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Literacy and Health
Rima Rudd, lecturer in the Department of Health and Social
Behavior, is concerned about people's ability to read. "People who have low
levels of functional literacy," she says, "are the same people we've
found to be at higher-than-average risk for health problems.
"The connection is too pervasive to be coincidental. In the interests of public health, we need to explore and understand the ways that literacy and education are connected with health outcomes."
Rudd and a group of HSPH faculty, staff, and students are investigating these connections through a group of research projects collected under the umbrella title of Health and Literacy Studies.
A person's reading ability can influence his or her health care in a number of ways. An obvious case is a patient who is unable to read the dosage instructions on a prescription label.
A subtler influence can be seen in the coping strategies employed by some marginally literate patients when they are asked to answer the medical history questionnaires frequently given before a medical appointment. "A number of people have told me that they just go down the list and check 'no' for everything because it's the simplest thing to do. They don't want to embarrass themselves by admitting that they can't read," said Rudd. "The problem is that this short-circuits the initial communication between patient and physician--the patient has possibly misrepresented his or her health and has denied the physician information valuable to making a diagnosis."
Another problem is the mismatch between the difficulty of the material and the reading ability of the public. Rudd recently completed a review of the medical and public health literature of the past 30 years and notes: "While this mismatch has been well documented, solutions have not been forthcoming. There are serious legal and ethical issues concerning patients' ability to comprehend informed consent forms. There are potentially harmful outcomes of jargon-filled or poorly written health directives. For practical purposes, health information is inaccessable if it's written at a level beyond the comprehension of most adults."
While an appreciation of the importance of literacy is nothing new, an understanding of the magnitude of America's literacy problem is. In 1993, the National Adult Literacy Survey found that approximately 50% of those surveyed had marginal reading skills--or worse. "These are people who have real difficulty figuring out bus schedules, computing discounted sale prices in stores, or distilling the main point of a newspaper article," explained Rudd.
Who are these people? While marginally literate people are found among all socioeconomic groups, they are concentrated in poor populations, minority populations, immigrant populations, and among the elderly. "These are precisely the groups that we have found to be at higher risks for many public health concerns," said Rudd.
Rudd and her colleagues in health and literacy studies are tackling literacy through several projects. In one project, Rudd is working with adult educators to incorporate functional health literacy into the curriculum.
Another project, also associated with adult education, examines the effects of breast and cervical cancer curriculum materials in adult learning centers. The materials have been written and designed to be understandable to a wide range of reading skill levels.
A third program builds on recent studies that have provided evidence of the health effects of limited literacy and uses recently developed methods for measuring health literacy. In this project, researchers are looking at the experiences of patients with chronic diseases, their literacy levels, and their management of their health.
Rudd and her colleagues believe that a full understanding of literacy and its effects is requisite to effective public health practice. "Communication is basic to public health," said Rudd. "The question is, 'are we good communicators?' Literacy is a fundamental component of communication.
"Numerous studies have
shown that there are links between literacy, specifically; education,
generally; and health. We've just begun to tease out the ways that these
are linked together. It's a health issue, and people would benefit if we
had more public health eyes looking at it."
Members of the school's health and literacy team: back row, from left: Andrea
Parrella, Kim Kaphingst, Susan Koch-Weser, Lucy Zahner, Tayla Colton. Front row, from
left: Lawren Daltroy, TinhVan Diep, Anna Martin, Rima Rudd.
