[AAACE-NLA] health literacy

[AndresMuro@aol.com]

below is a short article that i rote about health literacy for the local literacy council newsletter

Andres

Defining a Health Literacy Paradigm
Andres Muro

Literacy is defined as the ability to use print, and other non-verbal clues to participate in all aspects of family, education, vocation and community life. According to the National Adult Literacy Survey (NALS, 1992), approximately 90 million adults score in the two lowest of five levels of literacy. This means that they can only perform limited reading and writing tasks using simple language. 
One feature of literacy is that it does not immediately transfer from context to context. So, having general literacy skills in every day life and scoring in the top three levels of the NALS doesn’t guarantee that those same literacy skills will transfer to a multitude of environments, including a health literacy environment. Examples of contextual literacy skills that a person who is considered highly literate might not possess include: buying groceries, cooking a meal, operating a cash machine at a grocery store, getting an airplane ticket form the automatic ticket dispenser, buying a subway card, navigating the health care system. 
    Another important aspect of communication is oracy (verbal communication). America is essentially an oral society in many aspects. This means that when we seek information for the first time, we want to get verbal input and feedback. When literate people face one of the above listed tasks for the first time, they often need someone to verbally and manually guide them through the process even if all the information necessary to fulfill the task is included in print. For example, buying a subway token from an automatic fare-card machine with no one to assist is a daunting task for even the most literate person. With someone walking you through the process verbally, it becomes much easier. We are dependent on verbal guidance and feedback.
While we can be amused by the fare-card machine scenario, with healthcare the issue is more serious. Since it is cheaper, in general, to provide information in print, a lot of human contact has been eliminated and replaced with printed info. As a result, a great deal of written information that is not supported with verbal guidance is lost. Regardless of our literacy skills, if we have difficulty buying a subway card, following a recipe, or operating a cashier, we will likely have difficulty filling out medical forms, understanding doctors’ instructions, a health insurance plan, or a prescription.  
In order to address health literacy limitations we must develop appropriate interventions. Interventions fall under the following two categories:

1.  increase the health literacy of the general population
2.  Make the medical/health care system aware of our limitations and provide interventions to address them.

With regards to point number 1, this means that health literacy instruction must be incorporated into the K-12 system, adult education and college. This is the recommendation of the Institute of Medicine and most health literacy experts. The argument is that in K-12, adult education and some college courses, students are acquiring reading, writing and math skills. This can be facilitated by having students read medical/health related information, write about health issues and solve math problems using health information such as nutrition labels, prescriptions, etc. There is a plethora of health literacy instructional resources that have been developed to accomplish this. If people can become more health literate before encountering a real health situation, they will likely be more successful at navigating such environment. 
Regarding interventions that the medical/health establishment needs to provide,  they are related to the following areas:

•   Creating more accessible print materials 
•   Creating a number of non-human contact interventions such as videos, illustrated brochures, internet accessible information, etc designed to increase comprehension
•   Train health/medical professionals to understand cultural and literacy barriers that people face
•   Train medical/health professionals on how to interact with people and how to elicit information and understanding

An important finding about the above interventions is that when implemented alone, they show ambiguous results. Only when a combination of two, or more interventions are offered, there is clear evidence of better understanding. 


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