Why Literacy Matters

Abstract

he ability to understand verbal and written materials is central to modern life. Yet, the US Department of Education estimated that 47% of all adult Americans in 1993 had poor reading and comprehension skills. 1 Analyses of the readability of patient education materials, discharge instructions, and consent forms throughout many specialties within medicine have found almost uniformly that these materials are written at too complex a level for many or most patients. 2-10 For example, a study of the patient ophthalmic education materials of the American Academy of Ophthalmology by Ebrahimzadeh et al 2 found large amounts of the material exceeded the reading abilities of much of the American adult population. Yet, this is only one small part of understanding the effects of literacy and reading abilities on our patient's health and their use of our increasingly complex health care system.

The self-assessed literacy index: Reliability and validity

“…Literacy is associated with many important economic, health and social outcomes, including educational attainment (Kirsch et al, 1993;Mellard et al, 2007), social isolation (Adkins and Ozanne, 2005), and numerous health behaviors and health status (see DeWalt et al, 2004 for systematic review; Lee, 1999;Parker, 2000). People with higher levels of literacy are more likely to be employed, work more hours, be in higher or supervisory positions and have higher incomes (Kirsch et al, 1992(Kirsch et al, , 1993.…”

“…Commonly used general purpose reading assessments include the Wide Ranging Achievement Test (WRAT-3), the Slosson Oral Reading Test-Revised (SORT-R) and the Peabody Individual Achievement Test (PIAT). Literacy has been assessed in health studies using the Test of Functional Health Literacy in Adults (TOFHLA) (Parker et al, 1995), the Rapid Estimate of Adult Literacy in Medicine (REALM) (Lee, 1999), or the Medical Terminology Achievement Reading Test (MART) (Hanson-Divers, 1997). Scores from these assessments measure literacy on a continuum, ranging from complete inability to read and write to high levels of proficiency (Fanta-Vagenshtein, 2008;Murray, 1995).…”

“…Scores from these assessments measure literacy on a continuum, ranging from complete inability to read and write to high levels of proficiency (Fanta-Vagenshtein, 2008;Murray, 1995). These assessments vary in length from about two to three minutes (REALM) to up to 22 min (TOFHLA), test for general or health-specific word recognition and pronunciation, ask respondents to complete simple tasks such as reading prescription labels, and have to be administered by trained interviewers (Davis et al, 1991(Davis et al, , 1993Hanson-Divers, 1997;Parker et al, 1995;Lee, 1999;Manly et al, 2004;Johnson et al, 2006;DeWalt et al, 2004), making them largely infeasible for most survey research settings such as those conducted by telephone, mail or web. Although the content of the literacy assessments vary, they are highly correlated (above r = 0.70) (Davis et al, 1993;Baldi et al, 2009).…”

“…While education level is correlated with literacy levels (Manly et al, 2004), measures such as years of education overestimate literacy skill level by three to five reading levels (Weiss et al, 2005;Lee, 1999;Wilson, 1995). In fact, only 5% of persons with a high school degree, 31% of persons with a Bachelor's degree and 36% of persons with a graduate degree scored at the highest proficiency levels in the 2003 National Assessment of Adult Literacy (Kutner et al, 2007, p. 39).…”

Wound Care

“…Literacy level of the patient will determine how information is taught. Reading ability is on average three to five grade levels below the number of grades of school completed [3]. The reading level of patient teaching materials and the best way to do patient teaching must be considered.…”