ESL Participation as a Mechanism for Advancing Health Literacy in Immigrant Communities

This study explores English-as-a-second-language (ESL) classrooms as a site for health literacy interventions.

Maricel G. Santos
Margaret A. Handley
Karin Omark
Dean Schillinger
Author(s) Organizational Affiliation
San Francisco State University
University of California San Francisco
Publication Year
Resource Type
Number of Pages

A reliance on the conceptualization of health literacy as functional skill has limited researchers’ views of the adult English-as-a-second-language (ESL) context as a site for health literacy interventions. To explore the contributions of alternative views of literacy as social practice to health literacy research, the authors examined teacher survey data and learner outcomes data collected as part of a multiyear collaboration involving the California Diabetes Program, university researchers, and adult ESL teachers. The survey results (n = 144 teachers) indicated that ESL teachers frequently model effective pedagogical practices that mediate social interaction around health content, the basis for acquiring new literacy skills and practices. In the classroom pilot (n = 116 learners), the majority of learners reported they had learned about diabetes risk factors and prevention strategies, which affirmed existing healthy behaviors or prompted revision of unhealthy ones. About two thirds of the learners reported sharing preventive health content with members of out-of-school social networks. This study represents a first step in research efforts to account more fully for the mechanisms by which social interaction and social support facilitate health literacy outcomes in ESL contexts, which should complement what is already known about the development of health literacy as functional skill.

The adult ESL system remains an untapped resource in the effort to address health literacy disparities among under-served immigrant populations, those with limited schooling and literacy skills, as well as other historically hard-to-reach populations, such as immigrants without legal documentation and elderly immigrants. 

What the experts say

ESL instruction is particularly well suited to an educational model of health literacy that combines both functional skills and social practices, adding to both language acquisition and health literacy. This resource documents this in theory and through its research findings related to practice. It also points up the need for the investment of time and resources to build partnerships between adult and health educators, teacher training, and curriculum development so that other teachers, who may be less skilled and motivated than the ESL teachers piloting the curriculum in this study, might feel ready to move ahead with health literacy.

Excellent resource. One of the best resources that is directly related to the application of health literacy in adult education classrooms. Also, the focus on literacy-as-social-practice is excellent. One caution, I would consider broadening the scope of skills beyond personal health / lifestyle. Many issues that adult education students face (e.g. social issues) are related to health literacy skills and health outcomes: housing, transportation, health insurance, discrimination (e.g. gender, race, immigrant status). Finally, Table 1 in the article is fantastic. It provides a clear description of how ESL content is related to health literacy as a skill as related to health literacy as practice. Also noteworthy is that sample lessons are available from the author, Dr. Maricel G Santos.

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