A Problem-posing Health Intervention: Developing an HIV /AIDS Health Literacy Toolkit With the African-American Community
R.V. Rikard, M.A.S.S. Dr. Maxine S. Thompson, P.h.D. Rachel Head, M.S.
Department of Sociology & Anthropology
North Carolina State University
Campus Box 8107
A Problem-Posing HeAltH intervention: DeveloPing An Hiv/AiDs Raleigh, NC 27695-8107
HeAltH literAcy toolkit WitH tHe AfricAn-AmericAn community
African Americans compose approximately twenty percent of the HIV/AIDS in the African American Community Discussion
population in North Carolina. Yet, the rate of reported HIV cases for Problem-posing & Health Literacy:
African Americans in North Carolina is disproportionately higher
than that of Whites. Public health agencies identify low health literacy Generating Health Literacy Through Problem-posing The problem-posing method is an effective means to develop culturally
and misconceptions about HIV/AIDS as contributors to the racial/ Peer sensitive health literacy information to raise awareness of HIV/AIDS in the
ethnic disparity in HIV infection rates. Educators African American community.
The Communities & Health Disparity Project is a partnership between Our project provides support for tailored HIV prevention strategies for
the Alliance of AIDS Services - Carolina (AAS-C), members of the populations:
African American Academic Focus
community, and Regional Adult/Adolescent HIV Cases by Race/Ethnicity* Partners Groups • With a high prevalence of inadequate health literacy levels
a research team
at North Carolina State Western • Literacy appropriate interventions to increase awareness about HIV/AIDS
University to develop an
accessible, culturally • To provide culturally appropriate information to identify risk-taking
sensitive, and Whites 14% Community
Whites 3% behaviors and make informed health decisions
malleable Blacks 43% Partners
Blacks <1% Other 7%
health literacy Other 0% Whites 6%
Blacks 18% Generative Theme:
Other 2% No one organization can effectively deal with raising the level of awareness of HIV/AIDS among African
Freire’s “problem-posing” methodology framed Source: 2009 HIV/STD Surveillance Report
Code: Relationship Gains:
the development of the HIV/AIDS health literacy toolkit N.C. Division of Public Health
“All hands on deck”
N.C. Department of Health & Human Services
and a peer-to-peer teach back format to deliver the health *Percentages includes cases with Unassigned County • Freire’s structured dialogue approach helped to initiate the partnership
intervention. The process of developing the toolkit (Fighting HIV/ with AAS-C.
AIDS in the African American Community: Become a Peer Educator!)
Partnership with AAS-C. • Professional courtesy helped to sustain the partnership with AAS-C.
was an on-going equal exchange between all participants.
• Active listening fostered the Freireian principle of equality between
Pedagogy of Collegiality - structured dialogue approach in which all participants are co-learners was
members of the African American community and members of the NCSU
central in initiating the partnership and creating an understanding of the reality of HIV/AIDS and STIs in
Paulo Freire & Problem-posing the African American community.
Freire rejected “Banking” education - the assumption that students are nothing more than empty Code:
• Development of a culturally-sensitive health literacy toolkit.
“receptacles” for teachers to deposit knowledge. “You are the experts and we are here to learn from you. We need your ideas to help make “our” project
• Tailoring of HIV/AIDS information to a high risk group.
Freire advocated that Liberating education involve dialogue, equal
exchange, and critical thought as a method to link literacy with Praxis:
• Development of critical consciousness using the Freireian learning-
broader social and political ills. Professional courtesy - meeting at the Alliance office and being accessible at times that fit the Alliance
dialogue approach with members of the AAS-C.
teams’ schedule. The NCSU research team established a role as “student learner” instead of “teacher-
Three Phases of Liberating education: researcher.”
• Empowering members of the African American community and AAS-C to
Generative Theme: contribute to the health literacy toolkit.
1. Teacher-students engage student-teachers in dialogue to Power differential between women and men to use a condom during sex.
collectively discover and develop generative themes of social Challenge:
problems. • Limited resources (money and time) due to the large size of the project
Code: and short timeframe for its completion.
2. Generative themes are codified into “codes” or visual, auditory,
and/or tactile representations that are culturally appropriate to the student-teachers.
“Hey! You are gonna use this!”
3. Reflection, conscientización (critical consciousness) and praxis or action!
Discussions concerning the complexity of negotiating condom The Communities & Health Disparities project was funded
use and the inclusion of examples of how partners can talk to through a SEED Grant from the Office of Extension,
The Problem-posing methodology is not problem-solving. Problem-posing is a means to
each other about using condoms in the health literacy toolkit. Engagement, and Economic Development at North Carolina
awaken critical consciousness to take action!