How Picture Stories Teach Health Literacy

February 24, 2014

Kate Singleton, LCSW, is a Virginia-based health literacy consultant who creates Picture Stories, which are a teaching tool for adult education instructors working with English for Speakers of Other Language learners. In 2009, she coauthored a scholarly article, Understanding Cultural and Linguistic Barriers to Health Literacy with VP of Policy and Communications, Elizabeth Krause.

Picture Story: “New Insurance, New Doctor”

This health literacy picture story was created in 2/2014 to help English for Speakers of Other Languages (ESOL) teachers explain basic information to adult English language learners about:

  • the Affordable Care Act (ACA) and how it applies to learners.
  • how to use insurance if you are not experienced with it; insurance terminology.
  • what non-clinical communication tasks to expect when seeing a US doctor or other healthcare provider for the first time.
  • strategies to improve communication in a doctor’s visit.

The story may also be helpful in other educational and healthcare settings to raise awareness of patients and providers alike to issues of communication, information, culture, and overall mutual understanding that are likely to intensify with current healthcare system changes.

So how would you use this Picture Story? Instructions follow after the image.

New Insurance, New Doctor (A story told in pictures) by CTHealth

The Basic Story

Frame 1: Ana applies for new insurance on It’s her first time getting insurance.

Frame 2:  Ana receives her new insurance card about a month later. She is ready to make an appointment for a check-up.

Frame 3: Ana goes to her appointment and presents her new insurance card at the front desk (reception). She has many questions about how to use the card and what she needs to do now that she is at the doctor’s office.

Frame 4: The receptionist says a lot of things that Ana doesn’t understand.  Ana feels more confused.

Frame 5: The receptionist gives Ana many forms to fill out. Ana feels even more confused.

Frame 6: Ana is now very confused. She says, “I’m so confused! Please explain!”

Introducing the Story

Tell learners they will be working on a story called “New Insurance, New Doctor.” Say that many things are changing about going to the doctor and paying for health care in the US, and the story will help them talk about this.

Ask them what they have done in the past in their native country or in the US to get health care or to pay for health care:

  • Where did they go?
  • What did they have to do to get to see a doctor or other healthcare provider?
  • How did they pay for it?
  • Have they had experience with medical forms, insurance, and making medical appointments in the past?

To get the full set of instructions, we encourage you to review this article. It has a list of vocabulary words for the student to learn, and additional questions to ask the student as they read through the picture story.

If you have questions or comments, leave them here – we’ll do our best to answer. We’d like to know if you find this approach helpful or useful, or how you might use it in your work.

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