目前日期文章:201507 (3)

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In these four chapters there are three of them continue discuss about knowing the audience of the Health Literacy (HL), so I would keep using the same title this time.


After reading this chapter I really think that the author should put it in the first chapter instead of the 21st.

The 2003 U.S. National Assessment for Adult Literacy (NAAL), which is the most recent and comprehensive measure, defines literacy as using “printed and written information to function in society, to achieve one’s goals, and to develop one’s knowledge and potential”. There are three type of literacy within it: prose literacy, document literacy, and quantitative literacy. And there are four levels of literacy: below basic, basic, intermediate, and proficient. Here is the research result of each literacy and level:


Prose Literacy

Document Literacy

Quantitative Literacy

Below Basic
















The author also lists out the four skills that a reader needs:

1. Print skills——knowing that certain letter combinations have specific sounds
2. Fluency——reading speed and accuracy
3. Vocabulary——knowledge of common, everyday words as well as those more rarely used
4. Comprehension——integration of all these skills

Although the reason of reading at a below basic level might be physical, mental or cognitive, on average literacy skills start to decline when people reach 55 years old. (I will introduce HL of older adults next)

Health care requires literacy. From prescription labels, health history forms, self-care instructions, wellness information, to even the sign of “Radiology Department”, rather than the “X-ray” that we usually talk in hospitals.

The author suggests that the “partnership of healthcare organizations and adult education programs” could improve health understanding. I think this research proofs her statement.

Older Adults

When people get older, they are much different than they were 2, 3 years old, as well as they were adolescences or adult. Some might still be able to walk, some, however, might be already hard to move by themselves. “Despite this diversity, a commonality as people age is that they are increasingly likely to be diagnosed with acute illnesses and chronic conditions.” Furthermore, three reasons make communicating health with older people more difficult than with others:

1. New words, new technologies and new concepts sometimes are hard to learn, even against their original understanding.
2. Being ill or weak affects their physical and cognitive function.
3. Realizing one’s own bodily irreversible degeneration makes them suffer emotionally.

Vision Problems

There are more than 25 million adults in the States report experiencing significant vision loss. The 1990 Americans with Disabilities Act (ADA) mandates that public facilities (like hospitals and health centers) provide reasonable accommodation for people in need. “These facilities must provide information in large print, audiotape, Braille formats, or have someone available to read information aloud.”

People who are visually impaired might have not only difficulty reading the words, but also “trouble distinguishing one medication from another because pill bottles are often identical in shape and size”. Although this is an old saying, we really have to put ourselves in their shoes to design a truly friendly environment.

Question for thinking

One simple strategy to “discover” patients at below basic literacy level is to “accidentally” hand them the print upside down and to see if they would turn it around. But how do we distinguish basic level patients since they usually “pretend” to be not?

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The author spends 7 chapters talking about knowing the audience. I think in any field of literacy, the “reader” is always the most important subject. Considering the 500 words limit, I decide to stick to my four-chapter-one article strategy. Here are the four “audience”:


In clinical settings, what is more complex about pediatric Health Literacy (HL) is that it must be considered in both parents’, caregivers’ and children’s HL. I think this is not only because, as the author states, that if you let children actively participate they would be more cooperative in treatment and be more honest about their health related behavior. But more importantly, as my past job in a hospital in Taiwan trained me, it is more “ethical” to let the patient himself/herself involves in the whole process. However it’s harder than adults, since children are usually ill and need to have unpleasant medical procedures. Using humor and real-life examples in hospitals might help the communication. For health children, provide age-appropriate education in school such as teaching them to read the nutrition labels is also an important HL skill training.

Culture and Language (the author has such great points so I decide to quote her saying directly)

As the author argues in the beginning of this chapter, “accessing, using, and understanding the U.S. healthcare system is difficult for almost everyone. But for people who speak limited English or come from other cultures, these tasks might seem impossible”. And, “as the U.S. population grows increasingly diverse, situation like these are becoming more common”.

US now has more Spanish speakers than Spain – only Mexico has more

Furthermore, even these people might be able to “talk about the food or weather”, but to discuss health condition? Not so well.

In addition, culture “impacts how people understand and make sense of health information”. The author gives two examples. First for some regions, health resource are scary, therefore they may not understand why blood pressure checks are routinely recommended. And second, in some cultures, patients are not the ones to make health decisions, so the “decision maker” must be included when discussing.

Emotions and Cognition

Since the author (and me) have talked several times about the influence of emotions in HL in my past articles, I would focus on the cognition part.

Cognitive problems, such as memory loss, dementia and mental illness, most of time will affect concentration, memory and communication, which are all important to literacy. The author provides some strategies to better communicate with these patients. One that relates to reading and writing is that to assist them writing a summary of what was discussed to help them memorizing and understanding.

Hearing Loss

For these patients, “literacy” could have a totally different meaning. Sign language such as American Sign Language (ASL); reading lips; or writing are some of the communicating systems. One thing to notice is that people usually think written information benefits all the hearing loss patients, “but this is not necessarily so—particularly for those who have been Deaf (with the capital D for distinguish)” since birth”, because they have never “heard” of those “words” like hearing people have to learn.

Question for thinking:

Cultural diversity—multicultural society seems to be the future trend of the States. How should both the education and health system “develop” for this change? (Big question, I know!)

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Although I am still trying to title every article, when each contains four chapters it’s actually a lot more than that. But I think this is also a way of summarizing my reading, so I will keep doing this.

I always think that literacy is cultural, and it presents in many elements, such as media, writing and attitude. In the field of Health Literacy (HL) it’s even more obvious. Since we are living in this melting pot, many times the word “cultural” is more “multicultural”.

First, for example, the author discusses about media. Unlike the old days when most people learned about health from their doctors, today they are more from television, radio, websites, newspapers and magazines. The good side is people might be taught more health knowledge, but the bad side is they might be too panic about decease, have too high of expectation toward treatment—one famous study is that in TV shows the success rate of CPR, about 55%, is actually much higher than in real life, about 10%—, or get pursued by ads to buy medicine they don’t need. Another example the author points out is that “the picture of a cute teddy bear or sleeping baby on the label of children’s medication may encourage parents to buy it”.

As one “treatment”, the author introduce a website called Health News Review that uses stringent criteria to grade health stories on a scale of 1 to 5.

Second, the author discusses about words in HL, which include translation, jargon and acronyms. In the States, about 20% of the population speak a language other than English at home. The author suggests three points that could have ESL patients:

1. Provide translated tools of basic phrases in clinical settings (but of course, patients must be able to read in their native language).

2. Communicate the message in alternative ways, such as body languages (of course must be cultural appropriately), drawings, an anatomic model, a visual rating scale, audio or video.

    Here are two websites that the author recommends. One is called Ethnomed, which is about integrating cultural information into clinical practice. The other is called MedlinePlus, which provides translated materials.

3. Use meaningful examples and illustrations. But remember to make sure that they are “consistent with the culture, age, and interests” of the readers.

Third, the use of jargons or acronyms. This reminds me of the “Discourse” Gee stated in his article. If you are not a member of one Discourse, nor a member-to-be through apprenticeship, it’s almost impossible for you to know the meaning of some words. One example the author points out is that in health care, the term “unremarkable” generally has a good meaning of “you are find”, while the term “positive” has a bad meaning of “you are not”, and this is quite different than our “feelings” toward these words.

Last, the author talks about being humor in the serious business of health care. While there are many conversations about life-and-death issues that can’t and shouldn’t be taken lightly, there also are occasions, either in clinical setting, in print or in video, when humor can improve learning and understanding.

Question for thinking:
1. The author suggests that we can include a dose of humor with cleaver illustrations or ridiculous examples in print. Do you agree with her? If so, how do we do it under the multicultural perspective?

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