Literacy and Readability

Literacy in the Adult Patient Population

 Today, The fact remains that many

individuals do not possess the basic literacy abilities to function effectively in our technologically complex society. Since then, awareness about illiteracy, thought to be mainly a problem confined to developing countries, has taken on new meaning. What must be of particular concern to the healthcare industry are the numbers of consumers who are illiterate, functionally illiterate, or marginally literate.

 Researchers have discovered that people with poor

reading & comprehension skills have disproportionately higher medical costs & more perceived physical & psychosocial problems than do literate persons. In todays world of managed care, the literacy problem is perceived to have grave consequences. Patients are expected to assume greater responsibility for self-care & health promotion, yet this expanded role depends on increased knowledge & skills. If patients with low literacy abilities cannot fully benefit from the type & amount of information they are typically given, then they cannot be expected to maintain health & manage independently. The result is a significant negative impact on the cost of health care & the quality of life.

Literacy an umbrella term used to describe socially required & expected reading & writing abilities.
- More specifically, literacy has been thought of as the relative ability to use printed & written material commonly encountered in daily living - (USDOE), the ability to use print & written information to function in society, to achieve ones goals, & to develop ones knowledge & potential

Examples of elements that affect readability & comprehension

Material Variables Legibility (e.g. print size, spacing) Organization & flow of content Concept level Length of text Sentence structure Level of vocabulary Relevance to the reader Jargon (medical terminology Number of polysyllabic words

Reader Variables Health status Perceived threat of illness Effects of illness or stress Physical & mental energy Level of motivation Visual & auditory acuity Educational attainment Background knowledge Ability to decipher language of message

Those at Risk
Illiteracy has been portrayed as an invisible handicap that affects all classes, ethnic groups, & ages. It is a silent disability. Illiteracy knows no boundaries & exists among persons of every race & ethnic background, socioeconomic class, & age category.

Low literacy also termed as marginally literate or marginally illiterate, refers to the ability of adults to read, write, & comprehend info b/w the 5th & 8th level of difficulty ` - have trouble using commonly printed & written info to meet their everyday needs such as reading a TV schedule, taking a telephone message, or filling out a relatively simple application form

Functional illiteracy have reading, writing, & comprehension skills below the fifth-grade level; that is they lack the fundamental education skills needed to function effectively in todays society

Winslow & Hayes, populations that have been identified as having poorer reading & comprehension skills than the average American include the ff: The economically disadvantaged Older adults Immigrants (illegal) Racial minorities High school dropouts The unemployed Prisoners Inner-city & rural residents Southerners (Louisiana, Texas, & Mississipi report the

highest rates of illiteracy in the nation) Those with poor health status due to chronic mental & physical problems

The observant practitioner should always be on the lookout for possible signs of poor reading ability in a patient. If healthcare providers become aware of a patients literacy problem, they must convey sensitivity & maintain confidentiality to prevent increased feelings of shame. During assessment , the nurse should take note of the following clues that illiterate patients may demonstrate:

 Reacting to complex learning situations by

withdrawal, complete avoidance, or being repeatedly noncompliant. Using the excuse that they were too busy, too tired, too sick, or too sedated with medication to maintain attention span when given a booklet or instruction sheet to read. Claiming that they just did not feel like reading, that they gave the information to their spouse to take home, or that they lost, forgot or broke, their glasses.

 Camouflaging their problem by

surrounding themselves with books, magazines, & newspapers to give the impression they are able to read. Circumventing their inability by insisting on taking the information to their spouse to take home to read or having a family member or friend with them when written info is presented. Asking you to read the info for them under the guise that their eyes are bothersome, they lack interest, or they do not have the energy to devote to the task of learning

 Showing nervousness as a result of feeling

stressed by the threat of the possibility of getting caught or having to confess to illiteracy. Acting confused, talking out of context, holding reading materials upside down, or expressing thoughts that may seem totally irrelevant of the topic of conversation. Showing a great deal of frustration & restlessness when attempting to read, often mouthing words aloud, or silently, substituting words they cannot decipher w/ meaningless words, pointing to words or phrases on a page, or exhibiting facial signs of bewilderment or defeat

 Standing in a location clearly designated

for authorized personnel only. Listening & watching attentively to observe & memorize how things work. Demonstrating difficulty w/ ff instructions about relatively simple activities such as breathing exercises or w/ operating the TV, electric bed, call light & other simple equipment, even when the operating instructions are clearly printed on them. Failing to ask any questions about the info they received.

 Revealing a discrepancy b/w what is

understood by listening & what is understood by reading.

 In summary, the level of completed formal

education is an inaccurate presumption by w/c to predict reading level, therefore nurses need this to incorporate into their methods of assessment. Negative feedback & clues in the form of puzzled looks, inappropriate behaviors, excuses or irrelevant statements may give the nurse the gut feeling that the message being communicated is neither received nor understood.