Fotonovelas (graphic stories) for Mental Health Stigma Reduction Among Latinos

Background:  This presentation describes a mental health stigma reduction project that used fotonovelas (graphic stories) to encourage dialogue in community settings and increases the knowledge and recognition of the problem and the services available, and confronts the cultural stigma of seeking behavioral health services The fotonovela is a genre of graphic novel incorporating pictures with text balloons which started as photographic stills of popular films of the 1940’s.   Its wide acceptance among U.S. Hispanics and ease of use makes the fotonovela an efficient alternative to wordy brochures for communicating health and safety messages to Spanish-dominant communities. The fotonovela has been applied with documented degrees of success to address barriers to heath care in limited English proficiency (LEP) and low-literacy Latino communities.

Program background:  A graphic story was developed with families with youth dealing for mental health and substance abuse challenges. The main plot portrays a family who faces the stigma of a bipolar diagnosis for their teen and the secondary plot shows how a father is resistant to accept the “medicalization” of his young child’s ADHD.  The stories are intended to address attitudes, beliefs and knowledge that impact help seeking behavior, provide information about services available in the community, and model how non-judgmental support can help families get through crisis.

Evaluation Methods and Results:  In a quasiexperimental evaluation study, volunteer participants were randomly assigned to he intervention (fotonovela) or control group (standard psychoeducational) groups.  Both discussions were led by trained peer educators.  Participants completed a brief questionnaire before and after the intervention that assessed knowledge and attitudes/beliefs.  In both groups, most participants were female (over 79%) over the age of 31 (over 48%) who were caregivers of children or adolescents (85.1%).  The majority (94.3%) of the participants were not U.S. born. The results of this study reveal that both the Fotonovela stories with guided discussion and traditional psychoeducational presentation and discussion are effective in changing attitudes in the desirable direction.  However, participants in the fotonovela group were more likely to share personal experiences with mental health.  They also expressed more interest in participating in future discussions and engaging in community change activities.

Conclusions:  Fotonovelas are effective in educating Latino caregivers about behavioral health issues and services, and in reducing stigmatized beliefs about mental health.  They are also effective in eliciting disclosure of personal experiences during the discussion, and seeking concrete information about services.

Implications for research and/or practice:  Storytelling-based interventions, in this case fotonovelas, are a useful tool to discuss issues that are stigmatized in the Latino community.  Participants identified with the charaters and situations in the story that was created through community-based participatory research with members of the target audience communities.