1. Literacy
The Effects To
Physical and Mental Health
Presented by Caroline R. Colbert, M.Ed., CHES

2. National Surveys of Adult
Literacy
• NALS: National Adult
Literacy Survey done in
1992 and 2003
• IALS: International Adult
Literacy Survey 1992
NALS

3. 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

4. 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

5. 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

6. 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.

7. 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.

8. 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.

9. 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.

10. Cost of Low Health Literacy
$73 Billion Annually
Source Friedland, Georgetown University, 2003.

11. 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

12. 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.”

13. Video

14. 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

15. 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

16. Exercise
• What does this say?
• Can we say it easier?

17. Tools that help:
• Testing Readability
• Guidelines for
evaluation

18. Two Readability Tests
A B C D E
Readability choice of number of words per syllables per grade level
Formula 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 words
of text words
Three 100 word Divide the Sum of the Plot the answer
samples 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

19. 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

20. 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

21. Printed Material
• Spacing
• Color and Fonts
• Pictures
• Watermarks

22. 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.

23. Use Simple Line Drawings
Colbert, C. (1996) Readability Study of Bloodborne Pathogens Material. University Park,
PA: Penn State University

24. 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.

25. Use of fonts and spacing
Literacy is an important and well-known correlate of
health status and health-promoting behaviors
in nonindust r ial ized nat ions. Despit e t his,
research on the relationship between
l it er a cy a n d h ea l t h in in d u st r ia l ized
c o u n t r ies h as been l i m i t 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 after adjusting for 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 found patients’ functional 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.

26. 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

27. Another Exercise
• Evaluate a
brochure

28. So what can we do at
ViaQuest?
• Brainstorming Time
– For our students
– For our parents
– For ourselves