Eagle Books: Diabetes Prevention Through Education-Entertainment

Background:  Type II diabetes is now a common disease in Native American children aged 10 and above. These youth will experience many years of disease burden and higher probability of developing serious complications, diminishing the quality and length of life.

Program background:  In response, CDC’s Native Diabetes Wellness Program (NDWP), in collaboration with Westat, developed the Eagle Books, a series for Native children (grades K-4) about diabetes prevention. Now the Eagle Books are being expanded to middle schoolers. Westat has developed a 200-page novel, Coyote and the Turtle’s Dream, for children (10-13) and a 4-volume graphic novel based on the book. These products feature health messages and child characters (now 12 years old) from the original Eagle Books. Character development, plot, and messaging are guided by education-entertainment (E-E) as a strategy for promoting behavior change and readership. Social learning theory, a foundation of E-E, is used to model healthy behaviors of the child characters. Using E-E’s formula for weaving education seamlessly into entertainment, diabetes prevention messages are integrated into a mystery-adventure plot in which the child characters use Native and western science to foil a ring of fossil poachers. This strategy intersects with the broader definition of health literacy which includes empowerment through culturally-relevant knowledge.

Evaluation Methods and Results:  To obtain feedback, NDWP sponsored ‘book club’ discussions hosted by tribal schools in three Native communities. Native diabetes educators and curriculum developers, elders, and youth leaders have also reviewed the novel. Based on response, the next novel (the second of three) will include more information about type 1 diabetes, Native science, and a plotline with an anti-bullying theme. NDWP is currently working with CDC’s Division of Violence Prevention on anti-bullying messages.  NIH’s Diabetes in Tribal Schools (DETS) curriculum developers are also working with NDWP to develop a teacher’s guide for the novel which complements the DETS curriculum The appeal of the new Eagle Books products was also assessed at New York’s 2010 Comic-Con and reported by the Huffington Post (“Wham! Pow! The CDC Goes to Comic-Con”). Hundreds visited our booth--with teachers, librarians, and parents eager to acquire the books. Positive response has reinforced plans to distribute these products through the Eagle Books website currently under development.

Conclusions:  E-E based materials include direct audience participation in development of entertainment and educational content, assuring relevancy of current and future products. Although E-E has not been widely used as a health education/promotion strategy in the U.S., Coyote and the Turtle’s Dream appears to have appeal to general audiences as well as Native Americans. Additionally, aligning E-E materials with previously existing curricula enhances appeal of current health education/promotion infrastructures, promoting sustainability.

Implications for research and/or practice:  New Eagle Books can potentially be used to fill gaps in evaluation of  E-E audience effects through field experiment designs. Moreover, in terms of practice, Eagle Books show ways to harness local and traditional forms of entertainment and education to fit modern media channels and formats. Additionally, Eagle Books will be a natural for Internet dissemination since distinctions between entertainment and education are blurred in this environment.