Picture Stories for Adult ESL Health Literacy


Created by Kate Singleton
Fairfax County (Virginia) Public Schools


The picture stories are:

What groups of students are the picture stories suitable for?

The stories "Emergency," "A Doctor's Appointment," and "Stressed Out" are suitable for most classes, as the topics are common and uncontroversial. "What Should She Do?," however, should be used with discretion, as its topic of domestic violence may evoke strong reactions and discomfort, especially if a class member has experienced domestic violence personally or knows someone who has.

How can the stories be used in class?

The Language Experience Approach (LEA) is an effective way to use the picture stories with beginners.

Benefits of LEA:

Suggested LEA procedure:

Are there any other considerations?

In using picture stories, teachers should carefully consider the images that they choose to use. Cartoons or similar drawings or illustrations that incorporate figures of isolated body parts may not be recognizable or comprehensible to all English language learners. This may be especially true for learners with limited literacy in their native languages. Drawings of people or body parts may even be offensive to some groups. Teachers need to be aware of these issues and be prepared to use alternative resources such as photographs, videos, or gestures.


 

Picture Story 1: Emergency

Picture Story 2: A Doctor's Appointment

Picture Story 3: Stressed Out!

Picture Story 4: What Should She Do?

Picture Story 5: Depressed

Picture Story 6: The Right Dose

Picture Story 7: What Happened to My Body?

Picture Story 8: Snack Attack

 

Picture Story 1: Emergency! to: Emergency!

View the picture story.

Health literacy issues:

The basic story:

A man feels pain symptoms in June, but ignores them because he doesn't have insurance and feels he can't afford medical care without it. A female acquaintance suggests that he see a doctor, but he repeatedly refuses to because of his concern about the cost. Six months after his pain starts, he is taken to the emergency room by ambulance because his condition has worsened. A month later, he is still in bed, faced with a large hospital bill which he doesn't know how he will pay.

Background information:

Suggested questions for prompting discussion while eliciting the story:

With the sixth frame the opportunity arises for particularly valuable discussion on students' health care options and responsibilities:

Additional Useful Information

The following information can be helpful for your students. Language is simplified, but you can decide how to present it, how much to present and what specific information suits the interest and needs of your students. The information may be used for teacher reference, or it may be modified for the level of your students to make an informational handout or other activity.

Paying for health care if you do not have insurance


Picture Story Two: A Doctor's Appointment to: A Doctor's Appointment

View the picture story.

Health literacy issues:

The basic story:

A man feels a pain and goes to the doctor. The doctor examines him, asks questions about the symptoms and gives him a lot of information. The man pretends he understands, but he doesn't speak much English and doesn't know what the doctor is saying. The doctor gives him a chance to ask questions, but the man doesn't ask any. He gets some new prescriptions but doesn't understand how to take them. At home one of his family members asks what the doctor said, and the man reports that he doesn't know. He is frustrated and confused.

Background information:

Suggested questions for prompting discussion while eliciting the story:

With the eighth frame the opportunity arises for particularly valuable discussion on language barriers in health care and what communication is expected of the patient in the U.S. health care system.

Additional Information

More advice for talking with doctors about your medicines

General advice for patients in the doctor's office/hospital
(This information refers to what is expected from the patient in U.S. health care culture. It is simplified, but still uses useful health care vocabulary which may need to be introduced to your students. Again, you can decide how much and what kind of information is suited to your students' levels and needs. You may use these as a reference, or you may modify them for your students' level to make informational handouts or other activities.)


Picture Story Three: Stressed Out! to: Stressed Out!

View the picture story.

Health literacy issues:

Basic Story:

A woman wakes up in the middle of the night to feed her baby. Her family (her husband and 2 older children) is waiting for her to cook them breakfast at 7AM. She arrives late to work, and her supervisor is angry with her. On her way home from work, she is in a fender bender. Later that night, she looks at her bills and worries about money. After that, she feels completely stressed out from all the stressors of her day.

Background Information:

Suggested questions for prompting discussion while eliciting the story:

With the sixth frame the opportunity arises for particularly valuable discussion on stress reduction and stress management.


Picture Story Four: What Should She Do? to: Stressed Out!

View the picture story.

Health literacy issue:

IMPORTANT: "What Should She Do?" should be used with discretion, as its topic of domestic violence may evoke strong reactions and discomfort, especially if a class member has experienced domestic violence personally or knows someone who has.

It is the author's experience that students who feel comfortable in a class sometimes ask their teacher for information about the rights of domestic violence victims in the U.S. as well as services that can provide refuge from abuse. Such students may indicate that they know a friend of a friend who is in an abusive situation. The picture story can be a safe catalyst for discussion of the law and dissemination of accurate information on services for victims.

The timeline: Times of events are shown in the story simply to indicate the passage of time for a learner to follow. They do not indicate a standard timeline of a domestic violence situation. Each situation in real life is different, and events should not be discounted as domestic violence because they are far apart or intense periods of violence are followed by fewer episodes.

The basic story:

A woman and man fall in love. They live peacefully together and start a family. One day, the man drinks too much. He gets angry and hits the woman. The woman has a black eye. The children see what happens and become upset. Later the man apologizes to the woman, tells her he loves her and gives her flowers. She is confused, but she hopes things will be better. The man drinks again, and he beats the woman again. Now the woman is very confused. She doesn't know if she should stay with the man, who says he loves her, but keeps getting drunk and beating her. She doesn't know what she should do to protect her children. She thinks about calling 911, but she isn't sure what will happen if she does.

Background information:

Suggested questions for prompting discussion while eliciting the story:

With the eighth frame the opportunity arises for particularly valuable discussion on the problems a victim of abuse faces and sources of help available in the community.




Picture Story Five: Depressed to: Depress

View the picture story.

To print picture as a handout, use the pdf version of the file.

Health literacy issues:

The basic story:

In January, a woman is having an active, happy life. She is busy with work, friends, family, school, exercise and parties. In February she starts to feel sad. In March she feels worse. She cries a lot. In April she is still sad, and she doesn't want to eat. In May she feels very tired and stays in bed all day while other people are busy outside. In June she decides to ask for help.

Background information:

Depression is a very common illness worldwide, affecting an estimated 9.9 million adults in the U.S. alone annually. It is believed to be in part caused by environmental factors and in part caused by biological factors. Nearly twice as many women as men experience major depression. Depression can occur at any age to people from all ethnic, racial and socioeconomic groups. Depression is highly treatable with counseling, antidepressant medication, or a combination of the two. Many people from other countries don't know about treatment, in part because of a low presence of mental health care in many parts of the world. The World Health Organization reports that:

Many people come to the United States to escape situations of war and torture, which may have left them traumatized and depressed. Others may experience socioeconomic hardship or other challenges of cultural adjustment which make them more vulnerable to depression. Often immigrants don't seek care because they are unaware of mental health care options, feel stigma around the issue of mental health, or feel they can't afford care.

Many communities in the United States provide sliding scale mental health services. These services may be found via county or municipal health departments or community service boards. Increasingly, services are being offered in languages other than English from government and other non-profit mental health care providers.

Major depression (sometimes called clinical or chronic depression) is believed to have a biological basis that can respond to triggers in life. Neurotransmitters in the brain are out of balance. The term major depression is used when a person has some of the following symptoms for more than 2 weeks and the symptoms don't get better. Possible symptoms:

Some other important things to know about depression:

Suggested questions for prompting discussion while eliciting the story:

Go over the title, "Depressed," with students. Ask if anyone knows what depression means. Ask if they know what symptoms a person has if they are depressed. Ask what a person can do if they are depressed.

Preteach vocabulary as needed: symptoms (problems you have when you are not healthy, like sneezing and a runny nose for a cold), treatment (something to help you get better, like medicine; you go to the doctor for treatment), energy (pantomime the difference between having energy and having no energy).

First frame: What do you see in the picture? What is the woman's name? What month is it in the picture? How is she? (busy) Why is she busy? What does she do? (You can emphasize that she is busy and happy in her life. She does many different things and she has friends and family in her life.)

Second frame: When is it now? How is the woman now? Is she very depressed, or just a little depressed? Do you know why she is sad? (Tell students that we don't know why she is sad. Sometimes people get depressed because something bad happened in their life. Sometimes people get depressed without something bad happening in their life.)

Third frame: Now what month is it? How is she in March? Is one month a long time to be sad, or a little time?

Fourth frame: When is it now? How does she feel now? Does she want to eat the food? Why not? (Explain that being sad for a long time and having no appetite are symptoms of depression.)

Fifth frame: When is it now? Where is she now? How is she feeling? (You might want to elicit words like very depressed, no energy, very tired. You can explain that having no energy and being tired all the time are symptoms of depression.) What's happening outside? (It's sunny. People are busy/playing/walking, etc.) What time do you think it is? Do you think she feels lonely? (Explain that feeling lonely and not wanting to do activities that you liked before are symptoms of depression.)

Sixth frame: Now what month is it? Where is she now? What is she doing? Who do you think she is calling? (Maybe a friend, family member, person from her church, counselor, or doctor.) Why do you think the woman waited until June to get help? (e.g., stigma, no information about help, thought she might get better on her own.)

With the sixth frame the opportunity arises to talk with students about cultural differences and options for treating depression in the United States. You can ask if there is treatment available for depression in their native countries.

Reference:

World Health Organization (WHO). (2001). Mental health policy project policy and service guidance package. Executive summary. Geneva: WHO.

Resources:

National Alliance for the Mentally Ill website at http://www.nami.org. Click on "Education."

National Mental Health Association at http://www.nmha.org. Click on "Mental Health Information."


Picture Story Six: The Right Dose to: Depress

View the picture story.

To print picture as a handout, use the pdf version of the file.

Health literacy issues:

The basic story:

One medicine label says that children should take 2 teaspoons of the medicine every 2 hours. A mother gives the medicine to her son. She confuses the teaspoon and tablespoon. She gives her son 2 tablespoons of the medicine at 7 AM. It is too much medicine. At 11:30 her son is very sleepy. The mother shouts, "WAKE UP!!!" She is worried.

Another medicine label has one dose for adults and one dose for children. A father reads the label wrong. At 7:00 AM, he gives his little daughter the adult dose by accident. He should give her 2 pills, but he gives her 4. At 12:00 PM his daughter is very sleepy. The father shouts, "WAKE UP!!!" He is worried

Background information:

Medication errors are a big problem in the United States. It is important to understand all the information on the medicine label, and to ask your health care provider questions about medication for yourself and your children. If reading skills are limited, asking questions about medication directions is essential. Mistakes can include taking the wrong dose, taking the wrong medicine, or taking a medicine you are allergic to. Adult ESL learners often report to their teachers that they have difficulty understanding medication labels to decide the correct dose to take themselves or to give their children. People make medication mistakes in their homes and hospitals also make mistakes. An estimated 7,000 people die each year in the United States from medication errors.

Common suggestions for medication safety: