was implemented in partnership with the local health clinics in familiar community settings. Clinic staff assisted with member recruitment, medical/referral support as needed, and educational collaboration. For instance, a lactation consultant and family planning educator were guest presenters to build relationships and to offer more in-depth information and Q&A.
The Center for Health Care Strategies' demonstration project at the Neighborhood Health Plan of Rhode Island (NHPRI) was a clinic-based TWS prenatal program for Latinas with high-risk pregnancies. The facilitators were bilingual lay educators. A nurse supervisor who spoke only English coordinated the project and provided on-site medical/educational support as needed.
"The De Madre A Madre photonovels and the Teach-With-Stories (TWS) Method™ served as a catalyst to reach and engage the Latina Neighborhood Health Plan of Rhode Island members...
We have recognized the value of the personal interaction that TWS supports. The high level of participation and obvious comfort of those participating in the TWS approach was noticeable...
The highly adaptable TWS Method and use of the De Madre A Madre photonovels allowed the NHPRI's professional and lay health educators to connect with the participants based on their cultural and educational needs.
Unlike most experiences in healthcare, the TWS groups were totally driven by the participants allowing them to develop their learning experience. This ability provided the NHPRI staff with a sense of accomplishment and job satisfaction that traditional education has not historically provided."
Neighborhood Health Plan of Rhode Island
Beth Marootian, MPH
Michelle Lupoli, RN, MS, CCM
"I have used the Teach-With-Stories Method and photonovels for several years for prenatal education with Latina women. It was always delightful to see how engaged the participants became with the material, and how the characters in the stories became real to the group.
The discussions were lively and covered a lot of important material. Participants were more likely to make changes and use something they learned from another group member, and they made a lot of changes -- eating healthier, making a list of questions to ask their doctor at prenatal checkups, quitting drinking, leaving an abusive marriage.
Reading and discussing the photonovels together created a very safe and comfortable environment for group members to freely share their questions and concerns, as well as their knowledge and experience with one another.
The groups also bonded well, and many long lasting friendships and mutual support systems were formed. I think teaching with stories, using photonovels is a deceptively simple, and extremely effective way to create and use teachable moments."
Mary DeCoster, MLS, IBCLC, ICCE, MPH
The photonovel was 1st Week Home with Baby. The discussion focused on depression, anxiety, and the stress of having a new baby at home.
One participant, who was six
months pregnant, identified with many of the issues that were discussed during this session.
She did not feel comfortable discussing her feelings in an open forum, but contacted the facilitator two days later. The mother explained that she was experiencing a lot of stress, depression, that she had trouble sleeping and had suicidal thoughts.
The facilitator asked for permission to contact Beacon, their behavioral health partner to arrange an immediate intervention. The facilitator contacted the agency and served as an interpreter during the initial screening interview.
After being assessed, the staff immediately contacted the local hospital and arranged for transportation by taxi. The agency personnel and the facilitator stayed on the line with the member until her cab arrived.
The mother was treated at the hospital and released. As she spoke limited English, the group member took the photonovela with her to the hospital to help her explain what she was experiencing. She was prescribed appropriate medication. A family therapist from Beacon met with the mother at her home, and enrolled her in the Day Program at Women and Infants Hospital.
"I have been very impressed with the results I have seen in the women attending these classes. Having taught childbirth classes myself using a traditional childbirth class curriculum, I would like to highly recommend this model…The participants are able to learn the material and feel more confident rather than fearful. I feel this is a vital part of promoting healthy pregnancies."
North Carolina Maternity Care Coordinator (MCC)
"All participants were thrilled with the experience provided by NHPRI. They raved about the facilitators, especially their sincere concern for the participants' well-being. According to these women, the staff’s courtesy, and attention to individual needs as well as education provided makes NHPRI “lo mejor que existe” (the best there is)."
based on NHPRI Focus Group Feedback