Advancing Health Literacy A Framework for

Advancing Health Literacy addresses the crisis in health literacy in the United States and around the world. This book thoroughly examines the critical role of literacy in public health and outlines a practical, effective model that bridges the gap between health education, health promotion, and health communication. Step by step, the authors outline the theory and practice of health literacy from a public health perspective. This comprehensive resource includes the history of health literacy, theoretical foundations of health and language literacy, the role of the media, a series of case studies on important topics including prenatal care, anthrax, HIV/AIDS, genomics, and diabetes. The book concludes with a series of practical guidelines for the development and assessment of health communications materials. Also included are essential techniques needed to help people make informed decisions, advocate for themselves and their community, mitigate risk, and live healthier lives.

Christina Zarcadoolas, Ph.D., is associate clinical professor in the Department of Community and Preventive Medicine, Mount Sinai School of Medicine, in New York City. She is a sociolinguist who has spent thirty years studying language and literacy of vulnerable populations.

Andrew F. Pleasant, Ph.D., is an assistant professor in the Department of Human Ecology and the Extension Department of Family and Community Health Sciences at Rutgers, the State University of New Jersey in New Brunswick, New Jersey. He previously served as a temporary advisor to the World Health Organization in Geneva, Switzerland, and actively conducts research both in the United States and internationally.

David S. Greer, M.D., is dean of medicine emeritus, and professor of community health emeritus at the Division of Biology and Medicine, School of Medicine, Brown University. Greer has been a family doctor, researcher, medical school leader, community leader, and mentor to countless health professionals for many decades. He was a founding director of International Physicians for the Prevention of Nuclear War, which won the Nobel Peace Prize in 1985.

List of Tables, Figures, and Exhibits

xi

Preface

xv

The Authors

xxiii

1. Health Literacy: Why Is It a Public Health Issue?

1

(20)

Definitions of Key Terms

4

(2)

Medical Information

6

(4)

The Relationship Between Health and Literacy

10

(6)

Characteristics of People as Language Users

16

(2)

Wrapping Up

18

(1)

Exercises

18

(3)

2. Advancing Health Literacy: Getting Here from There

21

(24)

Historical Considerations

21

(2)

A Brief History: How Did We Get to Health Literacy?

23

(4)

Early Public Health Promotion and Education

27

(7)

Social Movements and Advocacy in the 1960's and 1970's

34

(1)

Informed Consumer Decision Making and Community Collaboration in the 1980's and 1990's

35

(3)

The 21st Century

38

(5)

Wrapping Up

43

(1)

Exercises

43

(2)

3. Defining Health Literacy

45

(24)

Literacy: Defining Terms

45

(1)

Reality Bytes

46

(3)

The Evolving Field of Health Literacy

49

(6)

A Multidimensional Model of Health Literacy

55

(12)

Wrapping Up

67

(1)

Exercises

67

(2)

4. Literacy at Work

69

(24)

How Language Works

69

(6)

Reading

75

(7)

Spoken Language

82

(8)

Implications for Spoken and Written Health Messages

90

(1)

Wrapping Up

91

(1)

Exercises

91

(2)

5. The Traditional Mass Media

93

(24)

Introduction to Mass Media

94

(9)

Media Content: Challenges and Opportunities to Advance Health Literacy

103

(12)

Wrapping Up

115

(1)

Exercises

115

(2)

6. Health Literacy and the Internet

117

(24)

Internet Use in Health Care

118

(9)

Potential Disadvantages and Barriers to the Internet for Conveying Health-Related Information

127

(9)

Wrapping Up

136

(1)

Exercises

136

(5)

7. Baby Basics: A Prenatal Program Focusing on Developing Health Literacy

141

(24)

Healthy Beginnings: Infant and Maternal Health

142

(4)

The Baby Basics Book and Program

146

(13)

The Baby Basics Program Model

159

(3)

Wrapping Up

162

(1)

Exercises

163

(2)

8. Anthrax: A Missed Opportunity to Advance Health Literacy

165

(18)

The American Public Reacts

170

(2)

The U.S. Postal Service Postcard: A Mixed Success

172

(3)

Seeking Anthrax Answers on the Internet

175

(2)

Scientific Uncertainty: A Consistent Challenge

177

(3)

Wrapping Up

180

(2)

Exercises

182

(1)

9. Genomics and Health Literacy

183

(22)

Why Genomics?

183

(3)

Understanding and Misunderstanding Genomics: A Review

186

(17)

Wrapping Up

203

(1)

Exercises

203

(2)

10. Highlighting the Role of Civic Literacy: The Massachusetts Tobacco Control Program

205

(18)

Smoking and Health: The Threat

205

(2)

Smoking and Health Literacy

207

(1)

Massachusetts Tobacco Control Program

207

(13)

Wrapping Up

220

(1)

Exercises

220

(3)

11. Highlighting the Role of Cultural Literacy, Part 1: The Changing Face of HIV/AIDS

223

(20)

HIV/AIDS in the United States

225

(2)

The Public Dialogue

227

(1)

The Conflict in Communicating About HIV AIDS

228

(8)

Community Planning: The San Francisco AIDS Foundation

236

(4)

Wrapping Up

240

(1)

Exercises

241

(2)

12. Highlighting the Role of Cultural Literacy, Part 2: Diabetes and Native Americans

243

(20)

How to Be Culturally Relevant

244

(1)

Diabetes and Native Americans: An Epidemic of Culture

245

(3)

The Role of Culture in Diabetes Prevention and Care

248

(2)

The Sioux San Hospital Diabetes Program

250

(7)

Listening to the Community

257

(3)

Wrapping Up

260

(1)

Exercises

261

(2)

13. Program Evaluation: World Education's Breast and Cervical Cancer Project

263

(24)

Adult Basic Education and Health Literacy

264

(2)

Targeting Breast and Cervical Cancer

266

(5)

What Is Evaluation?

271

(2)

HEAL: BCC Implementation and Evaluation

273

(10)

Lessons Learned from the Evaluation

283

(1)

Wrapping Up

284

(1)

Exercises

285

(2)

14. Guidelines for Advancing Health Literacy

287

(28)

Guideline 1: General

288

(3)

Guideline 2: Vocabulary

291

(2)

Guideline 3: Sentences

293

(6)

Guideline 4: Text Structure

299

(3)

Guideline 5: Giving Instructions

302

(1)

Guideline 6: Field Testing

303

(2)

Guideline 7: Spoken Language

305

(1)

Guideline 8: Language Translation

306

(3)

Guideline 9: Web Design

309

(1)

Guideline 10: Graphics and Layout of Print Materials

310

(1)

Guideline 11: Media

311

(4)

References

315

(26)

Name Index

341

(8)

Subject Index

349

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Advancing Health Literacy A Framework for Understanding and Action

Summary

Author Biography

Table of Contents

Supplemental Materials