Health Promotion and Health Advocacy for and by Immigrants Enrolled in English as a Second

Language Classes
Author(s): Nancy Edwards, Donna Ciliska, Tracy Halbert and Myrna Pond
Source: Canadian Journal of Public Health / Revue Canadienne de Sant Publique, Vol. 83, No. 2 (
MARCH / APRIL 1992), pp. 159-162
Published by: Canadian Public Health Association
Stable URL: http://www.jstor.org/stable/41990764
Accessed: 16-11-2015 04:11 UTC
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ABSTRACT

Health

Promotion

and

Health

health
Anintersectoral
promoimmigrant
for
and
by
Immigrants
inHamilton,
tionproject
isdescribed. Advocacy
Ontario
of
theentry
Theproject
goalwastofacilitate
in
as a
Enrolled
care
newimmigrants
to theOntario
health
English
and
with
and
them
system equip
knowledge
skills
tostrengthen
their
andproClasses
Second
preventive
Language
motive
health
practices.
develA needs
assessment
preceded
project
are
The
three
of
the
project
opment.
phases
Nancy Edwards, RN,MSc,1Donna Ciliska, RN,PhD,2
the
Thefirst
with
described.
commenced
phase
TracyHalbert, RN,MScN,3
Myrna Pond, RN,BScN4
ofculturally
health
sensitive
prodevelopment
to be usedwith
motion
resource
materials
in
enrolled
as a Second
immigrants
English
and 1,400 childrenenandrefugees
an im- adultimmigrants
comprise
Immigrants
In
activities
foClasses.
two,
Language
phase
in
as
a
SecondLanguage
rolled
for
health
(ESL)
portant
promotion
English
target
group
theability
ofESL
cussedon strengthening
Theirarrivalin a new country Classesin Hamiltonat anyone time.This
programs.
a preventive
andproteachers
toincorporate
ofthenew
a significant
reflects
a periodofsignificant
Thefinal
motive
health
focus
intheir
classes.
proportion
adjustments. represents
ESL
an unfa- immigrant
network;
toa community-based
Consequently,
population.
phaseshifted
project. Lossoftheirownsupport
as a contactpointfor
miliar
setofcultural
valuesandsocialnorms; classeswereidentified
thisphase,a coreimmigrant
During
group
skills
as health
for
their
advocates
to imactivities
obtain- healthpromotion
skills;difficulty
developed
targeted
inadequate
language
their
with migrants.
andlackoffamiliarity
community.
immigrant
ingemployment
all contribute
to the
thehealthcaresystem
of thistargetgroup ProgramRationale
ABRG
vulnerability
potential
In preparation
forthisproject,a needs
of these
Recognition
following
migration.
wasconici un projetinter-sectoriel
de
ofthetarget
On dcrit
led severalPublicHealthNurses assessment
population
problems

dela santchezdesimmigrants
needsasofPublicHealth ductedwhichincludeda learning
promotion
(PHNs) intheDepartment
en Ontario.
du projet
Hamilton,
translated
intoSpanofdevelop- sessment
Services
toexplore
thefeasibility
L'objectif
questionnaire
immitaitdefaciliter
l'entre
desnouveaux
to
at
ish,Polishand Chineseand distributed
program
targeted
inga healthpromotion
et
danslesystme
desant
del'Ontario
grants
in Hamilton, ESL students,
oftheliterature
anda review
newimmigrants
and refugees
et aptitudes
de lesdoterdesconnaissances
healthstatusandconOntario.
immigrant
reporting
ncessaires
renforcer
leurs
de
pour
pratiques
factors.
tributing
etdepromotion
delasant.
prvention
were
The learningneedsquestionnaires
The Setting
Unevaluation
desbesoins
a prcd
lamise
students.
Resultsindicated
as anyonebornout- returned
94
(defined
by
Immigrants
au pointdu projet.La premire
a
phase
wasneededregarding:
den26% ofHamilton's thatinformation
commenc
de matriel sideofCanada)constitute
parle dveloppement
talcare,contraception,
nutrition
anduseof
ofapproximately
sen425,000(1986
depromotion
dela santculturellement
population
tohealthcare unfamiliar
sible
etdestin
tre
utilis
aveclesimmigrants census).1
foods,medicalcare,and emerLanguageisa barrier
inscrits
dansdescours
seconde
that
The literature
withhalfof thoseimmigrants gencyservices.
d'anglais
langue
accessibility,
suggested
sesont
lesactivits
(ALS).Endeuxime
in 1980 speakingneitherEnglish certain
ethnicandimmigrant
phase,
groupsareless
arriving
desaptitudes norFrench.2,3
concentres
surlerenforcement
infant
1,200
to:demonstrate
Thereareapproximately
likely
optimal
feeding
desenseignants
del'ALSpourleurpermettre
havegood dentalhealth,12
atpractices,4"11
unlment
etpromod'incorporer
prvention
be appropriately
tend
classes13
and
prenatal
1.
Ottawa-Carleton
Nurse
Community Specialist,
tiondelasant
dansleurcours.
Laphase
finale
withHamilton- immunized
Health
fortheirage.14Specificgroups
(Formerly
Department
s'estdroule
dansuncadrecommunautaire.
ofPublic
Health are also more
Wentworth
Department
Regional
mental
likelyto: experience
de base
Aucoursde cettephase,ungroupe
Services)
healthproblems,15,16
avoidseeking
Re2.
Hamilton-Wentworth
Consultant,
appropriont
Nursing
leurs
apd'immigrantsdvelopp propres
21
ofPublic
Health
Asso- atecare,17"19
Services;
gional
Department
andusetobacco.20'
comme
titudes
de la santdans
promoteurs
of HealthSciences,
ciateProfessor,
Faculty
leurs
communauts
McMaster
respectives.
d'immigrants
University
Hamilton- ProgramDesign
NurseConsultant,
3. Supervisor,
ofPublic
Health
Wentworth
Department
Regional
Data arisingfromtheneedsassessment
ofHealth
SciClinical
Services;
Lecturer,
Faculty
withthe
toproceed
McMaster
ences,
University
provided
support
strong
Health
Re4. Public
Hamilton-Wentworth
Nurse,
ofthehealth
promotion
project
development
ofPublic
Health
Services
Department
gional
We
howESL
classes.
for
Donna
recognized,
through
Author/Requests
Reprints:
Corresponding
Hamilton- ever,thata) not all new immigrants
Consultant,
Ciliska,
RN,PhD,Nursing
and
ofPublic
Wentworth
Health
Department
Regional
benefit
from
this
who
promight
refugees
L8N3P6
P.O.Box897,Hamilton,
Ontario
Services,
Tel:(416)546-3528
gramwereenrolledin ESL classes,b) onMARCH- APRIL1992

CANADIAN
OF PUBLICHEALTH 159
JOURNAL

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HEALTHPROMOTIONFORIMMIGRANTS
toobtainif
wouldbedifficult
goingfunding
the projectcreateda dependenceof ESL
teachers
on PHNs comingto run health
areenandc) students
sessions,
promotion
in
time
rolled ESL classesfora limited period
(sixmonthsin thecaseof thecommunity
ledus to incorporate
college).Thesefactors
intotheproject:
twoadditional
components
ESL
teachers
tostrengthen
onewhichassisted
focus
of
theirclasses,
thehealthpromotion
to
a
anda secondwhichmoved morecommodelwherein
keyimmigrants
munity-based
in the community
would be assistedto
theirroleas healthadvocates.
strengthen

TABLEI
of Respondentsin ESLClasses at Pre-test
Characteristics
Characteristics
TotalN
Age(years)

X
SD
CametoCanada
Year
x
longago x(SD)
Do youhavechildren?
(%)
yes
no
classessince
Takeother
English
toCanada?
(%)
coming
yes
no
data
missing
M.D.?(%)
Do youhavea family
yes
no
Ifyouhavea family
M.D.,
doeshespeaksamelanguage?
(%)
yes
no
Do youhaveOHIP?(%)
yes
no
missing
Do youhavea dentist
(%)
yes
no
missing
Do youhavea jobnow?(%)
yes
no

Intervention

Control

51

15

29.5
8.5

29.1
7.3

1^87
0.7(2)

1983
5.4(10.7)

45.1
54.9

46.7
53.3

41.2
54.9
3.9

60
33.3
6.7

GoalsandObjectives
The overallgoal of thisprojectwas to
93
78
in
thehealthstatusofimmigrants
improve
7
22
The
theHamilton-Wentworth
Region. spewere:
cificprojectpurposes
50
55
ofnewimmigrants
theentry
a) tofacilitate
45
50
and
to theOntariohealthcaresystem
and
equip themwiththe knowledge
86.7
74.5
and
skillstostrengthen
theirpreventive
13.3
19.6
5.9
healthpractices;
promotive
sensitivehealth
b) to developculturally
26.7
29.4
thatmeettheeduresources
promotion
66.7
68.6
cational
needsoftheimmigrant
6.7
2
populatheESL teacher's
tion,and strengthen
26.7
7.8
to usethese;and
ability
66.7
90.2
ofimmigrants
theability
c) to strengthen
forother
memtoactashealth
advocates
cohortgroupdesign.A quesmaterials.
andfu- educational
bersoftheirethniccommunity
Examplesofresource a before/after
of
was
whichconsisted
tionnaire
foci
immunizatureimmigrants.
developed
packagecontent included:
behaviour
and
winter-time
stress;
tion;nutrition;
quessexuality;
knowledge
demographic,
wasmore
occu- tions.We decidedthatanonymity
The Program
health;theOntariohealthcaresystem;
whosehistory
forthesestudents,
tobaccouse;andhomesafety. important
com- pational
After
a pilotphase,we successfully
safety;
torture
and political
sometimes
included
involved
mulused
Classroomstrategies
fromtheMinistry
petedfor.
projectfunding
than
our
to
the
role
of message: playing, oppression,
of Healthof Ontario,HealthPromotion tiplereinforcers
ability be able to
them
at post-test.
Class
and
match
students
to
there
werethree demonstration
Funds.Forthemainproject,
methods,
identify
asking
new
in
lanwords theirown
membership
changesfrequently: stuoperative
phasesovertheperiodofJuly1988toJune identify
toa higher
dents
students
andprob1990.
join,
getpromoted
guagefora topicunderdiscussion,
some
their
class
level
as
studentsto
lem-basedscenariosrequiring
Englishimproves,
the
for
howtheywoulddealwithproblems dropout
Phase1: Thedevelopment
Therefore,
employment.
ofhealth
promotion consider
from
Alof
classes
and in Canada.
with in theirown country
material
resources
membership
changed pre-test
forusebyESL teachers
topost-test.
their
students
time,twoofthefive
Bypost-test
plannedto use
thoughwe had originally
classes
had
beendissolved
and
intervention
in con- translators,
wefoundthatthiswaslogistically
Theseresources
weredeveloped,
classes.
moved
to
other
students
of different remaining
ofESL
witha steering
committee
sultation
impossibledue to thevariety
data
Table I showssome demographic
in anyoneclass.
tofoster
students
andteachers,
participative languages
The
intervention
obtained
atpre-test.
sessions
on
A totalof95 healthpromotion
andprogroup
Theycoveredpreventive
learning.
toCanada.
tohavecomemorerecendy
motive
healthconcepts
andincludeda vari- ninedifferent
bythe tended
topicsweregivenjointly
thisdifference
wasnotstatistically
teachers However,
which projectPHN andvariousclassroom
activities
etyof pre-and post-class
totimeinCanada
related
thetwo-year
con- intheESL classesduring
student
Probably
period. significant.
learning
experiential
encouraged
ofhealthknowledge
andpre- wasthefactthatthecomparison
A cross- Anevaluation
sistent
withadultlearning
groupwas
principles.
to
have
taken
ESL
classes
wasplannedusing morelikely
healthbehaviours
intothese ventive
culturalfocuswas incorporated
previDE SANTPUBLIQUE
160 REVUECANADIENNE

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VOLUME83,NO. 2

HEALTHPROMOTIONFORIMMIGRANTS
oustotheonecurrently
enrolled
in,tohave
a family
and
to
have
a
physician,
job.
in thetwogroupsat preThe differences
teston demographic
the
characteristics,
in
class
of
two
and
loss
composition
change
classesmadecomparison
ofpre-topost-test
and
behaviour
scoresandstatistiknowledge
cal analysisinvalid.However,theimpressionsoftheprojectPHN werethatthestudentswereparticularly
ableto usetheinformationrelated
to finding
a doctoranddenfor
our
andtheusesand
tist,
climate,
dressing
limitations
of our provincial
healthinsurance.Thiswas evidentin theirdiscussions
andactualappearance.

theselimitations.
Alternate
need
approaches
to be explored
whichwouldminimize
unof
ESL
teachers
on
the
necessary
dependence
PHN.
The projectPHN sawanecdotal
evidence
oflearning
intheintervention
groupofESL
Phase3: Community
activities
with
both
of
The
students
and
teachers.
advocacy
groups
in
have
nonintervention
teachers
immigrants
particular,
In thethirdand finalphase,themajor requested
andusedthemanualsin teaching
fromwithinESL classacshifted
aboutthehealthtopics,
anda targeted
emphasis
Spantivities
tohealthadvocacy
inthecommunity. ishgroupcontinues
togrowinhealthadvoTherapidly
Hispaniccommunity cacyskills.
expanding
was selectedas the target.1991 estimates
thata
Thisprojecthasprovided
evidence
thispopulation
tobebetween
indicated
hard-to-reach
vulnerable
5,000
relatively
groupcan
and7,000andcontinuing
to increase.
be contactedin a timelyfashionthrough
The PHN used severalstrategiesto
othercommunity
outsidethetradiagencies
' abilities
Phase2: Strengthening
ESL teachers
the
health
of
the
tional
role
health
sector.
The
advocacy
strengthen
projecthas raised
a healthpromotion
to incorporate
in
She
in
immiwas
active
diverse
awareness
of
the
needs
of
diverse
culturally
focus
immigrants.
classes
networks
within
in
a
outside
of
and
the
health
as
department whole,
grant
planning
groups
This phaseinvolvedstrengthening
ESL
theRegionwithkeyinformants
to workat leasthalf
andagency and a PHN continues
teachers'
to
health
in
the
of
time
on
the
continuation
and expansion
ability incorporate
pro- representatives,
particularly
Spanish
motionin classcontent.The PHN con- community,
as thenetworks
inthisproject.
carriedout a
liaisonsdeveloped
Thecoopductedworkshops
theuse of the number
ofspecific
activities:
eration
wehavemetamong
andenthusiasm
regarding
resource
manuals
fortheteachers
atboththe assessed
andpriorized
and
the
ESL
and
offercommunity institutions
preventive prointervention
and thenonintervention
sites.
motivehealthneeds(through
disthese
classes
that
this
maybean
group
ing
suggests
A questionnaire
administered
a
cussion
2
and
worthwhile
for
others
to
(as pre-post
community
surveys)
approach
pursue.
totheteachers,
hadbeendeveloped identified
toaddress
theseneeds
measure)
strategies
to tapthreeissues:1) extentto whichthe
andongoingdelivery
ofSpan- ACKNOWLEDGEMENT
(initiation
teachers
hadtaught
thecontent
ofthemanuishprenatal
for
classes,
support
group Spanals overthe last threeteachingmonths,
ish community,
and community
workThis projectwas fundedbytheOntario
resources
available
to
them
the
on
Violence
for
the
wider
ofHealth,HealthPromotion
Fund.
2)
Family
regarding
shop
Ministry
their
and
of
the
value
of
ethnic
The opinionsexpressed
herearethoseofthe
topics, 3)
community)
judgement
thecontent
fortheESL students.
The ques- identified
resourceswhich authors.No officialendorsement
community
by the
tionnaire
was completed
at pre-testby 50
andrefugees
couldtaptoimple- Ministry
ofHealthis intended
orinferred.
immigrants
intheintervention
teachers
menthealthpromotion
and prevention
groupand 15 in
thecontrol
A
teacher
strike
hindered
to,forexample,
(related
group.
strategies
employ- REFERENCES
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site.
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CANADIAN
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reclass
attenders 18.LinTY,LinMC.Love,
andrejection:
13.Goodman
denial,
J,Abernathy
andnon-attenders:
Acomparison.
The1987ANA
ofChinese
families
tomental
illness.
In:A.
Received:
16,1991
July
sponse
Council
ofNurses
Researchers'
Kleinman
Normal
andAbnormalAccepted:
December
International
NursandTYLin(Eds),
19,1991

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