Evaluation of a Fotonovela to Increase Depression Knowledge and Reduce Stigma Among Hispanic Adults Authors
First Online: 08 April 2012 DOI:
10.1007/s10903-012-9623-5 Cite this article as: Unger, J.B., Cabassa, L.J., Molina, G.B. et al. J Immigrant Minority Health (2013) 15: 398. doi:10.1007/s10903-012-9623-5 Abstract
Fotonovelas—small booklets that portray a dramatic story using photographs and captions—represent a powerful health education tool for low-literacy and ethnic minority audiences. This study evaluated the effectiveness of a depression fotonovela in increasing depression knowledge, decreasing stigma, increasing self-efficacy to recognize depression, and increasing intentions to seek treatment, relative to a text pamphlet. Hispanic adults attending a community adult school (
N = 157, 47.5 % female, mean age = 35.8 years, 84 % immigrants, 63 % with less than high school education) were randomly assigned to read the fotonovela or a low-literacy text pamphlet about depression. They completed surveys before reading the material, immediately after reading the material, and 1 month later. The fotonovela and text pamphlet both produced significant improvements in depression knowledge and self-efficacy to identify depression, but the fotonovela produced significantly larger reductions in antidepressant stigma and mental health care stigma. The fotonovela also was more likely to be passed on to family or friends after the study, potentially increasing its reach throughout the community. Results indicate that fotonovelas can be useful for improving health literacy among underserved populations, which could reduce health disparities. Keywords Hispanic Depression Fotonovela Stigma Knowledge Attitudes Intentions Health disparities Health literacy Narrative References
Ajzen I. The theory of planned behavior. Organ Behav Hum Decis Process. 1991;50:179–211.
Cabassa LJ, Molina GB, Baron M. Depression fotonovela: development of a depression literacy tool for Latinos with limited English proficiency. Health Promot Pract. in press.
Cabassa LJ, Zayas LH. Latino immigrants’ intentions to seek depression care. Am J Orthopsychiatry. 2007;77:231–42.
Cabassa LJ, Hansen MC, Palinkas LA, Ell K. Azúcar y nervios: explanatory models and treatment experiences of Hispanics with diabetes and depression. Soc Sci Med. 2008;66:2413–24.
Cabassa LJ, Lester R, Zayas LH. “It’s like being in a labyrinth”: hispanic immigrants’ perceptions of depression and attitudes toward treatments. J Immigr Minor Health. 2007;9:1–16.
Cabrea DM, Morisky DE, Chin S. Development of a tuberculosis education booklet for Latino immigrant patients. Patient Educ Couns. 2002;46:117–24.
Delgado PL, Alegria M, Canive JM, Diaz E, Escobar JI, Kopelowicz A, Oquendo MA, Ruiz P, Vega WA. Depression and access to treatment among US hispanics: review of the literature and recommendations for policy and research. Focus. 2006;4:38–47.
Estremera DY, Arevalo M, Armbruster J, Kerndt P. Parece que va a Llover. Compadre, Ponte el Sombrero (It Looks Like Rain. Put on Your Hat, My Friend): an HIV/STD risk awareness fotonovela for Latino day laborers. 2002. American Public Health Association, 130th annual meeting, 11 Nov 2002.
Griffiths KM, Christensen H, Jorm AF, Evans K, Groves C. Effect of web-based depression literacy and cognitive-behavioural therapy interventions on stigmatising attitudes to depression: randomised controlled trial. Br J Psychiatry. 2004;185:342–9.
Hinyard LJ, Kreuter MW. Using narrative communication as a tool for health behavior change: a conceptual, theoretical, and empirical overview. Health Educ Behav. 2007;34:777–92.
Howard DH, Gazmararian J, Parker RM. The impact of low health literacy on the medical costs of Medicare managed care enrollees. Am J Med. 2005;118:371–7.
Interian A, Martinez I, Rios LI, Krejci J, Guarnaccia PJ. Adaptation of a motivational interviewing intervention to improve antidepressant adherence among Latinos. Cult Divers Ethnic Minor Psychol. 2010;16:215–25.
Interian A, Ang A, Gara MA, Link BG, Rodriguez MA, Vega WA. Stigma and depression treatment utilization among Latinos: utility of four stigma measures. Psychiatr Serv. 2010;61:373–9.
Kreuter MW, Haughton LT. Integrating culture into health information for African American women. Am Behav Sci. 2006;49:794–811.
Kreuter MW, Green MC, Cappella JN, Slater MD, Wise ME, Storey D, et al. Narrative communication in cancer prevention and control: a framework to guide research and application. Ann Behav Med. 2007;33:221–35.
Kutner M, Greenberg E, Jin Y, Paulsen C. The health literacy of America’s adults: results from the 2003 National Assessment of Adult Literacy (NCES 2006–483). Washington (DC): U.S. Department of Education, National Center for Education Statistics; 2006.
Larkey L, Hecht M. A model of effects of narrative as culture-centric health promotion. J Health Commun. 2010;15:114–35.
Larkey LK, Gonzalez J. Storytelling for promoting colorectal cancer prevention and early detection among Latinos. Patient Educ Couns. 2007;67:272–8.
Lorig K, Stewart A, Ritter P, Gonzalez V, Laurent D, Lynch J. Outcome measures for health education and other health care interventions. Thousand Oaks: Sage Publications; 1996.
Menselson T, Rehkopf DH, Kubzansky LD. Depression among latinos in the United States: a meta-analytic review. J Consult Clin Psychol. 2008;76:355–66.
Miranda PY, Schulz AJ, Israel BA, González HM. Context of entry and number of depressive symptoms in an older Mexican-origin immigrant population. J Immigr Minority Health. 2010. epub ahead of print,
Moyer-Guse E. Toward a theory of entertainment persuasion: explaining the persuasive effects of entertainment-education messages. Commun Theory. 2008;18:407–25.
Olfson M, Marcus SC, Tedeschi M, Wan GJ. Continuity of antidepressant treatment for adults with depression in the United States. Am J Psychiatry. 2006;163(1):101–8.
Peres F, Moreira JC, Rodrigues KM, Claudio L. Risk perception and communication regarding pesticide use in rural work: a case study in Rio de Janeiro State, Brazil. Int J Occup Environ Health. 2006;12:400–7.
Scott TL, Gazmararian JA, Williams MV, Baker DW. Health literacy and preventive health care use among medicare enrollees in a managed care organization. Med Care. 2005;40:395–404.
Simpson SM, Krishnan LL, Kunik ME, Ruiz P. Racial disparities in diagnosis and treatment of depression: a literature review. Psychiatr Q. 2007;78:3–14.
Singhal A, Rogers E. Entertainment-education: a communication strategy for social change. Mahwah: Lawrence Erlbaum Associates; 1999.
Singhal A, Njogu K, Bouman M, Elias E. Entertainment-education and health promotion: a cross-continental journey. In: Singhal A, Dearing JW, editors. Communication of innovations: a journey with Ev Rogers. Thousand Oaks: Sage; 2006. p. 199–229.
Unger JB, Molina GB, Baron M. Evaluation of sweet temptations, a fotonovela for diabetes education. Hispanic Health Care Int. 2009;7:145–52.
Valle R, Yamada A, Matiella AC. Fotonovelas: a health literacy tool for educating Latino older adults about dementia. Clin Gerontol. 2006;30:71–88.
Van Voorhees BW, Walters AE, Prochaska M, Quinn MT. Reducing health disparities in depressive disorders outcomes between non-Hispanic Whites and ethnic minorities: a call for pragmatic strategies over the life course. Med Care Res Rev. 2007;64:157S–94S.
Vega WA, Rodriguez MA, Gruskin E. Health disparities in the Latino population. Epidemiol Rev. 2009;31:99–112.
Vega WA, Rodriguez MA, Ang A. Addressing stigma of depression in Latino primary care patients. Gen Hosp Psychiatry. 2010;32:182–91.
Wilkin HA, Valente TW, Murphy S, Cody MJ, Huang G, Beck V. Does entertainment-education work with Latinos in the United States? Identification and the effects of a telenovela breast cancer storyline. J Health Commun. 2007;12:455–69.
Williams MV, Baker DW, Parker RM, Nurss JR. Relationship of functional health literacy to patients’ knowledge of their chronic disease: a study of patients with hypertension and diabetes. Arch Intern Med. 1998;158:166–72.
Young AS, Klap R, Sherbourne CD, Wells KB. The quality of care for depressive and anxiety disorders in the United States. Arch Gen Psychiatry. 2001;58:55–61.
PubMed CrossRef Copyright information
© Springer Science+Business Media, LLC 2012