Literacy, ESL, and Health
Care - Candace Myers, MSc, SLP(C)
Low literacy levels among ESL speakers are
a significant concern in health care. Much of the information
health care professionals provide is in written form. The following
article reviews the effects of low literacy skills, and provides
resources for health care professionals in producing clear "plain
language" materials for patients. This information was obtained
from Literacy Partners of Manitoba http://www.mb.literacy.ca
and other websites as indicated.
Burt Perrin summarises the direct and indirect impact of
literacy on health in How Does Literacy Affect the Health
of Canadians, 1998, found at http://www.phac-aspc.gc.ca/ph-sp/phdd/literacy/literacy.html.
Some of these effects are listed below.
Direct
Effects
- Persons with low literacy skills cannot read medication
labels and sometimes take medication incorrectly. This applies
to both prescription and over-the-counter medications.
- Persons with low literacy skills
have problems complying with medical directions (e.g., a diabetic
following a prescribed treatment).
- Persons with low literacy skills cannot read written instructions
for preventative care, self-care and follow-up care after
an illness or injury.
- Persons with low literacy skills have problems understanding
appointment slips, informed consent forms, discharge information
and oral instructions.
Indirect
Effects
- Persons with low literacy skills are less likely to request
care early in the course of their illness.
How Can Health
Care Workers Overcome Literacy Barriers?
- Health care workers can help patients overcome literacy
barriers by creating an environment accessible to low literacy
people
- Following effective teaching principles to make sure that
their patients understand vital information
- Using principles of plain language and clear design when
preparing written information for patients
________________________________________________________________________
Health Literacy
Project, Phase 1: Needs Assessment of the Health Education and
Information Needs of Hard-to-Reach Patients. (2001). Montreal:
The Centre for Literacy of Quebec. Part 1: Background Document
on Literacy and Health. [46 pages. ISBN 0-9681034-9-9 Printed
copies of these documents may be purchased at $ 10.00 for single
copies or $ 15.00 for the pair (Parts 1 and 2), including shipping
& handling from the Centre for Literacy of Quebec, 3040
Sherbrooke St. West, Montreal, QC, H3Z 1A4. Phone (514) 931-8731
ext. 1415, Email: literacycntr@dawsoncollege.qc.ca.
This is also available on the web at http://www.nald.ca/PROVINCE/QUE/litcent/health/
Execsumm/Promo.html]
Section 1 gives an
overview of health literacy. It gives the IALS statistics, and
mentions the concern raised by Thomas Sticht that the arbitrary
criterion used for separating individuals into different levels
may have led to an overestimation of the percentages of adults
at levels one and two. It discusses the links between literacy
and health, focusing on the work of Burt Perrin. It then records
the progress made in recognizing the need to produce health
documents in plain language. It summarizes the currently recommended
techniques to improve oral communication. "These techniques
typically include:
- Limiting teaching objectives
- Giving many examples that have meaning to the patient
- Demonstrating procedures such as measuring dosages and
counting pills
- Making learning participatory. Ask patients to restate
instructions in their own words
- Repeating the information several times
- Organizing your instruction so the most important messages
are presented first and last
- Including family members or other caregivers in the education
process (p.10)."
Plimpton, S. &
Root, J. (1994). Materials and Strategies that Work in Low Literacy
Health Communication. Public Health Reports, 109(1),
86-92.
The authors describe
their response to the problem of the gap between the high reading
level of health pamphlets and the low literacy skills of the
target audience: a series of training sessions on how to produce
low-cost, easy-to-read, easy-to-reproduce documents. In 1994,
the authors found a virtual absence of, but universal need for,
easy-to-read materials. Certainly much progress has been made
since then, but the article is still interesting for its list
of things to avoid, such as
- information overload
- unclear message
- long words, complex sentences
- technical language
- uninviting tone
- disregard for culture or literacy level of target audience
- solid print without graphics
- cluttered page with graphics overload
- small font
- irrelevant illustrations (p.88).
Literacy and Health
Resources on the Web
(This is only
a sampling of the many resources available on the web. Please
send any interesting resources that you find to
health@mb.literacy.ca)
Health Sites
The American Medical Association.
Enter "literacy" in their search engine to find articles
on literacy and health. http://www.ama-assn.org/
Harvard School of Public Health, Health Literacy Studies.
This site offers powerpoint and video presentations and research
reports on literacy and health. http://www.hsph.harvard.edu/healthliteracy/
Health Canada.
This site contains a wealth of reports and resources.
http://www.hc-sc.gc.ca
Health Literacy Consulting.
This private site contains articles on "helping health
organizations communicate in ways people can understand".
Health Literacy Tips is a useful section. http://www.healthliteracy.com
The National Literacy and Health Program.
The Canadian Public Health Association's (CPHA) National Literacy
and Health Program (NLHP) promotes awareness among health professionals
of the links between literacy and health and contains some excellent
resources. http://www.nlhp.cpha.ca/
Literacy Sites
International Adult Literacy Survey (IALS)
http://www.nald.ca/nls/ials/introduc.htm
National Adult Literacy Database (NALD).
NALD is the host of hundreds of Canadian literacy websites,
the source of up-to-date news, and the repository of important
Canadian literacy reports and papers. http://www.nald.ca
Full
Text Documents
Beyond the Brochure: Alternative Approaches
to Effective Health Communication.
A guidebook published by Cancer Prevention and Control to adapting
existing materials for hard to reach audiences, and developing
new materials such as posters, display boards, fotonovellas,
role-play, songs, storytelling, games, etc. http://www.cdc.gov/cancer/nbccedp/bccpdfs/amcbeyon.pdf
Clear and Simple: Developing
Effective Print Materials for Low Literate Readers.
A publication of the National Cancer Institute, this
guide presents a process for developing publications for people
with limited-literacy skills. With helpful examples, it outlines
the following steps: 1, Define the target audience; 2, Conduct
target audience research; 3, Develop a concept for the product;
4, Develop content and visuals; 5. Pretest and revise draft
materials. http://oc.nci.nih.gov/services/Clear_and_Simple/HOME.HTM
The Directory of Plain Language
Health Information.
This document, available in HTML and PDF, tells health educators
how to find excellent examples of plain language health information
on a variety of subjects. It also contains plain language and
clear design tips and the SMOG readability formula. http://www.pls.cpha.ca/english/directry.htm
Perrin, Burt. How Does Literacy Affect the Health
of Canadians
http://www.phac-aspc.gc.ca/ph-sp/phdd/literacy/literacy.html
