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Annotated Bibliography

Updated October 2007

 

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Articles

  • Baker DW, Wolf MS, Feinglass J, Thompson J, Gazmararian JA, Huang J. “Health literacy and mortality among elderly persons.” Archives of Internal Medicine. 2007 Jul 23;167(14):1503-9A.

The authors wanted to determine “whether low health literacy levels independently predict overall and cause-specific mortality.” Understanding that those with low health literacy have low health knowledge, self-management of chronic disease, and use of preventive services, the authors discovered that reading fluency “independently predicts all-cause mortality and cardiovascular death among community-dwelling elderly persons” (article abstract).

  • Houts PS, Doak CC, Doak LG, Loscalzo MJ. “The role of pictures in improving health communication: a review of research on attention, comprehension, recall, and adherence." Patient Education and Counseling. 2006 May; 61(2):173-90.

The goal of this article was to assess the effects of pictures on health communications. The authors found that “pictures closely linked to written or spoken text can, when compared to text alone, markedly increase attention to and recall of health education information. All patients can benefit, but patients with low literacy skills are especially likely to gain. Patients with very low literacy skills can be helped by spoken directions plus pictures to take home as reminders, or by pictures plus very simply worded captions” (article abstract).

Arguing that inadequate health literacy can result in “difficulty accessing health care, following instructions from a physician, and taking medication properly,” this article offers suggestions to health professionals on how to help patients who struggle with low literacy (article abstract).

Booklets and Brochures Available on the Web

This booklet “reviews the problem of health literacy, its consequences for the health care system, and the likelihood that a clinician’s practice includes patients with limited literacy” (p. 7). The booklet also offers practical suggestions to clinicians and concludes with case discussions.

This report on literacy and health outcomes was requested by the American Medical Association and funded by the AHRQ. The report addresses two key questions:
1: Are literacy skills related to: (a) Use of health care services? (b) Health outcomes? (c) Costs of health care? (d) Disparities in health outcomes or health care service use according to race, ethnicity, culture, or age?
2: For individuals with low literacy skills, what are effective interventions to: (a) Improve use of health care services? (b) Improve health outcomes? (c) Affect the costs of health care? (d) Improve health outcomes and/or health care service use among different racial, ethnic, cultural, or age groups? (p. 5)

This series of nine fact sheets was created for those who are designing patient education materials for consumers with low health literacy skills. The sheets define health literacy, describe its impact on health outcomes, provide strategies to prepare appropriate educational materials to assist low-literate consumers, and provide resources for additional health literacy information and publications.

Kathleen Crea compiled a list of websites of health literacy resources for health professionals and patients and families.

The FDA provides easy-to-read health brochures in English and Spanish. Brochures are available in both HTML and PDF formats and topics include keeping food safe, diabetes, losing weight safely, giving medication, etc.

This booklet is the culmination of a roundtable discussion addressing health literacy. Believing that many people play a role in improving health literacy, the roundtable discussion offers methods for tackling the underlying problems of health literacy, the impact of low health literacy and patient safety, and the current state of health care communication.

This booklet has suggestions for developing and improving print materials related to government programs. Strategies include writing and formatting specifically for clients, many of whom have limited literacy skills.

These brochures help consumers translate "medspeak," the specialized language of health professionals. Written in English and Spanish, these brochures address HIV/AIDS, stroke, eye disease, heart disease, diabetes, and breast cancer.

This bibliography in the Current Bibliographies in Medicine (CBM) series covers information on health literacy primarily from online databases and the Internet. Relevance to the subject is the only criterion for inclusion of works in a CBM.

This guide contains a basic overview of key health literacy concepts and techniques for improving health literacy through communication, navigation, knowledge-building, and advocacy. It provides the information needed to become an effective advocate for improved health literacy.

Books

  • Committee on Health Literacy Board on Neuroscience and Behavioral Health. Health Literacy: A Prescription to End Confusion. Washington, D.C.: The National Academies Press, 2004. http://www.iom.edu/?id=19723&redirect=0

Taking social, cultural, and educational issues into consideration, the Committee on Health Literacy demonstrates the problems of health literacy, its origins, consequences, and solutions. The report defines health literacy as “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions” (p. 2). The committee also suggests a strategy to improve health literacy in the United States.

  • Osborne, Helen. Health Literacy from A to Z: Practical Ways to Communicate Your Health Message. Sudbury, Massachusetts: Jones and Bartlett Publishers, 2005.

Osborne argues that health providers face two problems: “recognizing when patients do not understand written words . . . [and] knowing how to communicate through words, pictures, computers screens, and other visual media” (p. xiii). She focuses on helping solve these two issues and providing practical suggestions to health providers and others who communicate health information. Designed as a “tool of action,” Osborne, in each of her chapters, provides the reader with starting points, strategies, ideas, solutions, and sources to learn more about health literacy. Chapters, which are in alphabetical order, include consumer health libraries, hearing and communicating with people who are deaf and hard of hearing, language and culture, pictographs, plain language, signs, stories, website design, and word choice.

  • Zarcadoolas, Christina, Andrew F. Pleasant, and David S. Greer. Advancing Health Literacy: A Framework for Understanding and Action. San Francisco, California: Jossey-Bass, 2006.

Acknowledging the consequences of low health literacy and the complexity of medicine and health, the goal of this book is to answer the following question: “How can this model of health literacy and the literacy principles it outlines improve the daily performance of health professionals and health programs in their efforts to advance individual and public health literacy?” (p. xvi). The authors define health literacy as “the ability to understand, evaluate, and act on spoken, written, and visual health information to reduce risk and live a healthier life” (p. xvi).

Presentations

Sponsored by the National Center for Education Statistics, the 2003 National Assessment of Adult Literacy (NAAL) is a nationally representative assessment of English literacy among American adults age 16 and older. Webcasts are available on such topics as addressing low literacy and defining the goals and research behind the National Assessment of Adult Literacy.

  • Stableford, Sue. Write It Easy to Read: Vibrant Plain Language for Clear Health Communication. Biddleford, Maine: AHEC Health Literacy Center, 2004. Presentation. http://www.clearlanguagegroup.com

Stableford focuses on the need for “plain language” and defines “limited health literacy” and “easy-to-read.” She argues that health literacy is critical to lowering health disparities and to increasing safety and quality care, chronic disease prevention, and bioterrorism preparedness. Using real world examples, she helps the student understand the importance of writing clearly, using “plain language,” and utilizing layout and design for reading ease. To contact Sue Stableford, email sstableford@une.edu or call 207-283-0170 ext 2205.

  • Wescott, Beth. Easy-to-Read Health and Wellness Material for Consumers: recognizing it, finding it, writing it, rewriting it. National Networks of Libraries of Medicine. August 2007. http://nnlm.gov/sea/training/easytoread.html. CD.

The CD aids the user to critique, rewrite and create materials that get health and wellness information across quickly and clearly. This CD reviews the disconnect between information providers and information seekers, the process of educating adults, the success of "plain language" initiatives and the importance of text, type, graphics, space and layout. The user is provided with brochure examples, SMOG and REALM tests, a webliography and links to other training. Clear health communication is the goal, regardless of the medium. To contact Beth Wescott, email bwescott@hshsl.umaryland.edu or call 1-800-338-7657.

This online tutorial is designed for health and literacy educators interested in getting more involved in health literacy work. Users learn about the challenges associated with low health literacy, meet some of the new health literacy practitioners in the field, hear about successful strategies and practices, and apply what they have learned to a challenging health literacy scenario. The tutorial was developed by World Education and funded by the National Network of Libraries of Medicine New England Region (NN/NL NER).

Toolkits

Using a multimedia approach focused on health professionals, the American Medical Association (AMA) uses real-life scenarios and statistics to address the problems of health literacy. They define health literacy as “the ability to read, understand, and act on medical information” (DVD). Understanding the need for more research on health literacy, the AMA gives several ideas to enable health professionals to help their patients understand the health information given. These suggestions include offering an open and shame free environment, an attitude of helpfulness, and a place where patients feel safe. The AMA Foundation Health Literacy Kit costs $35 and includes a manual, Continuing Medical Education credit, and two videos/DVDs, Low Health Literacy: You Can't Tell By Looking and Health Literacy: Help Your Patients Understand. Both videos can be viewed free of charge from http://www.ama-assn.org/ama/pub/category/8035.html

This kit provides steps to writing a handout that is easy to read and understand. The information is based on readability research about word use, font styles and layout. The kit also helps the reader with the process of planning and evaluating resources for his/her own program on a broader scale.

This site offers a plethora of resources for health professionals and consumers and includes links and information to fact sheets, brochures, toolkits, and project ideas for health literacy. A corresponding CD version available from the Medical Library Association (MLA) also explains the resources from MLA and outside sources. Members of MLA can read more about the Health Information Literacy Research Project at http://www.mlanet.org/members/mla_news/2007/apr_07/literacy.html

Beginning 2004, the New York Medical College, School of Public Health and Health Sciences Library created Public Health Information Partners, an academic/local partnership with health professionals in the seven counties comprising the Hudson Valley Region of New York State. This toolkit is from a conference held May 30, 2007 at New York Medical College, Valhalla, NY. The conference goal was to provide health professionals and hospital staff with an educational opportunity to develop awareness of health literacy issues and improve communication skills with individuals throughout the Hudson Valley Region of New York. This toolkit offers links to websites that promote health literacy skills.

Answering questions such as what is health literacy and what resources are available, this Toolkit is a resource to help adult education instructors and administrators better understand the problem of health literacy as it affects their learners. It is designed to support creative approaches to help learners increase health literacy as they engage in sound, productive adult literacy instruction. Information and resources are provided to educate the educator about health care in the United States and cultural issues relating to health, and to simplify creation of health lessons and curricula for teachers and programs. Many online and print resources are available.

Websites

Online resources and pathfinders relating to health literacy, consumer decision aids, clinical information, and improving healthcare delivery.

This website helps consumers and providers learn how to communicate effectively with each other, address the problem of health literacy, and provide a solution to end health literacy. Ask Me 3 helps consumers ask three questions to their provider about their health: 1) What is my main problem? 2) What do I need to do? 3) Why is this important for me? This website, with printable materials, helps consumers.

Harvard School of Public Health’s Health Literacy Studies focuses on communication and literacy skills and are interested in exploring the pathways from education to health outcomes. Resources include a slide presentation, video, a chart about health literacy, literature, and how to create and access print materials.

The Health & Literacy Special Collection is created, compiled, and updated by World Education with support from the National Institute for Literacy (NIFL) and their LINCS Project. Information includes health lessons, easy-to-read material, multilingual health information, and health literacy research.

Helen Osborne, the developer of this website, directs health care professionals and consumers to a variety of health literacy resources. Osborne also offers ideas on how to celebrate health literacy month.

Funded by the National Library of Medicine, this website defines health literacy and lists health literacy organizations and websites.

Developed by the National Institutes of Health and National Library of Medicine, MedlinePlus helps consumers find up-to-date, quality information about health topics, herbs and drugs. Information is available in English, Spanish, and Easy-to-Read versions. Also see health topic, “Talking to your doctor.”

The Newest Vital Sign is a bilingual (English and Spanish) screening tool that identifies patients at risk for low health literacy.

This website from the National Institute on Aging and National Library of Medicine has easy-to-read health information and videos for senior citizens.

PLAIN, the Plain Language Action and Information Network, sponsors this site and its goal is to promote the use of “plain language” for all government communications. Plain language (also called Plain English) is communication an audience can understand the first time they read or hear it.

Useful Examples

Developed by READ Saskatoon, this easy-to-read book divides pregnancy into 3 trimesters. Each section explains what to expect for the mother and her growing baby.

These easy-to-read materials are written in English and Spanish and are available from the National Institute of Diabetes and Digestive and Kidney Diseases. Topics include information about diabetes and how it relates to medication, physical activity, and nutrition.

The purpose of Hands on Health South Carolina is to give South Carolinians a place to go to learn about health and wellness in an easy-to-read format. Health problems addressed include diabetes, heart disease, cancer, asthma, stroke, and suicide.

Developed by South Carolina Diabetes Prevention and Control Program Diabetes Initiative of South Carolina Enterprise/MUSC Neighborhood Health Program, this guide has easy-to-read information about Sugar Diabetes.

Developed by Alzheimer’s Disease Education and Referral Center (ADEAR), this booklet offers easy-to-read information about Alzheimer’s Disease. ADEAR also offers an easy-to-read booklet on Understanding Memory Loss.

Tests to Assess Health Literacy

The REALM is a medical-word recognition and pronunciation test comprising 66 medical terms, arranged in order of complexity by the number of syllables and pronunciation difficulty, starting with simple one-syllable words (e.g., pill, eye) and ending with multi-syllable words (e.g., antibiotics, potassium). Patients read down the list, pronouncing aloud as many words as they can while the examiner scores the number of words pronounced correctly using standard dictionary pronunciation as the scoring standard. Scores on the REALM vary from 0 (no words pronounced correctly) to 66 (all words pronounced correctly.) The score assigns health literacy skills into 4 categories of grade-equivalent reading level: 0–18 (3rd grade), 19–44 (4th to 6th grade), 45–60 (7th to 8th grade) and 61–66 (9th grade). It can be administered and scored in under 2 minutes by personnel with minimal training, making it easy to use in clinical settings (Adapted from Measurement Excellence and Training Resource Information Center.) A sample sheet can be found at http://www.nursing.columbia.edu/informatics/HealthLitRes/pdf/REALM_1.pdf

The TOFHLA measures the functional literacy level of patients, using real-to-life health care materials. These materials include patient education information, prescription bottle labels, registration forms, and instructions for diagnostic tests. The TOFHLA assesses two main constructs, numeric and reading comprehension; it has a total of 67 items. The numeric scale, used to measure the ability to read and understand numbers, includes 17 items; the reading comprehension scale, used to measure the patient’s ability to read and understand health care-related passages, contains 50 items. There is also a Spanish version called TOFHLA-S. A sample sheet in English can be found at http://www.peppercornbooks.com/catalog/pdf/tofhla_eng_12pt_websmpl.pdf

The WRAT-R is an individual achievement test that assesses skills in reading, spelling, and arithmetic. It is commonly used in educational settings, but the reading subscale has been used in the medical field to measure health literacy. The test assesses word recognition by having the person read aloud from a list of words. When 10 consecutive words are mispronounced, the test concludes and a score is derived. The WRAT-R is appropriate for people aged 5 to adults. It takes approximately 15 to 30 minutes to complete. A raw score is computed for each scale by summing the number of correct answers, and then the raw score may be converted to a grade equivalent score and a standard score. Standard scores have a mean of 100 and standard deviation of 16.

 

 
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