Teaching Nutrition to Hispanics at an English as a Second Language (ESL) Center: Overcoming Barriers

Introduction

As the Hispanic population in the United States continues to grow, Extension educators are challenged to find avenues through which education programs can be delivered to this group. The number of health promotion programs offered at the work site has increased as a means of reaching out. However, the participation of Hispanics in such programs has been low (Aguirre-Molina & Molina, 1993). One reason may be that 90% of farm workers in the Midwest are Hispanic migrant workers (Mas, Papenfuss, & Guerrero, 1997). Also, Hispanics may be over-represented in low, blue-collar occupations (NCLR, 1993). Workers at these job settings are difficult to reach.

Another route through which Hispanic groups might be reached is English as a Second Language classes (ESL). Lyons, Woodruff, Candelaria, Rupp, and Elder (1997) conducted a program (n=139) in which five 3-hour modules on nutrition were integrated into community college-based ESL classes. The researchers reported statistically significant intervention effects in changing sodium intake and several other trends. However, this report did not offer any insight into the process of reaching Hispanic clientele through ESL classes.

This article describes some of the challenges and barriers we found and strategies we used to overcome these barriers. In this regard, this article represents an evaluation of the process, rather than outcomes research. Learning how the process of program implementation changes depending on the culture of participants is important to consider whether conducting research or delivering programs.

Method

An 11-class Spanish nutrition education program was taught to low-income Hispanic men and women in an informal ESL program. This was a pilot test of the content and process of a bilingual nutrition education curriculum. Because Extension programs have had success in reaching low-income groups (Grogan, 1991), the nutrition curriculum was designed to be similar to the Expanded Food and Nutrition Education Program (EFNEP) basic nutrition curricula.

The curriculum consisted of seven nutrition classes based on the Food Guide pyramid with classes taught only in Spanish and emphasized nutrition and the prevention of cardiovascular diseases (CVD).

Results of the Process Evaluation

Throughout the program, a number of challenges were met and barriers overcome. Many of these barriers and possible solutions are similar to those that may be encountered with any low-income group. Other barriers seem to be specific to the Hispanic culture.

Challenges of Working with the Volunteer Organization

1. ESL Class Time and Schedule

The educator planned with the director of the volunteer organization the summer and fall schedules as well as the amount of time needed for the completion of each class. However, the schedule and the actual starting time of the nutrition classes varied according to the weekly volunteer organization's schedule and needs, with several last-minute changes due to unexpected events at the ESL site

2. ESL Tutor Volunteers' Participation in the Nutrition Classes

On many days there was a large number of tutor volunteers, not necessarily Hispanic, often highly educated, who expressed a desire to stay and participate in the nutrition classes. Tutor volunteers who sat with the participants sometimes helped them answer surveys used to evaluate the impact of the class. To overcome this barrier, the educator clearly defined tables for tutors versus participants. The educator also asked volunteers to ask their questions after class. In addition, the educator emphasized that all questions about class be directed to her rather than to the tutors.

3. Changes in ESL Classes' Location

The location of the ESL classes was changed from one religious community center to another. This caused the nutrition and ESL classes to start later in the fall than was scheduled. A second mailing of flyers announcing the beginning of the nutrition classes and having tutor volunteers call participants to inform them of the new ESL classes site helped alleviate confusion.

4. Competition with Concurrent Activities Offered at the ESL site

At the new ESL site, most participants attended religious and social activities in addition to the ESL and nutrition classes. Usually, these activities were scheduled on a different day than the ESL classes. Occasionally, these activities were scheduled during nutrition class time, causing lower nutrition class attendance. Scheduling flexibility was critical to ensuring optimum participation.

Challenges in Participation

The number of participants who attended the 11 classes varied throughout the program, ranging from 2 to 25. Participants who came to one class were not necessarily the same participants who came to the following class.

1. Childcare

Some families dropped out of the program because they were concerned that their children might disturb class. To overcome this, the educator assured participants that children were not a disturbance and included children in lunch or taste testing.

2. Transportation

Although there was public transportation to the site, most participants relied on rides from friends and family. If friends or family couldn't provide a ride home, participants wouldn't stay for the nutrition class after the ESL class. To overcome this barrier, the educator invited the owner of the car to come to class and involved them in lesson activities.

3. Employment Schedules

Many participants had rotating shift work schedules or second jobs that conflicted with class time. Each class was designed to be as self-contained as possible so that understanding the material in one class was not dependent on knowledge acquired in a previous class. In addition, the same important health messages were given in all classes.

4. Predominance of Males

Traditionally, nutrition education programs for low-income groups have targeted females, mostly homemakers. However, the majority of the participants in these classes were often male. To address this, the educator included eating behavior more typical of males (e.g., eating at the work site, eating at restaurants). Because many of the male participants had experience working at food services, the educator involved the male participants in food preparation activities to keep them interested.

5. Domination of Class Discussion by a Single Participant

In some classes, one participant dominated the discussion. To overcome this barrier, the educator always listened to what the dominant participant had to say but then directed the question to someone else. In addition, the educator involved this participant in other activities such as distribution of leaflets, cooking, setting lunch, and setting the room for the class.

When the participant happened to be a male, the educator was more careful in listening to him so he would not feel offended or disrespected. In this way the educator avoided conflict with the machismo value, which is quite prevalent in the Latino culture (Anderson, Ryan, & Leashore, 1997).

6. Hispanics' Value of Punctuality

Hispanics differ from many Americans in the value they attach to punctuality (Triandis, 1994; Clark & Hoffman, 1998). For instance, arriving 15 minutes late to an informal meeting or class may be considered acceptable by Hispanics. On some occasions, this delay disrupted the educator's teaching plans and survey administration.

To overcome this, the educator motivated the participants to be on time for a free light lunch. Also, after each class, the educator announced the next week's food preparation activity. Nevertheless, on many occasions the educator had to adapt to Hispanics' sense of punctuality and start the nutrition class later.

7. The Educator as a Community Resource

Once the educator gained the trust of participants, they identified her as a resource person. Many participants, especially females, started consulting the educator for problems related to seeking health services, housing, legal aspects, and their personal life.

This created a conflict of interest because, if the educator referred them to community services, then the educator would be doing the job of the volunteer organization. On the other hand, if the educator did not give them any information, they might have interpreted it as a refusal to help them and might have discouraged them from participating in the nutrition program. This raised the ethical question of providing information that the participants needed for their own good.

The educator referred them to the director of the volunteer organization but followed up. If they were not helped at the volunteer organization, then the educator personally referred the participants' problem to community services.

Challenges of Program Evaluation

The number of participants who answered surveys designed to demonstrate the impact of the nutrition program varied greatly. Not every person who attended the classes answered all the surveys. The participants who answered the survey at one class were not necessarily the same participants who answered the surveys at the next class, and there was a low survey response rate.

1. Fear of Offering Written Information

Participants' fear of offering written information may have been involved. This attitude could have been related to the legal status of participants and their desire to remain anonymous. To overcome this barrier, the educator assured participants of confidentiality. To assure participants of the good will of the educator, the director of the volunteer organization acted as witness and signed the study consent form of each participant. In addition, participants wrote a code number instead of their name in the surveys to keep them anonymous.

2. Number of Surveys

In order to lessen the burden of answering the surveys, the educator spread the surveys throughout the program. However, some participants still said there were many surveys to answer.

3. Low Literacy in Spanish

The low survey response rate is explained in part by the participants' low literacy in Spanish. According to the Spanish Skills Proficiency Test (SSPT), 63% (8) of summer and 50% (4) of fall participants who completed this test had low literacy in Spanish. The educator also observed that some participants helped others in reading and explaining the survey instruments. The educator asked participants to direct all questions to her.

4. Hispanics' Value of Cooperativism and Saving Face

Occasionally, some participants asked for help from other participants in reading and in explaining survey questions. In addition, some participants copied the survey answers from others. Hispanics value cooperative situations and simpatiamore than competitive situations (Triandis, 1994). The cultural script of simpatiaor to be simpatico means that they expect the other person to show loyalty, friendliness, affection, politeness, dignity, and respect. In addition, the participants' action could have been influenced by the desire to save face or to look good in front of the educator.

To overcome these barriers, the educator emphasized that participants should work alone and that the answers were confidential. The educator also arranged seating so that participants were separated.

Implications

ESL classes can provide easy access to the Hispanic population. There are, however, some disadvantages. Because the Extension program will be a dependent program, it will be secondary to the ESL program in terms of time and space. The primary purpose of the Hispanic group at ESL programs is to learn English. Therefore, it is important to find a balance between the needs of the volunteer organization offering ESL classes and those of the nutrition program.

Low class attendance is a common problem for low-income audiences. One way to lessen the impact of this is to make each nutrition class self-contained. The same important points should be emphasized in all classes to ensure participants receive it.

The classroom group dynamics of Hispanics may be different from those of other groups. In the study reported here, Hispanics' value of punctuality and machismo had an effect on the delivery of class, while their cultural scripts of simpatiaand the value of cooperativism had an effect on the evaluation of the program. The educator needs to understand, respect, and balance participants' beliefs with the goals of the program.

Because Hispanics frequently identify the educator as a resource person, the educator should learn about the needs of Hispanics and the community resources available for them. This may impose additional responsibility but will promote rapport with Hispanic clients and encourage their participation in the nutrition program.

Program evaluation is difficult because of sporadic attendance, low literacy, fear of written opinions, and cooperativism. Qualitative evaluation rather than traditional quantitative surveys may provide an answer to some of these difficulties.

References

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