A Problem-Posing HeAltH intervention: DeveloPing An Hiv/AiDs HeAltH literAcy toolkit WitH tHe AfricAn-AmericAn community

African Americans compose approximately twenty percent of the population in North Carolina. Yet, the rate of reported HIV cases for African Americans in North Carolina is disproportionately higher than that of Whites. Public health agencies identify low health literacy and misconceptions about HIV/AIDS as contributors to the racial/ethnic disparity in HIV infection rates.

The Communities & Health Disparity Project is a partnership between the Alliance of AIDS Services - Carolina (AAS-C), members of the African American community, and a research team at North Carolina State University to develop an accessible, culturally sensitive, and malleable health literacy toolkit and intervention.

Freire’s “problem-posing” methodology framed the development of the HIV/AIDS health literacy toolkit and a peer-to-peer teach back format to deliver the health intervention. The process of developing the toolkit (Fighting HIV/AIDS in the African American Community: Become a Peer Educator!) was an on-going equal exchange between all participants.

Problem-posing: HIV/AIDS in the African American Community

Paulo Freire & Problem-posing

Discussion

R.V. Rikard, M.A.S.S. Dr. Maxine S. Thompson, P.h.D. Rachel Head, M.S. Department of Sociology & Anthropology

North Carolina State UniversityCampus Box 8107

Raleigh, NC 27695-8107 chd.ncsu.edu

Objective

The Communities & Health Disparities project was funded through a SEED Grant from the Office of Extension, Engagement, and Economic Development at North Carolina State University.

Freire rejected “Banking” education - the assumption that students are nothing more than empty “receptacles” for teachers to deposit knowledge.

Freire advocated that Liberating education involve dialogue, equal exchange, and critical thought as a method to link literacy with broader social and political ills.

Three Phases of Liberating education:

1. Teacher-students engage student-teachers in dialogue to collectively discover and develop generative themes of social problems.

2. Generative themes are codified into “codes” or visual, auditory, and/or tactile representations that are culturally appropriate to the student-teachers.

3. Reflection, conscientización (critical consciousness) and praxis or action!

The Problem-posing methodology is not problem-solving. Problem-posing is a means to awaken critical consciousness to take action!

Generative Theme: No one organization can effectively deal with raising the level of awareness of HIV/AIDS among African Americans.

Code:“All hands on deck”

Praxis:Partnership with AAS-C.

Generative Theme:Pedagogy of Collegiality - structured dialogue approach in which all participants are co-learners was central in initiating the partnership and creating an understanding of the reality of HIV/AIDS and STIs in the African American community.

Code:“You are the experts and we are here to learn from you. We need your ideas to help make “our” project a success.”

Praxis:Professional courtesy - meeting at the Alliance office and being accessible at times that fit the Alliance teams’ schedule. The NCSU research team established a role as “student learner” instead of “teacher-researcher.”Generative Theme:Power differential between women and men to use a condom during sex.

Code:“Hey! You are gonna use this!”

Praxis:Discussions concerning the complexity of negotiating condom use and the inclusion of examples of how partners can talk to each other about using condoms in the health literacy toolkit.

AcademicPartners

PeerEducators

CommunityPartners

FocusGroups

Generating Health Literacy Through Problem-posing

Problem-posing & Health Literacy:

The problem-posing method is an effective means to develop culturally sensitive health literacy information to raise awareness of HIV/AIDS in the African American community.

Our project provides support for tailored HIV prevention strategies for populations:

• With a high prevalence of inadequate health literacy levels

• Literacy appropriate interventions to increase awareness about HIV/AIDS

• To provide culturally appropriate information to identify risk-taking behaviors and make informed health decisions

Regional Adult/Adolescent HIV Cases by Race/Ethnicity*

Whites 3%Blacks <1%Other 0%

Whites 14%Blacks 43%Other 7% Whites 6%

Blacks 18%Other 2%

WesternPiedmont Eastern

Source: 2009 HIV/STD Surveillance ReportN.C. Division of Public HealthN.C. Department of Health & Human Services

*Percentages includes cases with Unassigned County

ConclusionsRelationship Gains:• Freire’s structured dialogue approach helped to initiate the partnership

with AAS-C.

• Professional courtesy helped to sustain the partnership with AAS-C.

• Active listening fostered the Freireian principle of equality between members of the African American community and members of the NCSU research team.

Process Gains:• Development of a culturally-sensitive health literacy toolkit.

• Tailoring of HIV/AIDS information to a high risk group.

• Development of critical consciousness using the Freireian learning-dialogue approach with members of the AAS-C.

• Empowering members of the African American community and AAS-C to contribute to the health literacy toolkit.

Challenge:• Limited resources (money and time) due to the large size of the project

and short timeframe for its completion.