 What Dr. Zarquidels was talking about earlier, Anna Matea has a special gift that she's provided, I would say the whole nation, if not more than that. But we have definitely used the resource that she has in creating Photonovellas. The Ryan White, Bear County's Ryan White Department actually did a Photonovella for our older adults for STDs and management. And so we've partnered with her to develop something that was very conversational. That much to what Zarquidels was talking about today was about what we read and how we speak are things that we need to take a value. And so the Photonovellas that were created here were done by people just in the layman community and we had conversations, we had the literature written in such a way where it was a conversation and not something that was pre-written for them or pre-set. So I just want to take a moment to tell you a little bit about Ms. Anna Matea. She has in her 25-year career in health communications, Ms. Anna Consuelo has specialized in social marketing, multicultural health communications and specifically in Photonovellas development and production. She is one of the first health communications specialists in the United States to use Photonovellas as health education tools and is the most experienced educational Photonovella producer in this country. And today we're going to have a conversation here with her at Plenary, but then she's also going to be hosting a hands-on workshop later on this afternoon. So please help me welcome Ms. Anna Matea. Thanks a lot. What a great presentation. Thank you very much. I have a terrible cold, so I'm going to do special water, yeah, appreciate it again. Help me pronounce your name, Dr. Chris, Dr. Chris, for really widening and bringing us the attention to the spectrum of health literacy, right, which is very, very important. And I did read one of your papers on the airplane, on the way over here. So I got familiar with your concepts, but so I'm here today to talk to you about Photonovellas, which is like my life's work and passion. And is this the control? It's this little flesh up here, yeah, and I speak Spanglish, so and I think a lot of you do too, but my presentation is in English today, but I will entertain questions in Spanish as well. So yeah, so Photonovellas, so let's see here, or right here, yeah. So what is a Photonovella? A Photonovella is a story told of photos in dialogue. Dialogue and thoughts are presented in bubbles in comic book style and the narrative is presented in captions at the bottom of the frame. That's a simple definition of a Photonovella. And the way I came to this medium is through my childhood, because I was raised on the border in Nogales, so no, I was born in Nogales, Sonora, and raised in Nogales, Arizona, and both Nogales as they say in Arizona. And I was, I read Photonovellas for fun. And these were, you know, in the 70s and the 60s, 70s, when Photonovellas were about love stories, right? They were the maid falls in love with the son of the Hacienda owner, and then now becomes a señora and now she's like so successful and whatever. Those are the rosas, the Photonovellas rosas, the pink Photonovellas. And then there's the Photonovellas rojas, which is, I would probably be a lot wealthier woman today if I were doing Photonovellas rojas, because those are like pornographic Photonovellas. So I could do it under a pen name or something, what the heck, right? And then there's vaqueras, there's all kinds. So just a little anecdotal thing, a little tidbit on Photonovellas is they became very popular, a little history. They became, they date back to about World War II when we couldn't export films. And so what they would do is they would create these Photonovellas out of the, with pictures from the films and then export those. And so that way the film industry could get the stories out to people who, you know, because in those days it was very difficult to export film. So that's kind of a little bit of history about how Photonovellas came to be. But they became part of Mexican pop culture in media in the 70s and the 80s. And in 1979, this is another trivial thing about Photonovellas, but it's really, I think, interesting, in 1979 Mexicans, you know, in Mexico were reading 70 million copies of Photonovellas a month. Okay, so a month, 70 million copies a month. And it used to be, they used to go to Mexico and they were in the kioscos. You can still see them in the kioscos in Mexico. Now they're more like historietas which are drawn, illustrated stories like graphic novels. And so there's this wonderful study that a historian, sociologist Irene Erner, Mexican historian, and she did a wonderful study on Photonovellas. And one of her statements is why in the country, this was before we did Photonovellas educationally, why in a country of supposedly people who can't read, right, low, in those days we used to call them low literates, low literacy or low literates, supposedly in the country that has so much illiteracy, our Photonovellas so popular. I mean, you could get on the bus and there they were like people reading Photonovellas, historietas, and like by millions. And so there's a really, for those of you who are interested in Photonovellas, the work is called Mitos y Monitos. It's in Spanish, but it's like, it's an amazing study on Photonovellas and historietas. And so then they evolved, like I said, my history with Photonovellas is I used to read them. My mother hated that I read them because it's like reading like Harlequin's only with pictures, right? So she's like, I can't, Cochinero, estás leyendo, you know? She would get really annoyed. She didn't realize that I was going to make a living, you know, doing House Photonovellas. So then they evolved into an entertainment education tool in the 80s, right, along with telenovelas and Photonovellas. And Eve Rogers did a lot of work, entertainment education. There's very successful case studies of Brazilian Photonovellas and telenovelas that really moved the needle on family planning in Brazil. There's a very rich history of success of Photonovellas in reaching out, not just in the United States, but in other parts of the world. And today, because of the research that we've been able to do on Photonovellas, and I've done some of that research and my other colleagues have done other research, USC has done some pretty interesting research on Photonovellas. Today it's considered a best practice in bilingual health education. But one of the things that I think is the most significant about, yeah, I brought you pictures. These are like telenovelas rosas from the 70s. And I have quite a collection of Photonovellas. But I think one of the things that is kind of in line with what Dr. Chris said earlier, is that one of the reasons I think Photonovellas are so successful in terms of reaching out to people, and especially Hispanic folks, although they are not. I mean, Mexico, it was a Photonovella boom in Mexico, right? But I think one of the reasons that they are so popular is that they're real people experiencing real problems. And also in terms of our own people, in our own Hispanic people, in the United States, it's a way to show respect for them. Because it's a culturally normative, appropriate way to communicate in many parts of Latin America and Mexico. And when you do that for the population in your community, they feel respected. Because you're not just throwing some script at them, some 12th grade level pamphlet at them. So the way I produced the first picture that you saw, the black and white picture, let me see. This Photonovella, I produced this Photonovella in 1983 for the Southwest Arthritis Center at the University of Arizona. And the reason that I did that is that I worked at the Arthritis Center, and we were working with people with lupus, chronic conditions like lupus, MS, rheumatoid arthritis, arthritis. And one of the rheumatologists had developed a pamphlet on arthritis. And since I was the bilingual health educator on staff, he asked me to translate it. And a rheumatologist wrote it. I mean, rheumatologists are awesome. I love rheumatologists. But this guy wrote it like it was a dissertation or something. So here's this dissertation, threefold dissertation. And he gives it to me to translate into Spanish. So while before, it was like 12th grade level, maybe higher. Now it was 14th, if there's such a thing, after the Spanish. I did the Spanish. And then I joked around with my colleague. And I said, you know what? This is ridiculous, right? I mean, who's going to read this? And I said, you know what we should do is we should do a Photonovella, man. And then the executor director, Gail Riggs, bless her heart. She said, what's a Photonovella? And I told her, and she goes, do it. So she got money from the National Arthritis Foundation, and we produced our first Photonovella in 1983. And it was called Dolores y Esperanza. And for those of you who don't know what that means, it's about arthritis. It's pain, I love Hispanic names, right? Dolores, pain and hope. Yeah. I wouldn't name my child pain, you know? But Dolores works kind of in Spanish. It's just one of those things that doesn't translate. Anyway, so there's a little history of Photonovellas. So here's some Photonovellas rosas, and check it out. Check it out. Look it, cut and paste bubbles. We've come a long way since the cut and paste bubbles. But I still have the boards. Remember boards? I still have the boards of that Photonovella that we produced in Tucson. I mean, I still have all the little bubbles and everything. So this is what the guts of a vintage Photonovella looks like. So in the 1980s, when we were hit hard with the HIV AIDS crisis, I was working for a firm in Santa Cruz, California, ETR Associates, and they do a lot of sex education, family life education. And I was a staff writer and editor there. And we got funded to do the California AIDS Clearing House at the time to try to develop materials to spread the word about HIV and AIDS. And so Ojosque Novan is not one that we produced. That was produced by an organization in San Francisco. But Saturday Night Special, which is in Spanish Salado Loco, check out the hair there. And we produced this for California AIDS Clearing House. And a million copies were distributed of this Photonovella in Spanish and English all over the United States. And this one, Saturday Night Special, was actually, I'm very proud of this, was in an exhibit in the Smithsonian featuring our nation's response to the HIV and AIDS crisis. So that's when Photonovellas kind of hit their stride in the United States. And since then, I mean, I've probably produced 100 Photonovellas, but my colleagues have probably produced several hundred Photonovellas. And so now one of the iterations of Photonovellas is that we're going digital. And actually, we produced Barbershop Talk, which is out there for you guys to take, for the Ryan White program. And we produced it in print. But we did the digital piece, which was just turned over on Monday. With all this busyness, probably people haven't even delved into it. But we are producing digital Photonovellas now. And we're producing digital interactive Photonovellas. This particular one is not really interactive, but we did one on HPV that's interactive. So we've iterated on this. Here's an HPV prevention Photonovella that we did. And this is bilingual, entre nos, between us. And this we did with NIH. It's a research project. And it's a prototype, a very high fidelity prototype. Here's one of the. And we rotoscoped it, which is we used, we fooled around a little bit with a photography. It's not just straight up photography. It's rotoscoped like Barbershop Talk is rotoscoped. And one of the things that we found out through some of the research that we did is with this particular one, we went to L.A. It was CDC, NIH, CDC-funded project. And we went to L.A. and we compared a traditional Photonovellas with photos to the rotoscope Photonovellas and with women 18 to 26 Latinas, bilingual Latinas 18 to 26. And they preferred the rotoscoped approach. It just made it look more modern, more like a graphic novel than the straight up photography. So that was an interesting thing that we found. And so when we were doing Barbershop Talk, I recommended that we do a rotoscoped version. And we field tested, or shall I say, Charlene's staff field tested the idea. And the kids that we were trying to reach out to preferred the rotoscoped method. So it's a beautiful Photonovella. I hope you all, here's the cover. Yeah, here's the cover. But it's out there for you. And I had a white paper distributed that gives you everything you ever wanted to know about Photonovellas. And I think you each have one. So yeah, so the evolution of Photonovellas, they started off as a community-based solution to a problem. It wasn't a research-based solution. I'm probably one of the first people in the United States to develop Photonovellas. But AID was producing Photonovellas in Africa on family planning. And I don't think I was the first person to do Photonovella in the country. But it did start off as a community-based solution. And it evolved from a culturally responsive and pop culture medium to an entertainment education tool to make health information relevant and accessible. But let me also say that those of us in health communication that develop health communication materials know that a pamphlet of Photonovellas, a book, is never a substitute for good, solid health education. And person to person, deploying Photonovellas is a brilliant idea. We've come a long way in health education. And I just wanted to share a little bit, and I'll keep track of the time here. We just finished a study where we compared Photonovellas distribution, because it's really important to understand how you're going to distribute and disseminate the Photonovella before you even start. And one of the things that we did, we did a little research project in Albuquerque and Española and Sunland Park. And we compared a pamphlet, just a straight up little easy to read pamphlet and poster. Photonovellas distributed through the thrifting nickel. They have that in New Mexico. I don't know if you guys have that here. But it's where you go buy a washing machine. Well, I figure you know why you want buying a washing machine. Maybe you can learn a thing or two about prediabetes. And so we put it in there. And then so that was just publishing it in the newspaper. And then in the South Valley of Albuquerque, which is kind of a rural area of Albuquerque, we deployed promotoras and put it in the newspaper. And the response with the promotora distribution and it was just distribution. It wasn't like chatting people up in your neighborhood. It was just distribution. Promotoras distributing plus in the paper, the response was much, much better. And I was talking to Dr. Penny in our table there. And it's like, I do a lot of formative research. I'm a social marketer. So I approach everything from formative research, audience-centered, audience-driven responses, health communications. And I do a lot of focus group interviews. And when I do Spanish focus group interviews, I always tell them, this is a focus group interview and this is what it is. And I define it, right? And I say, I'm here to learn from you. You're not here to learn from me because I may not have any expertise in the topic that I'm gonna ask you about, because I don't know about every topic, right? So I make it super clear that I'm there for them to give me information because we wanna improve how we communicate with others, blah, blah, blah. At the end of the focus group interview, I always ask at the end, what else do you think we could do to reach out or to whatever, the last question? And they almost 90% of the time say, have more educational sessions like this one. It wasn't an educational session. It was a focus group interview, but because they learn from each other, they went, that's what, so that person-to-person contact, I mean, that's really, and especially with, I mean, my area of expertise is really grounded in educating Latinos about health. And especially with our Latino community, it's really, relationship is really important. So it's never a replacement for good, solid relationship building, health education, it's never a replacement. All right, so, so why Photonovellas? A little redundancy. Popular storytelling medium among Latinos, we covered that. They're entertaining, right? And the crazier the photographs, the more entertaining that they are. So a lot of times I have to really talk my health education colleagues into making the photographs crazy because it's gonna attract attention. You're gonna look at it. You have some weird expression or whatever. You're gonna look at it. You're gonna go, what is going on there, right? So the crazier the better. They're entertaining. They're visually appealing, hopefully, and they're emotionally engaging. And we'll get a little bit into, we'll get a little bit into the emotional engagement part, but come to our workshop because we're gonna talk more about that in hands-on, in a hands-on fashion. They're intrinsically easy to read because you don't have to do a readability test on Photonovellas. You do, you know, I do because that's what my clients want me to do is do a readability test. And I do, but I know that if you write dialogue and you have a conversation and your people are having a conversation, you don't need a readability test. So it's dialogue. It's what people say. The other thing is that they're great for role modeling and we'll get into a little bit about that, you know, Bandura has done some interesting things around social cognitive theory. This is an important anecdote for the Mexicans in the room. I always thought Bandura was Mexican because he's not, you know, he's like from Eastern Europe or something, but I always pronounce Bandura, Bandura because I thought like, hey, it's paisano, you know? And like it turns out like he's from Czechoslovakia or something. Anyway, it's, you know, the Czech Republic, excuse me. Anyway, I think, so yeah. So they're a very effective as role modeling tool and they're an ideal form of entertainment education and we'll get into a little bit on why. Now, you know, when we started, when I did the Dolores y Esperanza in 1983, I had no idea who Savito was. I had no idea who Bandura was. I hadn't read any applied research on graphic narrative, you know, because it kind of came like organically, right? It just comes from the gut, right? Then now everybody's just like, you know, validating what we already knew. But that's what, you know, so they used to joke that that's what sociology is anyway, is like validating what you already know. But anyway, that was like, I was a sociology major and I love sociology. It's not a diss on sociology. Anyway, so these are some of the theoretical frameworks that you can use that when you're writing your grant, you could say, we're gonna use these because they're all pretty much grounded in good solid research and I'll go over it a little bit. A little bit. So just some key things about the Savito methodology. So it's a typical narrative character structure from Savito would be that you have a positive character doing the thing you want the people to do. You have a defiant character who says, I'm gonna eat all the pumpkin pie I want. And then you have a transitional character, the one that's transformed by the dialogue and the story. So it's a very kind of easy way to build a story. And we kind of built that story with Barbershop talk, right? You have the barber who knows about HIV, has had experience and you have the young kid that's just having a good time walking in, he's the defiant character. I don't need to use a condom with this guy. Look at him, he looks clean, right? And then you have, well then he turns also into a transitional character because by the end, after hearing his friends talk and hearing the experience of his friend Alyssa about the cousin that ended up in the hospital, then he goes, yeah, you know what? Maybe I should start paying attention. So that's the Savito kind of narrative structure, a fotonovela. The other is the Bandura social cognitive theory, very simplified concept about that, is that the best way that you learn is by going through the experience yourself. That's the best way, right? The hard way, learn by experience. But the second best way is by observing others going through that. And so that's what a fotonovela does, right? Fotonovela shows you somebody going through the experience. It's vicarious role modeling is what it's called. And now there's fantastic work and those of you who are interested in comic, any kind of graphic storytelling to get your message across. There's wonderful work, great work done on the power of graphic narrative that iterates on the work of Bandura and Rogers and Savito. Sheila Murphy of USC has done some great work around these factors and she features others in her work and I have at the end a citation for you to just read, I just put one article in there because if you read that and you look at the bibliography you can get so many other research papers that you can access. But the iteration now is they talk about transportation into a narrative world and transportation is a distinct mental process that you go through and it involves the convergence of attention, imagery and feelings, right? And it's anytime you read a really good story, right? Anytime you read a good story, if it's a good story you're gonna be transported into that world. You're gonna identify with that character and you're gonna be transported into that world. And although that's very challenging to do in Photonovellas because they have to be very brief, it's still very possible and I would really encourage you to really think about that when you're developing characters. So the breaking down the transportation a little bit, it's engagement with the characters, it's engagement with the story, it's perceived relevance to what your situation is, perceived susceptibility and then the impact on behavior and change. Now the other thing too is that it depends on where, you know, one of the things that I do a lot of work with is around the stages of change, right? It depends on where you are and your Photonovellas, you know, do you wanna go, and it's really important that, well, where are they in the stage? You know, are they just contemplating? Are they, is it not even on their radar? Are they ready for action? Where are they? Because a lot of times people don't make changes because they're just simply not ready to make changes. So yeah, so let me talk a little bit about the process and then we'll have time for questions and answers. The first step is planning and defining your audience as specifically as possible is really, really important. And then after you define your audience or in conjunction with defining your audience, you involve your audience. And that's one of the things that the team did here. They got the young people involved in the process. And, you know, we had written a synopsis and then they ran the synopsis by them and they're going, and then the script is like, you know, I'm not 22 years old. And so we wrote the script and like nobody makes that joke, you know? So that we changed the language based on their input. So that was a really great process. And then you identify your educational objectives very, very, like three max. That's a lot of times people make them to stay going on and on and on in anything, any reading material. Two is probably better than three. And then, of course, obviously define the call to action, whatever that is that you need them to do at the end of reading your photo novella or engaging with it as it were if they're online. And then story development. Again, you consult with your audience like I told you, can't say that enough, cannot say that enough. And then you develop the storyline, the characters, the dialogue and the setting with the audience input. Because that's what's gonna, you want the story to resonate with them. You want it to be relevant. And so that's the second step. And then, well, going back to the second step, this is where the script development comes in at, in the second bullet, right? You develop a script and again, you test it. You test it with your audience. And then again, you just keep involving, it's iterative. It really is iterative. And I know a lot of times we don't have the time or the money, but it, and from a research perspective, you want three groups so that you can triangulate so that you can compare. But I can't stress this enough that even if you have one group at each interval, you're gonna get really valuable input. You're not gonna change the health information, but you're gonna change the approach to the health information. And that's really important. So yeah, so in summary, the Photonovena addresses health literacy in two important ways. Because of their personal, emotional and cultural relevance, they inspire our audiences to learn new healthy behaviors. And because they're based in dialogue, they're intrinsically easy to read. And just for fun, I brought you some pictures and I have some with me. Photonovelas from Brazil, Nigeria, Japan, and check it out. So that's Descubrindo Amor from Brazil, which is very funny. And look at that in black and white. I love black and white. But now our audiences want color, but I love black and white. That's Brazil. And this is from Nigeria. This is a family planning Photonovela developed in the late 70s in Nigeria. And then here's a Japanese one, man. That blew my mind when I saw that at a garage sale. I thought, whoa, but check out the cover. Yeah, that's inspiring, right? I want a cover like that, yeah. Anyway, so yeah, look at this. An American made in the USA Photonovela on how to make biscuits. It's really funny, it's so cute. I don't even know, I may have brought that so you could see the inside of it. And Jenny's favorite recipes. This is from probably right after the war. I looked for a copyright, but I couldn't find it. But that looks like right after World War II, doesn't it? So yeah, now, a pet peeve of mine. I had to end with a pet peeve. Photonovelas have photographs in them, okay? Photographs, if it doesn't have photographs, it's not a Photonovela, it's an historieta. So, you know, let's stay with the legitimacy. The CDC did a Photonovela quote, unquote, with illustrations and they asked me to review it. I said, it's not a Photonovela, folks. This is not a Photonovela, Photonovelas have photos. That photo is an operative word. Yeah, so anyway, here's Sheila Murphy's article. It's so great telling stories, saving lives. And she did a film with Latinas in it about cervical cancer, which is really great. And then here's an interesting article on the role of transportation and the persuasiveness of public narratives. If you want to take a deep dive, anyway. So yeah, there's my contact information. And yeah, gracias. Do you have any questions? Connor, I have the mic, so I want to start with my question if you don't mind. Can you explain what you mean by digital Photonovelas? Is that just a website? How are you going to make it interactive? Yeah, usually, the ones we've done, like for example, we did something like 16 of them for Kaiser Permanente in California. And you can just go to YouTube and say Kaiser Permanente, Photonovelas, and they'll pop up. And they have voiceover, they have the bubbles, but they have voiceover and they have movement. It's not film, right? It's still photography. But, and then of course soon, you'll have the barbershop talk, which is gonna live on their website. So you could do that, you could build an app with it, make it interactive. So that's what I mean by digital. Yeah. Christina, again, I have a comment and a question. So I'm not sure, can you guys hear me? In the military, at most of the military hospitals, we have pediatric, we call them comics. And to me, they look very similar to this, but they actually also have the characters in life that come around and will read to kids from time to time, those books. And they're all geared towards living with asthma or living with diabetes, and it's all pediatric. So would you consider this in the same realm or completely different? Oh yeah, yeah, yeah, yeah, it's graphic narrative. Yeah, yeah, yeah. Yeah, that's visual storytelling. And it's called MediKids just in case. I'm sorry? MediKids? Oh, MediKids. Oh, okay, yeah, I think I've seen those. The thing to watch out for is trying not to make them, you know, the medium is naturally low literacy if we could still use that word. They're naturally easy to read. Try to keep it that way by not overloading with concepts, you know, and keeping the language conversational. That's really important. And a lot of times I've seen, you know, Photonovellas, graphic narratives that are still, you can turn a Photonovella into a high literacy educational tool. You can. And plenty of my clients have tried. And you know, you push back and then you push back, but then so much, you know, there's only so much you can do and you go, okay, put it in the didactic. That's the part at the end, you know, where you can have question and answers or something. Yeah, any other questions, comments? None? Oh yeah? To ask, oops, sorry. I wanted to ask you, do you find that it's more effective using the Photonovellas to just give information about identifying diseases and I guess like knowing new, it's a new diagnosis, a new concept. Are you finding it effective in also managing conditions? Well, you know, we've done, for Kaiser we did a lot on just finding out more about a certain condition and then we also did for management, but I think you can use them for both. I mean, the other thing too is that they're really versatile in how you use them, right? So like for example, Kaiser in Central California, the print pieces, they go out and they take them to educational sessions. So they have a discussion about prediabetes or healthy eating or cutting down on television or whatever for parents and they give it out and they have it as a discussion tool, right? So that you're going deeper, you're interacting with it, you're having a conversation about it and I think almost any topic will lend itself to that kind of tool. Any other comments or questions? No? I have one again. Did you notice any differences between the U.S. Photonovellas versus the ones from Japan or Nigeria in terms of how they developed them? Well, the one from Japan is literally, I just have that one and it's like this little, I might have brought it, I thought I brought it. It's really small and it's one picture per page with the dialogue at the bottom, it doesn't have bubbles. So, and I have no idea what it says, right? But, so there are differences also in terms of cultural values, you know, you don't, I'm sure there's different cultural values that are promoted through the dialogue and through the conversation. So there are, there will be differences across, you know, I've done Photonovellas in a participatory process with African American and Hispanic kids in California where they actually wrote the dialogue and directed the shots and that was interesting and I had to take a step back and say, I'm just the facilitator, I'm not gonna, you know, so, and that was a very different approach. So, anything else? Any other questions? Are you ready for a break? Okay, a big round of applause again for Anna Matiara. Thank you very much. We have the round, no, the breakout session starting at 1040, so you're on break.