Young Adult Literacy and Problems In Nursing Education

Low Literacy Level In Young Adults and Issue in Nursing Education

Trends Associated with Literacy Problems,Schooling Level and Literacy Abilities,Literacy and Low Literacy In Nursing Education,Literacy  Level and Effects on Health Level,Literacy and High Risk Population In Nursing Education.

Trends Associated with Literacy Problems

    The trend toward an increased proportion of Americans having literacy levels that are inadequate for active participation in this advanced society is the result of factors such as the following (Baur, 2011; Gazmararian et al., 1999; Giorgio Gianni, 1998; Hayes, 2000 ; Hirsch, 2001; Kogut, 2004; Weiss, 2007):

An increase in the number of immigrants with English as a second language the aging of the population

The increasing amount and complexity of information

The increasing sophistication of technology

More people living in poverty

Changes in policies and funding for public education

Disparities between minority versus non-minority populations

Schooling Level and Literacy Abilities

    These factors correlate significantly with the level of formal schooling attained and the level of literacy ability. Although research indicates that the number of years of schooling is not a good predictor of literacy level, there remains some correlation between a person's educational background and the ability to read (O'Bryant et al., 2007). As society becomes increasingly more technologically challenging, with new products to use and more complicated functions to perform, the basic language requirements needed for survival continue to expand. Many more people are beginning to fall behind, unable to keep up with an ever more sophisticated world.

Literacy and Low Literacy In Nursing Education

    In cases of both illiteracy and low literacy. the level of readability is measured in terms of performance, not years of school attendance. The mean literacy level of the US population is at or below eighth grade. Medicaid. enrollees, on average, read at the fifth-grade level (Andrus & Roth, 2002; Giorgianni, 1998; Winslow, 2001). Many people read at least two to four grade levels below their reported level of formal education. For those in poverty, the gap between grade level completed and actual reading level is even greater (Andrus & Roth, 2002). 

Literacy  Level and Effects on Health Level

    This deficiency persists because schools tend to promote students for social and age related reasons rather than for academic achievement alone (Feldman, 1997), because clients may report inaccurate histories of years of school attended, and because reading skills may be lost over time through lack of practice (Davidhizar & Brownson, 1999; Miller & Bodie, 1994; Weiss, 2003; Williams et al., 2002). 

    Levels of literacy are often seen as indicators of the well being of individuals, and the literacy problem has larger implications for the overall social and economic status of the country (Kogut, 2004). Low levels of literacy have been associated with marginal productivity, high unemployment, minimum earnings, high costs of health care, and high rates of welfare dependency (Andrus & Roth, 2002; Eichler et al., 2009; Giorgianni, 1998; Weiss, 2007 ; Winslow, 2001; Ziegler, 1998).

    In addition, illiteracy contributes to many of the grave social issues confronting the United States and other countries worldwide, such as homelessness, teen pregnancy, unemployment, poverty, delinquency, crime, and drug abuse (Fleener & Scholl, 1992; Kogut. 2004; World Literacy Foundation, 2015). Deficiencies in basic literacy skills become compounded and create devastating cumulative effects on individuals, which produces a social burden that is extremely costly for the American people. 

    Illiteracy and low literacy are not necessarily the reasons for these ills, but the high correlation between literacy levels and social problems is a marker for disconnectedness from society in general (Kogut, 2004; USDHHS, 2003).

Literacy and High Risk Population In Nursing Education

    Illiteracy has been described “as an invisible handicap that affects all classes, ethnic groups, and ages” (Fleener & Scholl, 1992, p. 740). It is a silent disability. Illiteracy knows no boundaries and exists among persons of every race and ethnic background, socioeconomic class, and age category (Duffy & Snyder, 1999; Parnell, 2014; Weiss, 2003). It is true, however, that illiteracy is rare in the higher socioeconomic classes, for example, and that certain segments of the US population are more likely to be affected than others by lack of literacy skills. 

    Research shows (Cole, 2000; Hayes, 2000; Kogut, 2004; Montalto & Spiegler, 2001; Nath. Sylvester, Yasek, & Gunel, 2001; Rothman et al., 2004; Schillinger et al., 2002; Schultz, 2002; Weiss. 2007; Williams et al., 1998; Winslow, 2001) that the following populations have been identified as having poorer reading and comprehension skills than the average American:

Those who are disadvantageously disadvantaged older adults

Immigrants (particularly illegal ones) Those with English as a second language

Racial minorities

High school dropouts

Those who are unemployed prisoners

Inner city and rural residents

    Those with poor health status resulting from chronic mental and physical problems Those on Medicaid Of course, not every member of an Atri 29 population suffers from low literacy. Further, some people do not fall into an “at risk” category yet still lack literacy skills (Baur, 2011; Weiss, 2007). With respect to demographics, statistics indicate that 34 million Americans are currently living in poverty and that nearly half (43%) of all adults with low literacy live in poverty (Darling, 2004; Literacy Project Foundation, 2017). 

    Although those who are disadvantaged represent many diverse cultural and ethnic groups, including millions of poor Caucasians, one third of disadvantaged people in this country are minorities, and a larger percentage of minorities fall into the disadvantaged category (Giorgianni, 1998; Weiss et al. , 2005).

    In this 21st century, the major growth in the US population is predicted to come from the ranks of minority groups. By 2050, 53% of the people in the United States are projected to belong to a racial or ethnic minority and one in five will be foreign born (Passel & Cohn, 2008). The US Census Bureau (2012) reported that almost 40 million immigrants reside in this country, more than quadruple the number in 1970, with more than half of those individuals living in California, New York, Florida, and Texas. 

    One third of the foreign born population has arrived since 2000, 62% of immigrant families have children, and 30% of immigrants do not have a high school diploma (Grieco et al. 2012; US Census Bureau, 2012). Of the 1,000 community-based adult literacy programs supported by ProLiteracy, 86% teach English as a second language (ESL; M. Diecuch, personal communication, January 23, 2017). Nurse educators must recognize how these demographic changes will affect the way in which services need to be rendered, educational materials need to be developed, and information needs to be marketed (Andrus & Roth, 2002; Borrayo, 2004; Parnell, 2014; Robinson, 2000). 

    Many minorities and economically disadvantaged people, as well as the prison population which has the highest concentration of adult illiteracy (Duffy & Snyder, 1999) are not beneficiaries of mainstream health education activities, which often fail to reach them. Overall, they are not active seekers of health information because they tend to have weaker communication skills and inadequate foundational knowledge on which to better understand their needs. 

    Many lack enough fluency to make good use of written health education materials. Furthermore, although most PEMs are written in English, fluency in verbal skills in another language does not guarantee functional literacy in that native language (Horner, Surratt, & Juliusson, 2000). Areas with the highest percentage of minorities and high rates of poverty and immigration also have the highest percentage of functionally illiterate people. 

    When these people need medical care, they tend to require more resources, have longer hospital stays, and have a greater number of reading missions (Levy & Royne, 2009; Weiss, 2007). The challenge now and into the future will be to find improved ways of communicating with these population groups and to develop innovative strategies in the delivery of health care to them.

    As for Americans who are older than 65 years of age, two out of five adults (approximately 40%) are considered functionally illiterate (Davidhizar & Brownson, 1999, Gazmararian et al., 1999; Williams et al., 2002). Older adults constitute approximately 15% of the total US population now, but the number of those older than 65 will increase to approximately 21% or 74 million Americans by 2030. 

    Individuals older than 85 years of age make up the fastest growing age group in the country today and which is projected to reach 20 million by 2060 (Federal Interagency Forum on Aging-Related Statistics, 2016). Children born today can expect to live to an average age of at least 80 years (Crandell, Crandell, & Vander Zanden, 2012). Thus, it is likely that a greater overall number of older adults will have problems with functional illiteracy.

    With respect to educational level, members of the older population will be more educated and demand more services as time goes on. In 1960, only 20% of older people were high school graduates; in 2015, 85% were educated at the high school level (USDHHS, 2016). Although these statistical trends indicate the US population will include a more highly educated group of older adults in the future, the information explosion and rapid technological advances may cause them to fall behind relative to future standards of education. 

    Today, the illiteracy problem in older adults is caused by the fact that not only did these individuals have less education in the past, but their reading skills also have declined over time because of disuse. If a person does not use a skill, he or she loses that skill. Reading ability can deteriorate over time if not exercised regularly (Brownson, 1998). In addition, cognition and some types of intellectual functioning are affected by aging (Crandell et al., 2012; Kessels, 2003; Santrock, 2017). 

    A significant number of older people have some degree of cognitive changes and sensory impairments, such as vision and hearing loss. On the average, 28% of people age 65 and 38% of those older than 75 years of age have serious hearing impairment; women fare better than men in this regard (Crandell et al., 2012). 

    Along with these normal physiological changes, many older adults suffer from chronic diseases, and large numbers are taking prescribed medications. These conditions can interfere with the ability to learn or can negatively affect thought processes, which contributes to the high incidence of illiteracy and low health literacy in this population group (CDC, 2009; Nguyen et al., 2013; Sudore, Yaffe et al. , 2006).

    Beyond the issue of prevalence, illiteracy presents unique psychosocial problems for the older adults. Because older persons tend to process information more slowly than do young adults, they may become more easily frustrated in a learning situation (Crandell et al., 2012; Kessels, 2003). Furthermore, many older individuals have developed ways to compensate for missing skills through their support network. 

    Lifetime patterns of behavior have been set, such that they may now lack the motivation to improve their literacy skills. Today and in the years to come, those nurses involved with providing health education will be challenged to overcome these obstacles to learning in the older adult.

    Cultural diversity, although not considered to be directly related to illiteracy, may also serve as a barrier to effective client education. According to Davidhizar and Brownson (1999) and a contention backed up by the NAAL's 2003 statistics-most adults with illiteracy problems in the United States are Caucasian, native born, English speaking individuals. However, when examining the proportion of the population that has poor literacy skills, minority ethnic groups are at a disproportionately higher risk (Andrus & Roth, 2002).

    When healthcare providers communicate with clients from cultures different from their own, it is important for them to be aware that their clients may not be fluent in English. Furthermore, even if people speak the English language, the meanings of words and their understanding of facts may vary significantly based on life experiences, family background, and culture of origin, especially if English is the client's second language (Purnell, 2013) . 

    In conversation, an individual must be able to understand undertones, voice intonations, and the context (slang, terminology, or customs) in which the message is being delivered. Purnell (2013) stresses the importance of assessing other elements of verbal and nonverbal communication, such as emotional tone of speech. gestures, eye contact, touch, voice volume, and stance, between persons of different cultures that may affect the interpretation of behavior and the validation of information received or sent. 

    Educators must be aware of these potential barriers to communication when inter-acting with clients from other cultures whose literacy skills may be limited. Given the increasing diversity of the US population, most currently available written materials are considered inadequate based on the literacy level of minority groups and the fact that the majority of PEMs are available only in English.

    Thus individuals with less education, whose number often includes low income persons. older adults, racial minorities, and people for whom English is a second language, are likely to have more difficulty with reading and comprehending written materials as well as with understanding oral instruction (Winslow, 2001). This profile is not intended to stereotype people who are illiterate but rather to give a broad picture of who most likely lacks literacy skills. When carrying out assessments on their patient populations, it is essential that nurses and other healthcare providers be aware of those susceptible to having literacy problems.