Public-Private Collaborations to Promote Adult Literacy
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Health literacy entered health care discourse when the 2003 National Adult Literacy Survey revealed that nearly half the US adult population has serious deficiencies in reading & computational skills, with one in four Americans (40-44 million) being functionally illiterate. Functional literacy is the ability to read, write, speak and compute at levels of proficiency necessary to function on the job and in society, to achieve goals, and develop knowledge and potential. Findings from a recent NCI-funded study, “Learner Verification of Cervical Cancer Education with Mexican Immigrant Women” exemplify the impact of literacy and language on understanding disease and prevention. The study explored how Mexican immigrant women with less than 9th grade education understand the content of cervical cancer education. Findings showed that English to Spanish translations often did not use the words preferred and understood by the women and that many women lacked basic anatomic information on which to build reproductive health knowledge. They knew the terms, but not the “arrangement” of the female reproductive system. Various imagined models of female organs existed and 70% of women interviewed could not identify what or where the “cervix” was. Rather than shorter, simpler formats commonly recommended for low literacy learners, these women consistently expressed desire for more information and greater detail. In this study, inadequate knowledge of anatomy posed a barrier for understanding cervical cancer prevention. Adapting educational materials is an appropriate short-term intervention. But these women wanted and needed much more. Low literacy negatively impacts the quality of an individual's entire life, not just health. Examples of life tasks requiring literacy include reading a bus schedule; using an automatic teller machine; reading a medicine label; completing job applications, tax forms, and maps; and balancing a check book. Literacy helps provide the confidence to communicate with others to establish the social capital important for a productive life. Without skills and confidence, individuals can get lost, assume a passive role, retreat into silence, lose their entitlements and rights, and deny society the benefit of unrealized talents. Improving overall adult literacy is a more upstream, far-reaching approach than simply adapting health teaching, but requires collaboration.