









































Best Practices for Health Literacy 
Education for English

Language Learners
Amanda Gao, Lindsey Kuwahara, Britney Shaw

 
GEORGETOWN SCIENTIFIC
RESEARCH JOURNAL

Volume Three
Edition One
Fall 2022

32



Georgetown Scientific Research Journal 

 

Best Practices for Health Literacy Education for English 
Language Learners 
 
AAmmaannddaa  GGaaoo11*,,  LLiinnddsseeyy  KKuuwwaahhaarraa22*,,  BBrriittnneeyy  SShhaaww22*  
*IInnddiiccaatteess  eeqquuaall  ccoonnttrriibbuuttiioonn  
  
1 Department of Healthcare Management and Policy, Georgetown University, Washington, D.C. 
2 Department of Human Science, Georgetown University, Washington, D.C. 
Email: awg42@georgetown.edu, lkk16@gerogetown.edu, bs1081@georgetown.edu  
hhttttppss::////ddooii..oorrgg//1100..4488009911//ggssrr..vv33ii11..5555    

AAbbssttrraacctt  

Health literacy is the ability to retrieve, understand, and utilize health information. Poor health literacy is 
associated with diminished participation in primary and secondary disease prevention strategies, worsened 
mental health outcomes, and difficulties navigating the healthcare system—especially for English 
Language Learners (ELLs) who have language barriers. Pre-health undergraduate students at 
Georgetown University worked in partnership with the Alaska Literacy Program in 2021 to deliver two 
virtual health literacy courses titled “Health in the English Language” to 28 adult ELLs. This paper aims 
to detail key takeaways regarding best practices for virtual learning, teaching strategies, and the significance 
of health literacy experiences within pre-health education. Virtual learning increased course accessibility 
for students and instructors, supported the engagement of students’ family members and friends, and 
increased practice in digital literacy. Studying health literacy and engaging in experiential learning provides 
an important foundation for pre-health undergraduates to learn about how health can be influenced by 
one’s culture. Pre-health undergraduates gain insight into the importance of communicating with and 
advocating for non-native-English speaking patients. Observed success in virtual health literacy education 
supports developing partnerships for future implementation of health literacy courses in rural, under-
resourced, and/or immigrant communities by pre-health college students. 

Keywords: health literacy, ELL (English Language Learner), pre-health education

11..  IInnttrroodduuccttiioonn 
Health literacy, otherwise known as an 

individual's ability to gather, understand, and use 
health information, contributes to improved 
healthcare outcomes.1 Only 12% of adults in the 
United States are categorized as having proficient 
health literacy skills, and 35% of United States 
adults have basic or below basic health literacy 
skills.2 Low health literacy (LHL) is associated 
with worse health outcomes and poorer health care 
service utilization. This includes lowered 
participation in primary and secondary prevention 
strategies, such as influenza immunizations and 
mammogram screenings, and higher emergency 

care usage.3 Additionally, LHL is correlated with 
poorer mental health outcomes and an increased 
rate of depression symptoms.4 Immigrants in 
particular express challenges in navigating the 
healthcare system created by language barriers. 
This includes understanding insurance coverage, 
finding healthcare providers, making 
appointments, filling out paperwork, 
communicating with healthcare providers, and 
finding information about a diagnosis.5,6 

Disparities in health literacy levels exist across 
demographic factors. Immigration status and 
English proficiency levels are two crucial health 
literacy predictors. Individuals with limited 

33



Georgetown Scientific Research Journal 

English proficiency (LEP) are less likely to interact 
with health professionals than other immigrants 
who are proficient in English.7 Across many ethnic 
groups, individuals with LEP report higher rates 
of LHL than those who are English proficient.8 
Those with LEP are also less likely to ask 
questions to their healthcare providers than people 
with more advanced English speaking skills.9 
Although the gap in health literacy could 
potentially be alleviated through clearer 
communication between the patient and provider, 
the lack of patient-initiated questions from LEP 
individuals suggests that healthcare providers need 
to be more proactive when working with this 
community to prevent unnecessary health risks.10  

22.. MMeetthhooddss

Given the importance of health literacy in
facilitating positive health outcomes, Georgetown 
University (GU) undergraduate students 
volunteered at the Alaska Literacy Program (ALP) 
in 2021 to provide a health literacy course titled 
"Health in the English Language." This 
represented the fourth year of partnership between 
GU and ALP. Founded in 1974, ALP provides a 
variety of literacy services including English 
classes, test preparation, citizenship classes, and 
career pathway training to residents in Anchorage, 
the city with the highest immigrant population in 
Alaska.11 Students can enroll in multiple courses 
and may progress through course levels over time. 
The health literacy course was designed to help 
ELL students understand and use health 
terminology to protect their health, prevent health 
problems, better manage health concerns when 
they arise, and navigate the healthcare system—
including making medical or dental appointments 
and understanding one’s health insurance.  

Among all students participating in programs 
at ALP in 2020-2021, 22 language backgrounds 
and 27 countries and territories of origin were 
represented. On average, 44% of the student 
population held a regular, full-time job. The 
remaining 56% were either part-time workers, 
unemployed, or not in the labor force.12  

Three virtual class sections were offered 
depending on English literacy level and provided 
at various times and days of the week. The 2021 
course was the first year that multiple class sections 
were offered through this partnership to allow for 
the creation of two intermediate courses and one 
advanced course. This paper will only describe 
ELL students' and instructors' experiences in the 
two intermediate-level sections. Instructors for 
these sections were pre-health undergraduate 
students at the time of the course. Eighteen ELL 
students were enrolled in the intermediate evening 
class, and ten were enrolled in the intermediate 
morning class. There were 12 class sessions for 
each section, spanning six weeks from June to July 
2021.  

TTaabbllee  11..  CCoouurrssee  oovveerrvviieeww..  Topics and 
corresponding learning objectives that were 
discussed during the health literacy course. 

CCoouurrssee  TTooppiiccss  LLeeaarrnniinngg  OObbjjeeccttiivveess  

Going to the 
Doctor 

● Describing symptoms 
● Making an appointment 
● Advocating for oneself in health 

settings 
● Asking questions about one’s 

health 

What to do in 
Emergencies 

● Describing emergencies 
● Calling 911 

Healthy Eating 
& Exercise 

● Understanding macronutrients 
and nutrition labels 

● Sharing cultural attitudes towards 
food 

● Types of exercise 
● Importance of exercise 

Medication 
Safety and Use 

● Types of medications for 
common ailments 

● Getting prescriptions filled 
● Medication safety 
● Reading medicine labels 

Health 
Insurance 

● Types of care 
● Types of insurance 
● Importance of insurance coverage 
● Enrolling in private insurance 

Course topics included: Going to the Doctor, 
What to do in Emergencies, Healthy Eating & 

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Georgetown Scientific Research Journal 

Exercise, Medication Safety and Use, and Health 
Insurance (Table 1). Topics were selected based on 
student interests reflected in a pre-course survey, 
previous years' curriculum, and advising from ALP 
staff. The original curriculum was developed in 
2018 based on health problems identified in the 
Healthy Alaskans 2020 Scorecard, Health 
Literacy: Guidance and Tools, and through 
collaboration with community health leaders.13,14,15  
Exercises that built reading, writing, speaking, and 
listening skills were incorporated into each class. 
Both intermediate-level class sections followed the 
same lesson plans and materials. Instructors 
participated in the ProLiteracy Education 
Network’s training for ESL instruction. Staff from 
ALP offered feedback on educational content and 
delivery throughout the course.  

The course activities included student-led 
discussions, dialogues, vocabulary learning, 
practice questions such as practicing and reading 
medication or nutrition labels, writing activities, 
and games. For instance, during the “What to do 
in an Emergency” and the “Medication Safety and 
Use” units, dialogues allowed students to practice 
making emergency calls (Figure 1) and practice 
questions strengthened the students’ ability to read 
prescription labels (Figure 2), respectively. 

FFiigguurree  11..  EExxaammppllee  sslliiddee  ddrraawwnn  ffrroomm  tthhee  ““WWhhaatt  
ttoo  ddoo  iinn  aann  EEmmeerrggeennccyy””  ppoorrttiioonn  ooff  tthhee  ccoouurrssee. 
The slide depicts an example dialogue that allowed 
the students to simulate a conversation with an 
emergency operator. All text shown in blue are 
transcriptions of student responses for each 
question given and were not provided to students 
when initially presenting this slide. 

FFiigguurree  22..  EExxaammppllee  sslliiddee  ffrroomm  tthhee  ““MMeeddiiccaattiioonn  
SSaaffeettyy””  ppoorrttiioonn  ooff  tthhee  ccoouurrssee..  The slide depicts 
example questions used to test the students’ ability 
to draw information from medication labels. 

ELL students in both sections were at one of 
two English as a Second Language (ESL) levels: 
ESL 3 (High-Beginning) or ESL 4 (Low 
Intermediate) English proficiency level, as 
determined by ALP testing. The National 
Reporting Systems (NRS), Educational 
Functioning Level (EFL), Center for Applied 
Linguistics (CAL), and Student Performance 
Level (SPL) provide further information on how 
these levels are delineated.16,17 Students at these 
levels can read and write short sentences or 
paragraphs with familiar words, understand 
common words and sentences when spoken slowly, 
and speak about familiar topics using simple 
language.  

33.. RReessuullttss  aanndd  DDiissccuussssiioonn

33..11..  VViirrttuuaall  LLeeaarrnniinngg  ffoorr  EELLLL  SSttuuddeennttss  
Amidst the physical limitations of the 

COVID-19 pandemic, the Health in the English 
Language course was taught entirely online via 
Zoom and supplemented with communication 
platforms Remind and Work Ready Mobile to 
disseminate course materials and to serve as offline 
modes of communication between students and 
instructors.  

Despite concerns with navigating the non-
traditional, virtual class structure, online education 
increased ease of accessibility. Students engaged in 

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Georgetown Scientific Research Journal 

health literacy education while concurrently 
performing other obligations; during class sessions, 
students were observed taking care of their 
children and driving to work. Students had access 
to nearby family members and friends, who were 
often observed supporting students in 
pronouncing terms and facilitating a deeper 
understanding of topics by communicating with 
students in their native/first language. A post-
course survey found that all students preferred the 
online course format over the traditional in-person 
course structure. This was also reflected in an ALP 
student-wide survey—when ALP reopened for 
limited in-person classes, many students wanted to 
remain online.12 All five instructors in 2021 resided 
out of state during the course, as opposed to 
previous years when instructors were required to 
find funding to support living on-site for the time 
of the course. Finally, the number of students and 
instructors involved increased compared to past 
years. The convenience of virtual learning for both 
students and instructors supports the further 
development of online ELL courses to allow 
participants with time or transportation 
constraints to engage in health literacy education 
without interference in their routine schedule. 

Online teaching also posed undeniable 
challenges. Disparities in technology access and 
digital literacy posed an additional barrier to health 
literacy learning. ALP reported that 85% of 
students had internet access at home, while 15% 
relied on cellular data or hotspots.12 While 70% of 
ALP students had access to computers at home, 
many had trouble using them.12  

Course instructors attempted to reduce 
disparities in digital literacy by including a single 
30-minute lesson at the start of the course that 
taught how to use the basic features of Zoom; 
however, some problems persisted. Many students 
had trouble unmuting themselves to participate in 
class activities and connecting devices to the Zoom 
audio. Additionally, many students could not 
correctly type in the Zoom chat, which raised 
additional concerns about modern health literacy 
and students’ ability to fill out online forms and 
questionnaires.   These  aspects  of  digital  literacy

made it hard to gauge students’ comfort level with 
the course material, and technological constraints 
may have impeded learning. 

33..22..  CCuullttuurree  aanndd  HHeeaalltthh  SSyysstteemmss  
Discussions of health insurance revealed the 

diversity of experiences in students' interactions 
with the healthcare system. Students were from 
many different countries of origin, including  
Russia, the Philippines, Samoa, Mexico, China, 
and more. This represented an array of high, 
middle, and low-income countries, each with 
unique health systems. According to ALP staff, 
the students primarily accessed healthcare 
through the Alaska state Medicaid program; 
however, some individuals did not have insurance. 

 Some students expressed a preference for 
their country of origin's healthcare system 
instead of that of the United States. For instance, 
one student suggested that it would be preferable 
to access care in Russia  and that they would 
return to Russia if they became very sick. 
Another student described that they could simply 
talk with a doctor for free, even when there were 
no serious medical concerns, in their country of 
origin, but this is not financially possible in the 
United States under their current insurance plan. 

Others indicated that the United States offers 
more accessible services than their countries of 
origin. One student described financial barriers to 
seeking health care in their country of origin, 
stating that "when you have money, you see the 
doctor. You die before you see the doctor [if] you 
don't have money." Others expressed similar 
sentiments about having to pay upfront before 
accessing medical care in their countries of origin. 

It was evident that students had differing 
levels of understanding about United States 
healthcare. Taking these differences in 
knowledge into consideration, the class 
sessions on health insurance emphasized the 
role of primary care in disease prevention and 
the differences between urgent and emergency 
care. Additionally, classes highlighted the types 
of insurance available to 

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Georgetown Scientific Research Journal 

students (including Medicaid, Medicare, CHIP, 
options in the Health Insurance Marketplace, and 
private insurance), how to sign up for plans, and 
the resources available at a local community clinic.  
The content was designed to foster a deeper 
understanding of the full breadth of health 
resources available to students by providing the 
website to enroll for Marketplace insurance 
coverage, phone numbers and addresses to local 
medical, dental, and pharmaceutical clinics, and 
the website and handbook for the Anchorage 
Neighborhood Health Center.   

33..33..  NNuuttrriittiioonn  
Diet and nutrition have critical influences on 

health and disease. Multiple studies have found 
associations between low diet quality and chronic 
diseases such as cardiovascular disease, cancer, and 
type 2 diabetes.16  

To provide tools to support nutritional health 
literacy, nutrition labels were integrated into the 
two ‘Nutrition and Healthy Eating’ class sessions 
to highlight important vocabulary and teach key 
components on the label. Lessons included 
defining serving size, calories, % Daily Value, and 
nutrients—including fats, cholesterol, sodium, 
carbohydrates, and protein. Additional lessons 
allowed for the application of vocabulary into 
practical exercises. For instance, one activity 
involved comparing the nutrition labels of two 
different dessert items, and students had to 
determine which food was the healthier option.  

Upon reflection, the accessibility of foods 
introduced as healthy options during these sessions 
should have warranted more careful consideration. 
There is evidence that immigrants from low and 
middle-income countries, where some ALP 
students were from, to high-income countries such 
as the United States may experience a low post-
resettlement socioeconomic status. This has been 
shown to limit access to desired healthy foods and 
remove autonomy over food choices.17 Lesson 
plans for the nutrition unit included highlighting 
the differences between healthy and unhealthy 
fats. Fish and avocado were provided as examples 

of healthy unsaturated fats that can lower 
cardiovascular disease risk; however, such food 
items are generally more expensive and thus less 
accessible than food items containing saturated or 
trans fats. Students mentioned that accessing 
nutritious foods in the United States is more 
difficult than in their countries of origin. One 
student from the Philippines reported easily 
obtaining home-grown fruits and vegetables from 
farms, contrasting this to the inaccessibility of 
fresh produce in the United States, where fruits 
and vegetables are much more expensive. Many 
students reported having limited incomes thereby 
resulting in the consumption of more unhealthy 
foods or skipping meals since moving to the 
United States.  

To better support ESL students amid the 
rising cost of eating healthy, future health literacy 
courses should incorporate additional teachings for 
accessing affordable and healthful meals. For 
instance, students could be informed of the health 
benefits of purchasing additive-free and 
unseasoned canned and frozen foods. In a study 
conducted by Miller and Knudson, nutrient scores 
for canned (with no syrup additives) and frozen 
vegetables (with no seasoning or sauces) were 
similar to their fresh counterparts while possessing 
the additional benefits of a lower cost and longer 
shelf life.18 Additionally, students may benefit 
from understanding the nutritional power of low-
cost ingredients such as beans, lentils, and peas, 
which are high in protein and help reduce the risk 
of chronic conditions such as obesity and heart 
disease. Indeed, in a paper by Garden-Robinson 
and McNeal, food and nutrition specialists at 
North Dakota State University scored beans using 
the Nutrient Rich Foods Index as having the most 
amount of nutrients relative to price compared to 
other foods.19 

Beyond the issue of the price of healthy eating, 
studies have also found distinct differences in 
perceptions of healthy eating among individuals 
belonging to diverse cultural groups.20 It became 
evident that the Nutrition and Healthy Eating 
segment of the Health Literacy course fell short of 

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Georgetown Scientific Research Journal 

adequately considering cultural differences among 
students. Because food is deeply intertwined with 
cultural traditions, childhood, family, and friends, 
several discussion-based questions were 
incorporated to engage the students, including a 
conversation about the types of cultural food they 
enjoyed most at the beginning of the nutrition 
unit.  

In communities centered around food 
production and agriculture, there is a deep 
significance of certain foods that is incomparable 
to the practical role of food in urban societies, 
where food is purchased rather than produced.21 
Regrettably, the course material focused on 
normative American nutrition standards, 
including understanding nutrition labels, the 
recommended food pyramid, and explanations of 
nutrition-based terminology. It became clear that 
while these nutritional topics may influence how 
American doctors communicate health to patients, 
they may not be the sole frameworks of thought 
regarding food consumption in different 
communities. 

This experience highlighted the gap between 
standardized American nutritional literacy 
standards and the value of food in other countries 
that relate to personal, group, and cultural 
identities. Future health literacy curricula should 
aim to incorporate and be created with 
consideration for the students' cultural food 
backgrounds. 

33..44..  HHeeaalltthh  LLiitteerraaccyy  iinn  PPrree--HHeeaalltthh  EEdduuccaattiioonn  
During the health literacy course, the pre-

health student-instructors learned about the 
importance of grasping the cultural dimension of 
health to best support non-native English 
speakers, whether it be understanding how to best 
communicate, provide a safe space, or advocate for 
these students—all of which are strongly tied to 
caring for non-native English-speaking patients. 

American pre-health education heavily 
revolves around natural science courses in biology, 
chemistry, and physics, among others. 
Unfortunately, for many pre-health 

undergraduates, this focus on the natural sciences 
leaves little room for exploring the humanities, 
which gives way to understanding health’s 
psychological, cultural, and social dimensions. A 
more in-depth health literacy curriculum through 
coursework or experiential learning in a student’s 
pre-health journey would provide them with tools 
to better comprehend the vast complexities of 
health beyond the sciences.22 Because LHL is 
strongly correlated with the development of 
disease, increased mortality risk, and higher 
hospitalization rates, pre-health education should 
guide its students toward understanding the best 
practices to increase health literacy amongst 
patients. This would effectively work towards 
actualizing preventative health practices in 
everyday life. 

While teaching this course, one fundamental 
takeaway was the importance of speaking slowly, 
utilizing plain language, and implementing the 
teach-back method to allow students to 
comprehend what is being said comfortably and to 
exercise their recall memory for deeper content 
retention. The teach-back method involves asking 
patients or students to explain taught information 
back in their own words. A 2018 study found its 
efficacy by encouraging the clarification of 
information and correction of misunderstandings 
about health information, including medication 
use and skill-based treatments.23 Throughout the 
health literacy course, instructors used the teach-
back method through discussion-based sessions by 
asking students to summarize previously learned 
information and offer any personal experiences 
related to the topic at hand. This lesson structure 
not only allowed students to evaluate the depth of 
their understanding of the course content but also 
gave way to stronger retention due to the new 
correlations made between the course content and 
their own or other students’ lived experiences. 
Moreover, one of the sections within the course 
emphasized the importance of advocating for 
oneself as a non-English speaking patient by 
requesting an interpreter or for family members to 
be present during health appointments, 
remembering that treatments and tests can be 

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Georgetown Scientific Research Journal 

refused if one is uncomfortable with the procedure, 
or asking for one’s health records.  

A study conducted by Milford et al. 
investigated a year-long, community-focused 
learning opportunity offered to medical students to 
engage in and learn about health literacy and 
effective communication strategies. The medical 
students participated in a 5-month intervention 
program titled ‘Eat Healthily, Stay Active!’ 
targeting pediatric obesity amongst Head Start 
children.24 The medical students who joined this 
program reported a heightened awareness and 
understanding of the barriers of poor social 
determinants of health and poor health literacy and 
an increased sense of comfort and confidence in 
communicating with patients in a way conducive 
to patient-centered care. Other studies have found 
that physicians with patient-focused training are 
more likely to exhibit more compassion and form 
better physician-patient relationships.25 Being able 
to engage in health literacy, whether through a 
standard course or by serving in a health literacy-
related program, allows for the promotion of a 
patient-centered mindset and could subsequently 
improve health outcomes for all patients. 

33..55..  RReeccoommmmeennddaattiioonnss  

33..55..11..  EExxppaannddiinngg  HHeeaalltthh  LLiitteerraaccyy--CCeenntteerreedd  
SSeerrvviiccee--LLeeaarrnniinngg  OOppppoorrttuunniittiieess 

Engaging in this health literacy teaching 
opportunity was a pivotal experience for the 
volunteer instructors. Health literacy-centered 
service-learning allowed for a deeper appreciation 
of the importance of health literacy and 
communication for the promotion of health 
outcomes as a healthcare provider. Skills gained 
included practicing plain language 
communication, advocating for non-native 
English speakers, and considering cultural 
dimensions of health. The value of this course to 
both pre-health undergraduate volunteers and 
ELL students suggests that future partnerships 
between colleges/universities and community-
based organizations to provide health literacy 
programming may be mutually beneficial. For pre-

health undergraduates to have the chance to fully 
gauge the significance of health literacy and learn 
to advocate for and support patients of all 
backgrounds, pre-health curricula should take 
further steps to encourage the study of health 
literacy or participation in programs such as the 
Alaska Literacy Program. The possibility of high-
quality virtual programming suggests that more 
partnerships can exist between 
colleges/universities and communities that may be 
traditionally underserved by health literacy and 
health promotion programs. 

Though service-learning pedagogy has 
expanded in recent years, college and university 
faculty could receive further professional 
encouragement to participate in this work. In a 
study by Hou and Wilder, faculty from a public 
research university in the Southeast United States 
expressed that others perceive participation in 
service-learning as “less academic” than traditional 
research and publication, and less valuable in the 
promotion and tenure processes. They have also 
expressed that less funding is available to create 
service-learning opportunities such as the health 
literacy course described in this article.26 Greater 
incentivization to establish these experiential 
opportunities from university leadership and 
grant-makers may help increase involvement in 
such activities.  

33..66..  BBeesstt  PPrraaccttiicceess  wwhheenn  TTeeaacchhiinngg  HHeeaalltthh  
LLiitteerraaccyy  EEdduuccaattiioonn    

Through this experience, several reflections 
and recommendations about teaching methods for 
a health literacy class have emerged.   

33..66..11..  VVaalluuee  ooff  SSttuuddeenntt--LLeedd  DDiiaalloogguueess  aanndd  
DDiissccuussssiioonnss  

Incorporating teaching methods that reflect 
the spectrum of English literacy skills—reading, 
writing, listening, and speaking—facilitates the 
development of a more comprehensive grasp of 
health literacy. Using dialogue and vocabulary 
exercises, audiovisual components, and games 
throughout the class period appeared to have 

39



Georgetown Scientific Research Journal 

higher engagement and were more helpful for 
ELL students. In a post-class survey, ELL 
students indicated that their favorite learning 
activities were "Dialogues" (100%) and “Practice 
Questions” (63%) (Figure 3).  

FFiigguurree  33..  PPoosstt--ccoouurrssee  ssuurrvveeyy  ooff  eeiigghhtt  
rreessppoonnddeennttss  rreevveeaalliinngg  iinntteerreesstt  iinn  tthhee  ddiiffffeerreenntt  
lleeaarrnniinngg  mmeecchhaanniissmmss  uuttiilliizzeedd  tthhrroouugghhoouutt  tthhee  
ccoouurrssee..  The highest to lowest interest was reported 
in: Dialogues (100%), Practice Questions such as 
practicing and reading medication or nutrition 
labels (63%), Discussions (50%), Vocabulary 
(50%), Games (50%), and Writing Activities 
(38%). 

Another strategy was encouraging 
conversations and class discussions to be largely 
student-led rather than instructor-driven. As 
commonly seen in pre-health education, the 
instructor is highly involved in speaking during 
class in traditional lecture-based learning. To 
better engage students, this course emphasized 
ELL student responses and conversations over 
lecture-based learning. By implementing this 
teaching style, students were given greater 
autonomy over course content and increased 
opportunities to practice their English-speaking 
skills. 

Throughout the course, it became evident that 
exercises such as dialogues and discussions that 
taught practical skills were more valued by students 
than learning vocabulary terms. This became 
abundantly   clear  in   the   ‘Going to the Doctor’

unit, which included a mixture of vocabulary and 
advocacy. Vocabulary and pronunciation were 
taught to equip students with skills on how to 
describe their symptoms effectively. The emphasis 
on advocacy taught students how to ask their 
doctors important questions about their health, 
explain any concerns or discomfort they may have 
regarding treatment plans or other health topics, 
and request a translator.  

Student engagement and participation were 
the highest during the discussion- and dialogue-
based portions of the classes. An end-of-course 
survey confirmed this observation— every student 
reported dialogues as their favorite type of learning 
activity (Figure 3). This affirms that health literacy 
in the United States goes far beyond merely 
knowing the vocabulary but also being able to 
communicate with healthcare professionals in 
English regarding health concerns, as practiced in 
dialogue-based activities. Future health literacy 
courses should be taught with an emphasis on life 
skills and self-advocacy to make students 
comfortable with asking questions, identifying 
concerns, and ensuring patient-centered health 
visits. 

33..66..22..  SSiiggnniiffiiccaannccee  ooff  DDiivviiddiinngg  CCoouurrsseess  BBaasseedd  
oonn  LLiitteerraaccyy  LLeevveellss  

Previous years of implementing this course at 
ALP involved students with a broader range of 
literacy levels and resulted in sentiments of 
frustration from the instructors. They found it 
difficult to effectively meet each student’s 
demands in the past. As a result of ALP’s 
separation of courses by English proficiency level, 
the course was better adjusted to the students' 
literacy levels to prevent students from 
experiencing disengagement from too minimal 
academic stimulation or stress from too 
challenging course material. Due to students' 
shared English backgrounds, instructors were best 
able to provide a high level of support and a 
high challenge level, allowing for the 
students' maximum growth.  

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Georgetown Scientific Research Journal 

33..66..33..  GGaappss  iinn  KKnnoowwlleeddggee  aaccrroossss  VVaarryyiinngg  
SSttuuddeenntt  DDeemmooggrraapphhiiccss 

This course highlighted the importance of 
considering the demographics of students and the 
resources and knowledge they have had access to 
throughout their lives when teaching health 
literacy classes. It was evident that many enrolled 
in the course had gaps in their knowledge that 
went beyond their knowledge of the English 
language—there was a lack of knowledge about 
resources in their community, cultural aspects of 
the United States, and health systems. A deeper 
understanding of the cultures and baseline 
knowledge of the student population would 
provide helpful context for their current 
perspectives, leading to a more effective 
development of class content and better learning.  

44.. CCoonncclluussiioonn

The relationship between increased health
literacy and positive health outcomes highlights 
the value of offering health literacy programs to 
ELL and immigrant populations, who often face 
disparities in health literacy levels. The 2021 
intermediate-level "Health in the English 
Language" course led in partnership with 
Georgetown University and the Alaska Literacy 
Program helped ELL students gain essential 
vocabulary and practical skills related to preventing 
disease, health promotion and maintenance, and 
navigating the US health system. Instructors made 
efforts to incorporate discussions of how one's 
identity influences their health status and care 
experience. However, instructors could have 
further considered the effect of students’ 
socioeconomic status and varying cultural 
perceptions of health on the accessibility of health 
measures. 

Future health literacy education programs 
should also emphasize student-led dialogue 
activities, divide courses based on literacy levels for 
maximum efficacy, and continue adapting content 
based on student demographics. Additionally, 
despite some challenges in digital literacy, the 
virtual course format was overall successful and 

could be sustained in future programming. The 
convenience of a virtual learning model for both 
instructors and students suggests that 
colleges/universities can forge additional 
partnerships with community organizations to 
facilitate mutual learning opportunities for pre-
health students and ELLs. For the pre-health 
students leading the courses, their experiences 
allowed them to learn valuable lessons regarding 
the importance of health literacy, health 
communication strategies, and cultural aspects of 
health that will certainly shape their future patient 
interactions.  

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43




	Table of Contents
	Letter From the Editors
	Trends in Pro-Gun Control Tweets Surrounding a Mass ShootingEvent Suggest Time-Dependent Changes in Public Response
	Human Papillomavirus Vaccination Among Low-Income,Underserved Youth in the Greater Washington, D.C., andHackensack, NJ Metropolitan Areas
	Best Practices for Health Literacy Education for EnglishLanguage Learners
	About the Authors
	Acknowledgments
	GSRJ Volume 3 Edition 1 back.pdf
	Table of Contents
	Letter From the Editors
	Trends in Pro-Gun Control Tweets Surrounding a Mass ShootingEvent Suggest Time-Dependent Changes in Public Response
	Human Papillomavirus Vaccination Among Low-Income,Underserved Youth in the Greater Washington, D.C., andHackensack, NJ Metropolitan Areas
	Best Practices for Health Literacy Education for EnglishLanguage Learners
	About the Authors
	Acknowledgments




