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Maricel Santos, Ed.D.San Francisco State University

mgsantos@sfsu.edu

Logic models in service of community-based research: Lessons learned from

ESL Diabetes Prevention Project

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Today’s Agenda

1. Introductions

2. Lecture: Overview of Logic Models

3. Lessons learned from ESL Diabetes Prevention Project

a. Backdrop: Why focus on adult ESL in health disparities

b. Theories of change

c. Interactive exercises

4. Q & A

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About me

• Applied Linguistics Training: adult ESL teacher, adult literacy researcher,

• SF State:O Coordinator, MA TESOL Program, Certificate in

Immigrant Literacies ProgramO Faculty Research Fellow, National Center on

Minority Health And Health Disparities (RIMI Program)

Mentors

Dean Schillinger, MD

UCSF- CVP

Margaret Handley, PhD

UCSF-CVP

Rima Rudd, PhDHarvard School of

Public Health

Harnessing the U.S. Adult ESL System

• 44.3% of 2.5 million adults in federally-funded adult education programs

• 72% of 590,000 adult learners in California

• 35,000 learners in ESL/vocational classes at City College of San Francisco each year

U.S. Dept of Education, http://www.ed.gov/about/offices/list/ovae/pi/AdultEd/aedatatables.html

Workforce Investment Board of San Francisco, http://www.picsf.org/research/misc2003/brief_06-03_ccsf.pdf

A process of finding focus

1991 2011

¡Ánimo, que tú puedes! がんばります ! Stay on track - you can

do it!

Coming full circle

Familiar goals, new frames

REACH• Reaching people where they are• ESL students often small sub-populations of transnational

communities who have migrated together

ENGAGEMENT• Students motivated to learn and figure out the US system

(community resources, health care, etc) • Social support between classmates to provide ongoing

motivation

TOOLS• Participatory, critical thinking to confront inequities• Beyond the brochure• Utilization of educators already in place

Expanded definition of health literacy (Nutbeam, 2001)

functional health literacy (eg., reading safety signs)

interactive health literacy (eg., communicating with health practitioners)

critical health literacy (eg., advocating for one’s health)

Health care communication is never just about language• Proficiency ≠ success

• “Right to speak” is unequally distributed

• Communicative competence defined by the learner’s “power to impose reception” and to “shape the very context in which the language is learned and used”

(Bourdieu, 1991; Gee, 1996; Kramsch & Whiteside, 2008; Norton, 2000)

ESL participation as a possible health-ESL participation as a possible health-protective factor protective factor (Santos, McClelland, & Handley, 2011; Santos, 2011)

• Classrooms viewed as “safe places” to admit confusion, ask questions, analyze information … and display shared expertise

• Access to communities who often are hard to reach

• Links to existing social networks within marginalized communities

• Learners explore social positions that are less accessible to them in their extant social networks

Photo © Jon Crispin

Engaged classroom learning (Moriarty, 2011)

What does this student need from this lesson today?

Moriarty (2011)

Exercise 1. Analyzing the situation

Premise: Identifying the situation clearly and concisely is key to the development of a good logic model… in the face of many complex contextual factors

Applications to the ESL Diabetes Prevention Project:

•What is the problem/issue?

•Why is this a problem? (What causes the problem?)

•Who is affected by this problem?

•Who has a stake in the problem? (Who cares whether it is resolved or not?)

•What do we already know about the diabetes prevention issue within immigrant communities, ESL learners, ESL teachers, public health practitioners? What research, experience do we have?

Whose discourse do we use to articulate the problem?Individuals with lower English literacy levels are:

• Less likely to engage in screening & preventive action

• Less likely to have chronic disease under control

• More likely to be hospitalized

• More likely to report poor health

• More likely to die earlier

(Rudd 2010)

Articulating the problem

• Beyond the brochure

• Beyond a skills focus

• Health literacy as a social outcome (Rudd, Nutbeam)

• Emphasis on positive change, not deficit

Our Project

Inputs

“Resources dedicated to or consumed by the project”

Examples

- Funding from CDC and SF State

- ESL Task Force members, ESL teachers

- ESL learners, community leaders

- Facilities, technology

- Curricula

- Existing research

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Activities

“What is done with the inputs to fulfill project objectives”

Examples• Task Force activities: meetings, trainings• Research activities: survey, focus groups, literature

review, curricular review/development• Implementation of curriculum• Classroom learning

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Exercise 2. Distinguishing outputs from outcomesPremise: Need to clarify outputs (what is produced as a direct

result of project activities) from outcomes (how community is benefiting or changing as a result of those activities)

Applications to the ESL Diabetes Prevention Project:

• “…The objective of this project is for 1000 ESL learners to….” OR “…The objective of this project is for ESL teachers to….”

• “…The ultimate goal of this project is…”

“There is a shift in the ways that CBO funders and communities measure success. ‘Simply measuring the number of organizational outputs (houses, counseling sessions, events, and so on) is no longer adequate. Now we need to answer the 'so what' question. What outcomes have occurred because of your work?’”

- Martin Johnson (Executive Director of the Isles Community Development Corporation, Trenton, NJ) 

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Outputs

“What is produced as a direct result of project activities”

Examples

- TF creates logic model, evaluation/dissemination plan

- TF develops, implement lessons

- Teacher training materials

- Learner completion of lessons

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Outcomes

“Benefits or changes for participants during or after project activities”

Examples

- Classroom level: improved health literacy, English proficiency, retention/engagement, Reduced risk for diabetes in immigrant communities

- Programmatic level: stronger infrastructure within ESL programs to support diabetes prevention

- Broader community: reduced diabetes risk, capacity for change

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Exercise 3. Negotiating the ‘so what’

Premise: Need to clarify outputs (what is produced as a direct result of project activities) from outcomes (how community is benefiting or changing as a result of those activities)

Applications to the ESL Diabetes Prevention Project:

• Focus on engagement processes – Is social engagement an outcome, or an activity that leads to an outcome?

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The ‘fundable’ logic model

• What is the minimum amount for which you could accomplish at least part of your project?

• What constraints exist in your work context for making this happen?

• What is the time window for building and running your program?

• Who are likely funders???

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Which public guides public health messages?

“Hierarchies of biomedical knowledge do not lend themselves to identifying who is most capable of deciphering the complex pragmatics of public discourse about health…..why not include people who are ‘experts’ in reading how information is interpellated within their own communities? In doing so, we might learn a lot more about the full range of publics that emerge as discourse about health circulates.”

Briggs C Med Anthro Quartlerly p 313- 2003

Participation in ESL as a possible health-protective factor

“Our ESL classroom [provides] students with an opportunity to share their personal difficulties, evaluate them against the experiences of others, and begin to recognize them as socially constructed and potentially transformed through social action. We might see this process, and its active facilitation in our classes, as a primary means by which new solidarities and ‘traditions’ are developed within immigrant communities.”

Morgan, B. (1998). The ESL classroom: Teaching, critical practice, and community. Toronto, Canada: University of Toronto Press.

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Into the classroom

• Who does an ESL-learner initiated dissemination model reach?

• Does an ESL-learner initiated dissemination model provide a broader ‘reach’ to vulnerable populations?

• What unique opportunities does an ESL-based model create for improving health promotion, and how specific is it to local community identity?