Darren

Yes you are correct the results are surprising in light of our
assumptions. Almost everyone I talked to pre-results did expect the
health literacy levels to be lower than general literacy. Many of the
arguments for health literacy's importance were based on statements re:
the inherent difficulties of healthcare, especially in comparison to
other situations. So you pose a fundamental question - were we wrong and
if so why?

I will go on record (and out on a limb) that I don't think we were
wrong. What I think happened is we got results that reflect the
sensitivity of our instrument. To the extent that literacy skills are a
component of health literacy skills, we got an answer about that. They
are closely linked but not exactly the same. The NAAL is not designed,
however, to account for, let alone assess many of the factors identified
in the discussion so far. Because the NAAL requires respondents to
demonstrate skills, we can say we have accounted for some aspect of
decision-making and performance, but certainly not under the same type
of confusion and duress people experience in critical health situations.

So I would not say the NAAL health materials or items were easier than
any other on the instrument. They all had to meet the same standard. But
many of the worst examples such as patient discharge instructions and
informed consent forms were excluded because of level of difficulty and
too specific a focus on a narrow health problem. Even the materials
included though may not have been as difficult as they would have been
in live healthcare settings, which is where the qualitative and
anecdotal information we had before NAAL came from. Also the qualitative
and anecdotal information includes a lot of examples of oral
communication, limited English speakers, and lack of experience with
healthcare systems, none of which are captured by the NAAL.             
                                          
This may not answer your question completely though. Rima Rudd often
refers to the mismatch between skills and demand. In this case I think
the mismatch was between service providers' experience on the ground
which in large part informed our pre NAAL expectations and this
particular set of materials and the specific tasks respondents had to
complete. Experience of people's frustrations with the system were more
complex than we could measure with the NAAL.

Mark, any thoughts?

Cynthia
                     
--------------------------
Sent from my BlackBerry Wireless Device


-----Original Message-----
From: healthliteracy-bounces at nifl.gov <healthliteracy-bounces at nifl.gov>
To: The Health and Literacy Discussion List <healthliteracy at nifl.gov>
Sent: Wed Sep 19 14:03:07 2007
Subject: [HealthLiteracy 1247]  NAAL interpretation question

I have enjoyed the discussion this week.

I think my question could be addressed by Mark or Cynthia or maybe
others on this list. 

For years, we have assumed that individuals' health literacy was worse
than their general literacy (as measured by current instruments that
mostly measure reading ability). The rationale usually was that the
health care context was different from usual contexts for most people.
However, from the NAAL data, offers conflicting information on this
question.  When viewed in the categories of below basic to proficient,
it appears that we score better on the health literacy items than on the
other items.  We have lower percentages of our population in the basic
and below basic groups and more in the intermediate group.  When
analyzed as a continuous variable, the average health literacy score was
around 245 and the average general literacy score somewhere around 270.
Why is this?

I'm interested in this question because it challenges some of our
assumptions. 

Sincerely,
Darren DeWalt

Darren A. DeWalt, MD, MPH
Assistant Professor of Medicine
Division of General Internal Medicine
5039 Old Clinic Building, CB#7110
Chapel Hill, NC  27599
office: 919-966-2276, ext 245
fax: 919-966-2274

-----Original Message-----
From: healthliteracy-bounces at nifl.gov
[mailto:healthliteracy-bounces at nifl.gov] On Behalf Of Julie McKinney
Sent: Wednesday, September 19, 2007 12:18 PM
To: healthliteracy at nifl.gov
Subject: [HealthLiteracy 1240] Re: Children's Health Literacy

I just want to add two plugs about the process of creating materials:

    * the importance of field testing materials with your intended
audience, and

    * using pictures

According to a literature review that we discussed last year with Len
and Ceci Doak and Dr. Peter Houts, there is strong evidence that pairing
a simple picture with an oral or written message dramatically improves
the recall of the message. See this link for the article:
http://healthliteracy.worlded.org/doaks_houts_article.pdf

And a slide presentation of the results by Dr. Houts:
http://healthliteracy.worlded.org/visuals_in_health.pdf

Julie

Julie McKinney
Discussion List Moderator
World Education/NCSALL
jmckinney at worlded.org


>>> "Edward Keer" <edkeer at gmail.com> 09/19/07 10:55 AM >>>

Neil,

You make a good point about the educational goal of the content. Let me
also
add that there are many conceptual problems with using these "grade
level"
analyses. For example, there is a great deal of research showing that a
sense of coherence is an important factor in making something easily
readable. Unfortunately many of the linguistic tricks that we use to
heighten coherence, such as the use of connectives like "therefore",
"because", etc., are considered optional in writing. And since these
grade
level algorithms value short words and short sentences, there is
tremendous
pressure to leave them out to make the grade. Therefore, it's important
to
take grade level numbers with a grain of salt. I also think there is a
great
opportunity to develop better algorithms based on the linguistic
features we
know to promote readability.

Ed Keer

On 9/18/07, Neil Izenberg <izenberg at kidshealth.org> wrote:

>From time to time we're asked about the "literacy levels" of the site

(by
which the questioner usually means what "grade level" score would pop up
were the site to be analyzed with the various rapid tools available that
emphasize such things as sentence length, number of polysyllabic words,
etc). Such measurements, though satisfyingly simple, can be somewhat
deceptive, since part of the goal of the content can be to include,
define,
and explain such polysyllabic words - putting them into context. Good
content development might take something seeminly complex and explain in
a
systematic way.  In addition, lower grade level content does not
necessarily
mean that the process is well explained - or even accurate for that
matter.

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