Improving Adult Literacy: Basic and Health Literacy

 Harvey Pressman and Heather Smith

Central Coast Children’s Foundation, Inc.

1. Cindy Irvine, Health and Literacy Compendium: An annotated bibliography of print and Web-based health materials for use with limited-literacy adults. http://healthliteracy.worlded.org/docs/comp/Materials/background.html

The materials included cover adult education techniques, describe the links between health status and literacy status, and uncover myths and cultural stereotypes about "illiteracy" and health care. Books are included to familiarize people with the philosophy of "participatory" education, a technique that works well for helping people not only learn health facts but to actually incorporate healthy changes into their lives. Reports included look at adult literacy programs that integrate an "empowerment" approach to health in their classrooms. Other titles cover the important research linking limited literacy to lower health status. A few titles provide concrete “how-to” information for those wishing to bring health into their adult literacy classrooms or for those working with limited-literacy populations. 

2. Virginia Adult Education Health Literacy Toolkit

http://www.aelweb.vcu.edu/publications/healthlit/sections/d/index.shtml

This website presents a toolkit designed to help health educators teach health topics to illiterate adults. It consists of a curriculum and instructional supports, including resources and activities for increasing the impact of health instruction. The website advocates for such instructional supports as printed information written in plain, simple English and project ideas that can be implemented in a variety of settings.

It is also an example of an instance in which an ESL teacher developed a four course health curriculum pilot program to incorporate a health literacy component into her work in basic literacy. Information about this program can be found at the link below.

http://www.aelweb.vcu.edu/publications/healthlit/sections/d/secD-p4.pdf

3. Expecting the Best

http://www.expectingthebest.org/home.htm

Expecting the Best is a health and wellness curriculum for English as a Second Language (ESL) students designed to improve health literacy, functional literacy, and enhance English communication skills. Lessons focus on health care and nutrition, and the project addresses common literacy concerns that adult educators and health care professionals have expressed, building upon the strengths of these two disciplines. The program is targeted toward high beginner/low intermediate ESL students. Lessons teach a variety of functional and health literacy skills through creative methods, such as conversation, role playing, reading, and games.

4. The El Paso Collaborative Health Literacy Curriculum

http://www.healthliteracy.worlded.org/docs/elpaso/

The El Paso Collaborative’s Instructional Model for Adult Education is a “Five Step Model” built on using learner-generated topics, information-gathering involving reading and discussion, and a learning process that engages reading, writing, speaking, listening, and critical thinking, resulting in practical out-of-the-classroom English language use. Philosophically, the approach builds on whole language theory while addressing learner needs for practical instruction, including the need to improve health literacy. The Five Step model has been applied in a numerous contexts, including workplace literacy, family literacy, health literacy, and home ownership literacy. The methodology is effective in improving functional and health literacy because it can be applied to groups with various levels of literacy and is adaptable to many different situations.

5. Health Literacy Curriculum: Beginning ABE Level
http://www.healthliteracynetwork.org/curriculum/

The Health Literacy Curriculum was designed to provide important health information to adults, while simultaneously providing effective basic literacy skill instruction. The curriculum is specifically intended for beginning level adult basic education (ABE), and it employs strategies to develop and strengthen the components of the reading process. The curriculum is composed of three parts that offer a foundation for basic literacy before commencement of the health literacy component. These sections include the following: (1) Basic skills (alphabetics) and vocabulary, (2) reading and comprehension and (3) supplemental activities. The health literacy component is composed of eighteen sections designed to help patients become more informed consumers of health care.

6. Institute for Healthcare Advancement’s (IHA’s) Health Education Literacy Program (HELP)
http://www.iha4health.org/default.aspx?MenuItemID=232&&AspxAutoDetectCookieSupport=1

IHA’s HELP curriculum is a dual-faceted approach that addresses both functional literacy and health literacy for adults. The ESL (English as a Second Language) curriculum uses IHA's self-help health textbook, What To Do When Your Child Gets Sick. As learners begin to master reading, writing, and speaking in English, they also learn healthcare skills to become effective child caregivers. This curriculum furthers the development of literacy and communications skills in ESL adults by using the health and well being of their children as a motivator. The increased ability to navigate the intricacies of the healthcare system provides a powerful driving force for ESL learners to remain in the adult education program because the content of this curriculum is personally meaningful and relevant. Each unit includes vocabulary in a word bank, a problem-based scenario on 3 levels, and 3 listening exercises, 2 speaking exercises, 7 reading exercises, 5 writing exercises, and 4 thinking exercises.

7. Florida Literacy Coalition’s Student Resource Book and Teacher’s Guide
http://www.floridaliteracy.org/literacy_resources__teacher_tutor__health_literacy.html

The Florida Literacy Coalition’s Student Resource Book focuses on teaching high beginning/low intermediate level ESL learners how to navigate the United States health care system, thereby improving the quality of care they receive. The accompanying Teacher’s Guide is composed of six sections, some of which are geared toward functional literacy and others that specialize in health literacy. The functional literacy section focuses on such competencies as pronunciation, grammar, math, hands-on learning, comprehension, and technology, skills which are also useful in improving health literacy. This intervention is designed to improve students’ English skills by encouraging open discussions about a meaningful and motivating topic, and to create a safe environment in which they can discuss cultural differences related to health and health care.

8. Tobacco and Literacy Education Project

http://tobaccoliteracy.jsi.com/

The Tobacco and Literacy Education Project is comprised of three health literacy lessons designed for ESL instruction, providing compelling information about the hazards of tobacco use, while teaching basic literacy skills. Each lesson includes a lesson overview, multiple learning activities, teacher notes, and answer keys. The math lesson teaches students about the high cost of smoking cigarettes while practicing multiplication and percentages, comparing quantities, and interpreting graphs. The language arts lesson involves enhancing reading, vocabulary and writing skills while teaching how secondhand smoke harms the health of nonsmokers, especially young children. The research skills lesson teaches how to search the Internet for health resources, and provides information about quit-smoking help lines and other smoking cessation support.

9. TV411

http://www.tv411.org/

This multimedia adult education curriculum is aimed at giving adult learners basic skills in reading, writing, and math that they can use to keep themselves healthy. Each unit includes a 30-minute video episode and an instructional workbook with activities and support materials to use with the episode. TV411 presents skills in the context of real-life problems, like reading a utility bill or learning about pregnancy, and shows adults tackling these familiar challenges. TV411 has created new videos, print materials, and web lessons that impart health-related information in plain language for low-level readers. Many of these materials are featured in the seven units of the “Health Smarts Kit,” a multimedia curriculum for literacy instructors and community health educators. The curriculum is generates lively classroom discussion and motivates students to learn, making acquisition of basic and health literacy skills more participatory and engaging.

10. EL Civics Curriculum of Fairfax County, Virginia, Adult and Community Education (ACE)
http://www.aelweb.vcu.edu/publications/ELCivics/index.htm

This is a comprehensive curriculum composed of three learning modules: government, health, and consumer awareness. While created for high intermediate and advanced classes and adult high school classes, the lessons vary according to their academic rigor and life skills transferability. The health literacy component includes five units: (1) Preventive Care, (2) Healthy Community, (3) Understanding Health Insurance, (4) Communicating with Health Care Providers, and (5) Examining Health Conditions.

11. Eating Well, Living Well: Nutrition Education for Adult ESL Programs

http://eatingwell.ca5aday.com/

This site includes downloadable lessons that address nutrition education for adult ESL (English as a Second Language) students. An online webcast-based training demonstrates how to use the lessons to maximize effectiveness. The project aims to integrate in-depth nutrition education concepts into the language development lessons defined by the state of California in “Model Standards for Adult Education Programs.” The goal of this content-based approach is to prepare students to apply their language skills developed in the classroom in real-life situations, and to provide adult learners with critical life skills in the process. To provide basic and health literacy education to students, classes are geared toward teaching them how to apply the English language in daily life, with an emphasis on nutrition and health outcomes in “Eating Well, Living Well” lessons.

12. Fairfax County Family Literacy Curriculum
http://www.aelweb.vcu.edu/publications/famlitcurric/

The Fairfax County Family Literacy Curriculum is designed to be used in a multi-level adult English for Speakers of Other Languages (ESOL) family literacy class. There are six modules to choose from:

·        Introductory: Self, Family and Community

·        Government: Schools and Community

·        Parenting: Raising Children in the U.S.

·        Media: Setting Limits and Choosing Wisely

·        Health: Medicine and Stress

·        Consumerism: Shopping and Making a Budget

Each module provides easy-to-follow lesson plans and activities for adult English language learners at various levels and includes parent/child activities, computer/ internet activities, and reproducible worksheets. This practical approach to improving functional literacy focuses on tangible skills students can use once they complete the program. The health module is designed to help students navigate the United States health care system, thereby improving their chances of receiving quality care.

13. American Medical Association’s Health literacy and patient safety: Help patients understand manual for clinicians
http://www.ama-assn.org/ama1/pub/upload/mm/367/healthlitclinicians.pdf

While this resource focuses solely on improving health literacy, it provides helpful recommendations for ways in which clinicians can successfully communicate with patients who have low health literacy. When treating such patients, health care providers should consider the following:

·        Speak slowly

·        Use plain, non-medical language

·        Show or draw pictures

·        Limit the amount of information provided and repeat it

·        Use the “teach-back technique

·        Create a shame-free environment and encourage questions

The manual also provides detailed guidelines for ways in which medical practitioners can create patient-friendly written materials, as well as a comparison of appropriate and inappropriate patient education handouts. The resource includes several lists of medical jargon with alternative words and phrases health care practitioners can use to increase patient understanding of diagnoses, treatment plans, and medication instructions.

14. American Medical Association’s Health Literacy Video Program

http://www.ama-assn.org/ama/no-index/about-ama/8035.shtml

The American Medical Association (AMA) created two informational and instructional videos with case studies as part of its Health Literacy Kits. The 2001 video, "Low health literacy: You can't tell by looking," features actual physicians and office staff interacting with real patients challenged by low health literacy. The 2007 video, "Health literacy and patient safety: Help patients understand," gives more detailed techniques and specific steps for physicians and their staff on helping patients with limited health literacy.   The 2007 video offers practical methods physicians can employ to improve communication with and understanding of patients with low health literacy.

15. Rudd, Rima E.; Daube, Katharine, Zacharia, Catherine, (1998) Integrating Health and Literacy: Adult Educators' Experiences. NCSALL Reports #5. (ED427194) http://www.eric.ed.gov/ERICDocs/data/ericdocs2sql/content_storage_01/0000019b/80/29/c0/c8.pdf

This report details the experiences of adult educators in Massachusetts who integrated a health unit into adult literacy classes. Over a 5-year period, 31 adult learning centers in Massachusetts received funding to incorporate health topics into their adult literacy curriculum. More than half of the projects were integrated into programs of adult basic education or English for speakers of other languages. Most classes spent approximately four hours each week on their health project. Seven teachers reported having conducted health projects in their literacy classes during each of the past 4 years. Most participants were women. Twenty-six teachers addressed health topics in activities incorporated into the regular class structure. In some cases, projects were implemented by small circles of learners who worked separately from the class. In a few classes, both methods were used. Project activities included the following: using videotapes or computers; creating "products" such as cookbooks, health brochures, or health resource directories; role playing; and delivering presentations to the class, school, or wider community. Overall, the teachers credited their health projects with enhancing students' literacy skills, motivation, confidence, self-esteem, and empowerment.

16. Ask Me 3 Materials

http://www.npsf.org/askme3/PCHC/download.php

This website offers free downloadable materials of patient brochures, posters, fact sheets, an implementation guide, and more. The resources are available in several languages, including English, Spanish, French, Chinese, Russian, and Arabic. These materials will help patients better communicate with health providers by teaching them useful tips and skills, such as remembering to ask the right questions and bringing important information to every appointment.

Copyright 2010, The Central Coast Children’s Foundation, Inc.