I love both of these examples, but this seems like more of an example of 'culture shock', rather than health literacy. Let's all assume that universal health care is a basic right (heaven forfend!). This adds a new slant because it makes the elimination of systemic abuse of people with lower literacy a completely different issue to techno-culture shock. 
I know this detracts from the original discussion, but with all the talk about the difference between literacy/health literacy, and differences (or lack there of), we need to keep in mind that the right of a person to have access to a doctor, and health and wellness information is very different to the right to 'understand' all the functions and extras of a big screen TV (understanding technology), knowing how to catch a bus in another country (culture shock, Speaking Other Languages). 
Once we look at healthcare outside of the current systems of bureaucracy, we can then see where the communication breakdowns (betwen patient and healthcare worker) are, and where healthy behaviours are prevented.
 
 
-----Original Message-----
From: healthliteracy-bounces at nifl.gov [mailto:healthliteracy-bounces at nifl.gov]On Behalf Of Andrea Wilder
Sent: Tuesday, September 18, 2007 7:51 PM
To: The Health and Literacy Discussion List
Subject: [HealthLiteracy 1227] Re: (no subject)


Andres-- 

A 100% fabulous example. Boston has gone the way of DC, still haven't really figured out the system, and I always want to cry in frustration. I can envision the meltdown of people whose language isn't English when confronting our health institutions. Cambridge hospital has translators available in several languages, fortunately.. However, the buildings themselves are an additional puzzle. 

Andrea 

On Sep 18, 2007, at 11:50 AM, Muro, Andres wrote: 


Here is a little anecdote that I always share when I do health literacy workshops. 

I often travel to DC with colleagues to do workshops, attend conferences, etc. Most of my colleagues have post graduate degrees. In other words, we are on top of the food chain when it comes to educational achievement. Upon descending from the plane we head to the subway station were I always perform my “anthropological” observation of contextual literacy practices. Many of my colleagues go into a panic when they have to interact with the ticket purchasing and dispensing machine. They don’t want to stand out. They don’t want to hold the line and they don’t want to be left behind. In fact, it is common for people traveling alone to get the much more expensive and inconvenient taxis to avoid the “unfamiliar” literacy encounter. 

Fortunately, subway stations have a person that helps travelers interact with these machines and explain maps and routes. In fact, these helpers prefer to give oral directions to passengers rather than just refer them to the written instructions. See, while I doubt that any of them studied anthropology, they have figured out that we are still basically an oral society when it comes to getting directions. Even the most literate people prefer oral instructions when it comes to encounters with new forms of literacy. Once they master the context, then they perform fine within the print realm.    

We don’t have to go to DC to experience this. Airplane tickets are now dispensed by machines. Most grocery stores have electronic cash registers. While most of us are proficient with these and realize that they require basic literacy skills to operate, we can probably remember our first encounters with this type of technology. Businesses, like subway helpers know that we are still an oral society and always have a person ready to verbally assist shoppers navigate these literacy environments. Unfortunately, the much more sophisticated medical establishment is catching on a little too late. At Walmart the airport and the subway station, if you hesitate with the literacy task, an aid shows up to assist you. Or, you have the option to go through the human cash register. 

If we, highly educated people have difficulty getting a subway ticket, and reading a subway map, you can imagine what a less educated person must feel when they have to navigate through insurance documents, patient intake forms, medication information, etc. 

Andres 

From: healthliteracy-bounces at nifl.gov [mailto:healthliteracy-bounces at nifl.gov] On Behalf Of Barbara Duffy 
Sent: Monday, September 17, 2007 7:36 PM 
To: 'The Health and Literacy Discussion List' 
Subject: [HealthLiteracy 1206] Re: (no subject) 

I study health literacy and teach it  --- but I never personally felt what it must be like to be ‘illiterate’ until yesterday when I tried to read a computer manual. I can only assume the parallels with health literacy must be similar. Way too many assumptions were made by the authors of the computer manual for it to have much meaning for me…. And like much of the written materials we give to our patients to ‘go home and read – it explains everything’  there was no one I could ask questions of – no one I felt had the time or patience for my stupid inquiries, so I just muddle through and hope for the best. 

Literacy issues are not confined to health care --- I have a feeling it is epidemic and contagious. English may be but one language that we speak with many, very foreign words. 

Barbara Duffy 


From: healthliteracy-bounces at nifl.gov [mailto:healthliteracy-bounces at nifl.gov] On Behalf Of Kutner, Mark 
Sent: Monday, September 17, 2007 12:06 PM 
To: The Health and Literacy Discussion List 
Subject: [HealthLiteracy 1198] (no subject) 

Good morning all.  Cynthia Baur and I are very much looking forward to answering any questions or issues that you might have related to the health literacy component and report of the National Assessment of Adult Literacy (NAAL).  Just as way of introduction, from 1999 through last December I was the project director for the design, analysis, and reporting component of NAAL.  In that role, I worked with Cynthia in developing the health literacy component of NAAL.  The health literacy items also had to be prose, document, and quantitative items so that they could also be placed on the NAAL scale.  The health literacy items were field tested before being included on the national study.  As we discuss the health literacy component, it is important to remember that the NAAL was administered in the homes of individuals, not in a doctor's office or emergency room. 

In case folks are shy, I want to pose a couple of questions to all of you:  

1. As an individual who has been involved in adult literacy and assessment for almost 20 years, I am curious to hear you perspectives about the difference between measuring literacy and health literacy, especially when the definition of health literacy (which we used from HHS) does not indicate any prior substantive knowledge of health-related issues (such as I take aspirin for headaches).  

2. Also, NAAL highlights the challenges of improving health literacy for adults whose first language is not English.  What evidence do we have about successful approaches to ensure that the health literacy for these adults improves? 


As we begin these discussions, I want to clearly acknowledge that there would never have been a health literacy component of NAAL if it was not for the hard work, perseverance,  stubbornness of Cynthia Baur. For me, working with Cynthia on the health literacy component has been a real joy.  The field is quite fortunate to be able to benefit from her leadership!. 

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