Health Literacy Overview

Rima E Rudd, MSPH, ScD Health Literacy Studies

Harvard University School of Public HealthNational Center for the Study of Adult Learning and

Literacy

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Functional Literacy

NALSNAALSIALS

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Functional LiteracyAbility to read, write and speak in

English, and compute and solve problems at levels of proficiency necessary to function on the job and in society, to achieve one’s goals, and develop one’s knowledge and potential.

The National Literacy Act of 1991

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NALS: National Adult Literacy Survey 1992

1. 1. Prose LiteracyProse Literacy:: process information presented in full sentences/ paragraphs.

2. 2. Document LiteracyDocument Literacy:: process information presented in forms, tables, maps, schedules, charts…

3. 3. Quantitative LiteracyQuantitative Literacy:: apply numerical operations.

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2002: National Assessment of Adult Literacy Survey

National Assessment of Adult Literacy Survey, 2002:

Assessment items will include materials used for health related tasks.

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Functional Literacy Assessments

Findings grouped by 5 skill levels for each literacy area.

• Level 1 is the lowest skills level.• People at Level 1 have reading

skills of grade 1-3 level.

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Progression:Learning to Read Reading to Learn

Readers at Grade 1-3 level are learning to:

• decode letter groups• recognize and sound out words• derive meaning from words• link words in sentences• derive meaning from sentences.

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Prose Literacy49% of Adults May Have Some

Difficulty:• Finding one piece of information in a sports

article;• Finding 2 pieces of information in a news

article.They Generally Cannot:• Interpret instructions• Infer theme from a poem• Describe contrasting views in an editorial.

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Document Literacy 51% of Adults May Have Some

Difficulty: • Completing a job application;• Interpreting a payroll forms.They Generally Cannot: • Read tables and graphs• Locate intersection on street map• Use a bus or train schedule.

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Quantitative Literacy47% of Adults May Have Some

Difficulty: • Balancing a checkbook;• Figuring a tip.They Generally Cannot:• Complete an order form• Determine the amount of interest from a

loan advertisement.

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Literacy as a Tool

Reading to Do: HealthContext

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Basic Health Literacy•Read and comprehend health information and directions. •Complete medical history, informed consent, and insurance forms.•Apply literacy skills to: prescriptions appointment cards medicine labels directions for care.

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Interactive Health Literacy•Engage in decision making.•Take independent action to

promote health and prevent disease.

•Engage in partnerships with professionals.

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Critical Health LiteracyBe aware of and advocate for rights.Consider health implications of

community, workplace, and social policy.

Take part in policy analysis and decision making.

Take action for personal, community, and societal health.

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When Words Get in the Way

•Get lost•Make errors•Run out of

words•Retreat into

silence•Cover up or Lie

•Limit participation•Assume a passive

role•Be assigned a

passive role•Lose entitlements•Lose rights

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Research to Date

TrendsScopeFindings

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Review of the Literature: Trends

Number of Citations•1970s - ~ 11 •1980s - ~ 37 •1990s - ~ 240 •Each Year within Current Decade:

•2000 - ~ 24 •2001 - ~ 16 [through Sept]

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Review of the Literature: Scope

•Materials Assessment•Comprehension of written materials•Match between patients’ abilities

and reading materials•Use of services •Knowledge level•Outcomes

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Research Findings: Materials and Comprehension•Materials written at inappropriate reading grade levels.•Mismatch between reading levels of materials & reading ability of intended audience.

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Research Findings: Health Impact

• Poorer overall health• Less likely to make use of screening• Present in later stages of disease• More likely to be hospitalized• Poorer understanding of treatment• Lower adherence to medical

regimens

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Research Finding: Shame• Almost 40% of patients with low

functional literacy admitted feelings of shame:– 67% had never told their spouses – 53% had never told their children

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Review: Materials on the Internet

Digital Divide:• Of the 1,000 sites reviewed, only 10 were appropriate for limited-literacy adults.•Generalized information on topics of interest is available but not at literacy levels that underserved Americans need.

Lazarus and Mora, The Children’s Partnership, 2000

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Review: Materials on the Internet

Review of 89 pediatric patient information web sites: information is not written at appropriate reading levels for the average adult (8th grade or lower)

D'Alessandro et al, The Readability of Pediatric Patient Education Materials on the World Wide Web 2001.

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Agenda

Research &Practice

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Unexplored AreasHow well are people with limited

literacy skills managing:• Health Promotion and Protection• Early Detection and Screening• Broader health services such as Mental

Health, Oral Health• Interactions with social services and

entitlement programs• Community, work and social action for

policy change

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Unexplored AreasHow well are people with limited

literacy skills managing health related decisions:

• At Home, Work, Schools, Community

• In medical, dental, and other health service settings

• In the Policy Arena

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New Territories for Research

•Links between literacy and verbal skills

•Links between literacy and oral comprehension

•Links between literacy and background knowledge

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New Territories for Research

Causal pathways of how poor health literacy influences health

Outcomes & costs associated with poor health literacy

Effective health education techniques Evaluation of plain language directives

and use of non-print media