Advancing Health Literacy: A Framework for Understanding and Action

List of Tables, Figures, and Exhibits xi

Preface xv

The Authors xxiii

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

Definitions of Key Terms 4

Medical Information 6

The Relationship Between Health and Literacy 10

Characteristics of People as Language Users 16

Wrapping Up 18

Exercises 18

2. Advancing Health Literacy: Getting Here from There 21

Historical Considerations 21

A Brief History: How Did We Get to Health Literacy? 23

Early Public Health Promotion and Education 27

Social Movements and Advocacy in the 1960s and 1970s 34

Informed Consumer Decision Making and Community Collaboration in the 1980s and 1990s 35

The 21st Century 38

Wrapping Up 43

Exercises 43

3. Defining Health Literacy 45

Literacy: Defining Terms 45

Reality Bytes 46

The Evolving Field of Health Literacy 49

A Multidimensional Model of Health Literacy 55

Wrapping Up 67

Exercises 67

4. Literacy at Work 69

How Language Works 69

Reading 75

Spoken Language 82

Implications for Spoken and Written Health Messages 90

Wrapping Up 91

Exercises 91

5. The Traditional Mass Media 93

Introduction to Mass Media 94

Media Content: Challenges and Opportunities to Advance Health Literacy 103

Wrapping Up 115

Exercises 115

6. Health Literacy and the Internet 117

Internet Use in Health Care 118

Potential Disadvantages and Barriers to the Internet for Conveying Health-Related Information 127

Wrapping Up 136

Exercises 136

7. Baby Basics: A Prenatal Program Focusing on Developing Health Literacy 141

Healthy Beginnings: Infant and Maternal Health 142

The Baby Basics Book and Program 146

The Baby Basics Program Model 159

Wrapping Up 162

Exercises 163

8. Anthrax: A Missed Opportunity to Advance Health Literacy 165

The American Public Reacts 170

The U.S. Postal Service Postcard: A Mixed Success 172

Seeking Anthrax Answers on the Internet 175

Scientific Uncertainty: A Consistent Challenge 177

Wrapping Up 180

Exercises 182

9. Genomics and Health Literacy 183

Why Genomics? 183

Understanding and Misunderstanding Genomics: A Review 186

Wrapping Up 203

Exercises 203

10. Highlighting the Role of Civic Literacy: The Massachusetts Tobacco Control Program 205

Smoking and Health: The Threat 205

Smoking and Health Literacy 207

Massachusetts Tobacco Control Program 207

Wrapping Up 220

Exercises 220

11. Highlighting the Role of Cultural Literacy, Part 1: The Changing Face of HIV/AIDS 223

HIV/AIDS in the United States 225

The Public Dialogue 227

The Conflict in Communicating About HIV/AIDS 228

Community Planning: The San Francisco AIDS Foundation 236

Wrapping Up 240

Exercises 241

12. Highlighting the Role of Cultural Literacy, Part 2: Diabetes and Native Americans 243

How to Be Culturally Relevant 244

Diabetes and Native Americans: An Epidemic of Culture 245

The Role of Culture in Diabetes Prevention and Care 248

The Sioux San Hospital Diabetes Program 250

Listening to the Community 257

Wrapping Up 260

Exercises 261

13. Program Evaluation: World Education’s Breast and Cervical Cancer Project 263

Adult Basic Education and Health Literacy 264

Targeting Breast and Cervical Cancer 266

What Is Evaluation? 271

HEAL:BCC Implementation and Evaluation 273

Lessons Learned from the Evaluation 283

Wrapping Up 284

Exercises 285

14. Guidelines for Advancing Health Literacy 287

Guideline 1: General 288

Guideline 2: Vocabulary 291

Guideline 3: Sentences 293

Guideline 4: Text Structure 299

Guideline 5: Giving Instructions 302

Guideline 6: Field Testing 303

Guideline 7: Spoken Language 305

Guideline 8: Language Translation 306

Guideline 9: Web Design 309

Guideline 10: Graphics and Layout of Print Materials 310

Guideline 11: Media 311

References 315

Name Index 341

Subject Index 349