Assessing learning during health and nutrition education workshops among newly-arrived refugees: The usefulness of the pre/post test in a low-literate, non-English speaking, multi-lingual, multi-cultural group

Health education is a key component of the refugee resettlement process in the United States. Heartland Alliance Refugee Health Programs (RHP), with funding from the Office on Refugee Resettlement through the Illinois Department of Public Health, oversees a unique health and nutrition education and promotion program for newly-arrived refugees in Chicago. The program director and ethnic health educators (and, previously, a refugee nutritionist), provide education primarily during group workshops. Little research has been conducted to assess learning among low-literate, multi-cultural, multi-lingual adult participants, and there are no recommendations on health education strategies in a refugee population using evidence-based research. While the literature regarding cultural competency in health education is extensive, it is relevant primarily for ethnic and racial minorities who have spent the majority of their lives in the United States. To assess our approach, we chose to implement a simple pre- and post-test at each of our workshops and to determine if it was effective in evaluating learning. Activities included observation at health workshops, development of a template for data analysis, review of pre/post test data, and qualitative interviews with health promoters. Data were collected for 12 workshops, of which 10 were analyzed. Eight of the 10 workshops showed at least a 15 to 20 percent increase from the pre- to post-test. Testing the group (“group consensus”) produced better results than testing individual participants, and question type (multiple choice, open-ended) did not affect scores. As a result of this study, Refugee Health Programs decided to develop a modified pre/post test incorporating 5 key points to cover for each workshop topic, to incorporate interactive questioning of participants to ensure that these points are understood, and to use the group consensus method.