Language, Literacy and Healthy Development: The Work of CAPC and CPNP Projects

Introduction

The title for this section came from Gail Wylie, project director of the CPNP Healthy Start for Mom & Me project. "Literacy education and support?" she said, "It's in everything we do!"

In order to communicate information on maternal health and healthy infant/ child development, practitioners have to consider the language and literacy strengths and needs of the participants. Otherwise there would be no real access to health information. In fact, as one practitioner remarked, "there would probably be no program participants!"

In recognizing that literacy is embedded in everything we do, Gail Wylie reflects the views of many CPNP and CAPC project staff who responded to the Literacy Matters survey. Denny Taylor, a leading authority in family literacy, also expresses the idea that literacy is an ever-present feature of everyday life.

Literacy is not usually the focus of attention. The primary focus is on the accomplishment of the task in which literacy plays a part (Taylor, 1997).

Whether the task is shopping for nutritious food, understanding pre-natal development, singing to babies, or learning new parenting skills, language and literacy invariably play a part. Sometimes the part that literacy plays is obvious. For example, it's clear that accurately reading ingredients on product labels is important for healthy eating, essential for pregnant women, and life-saving when pregnant women have diabetes.

Sometimes the literacy connection is more subtle and less direct, but no less important. For example, programs that help forge bonds between parents and their newborns help cultivate the relationship that is essential for early language development.

In any event, language and literacy infuse every CPNP and CAPC program so that even when other health matters claim priority, staff must always be conscious of the impacts.

Ensuring access to information on health, parenting and safety: A learner-sensitive approach

At Healthy Start for Mom & Me we think carefully about:
Things that isolate...	Things that connect...
communicating with every person in the same style (your style)	mirroring the communication style of each individual
referring to people as "clients"	referring to people as "participants"
questions that box into a corner: "Do you plan to breastfeed?"	questions that open a discussion: "how have you decided to feed your baby?"
focussing on people's deficits	focussing on people's strengths; celebrating accomplishments
expecting people to fit the program	making the program fit the people
judgement and 'zero tolerance'	understanding and "harm reduction"
Excerpted from a longer list produced by Healthy Start for Mom & Me, a collaborative pregnancy and new parent outreach program in Winnipeg sponsored by Dietitians of Canada and funded by Health Canada (Canada Prenatal Nutrition Program and Healthy Child Manitoba (Healthy Baby program) Revised: October 2003

CAPC and CPNP program staff use a variety of methods and strategies to ensure participants can access health information. The strategies they identified in the Literacy Matters survey are most typical of a learner sensitive approach:

• Choice and adaptation of program materials to match the reading skills of the participants
• Mediation of print
• Highlighting key messages

Many of our current staff are former participants who have struggled with life circumstances. We find this helps staff relate to the life circumstances of participants. Michelle Ward, Kids First Association

Choosing program materials to match the reading skills of the participants

Many practitioners begin with the idea that clear simple messages are well suited to their program participants. They choose print materials that are:

• Short and to the point
• Simple with large print and visual supports
• Written in plain language

To make print more inviting and less intimidating, practitioners:

• Use lots of white space
• Communicate the main message with pictures and diagrams
• Include an audio, visual or hands-on component

To ensure that program materials are pitched at an appropriate reading level, practitioners:

• Consider their effectiveness elsewhere
• Preview materials carefully
• Solicit similar programs' suggestions
• Choose through partnerships with other organizations
• Subject print to 'readability' tests

There are over one hundred factors that affect how easy, or hard, a given document is to read and understand. These factors include sentence length, word choice, layout, tone, organization, use of illustrations and appeal to the reader. Helene Osborne Health Literacy Consulting Dec.2000

Motivation to read depends on the appeal of the content. It is easier for readers to engage with and understand print that is of high interest to them and relevant to their lives. Project staff therefore give consideration to materials that are:

• Age appropriate
• Culturally diverse
• Available in multiple languages
• A good match for the participants' social and cultural experiences

To adjust materials to better fit participants' reading skills, staff will:

• Adapt materials for both high and low literacy levels
• Simplify and shorten text
• Supplement with audio and visual components from the start of the program
• Provide written translations in the first language of participants

Looking for good, plain language health information on birth control or breastfeeding? Cancer or children? Febrile seizures or foot care? Pap tests or poverty? Tattooing or tuberculosis? Weight loss or workplace health and safety? You'll probably find a supplier in the Directory of Plain Language Health Information. You'll also find clear directions on how to assess the readability of program materials you are thinking of using. And great tips for how to make the fact sheets and pamphlets you design more inviting and easy to read. This resource was published by the Canadian Public Health Association and the National Literacy and Health Program. It is freely available on the Internet <www.pls.cpha.ca>.

Mediating print

Many CAPC and CPNP participants need personal help with understanding the printed word. While some may have a low level of skill when it comes to reading, others can read in their first language, but not in English. Sometimes a crisis has compromised the ability to make sense of a printed text; or unfamiliar medical terms may pose a problem. In all cases, project staff approach participants with the utmost tact to preserve the dignity of the individual yet ensure that essential information is conveyed.

We never assume people can read. We ask if they would like us to do paperwork WITH them. Gail Wylie, Healthy Start for Mom & Me

Often literacy support is given in the context of the home visiting program. Project staff noted that home visits are very important:

• Home visitation allows for one-on-one interaction with participants, so pamphlets about programs and sessions are explained and/or read together (Laurie Lafortune, Healthy Families)
• We use home visitors who are from those cultures and who support the integration into this society (Jim Howes, Babies Best Start)
• Will do one-to-one to accommodate literacy needs if necessary. (Diane Hill, Better Beginnings)
• I also model behaviour by reading to the children whenever possible (Rhonda Ginther, Egadz Teen Parent Program)

Centre based programs offer different kinds of opportunities for participants who are able to mediate print for each other as part of their involvement in parenting and health education groups. Staff are able to structure these group activities so that participants who struggle with reading and writing can be included without embarrassment.

We have community boards in which local events (including literacy) are advertised. Staff seeks out information to be placed on the board. In addition staff also point out these events to participants and through verbal communication provide the details. Michelle Ward, Kids First Association

• In circles we offer people the opportunity to read aloud but never pick people out to read. When questions are asked to be put onto paper, we ask the participants to use pictures and/or words, but never say "if you are uncomfortable writing..." (Barb Desjardins, In A Good Way)
• Any activities that do involve having the participants read something we structure in such a way that they have the option of having someone else read it (Lorraine Makus, Anna's House)
• We always put them in pairs or trios so that they can support each other in reading, even with simple children's books (UNB and Fredericton Regional Family Resource Center)
• Some of our fathers cannot read, but we always find ways to communicate through hands-on education. (S. Bauer, Liard Basin Task Force CAPC Programs (Rural))

Highlighting key messages

In health and safety education, lives can depend on how well key messages are understood. Staff of CPNP and CAPC projects cannot rely solely on print to communicate crucial messages. Therefore they employ a variety of approaches that combine print with pictures and other media to ensure that participants know what they need to know.

Combining talk, pictures and print

Sometimes a three-pronged approach is needed where print is minimized and pictures and discussion supplement the written word. The idea is to use whatever it takes to get key messages across:

• Many of our participants have low literacy levels and therefore we are always cognizant of using minimal verbal and maximum amount of visual content to get important messages across (Yvette Nechvatal-Drew, Pre & Post Natal Nutrition Project)
• We do not use a lot of written materials, but, when we do, we incorporate pictures and simple language (Barb Desjardins, In A Good Way)

Making posters

Posters can deliver a single key message effectively, leaving a lasting impression with only brief exposure. When participants make the posters themselves, they begin to think more critically about how posters work to get their message across. In one project: Many pamphlets and poster displays are in the Centre, usually created by a student, for example FASD Display on September 9, National FASD Awareness Day (Lynne Cornish-Braun, Saskatoon Friends of Students and Kids).

A Healthy Start... one of nine posters from a prenatal poster set produced by parents and staff and available for purchase from Healthy Start for Mom & Me. Winnipeg, MB.

This and other posters on diabetes are also available in English on the Health Canada website . Source: Aboriginal Diabetes Initiative, Health Canada, April 2002 © Reproduced with the permission of the Minister of Public Works and Government Services Canada, 2004.

Nutrition Memory Game: Players flip the tokens to make a pair! Playing games combines talk, pictures and print with pleasure. Nutrition Memory Game: Based on the Northern Food Guide. Created by Brenda Hall for Growing Together. Hay River, NT. Photographed by Joy Cummings, UNB Integrated Technology Services

Above: Poster Display of prenatal development. Submitted by Mary Ann Meagher, Brighter Futures. Peterborough Family Resource Centre.

Playing Pregnancy Balderdash helps de-mystify medical terms for expectant moms. Submitted by Gail Wylie, Healthy Start for Mom and Me. Winnipeg, MB

A Healthy Start... one of nine posters from a prenatal poster set produced by parents and staff and available for purchase from Healthy Start for Mom & Me. Winnipeg, MB.

Using multi-media

Increasingly, Canadians access information through television, videos, and the Internet. Project staff maximize these options by:

• Showing health videos on a regular basis
• Offering CDs, tapes, and books on tape via toy and parent lending libraries
• Making programs available in a variety of mediums (print, audio, video)

The fathers are interested in learning more about technology; computers will be used in our future classes." Robin Hicken, Gesundheit Für Kinde

Providing reading materials to take home

Apart from the flyers and pamphlets thrust relentlessly into our mailboxes, reading materials are not free. Books, newspapers and magazines are an unlikely budget priority for families on limited income. Knowing this, many projects provide current magazines and pamphlets on good housekeeping and parenting, as well as books for parents and children.

Parenting magazines and books

• Current Parenting and Youth magazines are available in the Centre (Lynne Cornish-Braun, Saskatoon Friends of Students and Kids)
• I hand out literature and recommend books . . . age appropriate to share with their children. And I offer other resource books to the parents if they need information on a certain topics, for example on parenting, anger management, crafts and so on (Rollanda Chezick, Brighter Futures Society)
• We have developed Readiness to Learn manuals (low literacy, curriculum-based workshops) handouts, resource booklets (e.g. Helping Dads Figure Out Breastfeeding) (Cathy Constantino, SIRCH / Bright Starts for Haliburton, Kawartha Lakes and Northumberland Counties)

Cooking recipes (in pictures and words) along with the food

• We have created a "picture dictionary" of common cooking terms, ingredients etc. to facilitate easier use of recipes. We create recipes to complement our group program that use pictures to help women to follow them at home (Robin Hicken, Gesundheit Für Kinder)

50 "Idea Kits" are in the process of being developed at the centre and all materials have been reviewed by the Adult Network. The Kits contain videos and easy to read manuals and handouts to reinforce learning outcomes. Michelle Margrait, Maggie's Place - A Resource Centre for Families

Book giveaways

• Many projects collaborate with other organizations to ensure that books are freely available to families that might otherwise have few or none. See p 42-43 for more detail on where projects get books from and how they distribute them

Collaboration with public libraries to ensure easier access to books

• We partner with local libraries
• We have also arranged with the library for participants to get no-cost library cards if money is an issue (name withheld by request)

We have had a range of fathers attend programs. They have different levels of literacy and different levels of commitment to changing their literacy levels. But I feel any programs they attend are beneficial for bonding and interaction with their children. Waltraud Grieger, Growing Years Family Resource Centre

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