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Advancing Health Literacy


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Table of Contents

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

About the Author

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.


"?an important book because it teaches us lessons from the history of health communications and moves us forward." (PsycCritiques, 08/08/2007) "This is one of the most understandable, useful, and practical texts available to assist with developing, implementing, and evaluating community health programs." (Choice, February 2007) "We recommend that public health directors make this book required reading for everyone in their communications department." (New England Journal of Medicine, February 15, 2007)

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