Health Literacy Overview by tmf12618

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									      Health Literacy
         Overview
          Rima E Rudd, MSPH, ScD
           Health Literacy Studies
         Harvard University School of Public Health
National Center for the Study of Adult Learning and Literacy
Functional Literacy


      NALS
      NAALS
      IALS
                      2
   Functional Literacy
Ability 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
                                           3
    NALS:      National Adult
      Literacy Survey 1992
1. Prose Literacy: process
 information presented in full
 sentences/ paragraphs.
2. Document Literacy: process
 information presented in forms,
 tables, maps, schedules, charts…
3. Quantitative Literacy: apply
 numerical operations.              4
2002: National Assessment of
   Adult Literacy Survey

National Assessment of Adult
 Literacy Survey, 2002:

 Assessment items will include
 materials used for health related
 tasks.
                                     5
       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.

                                          6
              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.        7
          Prose Literacy
49% 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.
                                           8
       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.
                                      9
       Quantitative Literacy
47% 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.                       10
Literacy as a Tool



      Reading
      to Do:
      Health
      Context
                     11
       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.             12
  Interactive Health Literacy
• Engage in decision making.
• Take independent action to promote
  health and prevent disease.
• Engage in partnerships with
  professionals.


                                       13
   Critical Health Literacy
Be 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.              14
  When Words Get in the Way

• Get lost        •   Limit participation
• Make errors     •   Assume a passive
                      role
• Run out of
  words           •   Be assigned a
                      passive role
• Retreat into    •   Lose entitlements
  silence
                  •   Lose rights
• Cover up or Lie                           15
Research to Date




     Trends
     Scope
     Findings

                   16
   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]      17
   Review of the Literature:
            Scope
• Materials Assessment
• Comprehension of written materials
• Match between patients’ abilities
  and reading materials
• Use of services
• Knowledge level
• Outcomes
                                       18
 Research Findings: Materials
     and Comprehension
•Materials written at inappropriate
reading grade levels.
•Mismatch between reading levels of
materials & reading ability of intended
audience.

                                     19
      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

                                           20
     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




                                             21
         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
                                                     22
       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.
                                                           23
Agenda




Research
    &
Practice
           24
          Unexplored Areas
How 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
                                           25
         Unexplored Areas
How 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

                                         26
       New Territories for
           Research
•Links between literacy and
    verbal skills
•Links between literacy and
    oral comprehension
•Links between literacy and
    background knowledge

                              27
       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           28

								
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