Nemawashi: Laying the Ground Work
Hitomi Yoshida is a Project Manager of the SHINE-MetLife Foundation Health Literacy Initiative based at Temple Universitys Center for Intergenerational Learning. As part of Project SHINE, a national service-learning initiative, the health literacy initiative aims to meet the health communication needs of older immigrants through collaborations between health professions courses and community partners which serve older immigrants and refugees.
As a member of the research team for the health literacy initiative, Hitomi has conducted a community-based needs assessment with immigrant elders. Currently, Hitomi works as a Project Manager to foster partnerships between community organizations that serve immigrants and refugees and health professions faculty and students in colleges and universities.
Hitomi received her M.S. ED. in Intercultural Communication from the University of Pennsylvania. In her previous work as a qualitative researcher at Research for Action, she utilized a collaborative approach to evaluate urban education reform initiatives and service-learning projects.
Project SHINE (Students Helping In the Naturalization of Elders) is based at the Center for Intergenerational Learning (CIL) at Temple University. CIL's mission is to strengthen communities by bringing generations together to meet the needs of individuals and families throughout the life cycle. SHINE aims to build partnerships between colleges and community-based organizations to engage students and older immigrants in service to their communities.
The health literacy initiative grew out SHINEs twenty-five years of experience with immigrants and refugee communities across the csountry. In 2001, the project conducted a needs assessment of immigrant learners in eight cities. The ability to access healthcare services and communicate with health professionals was identified as a critical need within immigrant communities.
In order to respond to these needs, the initiative was created in order to:
In order to understand the health literacy needs of older immigrants, we first carried out a needs assessment by conducting focus groups and interviews with a total of 101 older immigrants. The results from the needs assessment were recently published in the report entitled, Patient Listening: Health Communication Needs of Older Immigrants, which is available at www.projectshine.org.
Perspectives we gained directly from immigrant elders in the focus groups contributed to the development of the SHINE ESL Health Units, a comprehensive health literacy curriculum including ninety lessons designed to help older immigrants communicate with healthcare providers, take charge of their health, manage illness, and promote healthy aging.
In addition, eight SHINE consortium institutions (California State University, Northridge; City College of San Francisco; Emory University; Metropolitan State University; Minneapolis Community and Technical College; San Jose State University; Temple University; and Utica College) have engaged a total of over 600 health-professions students in service-leaning projects in the immigrant communities. Students have offered a variety of activities for immigrant communities such as health workshops, health screenings and exercise classes, community health fairs, and tutoring health literacy skills in ESL classrooms. A range of courses participated in the initiative such as Nursing, Gerontology, Occupational Therapy, Physical Therapy, Therapeutic Recreation, Medical Interpreting and Nutrition.
Our projects are intercultural, intergenerational and interdisciplinary.
Project SHINEs community partners are enormously rich in culture and language. We work with refugees and immigrants representing over twenty-two languages.
As part of Center for Intergenerational Learning, SHINE works to build partnerships between college students and older immigrants and refugees. SHINE is one of the few organizations which focuses specifically on the needs of older generations of immigrant communities, who face particular obstacles in accessing healthcare and navigating the complex U.S. healthcare system.
Many have difficulty understanding and speaking English in healthcare encounters and in reading prescriptions, insurance information, and consent forms. Some elders delayed necessary doctor visits due to confusion about insurance coverage or difficulty locating an interpreter. Many community-based projects tend to focus on immigrant workers and their children, but older populations are often left out and isolated. SHINE recognizes the wisdom and vitality of older immigrant communities and fosters learning across generations.
Our initiative especially stresses the significance of interdisciplinary partnerships between the fields of health and literacy/ESL(English as a Second Language). For example, SHINE staff worked with ESL instructors at community-based organizations and Nursing faculty member(s) at Temple University to co-create the ESL Health Units. In our service-learning projects, a range of health professions courses engaged their students with community-based ESL programs for immigrants and refugees. For example, a group of Therapeutic Recreation students from Utica College taught non-literate Bantu learners how to write at an ESL program at a refugee center. Many of them have never before held a writing implement. The students had them write in a container of sand with their fingers. It created a more enjoyable way for refugees to learn how to write. This is a wonderful example of health-profession students learning about literacy issues faced by refugees and at the same time contributing to their literacy education by introducing a technique from the field of health.
I am very excited about the learning opportunities created for health-professions students and immigrant elders through this initiative. I believe that experiential learning is so effective in teaching intercultural communication. Students who participated in our service-learning projects gained insight into the need to overcome linguistic and cultural barriers, as one Nursing student reported:
I am also excited about elders becoming more proactive patients through our educational services. Seniors who took our health literacy lessons in Taking Medications said:
The awareness and confidence they have gained are as valuable as the linguistic skills they have developed.
To maximize our community partners power and leadership role within our campus-community partnership. CCPHs Principles of Partnership provide us the vision for authentic partnership between institutions of higher education and communities.
Project SHINE started as a volunteer program in which older immigrants were our clients. Once SHINE developed from a co-curricular to a service-leaning program, older immigrants have become our teachers and colleagues. Now my hope is to engage seniors and their families as community leaders. We are starting a new project to involve older immigrants in civic engagement within their communities. My long-term dream is to work on collaborative grant writing with immigrant-serving CBOs (Community-Based Organizations) and engaging elders in more advocacy roles.
Lots of lessons learned. I would say spend time in planning. We live in a culture that emphasizes efficiency (saving time), action, and quick results. They are all important but if you spend more time observing, analyzing, strategizing and building relationships with others before taking actions, it would bring better outcomes. In Japanese, this concept is called, nemawashi, a term for laying the ground work.
Pressure to produce tangible results in a short period of time. Partnership takes time. Process-oriented approach takes time. A solution may be to advocate for more funding for research and programs that foster authentic partnerships with communities and that should be one of the criteria for research methodology and program evaluation. CCPHs promotion of CBPR (community-based participatory research) is a good example of that solution.
It is not advice but a request: more language assistance and support for LEP (Limited English Proficiency) patients at large hospitals. Immigrant elders we met through focus groups and interviews talked about the challenges theyve experienced in navigating the complex healthcare system and wished for more bilingual providers and interpretation services.
Several elders talked about bringing their family members as interpreters or making a decision not to seek treatment because they did not have language assistance. For instance, a Chinese elder shared her story in the interview:
Increased effort to provide language support for LEP patients would improve the healthcare access for this population.
As an organization, we wanted to learn more about the partnership-building work accomplished in the field of health. We also wanted to offer our knowledge and experience in the field of health literacy and working with immigrant and refugee populations. CCPH is a great forum for us to connect with professionals who are in different fields but share similar goals and values.
It is a long-term, mutually beneficial and institutionalized relationship between communities and institutions of higher education. It is a partnership that is reciprocal and brings out mutual understanding. Partnerships should be established at all levels including between students and community residents, university faculty and staff members and CBO staff, and between the leadership of institutions of higher education and community leaders.
I am a new member and I attended my first CCPH conference last May--CCPH's 9th conference. The conference was a great way to learn about CCPH. I found the conference engaging, stimulating, and inspiring. Sessions I attended represented the value that CCPH promotes: mutual learning. Sessions were not presented in one-way, rather, they offered venues for presenters and participants to exchange their experiences and ideas as colleagues. I found the culture of CCPH inclusive. Conference participants are diverse in terms of nationality and ethnicity, gender, age, experience, and types of organizations they belong to. I gained so much between sessions talking to other participants. (To learn about CCPH's 10th anniversary conference in April 2007, visit http://depts.washington.edu/ccph/conf-overview.html.
I also appreciate the fact that CCPH encourages members to discuss critical issues together but also pushes us to formulate action plans. The emphasis on asking so what and now what questions is so important.
As a person whose native language is not English, I would like to be
an advocate for language minorities and a supporter of linguistic diversity.
Being able to work on the educational and health issues that language
minorities face keeps me motivated.