Literacy and Health: A few notes

Yesterday I listened to the latest episode of the Health Literacy Out Loud Podcast, which is a great podcast dedicated to the health literacy (or illiteracy) and how to overcome it - a major problem not only for health professionals, but also for social marketers. Even in a non-medical centext, literacy levels are quite worrying, and more often underestimated than not: For example a study by Wallendorf (2001) points out that while almost all adults in first world countries are assumed to be able to read and write, 21% of adult Americans have only rudimentary skills, leaving them unable to extract even simple information from printed material. A further 25% can perform simple reading functions but “cannot integrate or synthesize several facts” from documents. In addition to these, many people don’t habitually communicate in a written/read form (for example by relying on visuals e.g. television rather than newspaper) and often learning through trial and error in preference to reading instructions. Even if adults have completed education to a level, their literacy skills are expected to drop three to four levels after leaving education as they no longer “keep up” their literacy skills.
Conversely, many medical professionals are highly educated to start with and are expected to keep up with the literature (i.e. through engaging with often extremely complex texts). Yet, an American study concludes as many as 42% of elderly patients can not functionally understand the instructions of how to take the medication they are being given (Roman, 2004). The recent podcast (no. 13) may provide some insight why this is often not picked up: As Doak & Doak argue, literacy is often associated with low intelligence, yet many people with low literacy levels haves exceptionally high levels of intelligence. Not least, they have learned how to circumvent intelligently reading complex information in everyday life. Thus, if a health professional falls into the “trap” to equate literacy and intelligence, it is likely that the literacy level will be heavily over estimated.
How to deal with it then? Well, the number one suggestion must logically be to not guess literacy. Of course more than that, it is a question of really making information material accessible, bearing in mind that literacy levels are likely to be much lower than expected. A simple tool may be McLaughlin’s online SMOG calculator - which calculates the literacy level from copied and pasted material. For more in depth suggestions on the topic, Doak, Doak, & Root’s book “Teaching Patients with Low Literacy Skills” is available online for free, offering more than just simple solutions - and a myriad of tips and tricks how to communicate more effectively.

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