[NIFL-HEALTH:3448] Re: approaching adults regarding literacy levels

From: Lendoak@aol.com
Date: Fri Nov 09 2001 - 16:59:32 EST


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Subject: [NIFL-HEALTH:3448] Re: approaching adults regarding literacy levels
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Dear Rosalie and net,

Regarding your question on approaching patients to assess their literacy 
skills, there are variopus ways to do this.  You can get good advice on this 
from the developers of the REALM test. Our experience was earlier and made 
use test instruments available then, the WRAT and Close tests.

Under a contract with the USPHS, Ceci Doak and I  tested the literacy skills 
of 100 patients at the Public Health Service Hospital at Norfolk, Va. in 
1979. These were both out patients in patients. The results were reported in 
Patient Counseling and Health Education 1979-80 Winter Ed.

Only 2 or 3 out of 100 declined to participate in the literacy assessment. 
Most participated very willingly. Our process was as follows:

For in-patients we checked with the nurse to assure that the patient was not 
too ill to participate.

First, and perhaps most important, we asked patients if they would help us. 
(This puts the transaction on an entirely different footing.) We explained 
that it would only take a few minutes, and if they were called we would stop 
right away.

We explained that we were trying to make health instructions easier to 
understand and needed to find out what the problems might be. 

For screening purposes, the patient was then asked to read the word list on 
the WRAT test. We broke the WRAT word list into two pages, and offered only 
the first page initially.) If the patient had trouble with the first page, 
they were not shown the second. We recorded their scores.

If the patient scored 5th to 8th grade, they were asked to read a health 
instruction that was written at the 6th grade level to test comprehension via 
a Cloze test. If they scored 9th grade and above they received a 10th grade 
Cloze test. If the patient scored below the 6th grade, they had the 
instruction read to them.

Thus, we could later show relationships between their WRAT scores and 
comprehension of health instructions. And by examining the Cloze results, we 
could see which parts of the health care instructions gave the most trouble. 
These data were reported to the USPHS.

Each patient session took about 10 minutes. 

Patients were thanked sincerely after they had participated.

We hope this helps Rosalie. By the way, our postion is that unless there is a 
very specific reason to test a patient's literacy skills, it should not be 
done. After all, even if every patient's literacy skills were tested and 
recorded in their records, would the health care provider have the training 
and skill to modify thier instructions appropriately? 

best wishes,

Len and Ceci Doak
Patient Learning Assoc. Inc.



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