Health Literacy Studies

Learner Developed Materials

An Empowering Project

Rima E. Rudd, ScD
John P. Comings, EdD

(Rima E. Rudd is with the Harvard School of Public Health, Boston, Massachusetts. John P. Comings is with the Harvard Graduate School of Education, Cambridge, Massachusetts.)

Health Education Quarterly, Vol. 21(3): 313 – 327 (Fall 1994)
Copyright 1994 by SOPHE.  Published by John Wiley & Sons 
CCC 0195-8402/94/030313-15

Freire used very specific materials in culture circles to support an empowering process that allowed learners to define the content and outcome of their own learning.   However, the materials themselves were carefully crafted and developed by Freire and his co-workers. This article focuses on an extension of Freire’s problem-posing educational methods to include participant involvement in the development and production of their own learning materials.

Four linked case examples, one in literacy and three in health education, illustrate the process of participatory materials development and we discuss some issues for facilitators and learners. The production process can be an empowering experience and the product stands as testimony to the participants as self-conscious agents and critical thinkers capable of transforming their world. The resultant materials, geared to a particular locale and reflective of the people and language in the community, can provide a powerful model for those who may not have been involved in the process, but who can identify with the friends and neighbors who developed the materials. Participatory materials development is suggested as a supplement to problem-posing educational experiences and is particularly well suited for community programs.

INTRODUCTION

Paulo Freire’s critique of the “banking” method of education where students are passive recipients of a teacher’s “wealth” has been welcomed by health educators who have long recognized the danger of equating teaching with telling,1 of assuming that students/clients are empty vessels, and of separating learning from action.2 Similarly, Freire’s call for a “problem-posing” approach to education appeals to health educators who recognize that because health and disease are socially determined, collective action and the full participation of learners are key to the educational process.3-5  Freire’s insistence on the primacy of empowerment as the outcome of an educational experience has transformed pedagogy. The view of learners as full participants and decision markers is shifting the locus of control of more traditional program and educational processes from experts to the participants.6 Indeed, many adult education, community development, and health education practitioners have sought to translate Freire’s education process into their field. As Minkler and Cox noted in 1980,7 such applications have necessarily modified the methodology to increase practical utility for participants.

This article focuses on an adaptation and extension of the Freirian method to include active participation of learners in the production of learning materials.  Learning materials are usually the only tangible aspect of an educational program and often serve as an emblem of that experience. In each of the cases, the materials used in the educational program were written and designed by the learners themselves. The discussion of these projects, one an adult literacy project and the other three health education efforts, delineates the steps in a participatory project and highlights issues for practitioners. Specific evaluation results of these efforts are reported elsewhere8-10 but the intent here is to look back to the origin of the concept and assess the application of a Freire-inspired approach to materials design and development. The discussion opens with an examination of Freire’s original approach to set the context for an examination of the case examples.

BACKGROUND:
EMPOWERMENT AND LITERACY

Paulo Freire’s philosophy and approach to critical thinking have influenced worldwide literacy efforts. The translation of his philosophy into the very specific design of literacy classes has inspired the innovative approaches of many adult learning programs as well as some creative health education interventions.11 Freire views education as a mechanism for liberation from the cycle of oppression that limits the freedom of the masses. For Freire, the process of liberation takes place when the oppressed see their situation as a reality that they can affect and transform. Education can hinder or support that process. Thus, Freire defines two forms of education: “banking,” which reinforces the system of oppression, and “problem posing,” which leads to liberation.12

The metaphor of banking is used to emphasize the process of a teacher depositing knowledge into the students, a process dominated by the teacher who makes all decisions and remains the “subject” of the learning process. According to Freire, the banking system of education supports the development of individuals who accept the passive role imposed on them and learn, along with a fragmented view of reality, to adapt to the world as it is and not to act upon it and change it. Thus, the banking form of education reinforces dependence. Problem-posing education, on the other hand, has as its first goal the breakdown of the dichotomy between student and teacher and establishes a situation of equality, dialogue, and mutual communication. Problem-posing education leads people to praxis (the process of action-reflection-action). Students become reflective, self-conscious agents and critical thinkers capable of transforming the world. Freire’s literacy classes were designed to offer problem-posing and problem-solving opportunities for participants who would learn to read in the process of developing critical thinking. By entering and observing the social environment of the learners, the teacher identified generative themes, delineated and codified key words, and facilitated structured discussion sessions enabling participants to acquire reading skills as part of a very powerful experience that was transforming their consciousness. Consequently, through critical reflection and action, participants could begin the process of transforming the world. Freire posits that participants come to the educational experience at varying levels of consciousness (often with a magical or naive awareness) and that the format of the culture circle and the decodification process through active dialogue must help transform that consciousness into a level of critical awareness.12 Both the structure of the culture circles and the format of subsequent classes are very carefully crafted.

Freire’s Use of Learning Materials

Freire believes that the form of the materials supporting an educational process contributes to the determination of whether or not an educational activity will empower or oppress.13 The materials he used consisted of a series of drawings done by Francisco Brennand, a well-known artist and friend. A set of 10 pictures that presented the distinction between culture and nature was discussed within a culture circle (a group of learners with a facilitator who helped structure the discussion). The materials were meant to stimulate dialogue, not to instruct.13 Using these materials, facilitators focused discussion on the distinction between culture and nature, helping participants discover themselves as the makers of culture and agents of change. Consequently, participants who could not yet read were involved in discussions of complex issues and in the process Freire called “conscientizacao”—a process that encourages participants to analyze their own reality, become aware of the constraints put on their lives, and take action to transform their world.

The first set of materials stimulated these discussions and the second set, symbolizing generative themes, was used to teach the elements of literacy. For example, the production of bricks was central to the lives of members of several literacy classes in Brazil. The Portuguese word for brick, tijolo, was depicted by a drawing of a brick and this drawing was discussed within the culture circle. Questions of housing, labor, who makes bricks, who lives in a brick house, and any other issues of importance to the culture circle members were considered before the word tijolo was presented.14 Words describing generative themes were compiled and would, in total, represent all the sounds of the Portuguese language. The drawings were objects for a discussion that allowed learners to describe their situation, investigate the causes of their problems, and consider possible solutions. Out of this discussion was to come action to change their situation and to solve their problems. Later, the group was to reflect, take action, and, after further reflection on their initial action, move on to new action. This process constituted what Freire called praxis.

Learner Involvement in Materials Development

Freire’s materials supported a process that allowed learners to define the content and outcome of their own learning; however, the materials themselves were developed by Freire and his co-workers. In Ecuador, a project implemented by the University of Massachusetts and the Ministry of Education experimented with other forms of learning/teaching materials and with bringing the learners into the process of materials development. The Ecuador project15 produced photonovels (called fotonovellas in Spanish), which are formatted like comic books but contain photographs instead of drawings to stimulate discussion. The photonovel format was used because it was and remains a popular form of literature in Central and South America. In this instance, the photonovel produced for the project became the object that was discussed and analyzed just as Freire’s drawings had been.

Although members of the target community were involved as actors in the production of the photonovels, they were not, in the Ecuador project, involved in the actual design of the materials or in the development of the message they contained. This design work, as with Freire’s literacy program, was done by experts. However, this work in community-based photonovel production and the overall concept of learner participation in the development of the learning materials inspired the activities reported in the case studies. Each of the cases attempted to increase learner involvement in the development of the materials.

PARTICIPATORY MATERIALS DEVELOPMENT

In each of the four cases, learner developed materials were used for a problem-posing educational process. In all four examples, the resultant materials were in the form of a photonovel and the decision to use a photonovel for educational support was based on pedagogic, popular, and practical considerations.

The Freirian process advocates the use of drawings or photographs of social issues as a method of focusing on common themes that are decoded through collective action because, in part, the visual mode is a less abstract representation of reality than written descriptions. Materials must be reflective of common social experiences and a photonovel can depict familiar faces and places within a story that draws on people’s experiences. The presentation of an issue or problem within the context of a dramatic story holds readers’ attention and interest. The format itself is eye catching and photonovels constitute a popular form of literature in many parts of the Americas. Most important, with participant involvement, the learners themselves can determine the content and the issues, can shape the action of the story, and are able to give voice and shape to the characters. On the very practical level, participants bring a variety of skills to the process and there is no need for sophisticated technological or artistic expertise. The product can be changed or modified at any stage, the production process is relatively inexpensive, and it relies on available technology. Finally, a photonovel offers a vehicle for appropriately gearing materials to the culture, ethnicity, race, gender, language, and class status of the learners (Fig. 1). The dialogue, drawn directly from people’s actual speech, can be naturally geared to literacy needs.

HealthQuartPic

Photonovel Development Process

To develop a photonovel, participants need an opportunity to discuss and explore the issue at hand. Often an issue predefined by outsiders and funders (such as a health problem) must be negotiated so that other, more pertinent, concerns to the participants can be included. Participants identify main characters who, like themselves, address an issue or problem. An action or decision around this issue forms the crux of the story. A group can then gather around a large piece of paper on a table and outline a story with stick figures and a few simple words. Next, the story can be laid out through the use of a story board: a page-by-page sketch of the story using stick figures with some dialogue included. A brief narration line can serve to offer transition where needed.

A photography session follows and participants (along with a wider group of friends, family, and neighbors) become the actors photographed in tableau. Other participants can serve as photographers. Often actors speak the lines given them in the story—a process that occasionally alerts the writers to a need for language or story modification. Photography sessions can be scheduled for special on-site shooting or can make use of simple props when such travel is not possible (e.g., individuals with luggage photographed walking down a hallway transforms that hallway into an airport). Scenes of familiar community places ground the photonovel in the reality of people’s everyday lives. The photography session can be made easier with the use of an instant camera to check the settings and be made more participatory with the use of several photographers and cameras. Pictures are then developed, chosen, and arranged; dialogue bubbles are typed and pasted on and a lay-out produced. There is ample opportunity at each stage to rewrite, recast, and change the book.

The final materials can take various forms. A photonovel can be displayed on a bulletin board., A low quality but adequate product can be produced on a photocopy machine. The story can be printed on newsprint and be set up like a newspaper comic. However, low-cost printing facilities are often available at technical high schools, community colleges, or through community-based businesses, yielding a professional looking book. Overall, the materials needed are relatively easy to procure (newsprint, pencils, cameras, film, development, typewriter, paper, and printing or photocopy access) and the production technology is simple (use of a typewriter and camera).

Case Studies

All of the cases under discussion are community based—drawing on community experts, reflective of community settings and norms—and the photonovels produced for these cases were used for educational purposes and distributed free of charge. Furthermore, the production process was documented so that the expertise for the development of the materials remained in the community. The first materials production project was with a literacy and English as a second language (ESL) program. The subsequent projects were all related to health education: an environmental health program with community residents, a smoking prevention program with adolescents, and an occupational health program with construction workers.

The four projects are linked in time and approach—with facilitators learning from the previous experience. Thus, the first two programs were facilitated by Comings and Cain; Rudd and Roter contributed to the health education evaluation design for the second. Subsequently, Rudd facilitated the third photonovel process and Rudd and Roter, the fourth. The case studies present an opportunity to explore the involvement of learners at the early stage of materials development and provide the reader with a chance to understand the role of the learner and facilitator in this process.

Farm Workers’ ESL and Literacy Materials

The first case involves the production of a series of photonovels for use in literacy and ESL by the New England Farm Workers Council, which was funded by the federal government to provide educational programs for adult farm workers. The Council had been unable to locate simple adult reading material of interest to their clients who had recently arrived from Puerto Rico. Because photonovels are a popular form of literature in Puerto Rico, the Council, in partnership with two consultants, decided to try producing photonovels with a goal of accumulating literature with which the clients could practice reading skills. The consultants determined that if stories in the photonovels reflected the clients’ own lives and issues, then the learning materials, like those in the Ecuador project, could serve to stimulate discussions similar to those in culture circles. A series of three photonovels was produced: Los Hermanos: The Streets of Gold, Los Hermanos: The Man Who Suffered a Lot, and Los Hermanos: La Trabajadora.

Production of each photonovel in the Los Hermanos series served as a training experience for the next. The clients and consultants were all learning how to work together on this specific medium and the learning-by-doing helped to support and develop the collaborative nature of the second and third photonovel. In this process, of course,, the clients gained expertise and the consultants were learning to let go and begin each new project at a higher level of participation than had existed earlier. Although the consultants were committed to client participation, this commitment coupled with experience allowed them to more closely model their work, at the end, on a broad-based interpretation of the Freirian method. Client participation in the development of their own learning materials would, it was assumed, posit the learner as subject and prime actor, incorporate generative themes, and, ultimately, stimulate problem-posing discussion.

However, for the first photonovel, project initiation took place in meetings between the consultants and the staff of the Council and did not involve clients as full decision-makers. Clients did provide information and stories, react to work in progress, and serve as actors for the book itself. Although clients were consulted, the writing and designing of the photonovel, the photography, and the production of the final layout for the printers was done by the outside consultants and teachers. Thus, the product, although reflective of the client’s reality, had not fully involved them.

For the second photonovel, a more collaborative project, the clients designed the draft of the story with minimal help from one of the teachers and their draft was put into final design by the consultants. The production was a cooperative effort with the clients doing some of the photography and layout. The third photonovel was planned to be completely directed by clients who would produce the material while the consultants and teachers acted as technicians. The clients did direct the process and were involved at every stage; however, the final layout was again put together by the consultants.

Freire’s belief that educational materials should express the reality of the learners was served here by having members of the learner population involved in the development of these reading materials. The Los Hermanos series presented important, real problems of worker-employer relations, police harassment, the confusion of an immigrant, and finding love in a new land. Adult literacy and ESL learners need simple reading materials to practice their new skills. The consultants interviewed learners, teachers, and administrators who reported that the photonovels gave the learners a chance to discuss their common problems and share solutions while practicing their literacy skills. 

Although the professional materials developers could have run focus groups to uncover important themes and then produce attractive stories, learner participation provided an authenticity that supported the process of empowerment. Based on informal interviews with learners using the materials, the consultants concluded that even for learners who were not involved in the development of the materials, the knowledge that these books were produced by learners like themselves was a sign that, as a group, they had become the subjects of their learning.16

Environmental Health

In the Los Hermanos series, the content of the photonovels was the generative themes of the prospective learners/writers. The learning of literacy came out of the reading of those themes, and, therefore, there was no need for the designers of the educational process to impose an area of content. With health education, however, the materials must have a focus on a health issue. This presents a dilemma to the educator who wants to follow the participatory, empowering methodology to its conclusion that learners should define the content and form of their materials.

In a neighborhood project in upstate New York, the consultants who managed the Los Hermanos project worked with the Department of Public Health to produce a photonovel, eventually called A Working Neighborhood: What Does It Take?, on a specific environmental health concern of the department’s-rodent control. Although rodent control was a major goal for the health department, community representatives did not regard this as a major problem. Racism and unemployment were both of major concern to a variety of community members who believed that these issues must be central to the story. Residents did believe that the refuge on local vacant lots was problematic and agreed that this could be the health focus of the photonovel as long as their issues were aired. Because refuge was providing rodents with food and harborage, the health department agreed.

Representatives of two neighborhood groups and other community residents interested in working on a project met at the community center. A final working group, drawn from this initial gathering, convened, wrote a story, and produced a final draft of a photonovel in three sessions of several hours duration. A working group of volunteers sat around a table in the community center building and rotated the responsibility of transcribing the story on newsprint by noting what would happen on each page of a 16-page book. Then each page was expanded and detailed with stick figures. The story line and theme emerged with the development of characters, dialogue, and action.

The story of A Working Neighborhood: What Does It Take? focused on neighbors (one African-American and one white) neither of whom talks to or likes the other. Issues of unemployment, racial tensions, and accusations are expressed and resolved and eventually, at the end, neighbors discover how much they could accomplish if they work together.8

In several additional sessions, the photography was completed with community members taking the role of actors. The last scene of the story focuses on a community working to clean up the lots. For the photography sessions, the community groups actually got together and cleaned several vacant lots with the assistance of public health officials. For this and earlier scenes, the facilitators functioned as photographers and technicians. One of the health department officials assembled the final layout of the photonovel and submitted the product to the community group who maintained veto power.

Evaluations indicated that users of the photonovel identified people and places in the photographs, believed that the events depicted were similar to events in their own lives, and were more willing to work in a neighborhood clean-up program than were readers of placebo materials addressing the same health problem.’ The production process, in addition, allowed community people an unusual opportunity to discuss and debate the issues of community sanitation with neighbors and with government officials. Community residents took action and were able to garner government support as well. This project only involved about 30 community residents and was a single event. A sustained collaboration between the health department and the community might have provided an ongoing problem-posing experience and produced more community action. As it was, this project illustrates the potential power of full participation but highlights the limitations of materials production isolated from a more encompassing educational/action effort.

Smoking Prevention

This public school-based participatory materials development project focused on smoking prevention among adolescents. The goals of the project were threefold: encouraging the inclusion of effective smoking prevention programs in schools in Franklin, a rural county of Massachusetts; stimulating the use of vocational or technical schools as regional centers for the production of learning materials; and facilitating the development of educational materials for students produced by students. As was true in the first two cases, the clients (students) were not involved in project initiation. The project director was particularly interested in the concept of a technical high school developing the capability to produce low cost, locally oriented health materials for its students and for younger students in feeder schools.

Students accepted the need to work within the given parameters of a focus on smoking prevention and agreed to prepare a book for fellow students that would also be suitable for elementary school children. Thereafter and within these constraints, they did have the freedom to develop their own product. The production process, although facilitated by an outsider, was influenced by the school setting and was more structured than was the production process for the previous cases that involved adults in a community setting.

The ninth-grade students followed a procedure that incorporated Freire’s problem-posing elements. Students were able to (1) engage in dialogue and together reflect on aspects of their reality (smoking embedded in issues of adolescents); (2) search for root causes (the hard sell of peers and advertisers and the modeling of adults); (3) examine implications and consequences of issues (the pros and cons of smoking); and (4) develop a plan of collective action (produce health education materials). However, the collective action seen as the production of an educational book in the form of a photonovel was clearly predetermined and imposed from without. At the start of the writing process, the girls and boys wanted to go in separate directions and, with the facilitator’s agreement, developed independent story lines. The class decided to track the two main characters throughout the book and present the girl’s story on one side of a page and the boy’s on the other, bringing the two characters together in a party at the book’s conclusion. Separate action stories for boys and girls and the emphasis on mundane concerns of smoking behaviors incorporated in the story might have been missed by professional materials developers.

Students were the decision-makers throughout the entire production of the book and completed a 12-page book titled Decisions, Decisions. Students planned for the distribution of the finished product, developed one of the evaluation instruments, and contributed to a teachers’ guide for the use of the materials. The photonovel served as the basis for lessons on smoking prevention for ninth and fifth graders from two neighboring schools. On the day of schoolwide distribution, reporters from the local paper and television news station covered the day’s activities. The project evaluation included examination of health locus of control, reported intent to smoke, reported smoking behavior, subjective assessments of the value of a participatory process, teacher ratings on student receptiveness and responsiveness, and user ratings on readability, relevancy, and preference. Overall, change was in the positive direction but not statistically significant; however, teacher and student ratings of the material were high.17

Participants maintained decision-making ability and fully developed a product. However, the participants were not strongly linked to the program goals and would not have identified smoking as a primary concern. The process was not without problems. For example, the boys had decided to use as the actor for their main character, a boy well known to be a heavy smoker. These and other built-in jokes surely had an effect on the peer group reading the materials. In addition, the photonovel was produced through a local printer instead of the school print shop when last minute school scheduling mandated a change. The materials were used in the classrooms as planned but, once the outside funding and consultants were gone, the project was not replicated, as had originally been envisaged.

Occupational Health

The occupational health materials development project was designed to support a larger asbestos educational and screening effort among union workers in the construction trades in Baltimore, Maryland. A small group of men drawn from seven unions, comprised the core of the voluntary work group. Again, project initiation was in the hands of the consultants but the work group, particularly interested in asbestos exposure issues, was eager to develop a photonovel to be distributed to union members in all the construction trades in the city.

The culture circle discussions about the key word asbestos provided opportunities for participants to analyze their own reality. In the first several meetings, participants (several of whom had diagnosed asbestosis) shared personal experiences with asbestos and began to explore the root causes of their exposures. Participants decided to focus on a true story and follow the events of one man’s life. Shared anger, frustration, and powerlessness shaped a story that chronicled this man’s path from active shop steward to retired semi-invalid.

The writing of this first story was a powerful event for the participants. They were not, however, pleased with the sense of hopelessness at the end. They began to discuss their active role in writing a book for others. This self-conscious awareness of their own action shaped the second story, which was illustrated in a 24 page photonovel, titled Workers Take Action: Fighting Asbestos in the Building Trades. The story characters, like the work group participants, take positive action in this educational booklet geared to activate others.

Work group members took the lead in story development, plot sketch, and filming scripts and brought together a wider group of workers and family members to participate in the actual filming. Facilitators were more active in the formatting and assembly stages and had full responsibility for the evaluation component. The first small printing (500 copies) was used exclusively for the evaluation. A random sample of 500 members of the building trades locals received either a copy of the photonovel or of a commonly distributed National Cancer Institutes’ asbestos pamphlet with an evaluation questionnaire. The photonovel was rated higher in readability and carried more general credibility. Readers scored higher on factual recall, had more positive attitudes towards future involvement in health and safety issues, and were more likely to take action in the future.10

The subsequent printing (12,000), used to encourage screening and union action, enjoyed wide distribution among all the building and construction trades of the city, and was supported by the Trades Council and the AFL-CIO. This case, more than the previous cases, combined a very powerful process with an issue of vital interest to participants who subsequently served to promote and distribute their product.

Analysis of Participation in the Cases

An empowerment model emphasizes the importance of participation and, as Wallerstein18 has noted, participation in decision-making is, in itself, health enhancing. Each case involved participants in different ways and at different stages in the process of materials development. Important decisions made at each stage determined the form, content, design, and use of the final product. To be true producers of the materials, clients must participate in these decisions.

Initiation

The first decision in the entire materials production process is to begin a project. In all the cases under discussion, that decision was made by professionals, not participants. Participants were brought into the initiation phase when they were asked whether or not they wanted to involve themselves in the materials development process. However, this question of who will participate and what authority they will have over the form of the material is at least as important as the decision to begin the project itself. Overall, bringing participants in before any other decisions are made is important and will set the tone of the rest of the work.

Certainly, there are situations where conflict and division exist and where the exclusion of one group could effect the outcome of the project. The involvement of a cross-section of all potential participants at this stage can bring important issues to the table and provide a way to argue out a consensus. In the environmental health case, the initial decision of who would participate was made by community groups; the school administration determined which ninth-grade class would have the option to be involved in the smoking prevention case.

Design

Both form and content are important considerations in the design stage. In each of the cases, the decision to use the photonovel form was predetermined; however, content decisions did involve participants. In the environmental health case and in the smoking prevention program, the participants were not initially interested in the health message but were offered opportunities to determine which additional issues would be included. Involvement of clients can mold the content and make the resultant product more effective than it might have been without it. In the smoking prevention case, the students decided to have both a boy and girl strand to the story and added nuances of teen culture, which the professionals may have left out or presented incorrectly. Furthermore, students were able to incorporate issues of salience to them but rarely stressed in traditional health education materials.

Production

Decisions at this stage are, for the most part, technical. In several of the cases, the professionals took care of the technical side of the production and the participants were involved as writers and actors. The most important decision at this stage is the decision that a final product is ready for distribution. If the participants do not have the decision to change or veto the use of a final product, then their decision-making and involvement throughout the process have no meaning. In the occupational health case, a clear point of decision was presented to the participants, and it was on their authority that mass production of the materials (with revisions) went forward.

Utilization

Who controls the distribution is the important decision at this stage. In none of the cases did the facilitators give complete control over this decision to the participants, but they all gave the participants the right to have the materials for their own use. Also, the participants knew in advance, in each case, how the materials were going to be used and by whom. In all cases photonovels were used for educational purposes and distributed at no cost.

Evaluation

Evaluation provides the participants with a chance to reflect on what they have done and learned from the experience. Out of that reflection can come greater decision-making and involvement. For these cases, evaluation was completed for the needs of a funding agency or for publication by the professionals. For the school-based photonovel, the students were able to add questions of interest to them for the assessment of, the learning materials. If an agency wants to develop a long-term relationship with a community, involvement in the evaluation stage can be crucial.

CONCLUSIONS

Participatory education requires learning materials that support the process of empowerment. These materials must help the learner understand and accept his or her role as the active subject of the educational experience. Strong and engaging learning materials can certainly be developed by professionals. The themes and key issues of people’s lives can be reflected in these materials if they are developed through rigorous formative research, adequately pretested, and redesigned. However, there is an added value to involving the learners early and at every stage in the process. Participant involvement ensures that the themes are relevant, allows the material to present the health issue from the point of view of the learners, carries the authenticity of the learner/authors, and can lead to further involvement. Most importantly, this level of involvement serves to reaffirm the vital role of learner as activist.

Resultant materials are products of, and credited to, members of the target audience and can inspire readers who may not have been directly involved in the process. For example, readers of the materials for both the environmental and occupational health projects were more likely to report activist behavioral intentions than were readers of other, more traditionally developed educational materials.9,10 Furthermore, participants in such a process, as members of a community, now have the needed expertise to develop additional materials.

To involve learners as real, empowered participants in materials development, the health educator must be willing to negotiate the content of the materials. Learner concerns and priorities must be included in materials along with the focus on a given health issue. This negotiation process often serves the issue well because a melding of the two topics grounds the problem in the reality of the targeted audience.

In addition, program planners and funders must be attentive to time needed for a process-oriented approach. Learners need the time and the space to become comfortable with directing the process and this often requires that the professional, as facilitator, not rush in to fill the temporary void with imposed stories and issues. The health educator must facilitate a process and not, consciously or inadvertently, determine the outcome.

The final product will often have flaws from the perspective of the professional and may certainly lack the slickness of commercially prepared materials. However, the production process can be a powerful learning experience and intervention in itself, one with a concrete product that is illustrative of the learning goals. The final product, owned by and credited to the learners, can inspire and stimulate others. Consequently, both the process and the product are reflective of a problem-posing approach.

Materials development, nonetheless, does not constitute a full learning experience or a complete educational program. Embedded within and supportive of a problem-posing educational program, participatory materials development activities extend the goals and posit the learner as activist and main subject. The participatory process can be an empowering one and the product stands as testimony to the authors as self-conscious agents and critical thinkers. This can provide a powerful model for the readers who can identify with the friends or neighbors who developed the materials and who, like themselves, grapple with similar issues in familiar settings. Furthermore, program goals will be enhanced even more so if the work groups who developed the materials can play an active role in leading group discussions among readers, in helping them “decode” the photonovel, and in planning further action. Overall, health education goals are enriched through learners who are active, self-conscious, critical thinkers capable of transforming their world.

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