Journal of Immigrant and Minority Health

, Volume 15, Issue 2, pp 398–406

Evaluation of a Fotonovela to Increase Depression Knowledge and Reduce Stigma Among Hispanic Adults

  • Jennifer B. Unger
  • Leopoldo J. Cabassa
  • Gregory B. Molina
  • Sandra Contreras
  • Melvin Baron
Original Paper

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

  1. 1.
    Ajzen I. The theory of planned behavior. Organ Behav Hum Decis Process. 1991;50:179–211.CrossRefGoogle Scholar
  2. 2.
    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.Google Scholar
  3. 3.
    Cabassa LJ, Zayas LH. Latino immigrants’ intentions to seek depression care. Am J Orthopsychiatry. 2007;77:231–42.PubMedCrossRefGoogle Scholar
  4. 4.
    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.PubMedCrossRefGoogle Scholar
  5. 5.
    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.PubMedCrossRefGoogle Scholar
  6. 6.
    Cabrea DM, Morisky DE, Chin S. Development of a tuberculosis education booklet for Latino immigrant patients. Patient Educ Couns. 2002;46:117–24.CrossRefGoogle Scholar
  7. 7.
    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.Google Scholar
  8. 8.
    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.Google Scholar
  9. 9.
    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.PubMedCrossRefGoogle Scholar
  10. 10.
    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.PubMedCrossRefGoogle Scholar
  11. 11.
    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.PubMedCrossRefGoogle Scholar
  12. 12.
    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.CrossRefGoogle Scholar
  13. 13.
    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.PubMedCrossRefGoogle Scholar
  14. 14.
    Kreuter MW, Haughton LT. Integrating culture into health information for African American women. Am Behav Sci. 2006;49:794–811.CrossRefGoogle Scholar
  15. 15.
    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.PubMedCrossRefGoogle Scholar
  16. 16.
    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.Google Scholar
  17. 17.
    Larkey L, Hecht M. A model of effects of narrative as culture-centric health promotion. J Health Commun. 2010;15:114–35.PubMedCrossRefGoogle Scholar
  18. 18.
    Larkey LK, Gonzalez J. Storytelling for promoting colorectal cancer prevention and early detection among Latinos. Patient Educ Couns. 2007;67:272–8.PubMedCrossRefGoogle Scholar
  19. 19.
    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.Google Scholar
  20. 20.
    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.PubMedCrossRefGoogle Scholar
  21. 21.
    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, http://www.springerlink.com/content/188032l33jw7l87m/fulltext.pdf.
  22. 22.
    Moyer-Guse E. Toward a theory of entertainment persuasion: explaining the persuasive effects of entertainment-education messages. Commun Theory. 2008;18:407–25.CrossRefGoogle Scholar
  23. 23.
    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.PubMedCrossRefGoogle Scholar
  24. 24.
    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.PubMedGoogle Scholar
  25. 25.
    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.CrossRefGoogle Scholar
  26. 26.
    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.PubMedCrossRefGoogle Scholar
  27. 27.
    Singhal A, Rogers E. Entertainment-education: a communication strategy for social change. Mahwah: Lawrence Erlbaum Associates; 1999.Google Scholar
  28. 28.
    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.Google Scholar
  29. 29.
    Unger JB, Molina GB, Baron M. Evaluation of sweet temptations, a fotonovela for diabetes education. Hispanic Health Care Int. 2009;7:145–52.CrossRefGoogle Scholar
  30. 30.
    Valle R, Yamada A, Matiella AC. Fotonovelas: a health literacy tool for educating Latino older adults about dementia. Clin Gerontol. 2006;30:71–88.CrossRefGoogle Scholar
  31. 31.
    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.PubMedCrossRefGoogle Scholar
  32. 32.
    Vega WA, Rodriguez MA, Gruskin E. Health disparities in the Latino population. Epidemiol Rev. 2009;31:99–112.PubMedCrossRefGoogle Scholar
  33. 33.
    Vega WA, Rodriguez MA, Ang A. Addressing stigma of depression in Latino primary care patients. Gen Hosp Psychiatry. 2010;32:182–91.PubMedCrossRefGoogle Scholar
  34. 34.
    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.PubMedCrossRefGoogle Scholar
  35. 35.
    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.PubMedCrossRefGoogle Scholar
  36. 36.
    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.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Jennifer B. Unger
    • 1
  • Leopoldo J. Cabassa
    • 2
  • Gregory B. Molina
    • 3
  • Sandra Contreras
    • 3
  • Melvin Baron
    • 3
  1. 1.Institute for Health Promotion and Disease Prevention ResearchUniversity of Southern California Keck School of MedicineLos AngelesUSA
  2. 2.Department of PsychiatryColumbia UniversityNew YorkUSA
  3. 3.USC School of PharmacyLos AngelesUSA

Personalised recommendations