Teaching Patients with Low Literacy Skills

Second Edition
by Doak, Doak, & Root, 1996

Teaching Patients with Low Literacy Skills can be read and downloaded here. The book is now considered a classic text in health literacy. The authors, Ceci and Len Doak, are often introduced at health literacy conferences as ‘the grandparents’ of health literacy. Indeed, their contribution to the field and to our understanding of clear communication principles has been profound.

The book’s popularity has grown amongst health educators, health communication specialists, and health care providers. The text provides insight for all of us concerned with improving health communication. I use the text in a graduate class on Health Literacy. My students find it very valuable.

The book title, if chosen today, would more likely address “patients with average literacy skills.” Findings from the 2003 National Assessment of Adult Literacy (NAAL) survey indicate that large numbers of adults in our country are constrained in their ability to use everyday print materials with accuracy and consistency. Mean scores for both men and women are quite low and are about the same or lower than they were 12 years ago when literacy skills of US adults were first measured (NALS, 1992). At the same time, well over 800 peer-reviewed articles in public health and medical journals attest to the fact that health materials are written at reading grade levels that far exceed the average reading skills of high school graduates. This mismatch between literacy demands and literacy skills limits access to important information as well as to health care and services.

Sadly, Teaching Patients with Low Literacy Skills is now out of print. In July 2006 the copyright on the text was returned to Ceci and Len Doak by the publisher, Lippincott Williams & Wilkins. I post the full text here, with encouragement from Ceci and Len Doak. However, this current version was done quickly, with an in-house scanner, and with no budget. The image quality is a bit low. I hope to raise funds and submit the materials for commercial scanning. This will enable me to post a high-resolution image — hopefully in the near future.

The book covers a wide range of topics, including educational theories, tests for literacy skills, assessments of the suitability of materials, as well as discussion and examples of understandable visuals. The book includes directions for using the Fry formula, the REALM assessment tool, and Suitability Assessment of Materials (SAM). The SAM brings our attention to elements of text that go beyond measures of word and sentence length.

I present the text in a chapter by chapter version. You may click on a chapter, listed with its proper title and page numbers. Some of you may want to read through the entire texts. Others may want to begin with the SAM and will click on: Chapter 4 – Assessing Suitability of Materials (pp. 41-60).

When you have opened a section of the book, the pages will display at a certain level of magnification, depending on the individual settings of your computer. To change the magnification level, click on the magnifying glass icon (also called the “Zoom In Tool”) and then click where you would like to zoom in to within the section you are viewing. To zoom out, click on the downward arrow next to the magnifying glass, then select “Zoom Out.” Click on the spot where you would like to zoom out within the document.


Rima E. Rudd, MSPH, ScD
Principal Investigator
Health Literacy Studies

To view this book, you will need Adobe Acrobat Reader, which can be downloaded for free here.

Introduction pg i-xii (includes Cover, Cataloging Information, Foreword, Preface, Acknowledgments, Table of Contents)

Chapter 1-Chapter 4 pg 1-60

Chapter 5-Chapter 7 pg 61-128

Chapter 8-Chapter 10 pg 129-188

Appendices & Index pg 188-212 (includes Appendix A- Appendix D, and Index)