En Familia: An Intergenerational, Multi-Media Health Literacy Training for Latino Families

Theoretical Background and research questions/hypothesis:  This paper presents the evaluation findings of En Familia (ENF), a five session, intergenerational, multi-media health literacy skills-building program for low-income Latino families on the topic of access to health care. Latinos in the United States (US) disproportionately experience health disparities and barriers to accessing care, including lack of culturally appropriate health information and limited knowledge of the US health care system. For implementation at Latino-serving community-based organizations, ENF uses engaging, participatory activities to improve families’ positive attitudes, confidence, and health literacy skills to find, use, and understand health care services and information. A central teaching aid is a ten episode DVD, scripted in the format of a telenovela. The DVD episodes are integrated throughout ENF and follow the experience of the Garcia family with the dual purpose of engaging participants and modeling the acquisition of new health literacy skills. We evaluated ENF using the following research questions: To what extent does participation in ENF increase participants’ positive attitudes, self-efficacy, and health literacy skills to find, use, and understand health care services and information? To what extent does participation in ENF improve family communication on the topic of finding, using, and understanding health care services and information? 

Methods:  We conducted an outcome evaluation using a pretest/post-test quasi-experimental design with 48 Latino families to assess ENF’s efficacy. Each family comprised three generations—a teen, a parent, and a grandparent, for a total of 144 participants. Families were evenly distributed across three community-based evaluation sites and we randomly assigned families to either a control group or a treatment group at each site. All participants took a pretest and then treatment group participants attended five sessions of ENF across several weeks. The control groups received no intervention. After the final ENF session, all participants took a post-test. Teens took slightly different surveys from adults. We analyzed the data using STATA to explore our research questions. 

Results:  Treatment group participants demonstrated positive gains from  pretest to post-test on attitudes, self-efficacy, and health literacy skills measures on the topic of finding, using, and understanding health care services and information compared to the control group. What is more, treatment group participants showed improved family communication scores at post-test. 

Conclusions:  Our findings suggest ENF increases participants’ positive attitudes, self-efficacy, and health literacy skills. The study findings more broadly indicate that an intergenerational program can improve low-income Latinos families’ ability to manage their health care as a family unit. 

Implications for research and/or practice:  ENF capitalizes on the Latino concept of familismo—the central role of family support and family responsibility to care for one another. These findings indicate that intergenerational health programs for Latino families can capitalize on familismo to produce positive outcomes.