Health Education and Adult Literacy: Breast and Cervical Cancer (HEAL:BCC) is a project of World Education in collaboration with the Centers for Disease Control and Prevention. HEAL:BCC promotes access to information and services about breast and cervical cancer to adults with limited literacy skills. A high proportion of these adults live in poverty, are from minority populations, and/or are new immigrants. The project locates its activities within adult learning centers, a network of adult education organizations used and trusted by adults with limited English literacy skills. Adult Basic Education (ABE) classes and English for speakers of other languages (ESOL) classes are the location of in-depth breast and cervical cancer health education. These literacy classes are designed specifically to address the learning needs of adults and to provide numerous opportunities for discussion, structured learning, and skill building. The current HEAL:BCC Curriculum incorporates over five years of teacher and learner feedback to better meet the needs of adult educators and their students.
In 2000, the U.S. Department of Health and Human Services published Healthy People 2010, an overview of the health status of various population groups in the country and a statement of health-related goals for the nation.1 This document identifies educational level as a key determinant of access to health services and to health promotion activities. It also points out that low-income and minority populations in the United States are less likely than more affluent members of society to benefit from health services and health promotion.
Health, United States 2000 presents national trends in health statistics and looks at health, educational level, and economic status.2 Highlighted findings include: life expectancy is related to family income. Those with less than a high school education die at a younger age than those with more education. In addition, death rates from chronic disease, communicable disease, and injuries are higher for people with less education. Those living in poverty are less likely than those with higher incomes to have health insurance coverage, to visit the doctor, and to use screening tests. They are also more likely than those with higher incomes to have reported fair or poor health. Health, United States 1998, focused on socioeconomic status and health and clearly illustrated the strong direct relationship between income and recent use of mammography. 3 From that report, the chart below shows that higher-income women 50 years of age and over were about 70 percent more likely than women with the lowest income to have received a mammogram within the past two years.
HEAL:BCC is an attempt to address the health information and access
disparities that exist in society today. The project brings together health and adult education practitioners to offer critical information about breast and
cervical cancer screening and early detection to low-income women in adult
literacy classes. Through collaborations between adult learning centers and
local health centers, the HEAL:BCC Curriculum is designed to help adult learners
better understand health information, take action for themselves, and advocate
for their families and communities.
The HEAL:BCC Curriculum is designed to increase functional health literacy skills - to improve the ability of adult learners to understand and navigate some of the complicated demands of the health care system. This curriculum embraces the complex nature of "taking care of oneself" and presents not only health facts, but strategies for turning facts into action. Although this curriculum focuses on screening and early detection of breast and cervical cancer, adult learners will also gain more confidence in dealing with the health care system and in advocating for themselves and others.
Throughout this curriculum, there are opportunities to analyze and explore the obstacles and supports to pursuing good health care. Addressing these obstacles and supports strengthens learners' abilities to turn their expanded knowledge into action that could save their lives. For example, the experience of both health and adult education practitioners shows that some low-income individuals and/or individuals from different cultures may not participate in "well" visits. Because of economic constraints, language barriers, or culturally embedded understandings of the health care system, they may visit a medical center only when they are ill. One of the outcomes of using the curriculum, however, will be a heightened awareness of the importance of the "well" visit since screening and early detection actually begin with a checkup.
Furthermore, the same low literacy issues that bring adult learners to our classes confront them when they interface with the health care system. Medical forms, vocabulary, and terminology are daunting in the best of circumstances and can seem more so when one has limited literacy skills. A number of researchers are examining patients' skills as well as the literacy demands of the health care system and are finding a mismatch.4 The health and literacy activities throughout the curriculum can support learners in their efforts to understand and navigate the complicated demands of the health care system.
A major underlying assumption of HEAL:BCC is that adult literacy classes provide a venue in which health information can be presented, discussed, considered, analyzed, and understood. Adults are particularly interested and motivated by educational content that has immediate relevance to their lives. And, although it may seem daunting to deal with cancer in the classroom, this topic, in fact, engages learners personally and academically. As pointed out in Ideas in Action, "Negotiating health is [also] part of every learner's life. Health education can therefore be a catalyst for learning and a catalyst for making meaningful changes."5
This curriculum was designed to be a catalyst for literacy as well as health education learning. It incorporates attention to basic skill development, supporting adult basic education goals and objectives. The lessons in the curriculum offer opportunities for building reading, writing, vocabulary, presentation, and critical thinking skills. It was also designed to be a catalyst for meaningful change in participants' lives. Throughout this curriculum, learners gain skills and are provided with information and materials they can share with family and friends to help themselves and others take healthful action.
As one adult learner observed:
"Fifteen minutes of health education in the school will save the world. Because you learn and teach your friends, your neighbors, and your family about different topics: stress, violence, HIV, smoking, and cancer."
Elsa Fowler, 1994
Operation Bootstrap, Lynn, MA
The work of HEAL:BCC is created in this spirit of vitality and potential for
positive change.