La Palabra es Salud
(The Word is Health):
A Comparative Study of the Effectiveness of Popular
Education vs. Traditional Education for Enhancing Health
Knowledge and Skills and Increasing Empowerment
among Parish-Based Community Health Workers (CHWs)
Objectives
By the end of the session, participants will be able to:
 Identify 3 key outcomes of the study, La Palabra es
Salud (The Word is Health);
 Identify 3 implications of these outcomes for building
capacity among Community Health Workers (CHWs);
 Explain the role that popular education can play in
helping CHWs and communities create a more equitable
society; and
 Name 3 benefits of using CBPR as the research
paradigm for a doctoral dissertation.
Agenda for presentation:
Introduction
 Dinámica/brainstorm
 Research methods
 Results
 Implications and evaluation
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Think, Pair, and Share Brainstorm
What do we already know or
imagine about popular education?
Definition of Popular Education
Popular education is a mode of teaching and
learning which seeks to bring about more just and
equitable social, political, and economic relations
by creating settings in which members of
marginalized and oppressed groups can become
active subjects in the construction of history.
Sources: Jara, Nuñez & Hernandez, cited in Bralich, 1994
Traditional Education
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The teacher is the expert and has higher status than the
students.
Knowledge is pre-existing and can be “delivered” from
the teacher to the students.
Academic knowledge is more valuable than experiential
knowledge.
Learning is primarily individualistic.
The purpose of education is to equip students with the
skills they will need to succeed in the workplace.
The primary mode of teaching is lecture.
Background and Significance
Popular education . . .
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Is arguably the most important educational philosophy
and methodology indigenous to Latin America.
Has played a crucial role in struggles for social justice in
the U.S.
Is largely unknown in the U.S. and other industrialized
countries.
Wider use in the U.S. could benefit many groups.
Increased knowledge about whether, why and how PE
works can benefit CHW training programs.
Primary Research Questions
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Is type of instruction (popular education vs. traditional
education) associated with any changes in health
knowledge and skills, psychological empowerment,
self-reported health status, and health behavior among
participants in a parish-based Community Health
Worker training program? If so, what is the nature and
strength of the association?
Do any changes from baseline to follow-up among
parish-based CHWs who participate in training differ
systematically from temporal changes that may occur
among members of a comparable parish community
who do not participate in any type of training?
Primary Research Questions (cont.)
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From the perspectives of the participants and the
researcher, how does popular education work, if it does?
What elements of popular education contribute to its
differential effects, if indeed these exist?
What changes, if any, do the CHWs perceive in
themselves, their families, and their communities as a
result of the CHWs’ participation in training? Do these
self-reported outcomes differ as a result of the type of
training that is used?
Empowerment-related
outcomes
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People taking more control over their lives and
their health
Increased self-esteem and self-confidence
Undertaking actions to improve the community
and help fellow community members
Increased participation
Increased activity to bring about change through
advocacy
Health-related outcomes
 Positive
health behavior change
 Increased health knowledge
 Improved health literacy
 Improvements in physical markers of
health risk factors
Methodological lessons
Combine qualitative and quantitative
measures to understand the outcomes of
popular education interventions
 Conduct experimental and quasiexperimental studies that compare popular
education to traditional education
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Community-based participatory
research
“. . a collaborative approach to research that equitably
involves all participants in the research process and
recognizes the unique strengths that each brings. CBPR
begins with a research topic of interest to the community
with the aim of combining knowledge and action for social
change to improve community health and eliminate health
disparities.”
(W.K. Kellogg Health Scholars Program, 2001)
Popular Education Group
Health knowledge
 Ability to promote health
 Critical consciousness (concientization)
 Global measure of empowerment
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Traditional Education Group
Health knowledge
 Control at the personal level (self-efficacy)
 Critical consciousness (concientization)
 Self-reported health status
 Self-reported health behavior
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Research Question 2
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Results of a mixed factorial ANOVA indicated that
changes in health knowledge differed significantly and
systematically between CHWs who participated in
training and members of a control group who did not.
The only statistically significant improvement in members
of the control group was in sense of community.
This suggests that improvements in the two experimental
groups are not just the result of having filled out the
questionnaire two times.
How does popular education
work?
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It sets the stage.
It builds trust (confianza).
It starts with what people know.
It encourages open communication.
It creates an environment of equality.
It uses a variety of interactive techniques.
It encourages and balances participation.
“In school, you arrive and you sit down and
you are going to listen to everything that
comes out of the teacher, and if you
understood, good, and if you didn’t
understand, not so good. And here no, if
you didn’t understand, you asked the person
who was giving the information and s/he
explained it in another way.”
Yesenia, PE Participant
“. . . [in] this course it was like all of us were
equal, not like, because we all are equal. All
of us were on the same level, with the
exception that you all know a lot more.”
Lupe, PE Participant
“As the classes went on, I am seeing all the
information and how all of us participated;
no one was left behind. As you all said, ‘all
questions are valid,’ so that no one would
fail to participate [so that] we would leave
feeling more encouraged.”
Angel, PE Participant
Research Question 4
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Overall, participants in the PE group
experienced a more pronounced increase in
empowerment, while improvements in health
behavior were more common among members
of the TE group.
On a wide range of domains, changes in the PE
group were more multi-faceted, while changes in
the TE group were more focused on health,
strictly defined.
Traditional Education Group
“For years I had been saying, ‘I am going to
do exercise, I need to eat healthy, I am
going to eat meat,’ because I had the
knowledge and it was my goal and there are
always things a person wants to do but
doesn’t. But after this course, I said, ‘I want
to and I am going to do it.’”
Sonia
Traditional Education Group
“Before, for example, we dedicated ourselves to
working and we said, ‘Well, let’s make a quick
stop, we bought some hamburgers, or we bought
pizza and then we went back, it is our food and it’s
fast food and then it’s back to work. And on the
other hand not anymore, because now we try to
take time and to arrive and eat in a healthier way,
right?”
Juanita
Traditional Education Group
“I had never in all my life learned the importance of what is,
for example, nutrition, how badly we sometimes eat. Well,
the bad nutrition that we have, the bad health of our bodies
many times, because we don’t wash our hands adequately,
exercise . . . We know it’s important, but sometime we don’t
take it . . . very seriously. And always I remember that . . .
when I went to the clinic, they always told me to walk.
Sometimes I walked, sometimes I didn’t. But now with this
course one becomes aware of all the errors that one
commits” (emphasis added).
Juanita
Popular Education Group
“For me, [the course] was like a door they
opened for me so that my life could be
better, so that I could say, ‘Okay, I can do it,
and if I decide I am going to do it, I am going
to get through it.’”
Yesenia
Popular Education Group
“This [course] opened up wider for me a
path that I was already walking. It opened
up that [thing] that was inside me. Because
it was already inside me. That’s what I see,
that this was already inside me but I didn’t
take it outside. And now it’s out.”
Lupe
Popular Education Group
“Before, I saw that my community needed
something . . . but I didn’t know how to do it. I . . .
was never going to be one of those people who
was going to take the initiative and start to do
something in the parish or in the community. And
now I feel capable of going and talking to the priest
and saying, ‘Well, this is what I am seeing. I think
we have to do something.’”
Yesenia
Implications and Applications
 What
implications can be drawn from
the approach and/or results of this
study?
 Did you feel differently in this session
than you have felt in other sessions
you have attended at APHA?
Conclusions
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PE was at least as effective as TE for increasing health
knowledge.
PE was more effective for increasing empowerment.
By using PE, we can achieve gains in empowerment
without sacrificing gains in knowledge.
In informal settings, PE can support participants to
recognize their capacity and work together for change.
In formal settings, PE can promote greater inclusion and
increased success for disempowered students,
producing a more equitable society.
Thank you!
¡Gracias mil!