Young Adult Literacy and Effect on Nursing Education
Terms Related to Literacy
Literacy has been termed the “silent epidemic,” the “silent barrier,” the “silent disability,” and “the dirty little secret” (Conlin & Schumann, 2002; Doak & Doak, 1987; Kefalides, 1999; Wedgeworth, 2007) . Based on available statistics over the past 25 years, clearly the United States has significant literacy problems. In fact, this country ranks only among the middle of industrialized nations on most measures of adult literacy yet many of its educators, elected representatives, and social advocates have remained blind to this significant problem (Kogut, 2004).
Assessment of Adult Literacy
In 1985, the US Department of Education undertook the first
national assessment of adult literacy, known as the Young Adult Literacy
Survey. Since then, the federal government has conducted two subsequent
large scale assessment surveys (USDHHS, 2003). These two national surveys are
described as follows.
The 1992 NALS, considered to be a highly accurate and detailed
profile on the condition of English language literacy in the United States,
revealed surprising statistics. NALS interviewed researchers and collected data
from a representative sample of 26,000 individuals, ages 16 years and older.
Based on the findings from an assessment of literacy skills in three areas
(prose, document, and quantitative), literacy abilities were categorized into
five levels, with Level 1 being the lowest and Level 5 being the highest.
Some 21% to 23% (approximately 40-44 million) of the 191 million
adults in the country at that time scored in the lowest level of the three
skill areas. They were considered functionally illiterate. Another 25% to 28%,
or approximately 50 million adults, scored in the Level 2 category; that is,
they were considered to have low literacy skills. Thus, the number of
illiterate and low literate adults in the United States conservatively was
estimated to be approximately 46% to 51% of the population (or 90-94 million in
total).
Literacy In Yong Adults and Link to Socioeconomic Status
This indicated that roughly half of the US adult population had
deficiencies in reading, writing, and math skills (Fisher. 1999; Weiss, 2003).
The researchers found that those individuals with poor literacy skills (Levels
1 and 2) were disproportionately more often from minority populations, from
lower socioeconomic groups, and had poorer health status (Andrus & Roth, 2002;
Fisher, 1999; Weiss, 2003).
In 2003, building on the NALS of 10 years earlier, the National
Assessment of Adult Literacy (NAAL) became the first study to identify the
literacy of America's adults in the 21st century. New, more sensitive
instruments were designed to enhance measurement of the literacy abilities of
the least literate adults. Most important, this evaluation included a health
literacy component to assess adults' understanding of health-related materials
and forms (National Center for Education Statistics, 2006).
Level of Literacy Measurement
The NAAL categorized literacy skills into four levels, and the
findings revealed the following percentages and total numbers: below basic. 14%
(30 million); basic, 29% (63 million); intermediate, 44% (95 million); and
proficient, 13% (28 million). Of the overall 216 million adults in the US.
population in 2003, 43% (93 million) fell into the lowest two categories
(National Center for Education Statistics, 2006).
The average score results indicated no significant change in prose and document literacy and only a slight increase in quantitative literacy between 1992 and 2003. However, a higher proportional percentage of several population groups, such as those who did not graduate from high school, Hispanics, and those older than 65 years of age, fell into the below basic level of prose literacy (Kutner, Greenberg, Jin, & Paulsen, 2006).
The
NAAL's Health Literacy Report specifically found that 36% (47 million) adults
had basic or below basic health literacy and that older adults (65 years and older)
had the lowest health literacy levels (Baer, Kunter, & Sabatini, 2009;
National Center for Education Statistics, 2006). For more detailed information
on the NAAL survey, visit the National Center for Education Statistics.
In 2004, the Institute of Medicine, the Agency for Healthcare
Research and Quality (AHRQ), and the American Medical Association (AMA) issued
their own reports on the status of health literacy in the United States. All
three reports revealed that as many as 50% of all American adults lack the
basic reading and numerical skills essential to function adequately in the
healthcare environment (Aldridge, 2004; IOM, 2004; Weiss et al., 2005).
Most recently, competencies of adults from 33 countries, including the United States, were surveyed through the Program for the International Assessment of Adult Competencies (PIAAC), which is supported by the Organization for Economic Cooperation and Development E (OECD). The PIAAC “measures relationships between individuals' educational background, workplace experiences and skills, occupational attainment, use of information and communications technology, and cognitive skills in the areas of literacy, numeracy, and problem solving” (National Center for Education Statistics, nda para .2).
In 2012 and 2014, data were collected from 8,600 US participants in two waves (National Center for Education Statistics, ndb). Literacy was quantified on a scale of 0-500 and categorized into levels (below Level 1, Level 1, Level 2, Level 3, and Level 4/5). In this assessment, those who scored below Level 1, although not considered illiterate, could do no more than enter simple information into a form or locate simple and specific information in a text document to answer a question.
In contrast, those at Level 4/5 could find and synthesize information across multiple high level texts. On the average, American participants scored at Level 2, significantly below the average of seven participating countries; only 13% of American adults scored at Levels 4/5. For numeracy, just 10% of Americans participating scored at the highest Levels 4/5 with the average American participant scoring at Level 2 (ProLiteracy, 2017; Rampey et al., 2016).
The PIAAC also assessed problem solving that involved technology, defined as “using digital technology, communication tools, and networks to acquire and evaluate information, communicate with others, and perform practical tasks” (Rampey et al., 2016, B9). This area is scored on four levels (below Level 1, Level 1, Level 2, and Level 3). Those below Level 1 have limited technology skills and can solve problems using only one simple technology related task at a time, whereas those at Level 3 can use multiple technology functions and tools simultaneously while problem solving.
In the US sample, only 5% of participants scored at the highest proficiency of Level 3, which was lower than the international average of 8%, and more participants scored at Level 1 or lower (64%), compared to the international average ( 55%) (ProLiteracy, 2017; Rampey et al., 2016).Although this newest measure does not seamlessly translate with those of the past, it demonstrates that the problem of low literacy remains, especially in areas of technology.
The PIAAC provides updated international standards on which to track and compare literacy progress not only in the United States but world-wide. The next round of PIAAC assessments is planned for 2017 (National Center for Education Statistics, nda). See Rampey et al. (2016) for more detailed information on findings of the PIAAC.
Because of the difficulty inherent in defining and testing literacy, the lack of inclusion of unidentified illegal immigrants in the United States in the national sample populations studied, and the fact that few people with limited reading skills admit to having any difficulty, the scope of the literacy problem is thought to be much greater than the estimates found in formal studies (Brownson, 1998; Doak et al., 1996; Weiss, 2003).
Link of Literacy to Level of Health In Nursing Education
Limited literacy leads to poor health outcomes. In fact, literacy skills are “a stronger predictor of an individual's health status than income, employment status, education level, and racial or ethnic group” (Weiss, 2007, p. 13). Individuals with limited literacy skills are less knowledgeable about their health problems and have higher hospitalization rates, more emergency department visits, higher healthcare costs, fewer healthy behaviors, and poorer health status (Eichler et al., 2009; Weiss, 2007; Weiss et al ., 2005).
McNaughton et al. (2015) found that acute heart failure patients with low health literacy scores were at higher risk for death after hospital discharge.The rates of illiteracy and low literacy generally and the low rates of health literacy particularly continue to pose a major threat to many segments of society. This problem is expected to grow worse because of the many trends described next that are operating in the United States and worldwide unless specific measures are taken to curb the tide.
To be literate 100 years ago meant that people could read and write their own name. Today, being literate means that one can learn new skills, think critically, solve problems, and apply general knowledge to various situations (Weiss, 2003).
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