1 Using the Deliberative Polling Method in the Spanish Classroom ABSTRACT Ana Cristina Sanchez Department of Languages and Cultures West Chester University West Chester, PA, 19382, USA Deliberative Polling was developed by Jim Fishkin and Bob Luskin at the Centre for Deliberative Polling at the University of Texas in Even though this method has been used by lawmakers to collect information about public opinion, Professor Sanchez used the method in the spring 2009, as a pilot project, in her Spanish 242 class: Spanish for nurses. The main objectives of the project were to enhance critical thinking skills and help students become better citizens by meeting the needs of their multicultural/ multilingual societies. The target topic was Universal Healthcare vs. Private Healthcare in the context of immigrants, especially Latinos in the United States and the language and cultural differences they bring with them. The Method also allowed Professor Sanchez to make students aware of some of the most pressing issues in their fields of study and the importance of taking action in order to make changes in their societies. I. PROCESS The Spanish 242 course had 17 students, and the course had two components. The first component was to develop basic communication skills within the context of a health care environment through grammar instruction, vocabulary acquisition, labs, workbook exercises and student s presentations. The second component enhances cultural awareness of contemporary Hispanic Culture through the assignment of readings and instructor s input. The Deliberative Polling Method would link the two components by making students aware of challenges they might face with Latino patients due to cultural and language barriers, and at the same time, the Method gave students the opportunity to improve their linguistic skills. The first step of the Method was to give students a pre-test to collect their opinions and compare them with their answers in the post-test at the end of the semester. During the semester, students learned about health care and Latinos in the United States through readings, news and instructor s input. All discussions were in Spanish. One month before the end of the semester, Professor Sanchez gave a packet with readings about Universal vs. Private Healthcare and about Latinos and other minorities in the United States. The packet was given to 10 students, out of 16, the other seven students did not have to do the readings, but they had to be present on Deliberation Day (Called D-Day), to listen and ask questions if they had any. The other 10 students were very well informed about the pros and cons of the two different Health Care Systems and about specific problems Latinos and the health Care System have to deal with on a daily basis. The main goal was to divide the class in two groups, one will be a very well informed (deliberative) group, and the other one will represent student s surface opinions, sometimes influenced by others. These differences would show in the student s responses in the post-test questionnaire. II. PREPARING FOR D-DAY In order to prepare for D-Day, Professor Sanchez invited five speakers from the health care field with different viewpoints regarding healthcare: Universal vs. Public, and the Latinos and minorities in the United States. Below is a brief description of the Panelists who participated on D-Day : *George Faulkner: Worked for 25 years as an employee benefits consultant with Mercer Human Resource Consulting, primarily working with larger employers on health care, health management, and disability programs. During the initial Clinton administration years, he wrote and spoke on health care reform and developed a model to simulate the impact of various reform proposals on employers. * Maryann Mesure, M.S.S., Director of Programs, Maternal and Child Health Consortium of Chester County. West Chester, PA. *Su Cartmell, MSN, CRNP. She has a Bachelor's degree in nursing which was completed at the University of Sao Paulo, Brazil and a Master's at the University of Pennsylvania School of Nursing. She also holds a post-master's degree in Health Care Administration, also from the U of Penn. She has more than 25 years of experience, ranging from cardiology, intensive-care, long-term care, clinical research, psychiatry, neurology and health care administration. She was the director of the first Latino Nurse-Managed Center founded in Philadelphia, and then worked in private practice as well as diagnosing, treating and managing the program for Latinos in clinical research for Alzheimer's disease at the University of Pennsylvania. *Mr. Malcon Johnstone: Executive Director West Chester, Business Improvement District. West Chester, PA *Dr. Tanya J. Morgan, Associate Professor and MPH Program Director, Health Care Administration, West Chester University After the panelists accepted the invitation to participate in D- Day, Professor Sanchez sent invitations to the students in the class, to the panelists, and to a few professors and
2 administrators of the University, so that they could listen to the deliberations and evaluate the student s role in the process. The D-Day took place on Monday, April, 20, 2009 from 4 to 7 pm at the Lower Level Conference Room of Philips Building, West Chester University. The deliberations need to be scheduled at a place other than the classroom to create a different, more relaxed and authentic atmosphere. Professor Sanchez ordered refreshments for everyone to take the event to a higher level of importance at least that is how students perceived it. The Deliberations lasted for three hours. There were very positive exchanges among the students and the panelists, and various points of view were evident on both sides. The group that was well informed about the target topics was very active asking and answering questions, the group who did not do the readings assumed a more passive role, however, a few asked questions about the issues under discussion. After the deliberations, students and panelists were able to informally, exchange ideas and talk about possible projects to help Latinos and other minorities. At the end of the D-Day, Professor Sanchez gave students the post-questionnaire test, which she then compared with the pre- questionnaire test. Below are some examples of the questions of the pre and post tests. III. RESULTS OF PRE AND POST - TESTS Below are some of the questions of the pre and post tests as well as the results. Important: 17 students took the pre-test and 15 students took the post-test. 1: Here is a list of problems our health care has. On a scale from 0 to 10, where 0 is completely unimportant and 10 is extremely important, and 5 somewhere in between, how important would you say it is that we do something to improve each of the following? Completely unimportant extremely important 1A. The cost of health insurance 1. : 17 students 10(10) 9(3) 8(3) 6(1) 2. Post- test: 15 students 10 (10) 9 (5) 1B. The number of Americans without health insurance. Pre- test 6 (1) 8(1) 10(10) 9(3) 7(1) Post test 10 (11) 8 (4) 1C. The cost of prescription medication: Pre- test 10 (10) 9 (4) 8 (2) 5 (1) 10(6) 9(3) 8(4) 7(1) 1D. Medical mistakes/ Malpractice 3 (1) 10(10) 9(2) 7 (2) 8(1) 10(7) 8(1) 9(4) 7(1) 8(1) Post- test 10(6) 8(5) 9(3) 1E. Rate Quality of health care provided to those with insurance. 2 (1) 10(7) 9 (4) 5(1) 8(1) 3 (1) 7(1) 6(1) 10(4) 9(3) 5(1) 8(5) 6(1) Q2. Would you be willing to pay more than you do now for health care if this meant that many more Americans would be covered? Yes, at least slightly more: 7 14 Yes, significantly more: 7 No : 2 1 : 1 Q3. How strongly would you agree or disagree with each of the following statements? 3A. The US should have a single system that collect all healthcare fees and pays healthcare for everyone. Agree strongly 3 1 Agree somewhat 7 9 disagree 3 4 Disagree somewhat 4 1 Disagree strongly 1 3B. The US should require employers to pay health care costs for all workers Agree strongly 8 3 Agree somewhat 3 5 disagree Disagree somewhat 5 2 Disagree strongly 2 2 3C. The US should require that all individuals buy minimal health coverage. Post- test Agreestrongly 1 Agree somewhat 6 7 disagree 5 2 Disagree somewhat 3 Disagree strongly D. The US should offer uninsured Americans financial assistance to help them purchase private health insurance Agree strongly 2 1 Agree somewhat Neither agrees nor disagree Disagree somewhat 2 3 Disagree strongly Q8B. The first priority of government should be to let people make their own choices
3 Agree strongly 4 1 Agree somewhat 8 7 disagree 1 Disagree somewhat 4 6 Disagree strongly 1 QUESTION: 11. Do you think that a Universal Healthcare System will work in the United States? Explain PRE-TEST POST-TEST NO : 7 1 YES : 8 12 NOT SURE: 2 A combination of both 2 IV. CONCLUSIONS OF PRE AND POST QUESTIONNAIRE After D-Day, and based on the students answers on the pre and post tests, the following conclusions were made: 1. More students were very concerned about the cost of health insurance and about the number of people without health insurance in the United States in the post-test. 76% pre-test (rated it 9/10 in a scale of 10 being the highest) 100% post-test (rated it 9/10 in a scale of 10 being the highest 2. Fewer students, in the post-test, said they disagreed/strongly disagreed to slightly pay more than what they were paying for their insurance premiums if that meant that more people in the United States will have health insurance. 30% said they disagreed/ strongly disagreed to pay more, but only 7% said they disagreed in the post-test. 3. Fewer students, in the post-test, disagreed to adopt a singlepayer system, where a government agency accepts all healthcare fees and pays out all health care costs for everyone. Fewer students favored the idea of having the employer pay for health insurance costs. 30% disagreed/ strongly disagreed in the pre-test. 6% disagreed/ strongly disagreed in the post-test. 4. More students said they would NOT rely on managed care through HMOs. 18% in the pre-test said it would be very or somewhat ineffective and 34% in the post-test. Even more significant, 53% said they did not know in the pre-test and only 13% in the post-test. 5. More students voted in favor of increasing government control of/ involvement in healthcare in the post-test: 58% in the pre-test and 80% in the post-test. 6. Fewer students in the post test agreed strongly/ or somewhat about requiring employer coverage of health care: 65% in pre-test and only 53% in the post-test. 7. More students answered that 90% of the uninsured come from low income families in the pre-test than in the post-test: 47% in the pre-test, but only 27% in the post-test. 8. Slightly more students, in the post-test said that people like them had little saying in what the Government does: 23% in the pre-test and 40% in the post-test % agreed strongly/ somewhat that the first priority of government should be to allow people make their own choices in the pre-test, but only 53% in the post-test. 10. The more significant shift in students thinking was whether they thought Universal Healthcare would work in the United States. NO : 40% NO : 7 % YES : 47% YES: 80%, and a combination of both. 14% 11. I can also say that I was not able to see a clear difference in the responses from the group that was better informed about the issues that were deliberated on D-Day and the responses of those who did not prepared for the discussion. The only clear difference was regarding the active participation and the questions and answers that were offered by the well informed group. One conclusion I may reach is that the passive group listened very carefully to the issues and the opinions and arguments of both the panelists and their peers. V. ADVANTAGES OF THE DELIBERATIVE POLLING METHOD. The Deliberative Polling Method was developed to address two challenges we face in modern democracies: how to obtain both a representative and an informed (deliberative) view of what the public thinks and feels about an important public issue to help guide public decision-making  Most of the surveys about public issues show the public s surface opinions which most of the time are influenced by media. However, this method can be used in any course to address social, political, cultural, environmental, and health issues, among others. The modified Deliberative Polling Method used in Professor Sanchez Spanish class, produced very positive outcomes: 1. It Increased student s motivation by incorporating cultural issues that were current and relevant. The targeted topics were: Private Healthcare vs. Universal Healthcare, and the challenges Health Care in the United States faces regarding Latino immigrants cultural differences and language barriers. 2. It gave students an opportunity to reflect on solutions/options. 3. It provided students the opportunity to make informed decisions by comparing-contrasting and weighing the pros and cons of the two health care systems. 4. It enhanced cultural competency by incorporating community members in the teaching/learning process, which is one of the recommendations of the American Council on the Teaching of Foreign Languages (ACTFL). 5. The panelist s expertise and diverse view-points on the targeted topics enriched the teaching/learning process. The aforementioned benefits can be supported by the feedback provided by the students on D-Day. I will share some below: *Buzz Bennett: The panel discussion was very helpful in understanding the pros and cons of universal vs. private health
4 care. The five panelists each contributed very well by sharing their perspectives from their own experiences. The panel discussion was also valuable for making contacts in the field of medical interpretation. *Emily Rutt: I learned a lot about the health care systems in other countries like England. I never had heard that there were 18 hour waits and such in the emergency rooms. I also learned a lot about the wasted money spent on health care in the US. I thought it was very helpful. It made clear some aspect of the health care industry that I was unaware of. The panelists all were so knowledgeable and had such insight on the topic of current health care. *Lindsay Naylor: D-Day was a very great event. Thank you so much for organizing it for us. I learned so much from the different panelists, they were all so intelligent and all had different life experiences. I learned about the government, other countries' health care systems, the advantages and disadvantages of our current health care system and the other systems people are interested in. I thought it was a great learning experience. It was enlightening and motivated me even more to work to help people. Thank you Profesora Sanchez, *Kimberly Giron: The roundtable discussion was very helpful. It was great learning the panelists opinions and reasons for their opinions. I liked how all the panelists were involved in healthcare somehow but had different careers and different experiences. The panelist Su impacted me the most because she is doing what I want to do in life. I want to become a nurse practitioner and help the under privileged people. Chi Upsilon Sigma- AA Chapter President * Dani Taroff: I learned a lot of information at our D-Day event. I learned that there is a lot more to the universal health care system than I thought. I thought it was just a onetime system that gave everyone the same insurance coverage. I did not realize that there were so many stipulations and how strict it was. I also did not realize, like one of the professors stated that there will be a very long wait in the hospitals. I thought that the panelists were very informative and really knew what they were talking about. I believe that it did change my opinion regarding universal health care. Overall, I think we still need to implement this idea in the US. I also found that a larger group of students will probably give more clear results in the pre and post tests. Overall, I do believe the few challenges I had outweigh the benefits of using this method in the classroom. VI. DISADVANTAGES: One of the disadvantages, especially in a language class, is to find panelists that are fluent in the language being taught. In addition, some of the speakers for D-Day may ask for an honorarium and/ or transportation. To secure a grant may be necessary to pay for the honorarium and also for the refreshments for the D-Day.
5 REFERENCES  CDDD/News Hour with Jim Lehrer: Deliberating Education and Healthcare: Pre-Deliberation Web Survey In  Janice Elliot, Participatory Methods: Deliberative Polling, Belgian Advertising, B.AD, September 2005