Literacy The Effects To

Physical and Mental Health

Presented by Caroline R. Colbert, M.Ed., CHES

National Surveys of Adult Literacy

• NALS: National Adult Literacy Survey done in 1992 and 2003

• IALS: International Adult Literacy Survey 1992

NALS

International Adult Literacy Survey

• American adults score at an average level of literacy performance when compared with adults in other industrialized countries

Higher About the same

Lower

Finland Canada United Kingdom

Norway Germany Ireland

Sweden Australia Switzerland

Netherlands Italy

2003 Results

Level % Millions Grade Level

Below Basic 14 30 6th grade or lower

Basic 29 63 8th grade

Intermediate 44 95 High School

Proficient 13 28 College but not graduate level

• No real change in numbers or levels between 1992 and 2003

• 1992 study had 5 levels, 2003 study had only 4 levels

Literacy and Health

• Report poorer overall health

• Are less likely to make use of screenings

• Present in later stages of disease

• Are more likely to be hospitalized

• Have poorer understanding of treatment

• Have lower adherence to medical regimens

Education and Health

• Mothers with more education are more likely to have received early prenatal care.

• Mothers with fewer then 12 years education are 10 X more likely to smoke during pregnancy.

• Death rates for chronic disease, communicable disease, and injuries are inversely related to education.

Health Literacy: Definition

The ability of individuals to obtain, interpret and understand basic health information and services;

AND

Use such information and services in ways that enhance health.

So….

A health literate person is able to use health concepts and material including applying information to novel situations.

A health literate person is able to participate in the ongoing public and private dialogues about health, medicine, scientific knowledge and cultural beliefs.

Mental Health Literacy is:

• an individual’s knowledge and beliefs about mental illness,

• poor mental health literacy often represents a powerful barrier to treatment – most members of the public cannot accurately label

common mental disorders – inadequate knowledge is associated with delays in

treatment seeking, decreased levels of treatment seeking, and utilization of non-optimal treatments

– associated with the belief that one should be able to solve emotional problems alone or that such problems will disappear without treatment

Addressing Patient Needs: The Role of Mental Health Literacy MEREDITH E. COLES, Ph.D., SHANNON COLEMAN, M.A.Binghamton, N.Y., and RICHARD G. HEIMBERG, Ph.D.

Cost of Low Health Literacy

$73 Billion Annually

Source Friedland, Georgetown University, 2003.

The Impact

• Filling out forms at hospital or doctor’s office• Completing insurance paperwork• Reading & acting on prescription labels• Reading & understanding directions given by doctor• Accessing information• Recognizing cues to action• Accessing care & navigating institutions• Following health care regimes• Understanding health promotion/disease prevention

materials

How patients hide illiteracy

• “I forgot my glasses.”

• “I don’t need to read this now; I’ll read it when I get home.”

• “I’d like to discuss this with my family.”

• “I have a headache now and can’t focus.”

• “I’ll just take this with me and read it later.”

Video

So what is being done?

• Writing material at a 6th or lower grade level. Federal government requires information for the Medicaid population be at a 5th grade.

• Evaluating health material for literacy and cultural competency.

• Training staff about health literacy.

• Evaluate the materials that we are using and giving to:– Parents

– Students

Effective Health Material

• Use plain language and vocabulary

• Acknowledge and honor the beliefs, values, and practices of the intended audience

• Respect the emotional and personal needs of the reader

• Is positive and accurate

Exercise

• What does this say?

• Can we say it easier?

Tools that help:

• Testing Readability

• Guidelines for evaluation

Two Readability Tests

A B C D EReadability choice of number of words per syllables per grade levelFormula text to measure words sentence 100 words calculation

Three 100 word Count each Divide the # Count # of .4(C) + 12 (d)samples selected word. Number of sentences syllables per -- 16 =

Flesch - from beginning, and symbols by the # of text selection grade level*

Kincaid middle, and end are considered wordsof text words

Three 100 word Divide the Sum of the Plot the answersamples selected total # of syllables in to C and D on

Fry from beginning, sentences by all 3 passages; the Fry middle, and end 3 then divide by Readability

of text 3 Graph*** alternative formula is Grade Level = .39(C) + 11.8 (D) -15.59** +0.865 added as an adjustment to the grade level factor

Componets

Fry Readability Formula - extended*

A. Choose three 100 word passages

B. Count the total number of sentences in the passages ______

C. Find the average number of sentences per passage (B/3) _____D. Count the total number of syllables in passages ______

E. Find the average number of syllables per passage ______

F. Plot the average on the graph

* Reproduction Permitted - No Copyright. Zalaku, B. & Sammuels, S. (1988) Readability, its past, present & future. Newark, DL: International Reading Association

Readability on your computer

• Microsoft Word has the ability to do a quick check of readability each time you do a document

• Here is how it is done:– Open a word document– Tools– Options– Spelling & Grammar Show Readability

Statistics

Printed Material

• Spacing

• Color and Fonts

• Pictures

• Watermarks

Use Illustrations/Graphs Appropriately*

• Use illustrations to help explain your text

• Use simple line drawings

• Illustrate the correct way to do things, not the wrong way

• Avoid non-human cartoon figures

• Show as much of the human body as you can

• Avoid abstract graphs or charts

*Szudy, E. & Arroyo, M. (1994) The right to understand: Linking literacy to health and safety training. Berkeley, CA: University of California, Berkeley.

Use Simple Line Drawings

Colbert, C. (1996) Readability Study of Bloodborne Pathogens Material. University Park, PA: Penn State University

Show as much of the body as you can

*Szudy, E. & Arroyo, M. (1994) The right to understand: Linking literacy to health and safety training. Berkeley, CA: University of California, Berkeley.

Use of fonts and spacing

Literacy is an important and well-known correlate of health status and health-promoting behaviors in nonindustr ial ized nat ions. Despite this, research on the relationship between l i ter acy and heal th in industr ial ized c o un t r ies h as been l imit ed by difficulties in disentangling complex factors that covary with literacy. These factors include education level, socialeconomic and other demographic factors, self-efficacy, and cultural background.

Several recent studies, however, indicate that even af ter adjusting f or these convariables, literacy is related to multiple aspects of health status, and use of health services. For example, a study in general medical clinics at 2 public hospitals evaluated 402 patients with hypertension and 114 with diabetes mellitus and f ound patients’ f unctional health literacy strongly correlated with knowledge of their illness.'

Note: Sometimes we use different fonts to make things “exciting” for the reader and to give a different look – the problem is that they may be difficult to people with visual or disabilities to read. Ad Hoc Committee on Health Literacy for the Council on Scientific Affairs, American Medical Association (1999). “Health Literacy Report of the Council on Scientific Affairs. JAMA (281) 6.

NOTE: Sometimes we use different fonts to make things “exciting” for the reader and to give a different look—the problem is that they may be difficult to people with visual or disabilities to read.

Ad Hoc Committee on Health Literacy for the Council on Scientific Affairs, American Medical Association (1999). “Health Literacy Report of the Council on Scientific Affairs. JAMA (281)6.

Literacy in the United States has been defined as “an individual’s 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 1992 National Adult Literacy Survey, the most accurate portrait of English-language literacy in the United States, found that 40 to 44 million Americans, or approximately one quarter of the US population, are functionally illiterate, and another 50 million have marginal literacy skills. This means that almost half of our adult population has deficiencies in reading or computational skills.....'

NOTE: It is difficult for some to read information that is over a watermark or picture – they wonder which is more important.

Use of watermarks or pictures behind words

Another Exercise

• Evaluate a brochure

So what can we do atViaQuest?

• Brainstorming Time– For our students– For our parents– For ourselves