Hello --
My colleague Mary Smith and I have been engaged for the last five years in creating dementia care training materials that are designed to be accessible to people with limited proficiencies in English, whether the limitationa are in reading, writing, or speaking. That is because we consider that entry-level health care workers have health literacy needs that must be met - but that's a different discussion.

We have noticed several things: we have found that including our target audiences in constant feedback and evaluation - and when possible, in creation -- has improved the quality of what we create. In addition, we find that people with fewer limitations in language proficiencies find these materials beneficial and remark on their clarity.

Boyd Davis

--- On Wed, 11/4/09, Rima Rudd <rrudd at hsph.harvard.edu> wrote:

From: Rima Rudd <rrudd at hsph.harvard.edu>
Subject: [HealthLiteracy 3683] Re: Labeling "at risk" people?  Orlabelingpoor communication?
To: "The Health and Literacy Discussion List" <healthliteracy at nifl.gov>
Date: Wednesday, November 4, 2009, 10:45 AM


 
Hello, 
This is a fascinating discussion. As Archie so wonderfully points out, it is always easier to talk about the 'other' rather than look in the mirror and examine ourselves. 
This focus on a deficit model did arise from the shared shock resulting from the 1993 published NALS findings [and the IALS and ALLS findings in other industrialized nations and the NAAL of 2006]... that adults do indeed struggle with print materials commonly available in our society and very much needed to accomplish everyday tasks for civic and family life activities. Something was amiss and our assumptions were faulty. This sense of surprise clearly contributed to the much used and very narrow definition of health literacy [a matter of the capacities of individuals]. 
Perhaps it is time to examine the words we use and how we infer blame. The 1993 HHS report [Communicating Health] and the 2004 IOM report [Health Literacy] both highlight the need to understand that literacy must be considered in context [as Andres pointed out] and that we must pay attention to the dual nature of health literacy: the skills individuals bring and the demands/assumptions institutions make. Action must be focused on making sure that communication happens -- only possible when there is a match between the two.
My literature reviews [2000, 2007, 2009] note that the bulk of the literature on health literacy --  focuses on the demand side [close to 1,000 peer reviewed articles], offering clear evidence of a mismatch between the materials/communications we in public health, medicine, nursing, mental health, dentistry, pharmacy, health education, health services administration.... provide and the documented literacy skills of the average adult in our society. Many researchers may be lagging a bit behind with a continued focus  on measures of deficits instead of a focus on effects of programs for change. Let's begin to address the mismatch to promote change and study effects.
Rima
 
Rima E. Rudd, ScD, MSPH
Department of Society, Human Development & Health
Harvard School of Public Health
677 Huntington Avenue
Boston MA 02115
Phone: 617 432 1135
fax:     617 432 3123
web:    www.hsph.harvard.edu/healthliteracy
www.hsph.harvard.edu/sisterstogether


>>> "Fetty, Kimberly" <kfetty at hsc.wvu.edu> 11/4/2009 9:35 AM >>>

My experience is that surgeons believe they are gods sent to earth to save the rest of us from ourselves! I make myself accept that this is the mentality necessary to do their work. And, we do need them in the world. : ) I think they probably have just as hard a time accepting me and my personality. 

________________________________________
From: healthliteracy-bounces at nifl.gov [healthliteracy-bounces at nifl.gov] On Behalf Of Marshall, Caroline D. [Caroline.Marshall at danhosp.org]
Sent: Wednesday, November 04, 2009 8:19 AM
To: The Health and Literacy Discussion List
Subject: [HealthLiteracy 3681] Re: Labeling "at risk" people? Orlabelingpoor    communication?

I like that angle.  I had not thought of it that way before. The
healthcare environment is a new and unfamiliar place for many people, so
materials should be written in plain language.  However when I did a
presentation to our Surgery dept I showed a paragraph of our Informed
consent  document, one paragraph came out at a college reading level but
one surgeon got so bent out of shape when I suggested making it more
readable, or putting in a space for the patient to write in what he
thought the procedure was and its side effects etc. .  The consensus was
that this document had been reworked and was considered the best that
could be done.  Really by who? the patients. Unfortunately there was not
enough time to discuss it further.  I am told surgeons are a "different
lot"


Caroline

-----Original Message-----
From: healthliteracy-bounces at nifl.gov
[mailto:healthliteracy-bounces at nifl.gov] On Behalf Of Helen Osborne
Sent: Tuesday, November 03, 2009 4:00 PM
To: The Health and Literacy Discussion List
Subject: [HealthLiteracy 3679] Re: Labeling "at risk" people?
Orlabelingpoor communication?

Hi NIFL-Health,

[I am sending this message on behalf of Archie Willard who, for some
reason,
had trouble getting his email through to you. ~Helen Osborne] Here is
what
Archie wrote:

This subject keeps coming back. Testing people for literacy skills in a
doctor's office or a clinic was something The New Readers of Iowa at
their 2d Health Literacy Conference said in a statement "a doctors
office is no place for a reading test because it brought back the times
when they had to take tests in school and they failed'. There were over
one hundred new readers at this conference from 9 different states.

The Question: Do you understand putting all the responsibility on our
shoulders. What about the person who writes the material or who is
talking to us? Are you a good communicator? Are you clear? Are you using
everyday words? Are you giving us directions or information in a logical
order? Are you helping us take action? Please don't test our literacy
skills. Look in the mirror and test your communication skills

I have been to some health literacy conferences the past year. At these
conferences it has been said "that people who come for medical help have
the right to have materials written that they can understand and they
need to be talked to in everyday words

Archie Willard
Adult Learner
Health Literacy Advocate
URL - http://www.readiowa.org/archiew.html

----- Original Message -----
From: Audrey Riffenburgh
To: 'The Health and Literacy Discussion List'
Sent: Tuesday, November 03, 2009 12:26 PM
Subject: [HealthLiteracy 3673] Re: Labeling "at risk" people? Or
labelingpoor communication?


Greetings, all,

Fran, I DO say "this makes sense for everyone" and it's true. If you
look at
the NAAL health literacy data, you'll see that "only 12% of the
population
is proficient" in the tasks required for health literacy. But I think we

need to turn that on its head and say "the health, medical, and
insurance
industries have built systems that do not work for 88% of their intended

audiences." I think we ought to start using that kind of labeling.

As we make the case, we don't have to point out any specific "at risk"
populations because 88% of us are at risk of not being able to handle
the
systems that we're forced to use to get our health care, learn about
healthy
choices, etc. We need to make the case for change from that perspective
and
challenge the institutions, corporations, agencies, etc. to recreate
systems
and processes that work for everyone, no matter their educational,
literacy,
or language skills. That is their responsibility, I believe! In
communication, whether patient education, technical writing, social
marketing, or advertising, the writers'/speakers' first task is to know
their audience and customize to the audience's needs and interests. That

means one does not use methods that reach only 12% of your audience!
Let's
put the responsibility where it should be.

Audrey Riffenburgh, M.A., President
Plain Language Works, LLC
Specialists in Plain Language & Health Literacy since 1994
Based Albuquerque, New Mexico, USA
Phone: (505) 345-1107   E-mail: ar at plainlanguageworks.com
========================================
Principal and Founding Member, www.clearlanguagegroup.com
Co-founder and former Faculty, www.healthliteracyinstitute.net
Ph.D. Student in Health Communication, Univ. of New Mexico

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