Literacy Concept In Health Care and Nursing Education

Concept of Literacy and Illiteracy In Health and Education

How to Define  Literate,Literate In the United State,Literate Definition By NAP,Literate and Illiterate In Functional & Conventional Way,Literacy Challenges In Health Care,Common and Health Literacy Concept Literacy and Illiteracy,Benefit of Literate Patient In Health Care and Nursing Education.

How to Define  Literate

   For many years, there was no clear agreement of what it meant to be literate in American society. A literate person was loosely described as someone who possessed socially required and expected reading and writing abilities, such as being able to sign his or her name and read and write a simple sentence. Over time, performance on reading tests in school became the conventional method to measure grade level achievement. 

    Because it is difficult, if not impossible, to measure reading abilities on a population wide basis, the number of years of schooling attended has been used to define literacy levels (Badarudeen & Sabharwal, 2010; Giorgianni, 1998). This method remains an imprecise means of estimating someone's true reading skills. Many have found researchers that the reported grade level achieved in school is an inadequate predictor of reading ability (Chew, Bradley, & Boyko, 2004; Doak et al., 1996; O'Bryant et al., 2007; Weiss, 2003; Winslow , 2001).

Literate In the United State

     In the United States, the term literacy is generally defined as the ability to read and speak English (Andrus & Roth, 2002). In the 1992 NALS report, the US Department of Education defined literacy as “the ability to use printed and written information to function in society, to achieve one's goals, and to develop one's knowledge and potential” (National Center for Education Statistics, 1993, p. 6). NALS categorized literacy into three types of tasks: prose (reading newspapers, magazines, books), document (interpreting insurance reports, consent forms), and quantitative (computing bills, taxes, paycheck stubs, caloe counts).

Literate Definition By NAP

    Most recently the NAP defined literacy as being able to demonstrate skills in reading. writing, basic math, interpreting speech, and comprehending information as well as skills in numeracy, which implies an aptitude with basic probability and numerical concepts (Baur, 2011). Overwhelmingly, those individuals with limited literacy also have limited ability in numeracy (Andrus & Roth, 2002; Doak et al., 1996; Fisher, 1999; Williams et al., 1995).

Although no precise cut off point defines the difference between literacy and illiteracy, the commonly accepted working definition of what is meant by literate is the ability to write and to read, understand, and interpret information written at the eighth-grade level or above. On the other end of the continuum, illiterate is defined as being unable to read or write at all or having reading and writing skills at the fourth-grade level or below.

Literate and Illiterate In Functional & Conventional Way

    Low literacy, also termed marginally literate or marginally illiterate, refers to the ability of adults to read, write, and comprehend information between the fifth and eighth grade levels of difficulty. Persons with low literacy have trouble using commonly printed and written information to meet their everyday needs, such as reading a TV schedule, taking a telephone message, or filling out a relatively simple application form (Doak et al., 1996).

    Functional illiteracy means that adults lack the fundamental reading, writing, and comprehension skills that are needed to perform the tasks of everyday life (Giorgianni, 1998; Vagvolgyi, Coldea, Dresler, Schrader, & Nuerk, 2016; Williams, Baker, Parker , & Nurss, 1998). They do not read well enough to understand and interpret what they have read or use the information as it was intended (Doak et al. 1996). 

    For example, someone who is functionally illiterate may be able to read the simple words on a label of a can of soup that directs them to “Pour soup into pan. Add one can water. Heat until hot.” However, they cannot understand the meaning and sequence of the words to carry through with these directions.

    Conventional grade level definitions of literacy are considered conservative because even an adult with the ability to read at the eighth grade level will encounter difficulties in functioning in today's advanced society. However, although an individual may have poor reading skills, this does not necessarily imply a lack of intelligence. Low literacy or illiteracy cannot be equated with 1Q level. A person can be illiterate or low literate, yet intellectually be within at least normal IQ range (Doak et al., 1996). Health literacy is defined by the patient

    Protection and Affordable Care Act of 2010, Title V, as the “degree to which an individual has the capacity to obtain, communicate, process, and understand basic health information and services to make appropriate health decisions” (Centers for Disease Control and Prevention ( CDC), 2016, para. 1). Health literacy requires a person to do more than simply read patient educational materials or make an appointment. A health literate individual must, for example, be able to read a medication label and then calculate the correct dose and frequency of taking the medication. 

Literacy Challenges In Health Care

    He or she must be able to fill out lengthy health insurance forms, know when to vaccinate his or her child or have a mammogram, or give informed consent for a lifesaving procedure. Although literacy and health literacy are closely related, they are different concepts (McCray, 2005). Health literacy is complex, such that even those people with strong reading and writing skills, high levels of education, and influence can face challenges with health literacy. In fact, 45% of high school graduates have limited health literacy skills (USDHHS, 2010). The CDC (2016) outlines the following common health literacy challenges facing many people:

1. They are not familiar with medical terms or how their bodies work.

2. They must be able to interpret or calculate numbers or risks that could have health and safety consequences.

3. They are scared and confused when diagnosed with a serious illness.

4. They have health conditions that require high levels of complicated self care instructions. 

5. They are voting on a critical local issue affecting the community's health and are relying on unfamiliar technical information.

Common and Health Literacy Concept Literacy and Illiteracy

    Health literacy level cannot be determined from stereotypes, generalizations, or assumptions, or by simply looking at a patient. Furthermore, health literacy levels change over time with education, aging, social interactions, language, culture, and life experiences with health and illness (Baker, 2006; Nguyen et al., 2013; Speros, 2011). 

    The Ad Hoc Committee on Health Literacy for the Council on Scientific Affairs of the American Medical Association (1999) concluded that an individual's functional health literacy is likely to be significantly worse than his or her general literacy skills because of the complicated language used in the healthcare field, known as medicalese. Health literacy is a complex issue, and many variables have the potential to influence an individual's capacity to obtain, process, and understand information. 

    Some have suggested that “if health literacy is the ability to function in the health care environment, it must be dependent upon the characteristics of both the individual and the health care system” (Baker, 2006, p. 878). Health literacy should be considered context specific and, as such, is influenced by the patient, the complexity of the condition and treatment, and the environment in which the treatment takes place (Volandes, 2007).

    With the expectations, economics, and complexities of the healthcare system today, which require individuals to take more responsibility for self-care and symptom management, health literacy is becoming an important determinant of health status. Poor health literacy may lead to serious negative consequences, such as increased morbidity and mortality, when a person is unable to read and understand instructions for medications, follow-up appointments, diet, procedures, and other regimens. 

    Patients cannot be expected to be compliant, autonomous, and self-directed in navigating the healthcare system if they do not have the ability to follow basic instructions (Bennett, Chen, Soroui, & White. 2009; Davis et al., 2006). Further, low health literacy can result in more emergency department visits and hospital admissions and reading missions, with the elderly experiencing lower health status with increased mortality (Stevens, 2015). 

    It also affects use of preventive services such as mammography and flu vaccination and lessens the likelihood a person will take medications or follow health instructions correctly (Berkman, Sheridan, Donahue, Halpern, & Crotty, 2011).

    Reading, readability, and comprehension also are terms frequently used when determining levels of literacy. Fisher (1999) defines reading or word recognition as “the process of transforming letters into words and being able to pronounce them correctly” (p. 57). Word recognition test scores, which can be misleading because they indicate only a person's ability to identify words, not understand them, are usually three grade levels higher than comprehension scores (Fisher, 1999). 

    Hirsch (2001) addresses the public's confusion between reading in the sense of being able to decode words fluently and reading in the sense of being able to understand the meaning of words.

    Readability is defined as the ease with which written or printed information can be read. It is based on a measure of several different elements within a given text of printed material, such as the level of language being used and the layout and design of the page (Hasselkus, 2009). These variables influence with what degree of success a group of readers will be able to read the style of writing of a selected printed passage.

    Comprehension, in comparison, is the degree to which individuals understand what they have read (Fisher, 1999; Koo, Krass, & Aslani, 2005). It is the ability to grasp the meaning of a message to get the gist of it. A healthcare professional can determine whether comprehension of health instruction has occurred by noting whether clients are able to demonstrate correctly or recall in their own words the message that was received (Caplin & Saunders, 2015).

    The ability to read does not, by itself, guarantee reading comprehension. Comprehension is affected by the amount, clarity, and complexity of the information presented. If the elements of logic, language, and experience in health instruction are compatible with and culturally appropriate to the clients' background, the message likely will be clear and relevant to them (Doak et al., 1996). Conversely, a mismatch will likely make the message confusing. incomprehensible, and useless to the individual.

Benefit of Literate Patient In Health Care and Nursing Education

    Illness, medication, treatment, or disruptive life situations, all of which may cause stress and anxiety, have been found to interfere significantly with comprehension. The ability to take in medical information, store it in memory, and recall it when necessary is affected by many other factors as well, such as the length of time between information disclosure and the need to remember the information, the nature of the information (how threatening), and the method of representation (Doak et al., 1996; Doak, Doak, Friedell, & Meade, 1998; Kessels, 2003; Ley, 1979; Stephenson, 2006; Stevens, 2015).

    Readability and comprehension, therefore, are particularly complex activities involving many variables with respect to both the reader and the actual written material (Doak et al., 1996; Fisher, 1999). Both are commonly determined by using one or more measurement formulas (see the later discussions of measurement tools in this chapter). BOX 7-1 shows examples of elements that affect readability and comprehension.