Dear Cynthia and list,
 
Thank you for your comments on the 2003 NAAL data on literacy and health 
literacy.  And we agree with your suggested action to address the individuals, the 
(healthcare) systems, and their  interaction.  However, we suggest that the 
majority of effort be focused on the latter two, for the following reasons:
 
1. Large improvement in the literacy skills of the adult US population will 
take many decades if it is practical at all.  We see little or no improvement 
when comparing the NAAL data of 1993 with the recent NAAL data. Our tutoring 
experience, and that of others, shows that "success" is helping the adult 
student advance about two grade levels after a year of hard study - if you can 
motivate them to hang in there for a year.  
 
Future decades may be brighter for children who may be helped by federal and 
state education initiatives. 
 
2. Methodologies are well researched and documented on ways to make written 
(and other) forms of communication easier to understand, and more motivating. 
But these methods are barely used, most likely because those producing the 
written health care instructions are not trained in these methods.  For example, a 
few years ago after one of our workshops a health  educator said to us:"I've 
graduated with an MPH from one of the best universities in the country, and I 
never heard of readability formulas, or the many other ways you've presented 
on how to make instructions more understandable."
 
Such training needs to be a part of every curriculum for health care 
professionals. It would not be enough to train just state and federal agency health 
workers because hospitals and clinics produce most of the written health care 
instructions. (Over the years Ceci and I analyzed the suitability of over 2,000 
such instructions from a very broad range of sources and noticed that over two 
thirds of the written materials were produced by hospitals and clinics rather 
than government and private agencies.)
 
3. Awareness of the benefits of patient-with-provider interaction seems to be 
just beginning. The Pfizer sponsored "Ask Me 3" project is a hopeful start.  
The health care systems are not likely to give doctors more time to interact 
with patients, so less costly, and trained,  health personnel need to be added 
to do this. A few clinics already do.  
 
CDC, HHS and AHRQ and others could do a lot to improve interaction by 
sponsoring research to show the huge payoffs that would accrue in both costs and 
patient wellness.  Social marketing programs could use the benefits data to 
promote change.
 
In summary, NAAL data show where the people are in terms of literacy and 
health literacy.  So much effort goes into measuring the skills of the population. 
 History shows us that the people aren't going to change much.  
Isn't it time to give equal effort to measure the health communication skills 
of our health care systems; and then train our professionals to do better?  
 
Does anyone have a list of current programs to do this training?
 
Len and Ceci Doak




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