Students Connecting with Students

Lessons in Health Care

Judy Berry, Vandal Ivaneko, Nguyet Nyugen, Ana Reynoso, Elsa Reynoso, Magali Torres and Charlene Wigfall. Marcia Hohn is the team facilitator.
Operation Bootstrap
Lynn, MA

Who are we? We are a group of eight women from different places with different languages and backgrounds: Dominican, Haitian, Mexican, Vietnamese, Russian, and American. We get together to work on health issues such as breast cancer, HIV and AIDS, and violence because we want our community to be safe and to be healthy. We are called The Student Action Health Team and got started in 1994, funded by the Comprehensive Health Project from the Massachusetts Department of Education to do health education at Operation Bootstrap, where we are or have been students.

Operation Bootstrap is located in Lynn, MA and offers classes in Adult Basic Education (ABE), English for Speakers of Other Languages (ESOL), and General Educational Development (GED) as well as Family Literacy and pre-vocational programs. There are about 200 students in all of Boot-strap’s programs and classes.

As The Student Action Health Team our job is to find out about the health education needs of students at Operation Bootstrap and develop plans to meet some of these needs. Every year we recruit new members for the team. Right now there are four original members and four new members.

After our first year together, we decided that we needed to do direct teaching in both English and native languages about health in the Bootstrap ABE, ESOL, GED, and Family Literacy classrooms because most community health education efforts did not meet the needs of Bootstrap students. We had brought in some community health educators during the first year but they talked too fast with difficult language and the materials they brought were too difficult to understand. Bootstrap students did not feel safe to ask questions or talk about whether the information was useful in their lives. The students told us they felt empty inside.

We decided we should let students choose the health topics they want to know more about. The team does this by putting on a health fair every fall for Bootstrap students and staff. We put up a list of health issues and then each student and staff member places one dot next to the issues they are most interested in learning about. In 1995-96, the top vote was for cancer education and we decided to focus on breast, cervical and testicular cancer because if they are detected early, successful treatment is more likely. In 1996-97, the top vote was for violence prevention. Bootstrap students were terrified because of the abduction of 6-year-old Jesus De La Cruz and this made them want to learn more about violence prevention in the community and in the home.

The educational programs are carried out in the classrooms as part of the regular classes. Our programs have three sessions of about 1.5 hours each and provide basic facts, hands-on practice, and information/discussion about community resources. We use lots of drama to get at difficult and sensitive issues. Drama has been a good way to break the ice between the team and Bootstrap students and to get to students’ hearts. We also use methods such as agree/disagree exercises, small group discussions, and pictures to get students and teachers participating, discussing, and interacting with the information.

For example, in the cancer education program, we held up written statements about basic facts and asked students to “vote” whether they thought the statement was true or false and then discussed the “answer” as it is known today. In beginning English classes we translated this information into as many as six languages. We wanted to make sure everyone really understood the information and had a chance to tell their stories and a safe atmosphere in which to ask questions.
In the next session small groups featured hands-on practice with breast and testicular models. A cancer educator helped us and we asked her to work with the men because we felt shy about teaching the men how to examine their testes.

In beginning English classes, we worked in small groups by language. The last session was a drama about going to the doctor and showed a situation where a patient with no insurance and limited English is not treated respectfully by the health care providers. This opened up the discussion about students’ fears about discrimination and we talked about rights and responsibilities in medical situations.

We used drama a lot in the Family Violence program to illustrate the stories strangers use to get innocent children to come with them and to illustrate the short- and long-term effects of witnessing violence in the home on children. Our dramas — called Tommy at Eight Years and Tommy at 14 Years — were about a boy from a violent home and illustrated the long-term effects of witnessing violence. Students discussed the drama afterward and gave their ideas about what could help Tommy. We also performed a man-woman violence drama with a similar small group discussion. The idea is to get students talking about the health issue, to help each other and to find community resources that help. All this must take place in a safe atmosphere where students’ privacy and cultural beliefs are respected.

Every year we assess our program to find out what the Bootstrap students thought about it and what changes in knowledge, attitudes and actions happened. As program coordinators, we also reflect about what we learned, how we changed and how we saw the program
affect other people. We want to tell you how we do this.

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Assessing the Program in Early Detection of Breast, Cervical and Testicular Cancer 1995-1996
For our assessment, we decided to conduct a student survey to see the results of the work the team had done in early detection of breast, cervical and testicular cancer.

We developed the survey by brainstorming all we wanted to know, writing these thoughts down on Post-Its. For example, we wanted to know if students felt they understood the information, if they liked our teaching methods, if they saw this information as important to them and their families. We grouped the Post-Its to create categories. We then worked in pairs to develop statements that Bootstrap students could agree or disagree with on a scale of 1-5. There were three categories:
1) the importance of learning about breast, cervical and testicular cancer at Bootstrap, 2) the effectiveness of the teaching, and 3) resulting actions or steps the students had taken (such as having gone for a PAP test or a mammogram, or doing self-exams). Each category had six statements or questions.

We distributed the survey to the students in their classrooms, then we compiled the results and put it in bar graph form, which we thought the students could easily understand. The teachers helped us by explaining how to fill out the survey since many students were not familiar with the use of 1-5 scales. Although many students who had participated in the program had already left, 42 students filled out the survey. Here is an example of one of the bar graphs.

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The survey showed that the students felt they had learned health information important for their lives and the lives of their families and friends, they liked having other students as their teachers and appreciated the many different teaching techniques, especially the drama. The survey further showed that students were taking action as a result of the education program.

We also conducted an internal team evaluation about how we felt about the work we did. We drew pictures and made statements about our personal feelings and shared these things in the team. Eighteen positive statements were reported, such as school being the best place to learn about health and that the information went beyond the classroom to family and friends. We were proud of each other and saw that we were role models for each other as well as for the Bootstrap students. We appreciated the support of Marie Wallace (who is a cancer educator). She informed us about cancer.

We also appreciated the support of the teachers working alongside the team by preparing students with vocabulary and following up with additional activities. Overall, we saw that receiving information in a native language and/or in simple ways with simple terms made for better understanding. It was our opinion that because students had better understanding they were able to take action such as doing self-exams or going for free PAP tests and mammograms.

Assessing the Program on
Family Violence 1996-97
We decided to do one-to-one interviews to find out about the effects of the family violence program because this is a personal and very sensitive issue. Many Bootstrap students have this problem in their lives. Two Operation Bootstrap women students have been killed by their partners over the past few years. Many others live in fear and in threatening situations. Also, Bootstrap students were very emotionally affected by the abduction of Jesus De La Cruz in September of 1996. (He remains missing today.)

We went to the students one by one after the second session of our program – the effects on children of witnessing violence in the home – and did 36 interviews. Team members went to the classrooms and explained that we were evaluating our program and needed students’ opinions. Many students volunteered to be interviewed. They told us they learned that children are emotionally affected for life, continue the pattern of violence, and are more likely to use drugs, be runaways, or have an early pregnancy – and that they did not know these facts before. For young students this was very important information for their future lives. After the man-woman violence drama we conducted some additional interviews and we were very careful to let students know we were not singling anyone out, that we needed to get their thoughts so we could improve our teaching.

Students told us they liked the use of drama, that it is a good way to present information. Family violence is a hard topic to talk about and drama keeps it safe so people do not feel singled out. The students liked the opportunity to give opinions in small group discussions after the dramas about how to help stop the cycle of violence.

We also learned that students were taking action. They were sharing the information with family, neighbors, friends and co-workers, learning how to use neighbors and the phone to call the police for protection, and using community agencies for assistance when necessary. Students were also using religion, support groups, and community counselors. Many students told us that they did not know about these resources before, especially resources for helping with children. Students within the program were also trying to help each other.

In our assessments of both the cancer and violence education programs, students told us that Operation Bootstrap is a good place to learn about health issues and that health education added to their language and literacy learning. Teachers told us that students got so interested in talking about health issues in the class that they would forget to worry about their English — they would just talk in English even if it was not perfect because they were so anxious to communicate about the topic.

Several students told us that the Student Action Health Team should teach in other places because we “know how to teach and teach important things.” This made us feel very proud. During 1997-98 we will be mentors to programs new to doing health education in their program. We have a lot of experience and lessons to share and we look forward to helping them with the important topic of health.

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Originally published in Adventures in Assessment, Volume 10 (December 1997),
SABES/World Education, Boston, MA, Copyright 1997.

Funding support for the publication of this document on the Web provided in part by the Ohio State Literacy Resource Center as part of the LINCS Assessment Special Collection.