[NIFL-HEALTH:3116] Re: health literacy

From: Nan GILMORE (Nan.GILMORE@state.or.us)
Date: Fri Jun 08 2001 - 18:12:55 EDT


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From: "Nan GILMORE" <Nan.GILMORE@state.or.us>
To: <Dwyoho@aol.com>, <nifl-health@literacy.nifl.gov>
Subject: [NIFL-HEALTH:3116] Re: health literacy
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Debbie,  I am new to public health after years of working in a hospital setting and after taking 4 years away from nursing to study education, sociolinguistics and anthropology.  I so appreciate your comments as I navigate the world of public health with an eye on literacy and education.  Thanks!




Nanis Gilmore
Oregon Diabetes Program
(503) 731-3492
(503) 731-4082 fax


>>> Dwyoho@aol.com 06/08/01 07:08AM >>>
In a message dated 06/06/2001 7:54:36 PM Eastern Daylight Time, 
c.brown@ballarat.edu.au writes:


> That is, how beneficial is improving health literacy when
> factors like economic status, housing, access to services etc are still
> making life difficult. Are there any key studies that have shown an
> 

Chris, normally as moderator I stay out of the discussions, but the list is 
quiet and this is one of my favorite issues, so I'm going to indulge myself.

As a literacy professional, I can share that the same question applies to 
literacy instruction.  One of our constant frustrations is the hit and miss 
effectiveness of helping people deal with a myriad of barriers that stymie 
adult parpticipation in our literacy programs.  The gurus and powers-that-be 
often talk about "seamless" services, "case management" techniques, etc.  
This is a prime criticism of the crowd that comlains about duplication of 
services. 

But after 25 years, I have come to the conclusion that we can't just "adopt" 
the entire person's life, almost like becoming a parent.  If you give me 10 
people to work with, I will not be successful with all 10, and I know that 
the reason(s) I am not successful with some are almost always beyond my 
control.  The trouble is, I cannot tell you either how many or WHICH of the 
ten will not work out, although researcher after researcher has tried to 
determine what factors might predict success or might be most likely to 
prevent it.  Some have succeeded.  We know, for example, that the single most 
powerful factor in whether or not a child will finish high school is whether 
or not the mother did. But this is a sweeping general predictor, applied to 
very large populations.  From where I sit, dealing with people day to day, it 
isn't very helpful in determining which of my literacy students will make it. 
 Most of them have parents who didn't finish school, but I know from 
experience that does not mean most can't learn to read.  

In short, I take the philosophical stance that in education, you cannot prove 
causation, only correlation, and the difference is profound.  It is a very 
hard pill to swallow among health professionals, who expect data that draw 
conclusions which can be replicated, and which generate reliable figures 
about efficacy and effectiveness.  For the most part, in my opinion, it is 
tilting at windmills when we are dealing with human beings whose lives 
include ten thousand factors that defy research controls.

And so I work with those ten people with the same attitude applied to each 
one--that what I can provide MIGHT help, and rest my job satisfaction on the 
pleasure of human relationships that I know intuitively are productive and 
helpful most of the time, even if I can't prove it so in terms of numbers, 
only case studies.

Of course, the rubber meets the road when the accountability geeks come 
along.  I can't dismiss them.  So I just do my best to incorporate some of 
those sweeping generalizations that research has uncovered (i.e. "risk 
factors") whenever I write a grant, for instance.  And I take a stab at 
achieving "benchmarks" like percentages of the population that I expect will 
meet xyz outcome.  When we meet the benchmarks, no one is more pelasantly 
surprised than me.  And the benchmarks I set are not pulled from the air, but 
based on experience and fairly wise guesstimates.  When we miss the mark 
spectacularly, I incorporate that experience into the next guess.  

And so it goes.  If someone here suggests some research results, look at the 
study carefully.  And don't hesitate to react and report on what you find out 
right here.  

Thanks for the question, Debbie

Deborah W. Yoho
Co-moderator, NIFL Health Literacy Discussion Group
Chief Executive Officer
Greater Columbia Literacy Council
921 Woodrow Street  
Columbia, SC  29205
803/765-2555   dwyoho@aol.com 


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