Original Publication
Open Access

Health Literacy & ESL Curriculum

Published: May 22, 2013 | 10.15766/mep_2374-8265.9420

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This is a theory-based health literacy curriculum for Hispanic adults. The development of the health literacy/ESL curriculum was a collaborative process between an interdisciplinary university-based research team comprised of researchers from the specialized fields of health education, communication and adult literacy, and practitioners from a local community college that offers an adult literacy program. The planning process involved qualitative data collection from adults participating in community-based instruction, the collection of health-related materials and forms, and ongoing consultation with researchers and practitioners. The development process occurred over a period of two academic years, including planning and formative research (Fall 2009 - Spring 2010), pilot testing (Summer 2010), and implementation and evaluation (Fall 2010 - Spring 2011).

The curriculum combines health literacy content and English language instruction, and was specifically designed for Spanish-speaking Hispanic adults with a low-to-intermediate level of English proficiency. It integrates theories of health literacy and health behavior research and practice, socio-cultural theories of literacy and communication, and adult learning principles. One goal of the curriculum is to help familiarize students with the particular literacy demands of healthcare settings so that they are better able to navigate these settings and the reading/writing/communication required within them. Similarly, the curriculum includes content and materials that matches the cultural values, communication systems, and rhetorical patterns of the participating audience in order to facilitate the learning process, thus making the curriculum “audience-centered.”

The evaluation process included both qualitative and quantitative approaches. The curriculum was first presented to a small group of ESL teachers and students who provided feedback on content and format. It was then piloted over a two-week period with a group of 12 ESL students. Classes were observed and notes on curriculum administration and class dynamics were compiled. The information was used to make modifications to the curriculum, such as adjusting time allotted for classroom activities and adding captions to handouts. The curriculum was then finalized and implemented in a 6-week course in fall 2010 and spring 2011. A preliminary evaluation with Hispanic immigrants indicated that the curriculum was effective in improving health literacy levels and English proficiency. The project was funded by the NHLBI.

Randomized control study with a pre post-test design. Health literacy was assessed using the Test of Functional Health Literacy in Adults (TOFHLA). The study received IRB approval by the academic institutions involved (University of Texas at El Paso and El Paso Community College).

Primary hypothesis: Participants in the intervention group will demonstrate greater post-test health literacy scores compared to participants in the control group.

Results: A total of 155 Hispanic adults competed the intervention and post-test (77 intervention and 78 control). We conducted both independent sample t-test for the unadjusted analysis to compare the average TOFHLA scores in the intervention and control groups. The intervention group had a mean post-test TOFHLA score of 72.79 (SD=12.387, N=77) and the control group had a mean post-test TOFHLA score of 73.69 (SD=12.437, N=78). The independent sample t-test produced a p-value of .652. The intervention group had an average change score on TOFHLA before and after-intervention of 9.4675 (SD=18.92, N=77) and the control group had an average change score on TOFHLA of 8.16 (SD=11.91, N=78). But an independent sample t-test for the change scores lead to a p-value of 0.61.

We further conducted an adjusted analysis using multiple linear regression with the post-intervention TOFHLA as the dependent variable, and the group membership as an independent variable adjusted for two covariates: pre-intervention TOFHLA and the length of English Class which were not balanced at the baseline. The adjusted analysis lead to a p-value of 0.973 for the group membership. To analyze the change of TOFHLA before and after intervention, we conducted an adjusted analysis using multiple linear regression with the change score as the dependent variable, the group membership as an independent variable adjusted for another covariate: length of English Class which is unbalanced at the baseline. This adjusted analysis yielded a p-value of 0.025 for the group membership.

To summarize our analysis, there is not a statistically significant difference in the average post-intervention TOFHLA scores between intervention and control groups even after adjusting for baseline TOFHLA and length of English Classes. There is a statistically significant difference between change in TOFHLA between intervention and control (p=0.025) after adjusting for length of English Classes at the baseline.

Educational Objectives

  1. Improve health literacy among participants
  2. Specific objectives include improvements in:
    1. “document” literacy
    2. “prose” literacy
    3. “numeracy” literacy
    4. confidence in accessing and using the health care system
  3. Improve English proficiency among participants
  4. Specific objectives include improvements in:
    1. in conversation ability (e.g. in social situations)
    2. recognizing and responding to intonation patterns in English speech
    3. understanding and using key subject-specific vocabulary with visual aids
    4. communicating orally using accepted features of English grammar
    5. using language features that indicate different levels of formality in English
    6. comprehension of key information from written and/or audiovisual materials

Author Information

  • Francisco Soto Mas, MD, PhD: University of New Mexico School of Medicine
  • Brenda O. Fuentes, MEd: University of Texas at El Paso
  • Erika Mein, PhD: University of Texas at El Paso
  • Patricia Arnal: University of Texas at El Paso
  • Josefina Tinajero, MEd: University of Texas at El Paso

None to report.

None to report.

Prior Presentations
A Promising ESL & Health Literacy Curriculum for Hispanic Adults. Presented at: 3rd Annual Health Literacy Research Conference; October 17-18, 2011; Chicago, Illinois.

Innovative ESL/Health literacy curriculum to build authentic learning experiences for adults. Presented at: International SunConference on Teaching and Learning; March 2011; El Paso, Texas.


Soto Mas F, Fuentes B, Mein E, Arnal P, Tinajero J. Health literacy & ESL curriculum. MedEdPORTAL. 2013;9:9420. https://doi.org/10.15766/mep_2374-8265.9420