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PubMed2004

The effect of a literacy training program on family medicine residents.

BACKGROUND AND OBJECTIVES: Pediatric literacy promotion programs carried out in the primary care setting, such as Reach Out and Read (ROR), have been associated with improved language skills for preschool children. Primary care physicians have frequent contact with young families and may be well situated for a literacy promotion program for both children and adults. We examined whether introducing ROR and an adult literacy intervention improves family medicine residents' literacy knowledge, attitudes, and practices. METHODS: We conducted a single group pretest/posttest evaluation design study of residents in a family medicine residency program serving low-income families. Residents completed self-administered questionnaires assessing literacy knowledge, attitudes, and practice. Then, through educational conferences, precepting, and ROR, residents were trained to assess and counsel patients about literacy. The same questionnaire was readministered 8 months later. RESULTS: All 24 (100%) residents completed both the pre- and post-intervention questionnaires. Literacy knowledge mean scores increased from 74.5% to 83.1%. After the intervention, residents reported a greater sense of comfort in counseling about childhood and adult literacy. After the intervention, a greater proportion of residents reported usually or always asking about literacy milestones (30.2% to 79.2%) and parent-child reading (65.2% to 97.8%) during well-child visits. CONCLUSIONS: A family literacy promotion program improved family medicine residents' self-reported literacy knowledge, attitudes, and practices. Such interventions can be incorporated into the education of family medicine residents with meaningful results.

Adult↗

PubMed2000

The value of book distribution in a clinic-based literacy intervention program.

The purpose of this study was to determine whether anticipatory guidance at well-child visits (WCV) that included early literacy development and the provision of books by the examining physician changed family literacy practices. It was conducted in an inner-city pediatric clinic that serves as the continuity practice site for pediatric and pediatric/internal medicine residents. There were 352 children (181 treatment: 171 control), aged 2 to 24 months, enrolled in this prospective, controlled study. The health care providers underwent training on literacy and on how to incorporate this information during WCV. Anticipatory guidance on safety, development, and early literacy was given to all parents. Additionally, the treatment group received an age-appropriate book at each WCV. There were 1,263 visits made (686 treatment, 577 control). Questionnaires were completed by parents on physician helpfulness and by physicians on parental receptiveness. Parental ratings on physician helpfulness were higher in the treatment group than in the control group (p<0.05). Physician's rating of parental receptiveness was also higher in the treatment group than in the control group (p<0.05). Two years after enrollment, mother-child pairs who received guidance and a book were two times more likely to report enjoyment in reading together than the controls who received guidance but no book. We conclude that anticipatory guidance that included early literacy development and distribution of books at WCV resulted in increased family literacy orientation, parental receptiveness, and perception of physician helpfulness.

Child Guidance↗

PubMed2005

The contribution of parenting to ethnic and racial gaps in school readiness.

The authors describe various parenting behaviors, such as nurturance, discipline, teaching, and language use, and explain how researchers measure them. They note racial and ethnic variations in several behaviors. Most striking are differences in language use. Black and Hispanic mothers talk less with their young children than do white mothers and are less likely to read to them daily. They also note some differences in harshness. When researchers measuring school readiness gaps control for parenting differences, the racial and ethnic gaps narrow by 25-50 percent. And it is possible to alter parenting behavior to improve readiness. The authors examine programs that serve poor families-and thus disproportionately serve minority families--and find that home- and center-based programs with a parenting component improve parental nurturance and discipline. Programs that target families with children with behavior problems improve parents' skills in dealing with such children. And certain family literacy programs improve parents' skills in talking with their children. Several interventions have significantly reduced gaps in the parenting behavior of black and white mothers. Not all improvements in parenting translate to improved school readiness. Home-based programs affect the mother but do not appear to affect the child, at least in the short term. But center-based programs with a parenting component enhance both parenting and school readiness. And some family literacy programs also improve readiness. Because these successful interventions serve a greater share of minority than nonminority families and have more positive effects for blacks than for whites, they offer promise for closing the ethnic and racial gaps in school readiness.

Adult↗

PubMedDate not supplied

Does literacy education improve symptoms of depression and self-efficacy in individuals with low literacy and depressive symptoms? A preliminary investigation.

BACKGROUND AND OBJECTIVES: Individuals with low literacy and symptoms of depression have greater improvement of depression symptoms when their treatment includes education to enhance literacy skills. The reason why literacy enhancement helps depression symptoms is unknown, but we hypothesize that it might be due to improved self-efficacy. We studied whether providing literacy education to individuals with both depression symptoms and limited literacy might improve their self-efficacy. METHODS: We studied 39 individuals enrolled in an adult literacy program and who, on further testing with the Patient Health Questionnaire (PHQ-9) had symptoms of depression. While they participated in the literacy program, we monitored their self-efficacy using the General Self Efficacy (GSE) scale, and also monitored the severity of depression symptoms with the PHQ-9. Changes in GSE and PHQ-9 scores from baseline were assessed with the Wilcoxon Signed Ranks Test. RESULTS: Thirty-one (79.5%) subjects participated for 1 year. There was a significant increase in their self-efficacy (P = .019) and a significant decrease in depression symptoms (P < .002). CONCLUSION: The results of this preliminary study suggest that among persons with low literacy and symptoms of depression, depression symptoms lessen as self-efficacy scores improve during participation in adult basic literacy education.

Adult↗

PubMed1996

Inner-city adults with severe reading difficulties: a closer look.

Relatively little is known about the characteristics of inner-city adults who seek assistance from literacy programs. Increased knowledge about this population will enhance the development of more effective programs, as well as policy options. This study describes the characteristics of 280 adults, ages 16 to 63, who came to an adult literacy program that focused on severe reading difficulties. The program, located within a hospital complex in a large, urban area, attracted these individuals through an extensive multimedia outreach effort. Results suggested that the adults who sought help were generally characterized by a vast array of cognitive, academic, and social difficulties. In addition, the extent of these difficulties increased dramatically as literacy level declined. These findings suggest that comprehensive educational, social, and vocational services may be needed to help adults with severe reading difficulties cope with the diverse and severe problems they face.

Adult↗

PubMed2001

The effects of maternal depression on the efficacy of a literacy intervention program.

The purpose of the present study was: (1) to determine whether depression was related to mother-child interactions in a group of low-income mothers participating in a literacy intervention; (2) to examine whether depression was related to retention; (3) to determine whether there were differential changes in depressed and nondepressed mothers in the intervention group. Participants included 488 ethnically diverse families. Depressed mothers engaged in fewer literacy enhancing behaviors with their children than non-depressed mothers and were more likely to drop out of the study. Depressed mothers were as likely to participate actively in the intervention, and benefited as much from the intervention as non-depressed mothers.

Child, Preschool↗

PubMed2003

The impact of early literacy guidance on language skills of 3-year-olds.

The objective of this prospective study was to determine the impact of early literacy anticipatory guidance (AG) with provision of books on language development in 3-year-olds in an early literacy program at a University-affiliated inner-city pediatric clinic. The Peabody Picture Vocabulary Test (PPVT-III) and the Expressive One Word Picture Vocabulary Test (EOWPVT-R) were administered to 33-39-month-old children exposed to an early literacy program, which included AG and provision of an age-appropriate book at each well-child visit starting at 2 months old. Children with developmental delays were excluded. Parental surveys on literacy and demographic data were obtained. Univariate and multivariate analyses were performed. Sixty-four children were evaluated; 88% African American, 89% Medicaid recipients. Fifty-eight percent of families reported family-centered literacy orientation. The PPVT-III scores directly correlated with the number of AG visits with book given x number of books purchased (r2 = 0.025, p = 0.0006). Higher scores in EOWPVT-R were predicted by race and the number of visits with books given x number of books purchased (r2 = 0.182, p = 0.0009). All families reported reading together, half reporting positive family-centered literacy. Given the same number of books purchased for each child, the outcome scores were higher the greater the number of clinic visits wherein AG included early literacy and provision of books.

Adolescent↗

PubMed2005

Impact of the media on adolescent sexual attitudes and behaviors.

BACKGROUND: Adolescents in the United States are engaging in sexual activity at early ages and with multiple partners. The mass media have been shown to affect a broad range of adolescent health-related attitudes and behaviors including violence, eating disorders, and tobacco and alcohol use. One largely unexplored factor that may contribute to adolescents' sexual activity is their exposure to mass media. OBJECTIVE: We sought to determine of what is and is not known on a scientific basis of the effects of mass media on adolescent sexual attitudes and behaviors. Method. We performed an extensive, systematic review of the relevant biomedical and social science literature and other sources on the sexual content of various mass media, the exposure of adolescents to that media, the effects of that exposure on the adolescents' sexual attitudes and behaviors, and ways to mitigate those effects. Inclusion criteria were: published in 1983-2004, inclusive; published in English; peer-reviewed (for effects) or otherwise authoritative (for content and exposure); and a study population of American adolescents 11 to 19 years old or comparable groups in other postindustrial English-speaking countries. Excluded from the study were populations drawn from college students. RESULTS: Although television is subject to ongoing tracking of its sexual content, other media are terra incognita. Data regarding adolescent exposure to various media are, for the most part, severely dated. Few studies have examined the effects of mass media on adolescent sexual attitudes and behaviors: only 12 of 2522 research-related documents (<1%) involving media and youth addressed effects, 10 of which were peer reviewed. None can serve as the grounding for evidence-based public policy. These studies are limited in their generalizability by their cross-sectional study designs, limited sampling designs, and small sample sizes. In addition, we do not know the long-term effectiveness of various social-cultural, technologic, and media approaches to minimizing that exposure (eg, V-Chips on television, Internet-filtering-software, parental supervision, rating systems) or minimizing the effects of that exposure (eg, media-literacy programs). CONCLUSIONS: Research needs to include development of well-specified and robust research measures and methodologies; ongoing national surveillance of the sexual content of media and the exposure of various demographic subgroups of adolescents to that content; and longitudinal studies of the effects of that exposure on the sexual decision-making, attitudes, and behaviors of those subgroups. Additional specific research foci involve the success of various types of controls in limiting exposure and the mitigative effects of, for example, parental influence and best-practice media-literacy programs.

Adolescent↗

PubMed2006

Home and community literacy experiences of individuals with Down syndrome.

This exploratory survey was conducted to gain a detailed understanding of the home and community literacy experiences of children, adolescents and adults with Down syndrome. The data were collected from 224 parents/guardians across Canada who were asked to indicate literacy goals and priorities for their children with Down syndrome, the literacy resources they and their children utilised at home and in the community, perceived barriers to their children's literacy attainment, and solutions for alleviating the barriers. The results were analysed according to age when appropriate, in order to better understand the course of literacy development. Overall, the number of respondents who indicated their children with Down syndrome could read and write appeared to be consistent with previously published estimates, including the number reporting advanced reading levels. The wide range of reading and writing materials observed in use at home appeared to be greater than the range of materials actually used by children with Down syndrome. Relatively few of the parents who read storybooks to their children reported asking higher-level questions, suggesting that some parents might benefit from support in this activity. Many respondents reported using the library, and many expressed concerns about the quality and scarcity of literacy programs. The results are discussed with regard to their implications for how parents, caregivers, teachers, and program providers can encourage literacy development in persons with Down syndrome, and suggestions for future research.

Adolescent↗

PubMed2004

Computer literacy in today's medical center environment.

The need for computer literacy is becoming increasingly important across the broad scope of the American work scene. At the Wilford Hall USAF Medical Center (WHMC) numerous computer systems have been introduced into the operational environment. Training for these systems has been restricted primarily to transaction processing and routine report generation for those actually involved as users of these systems. WHMC has developed and implemented a broad computer literacy program designed generally to raise the computer literacy of the overall staff, and specifically to inform executive and middle management of the general capabilities of the computer systems. The program consists of a brown-bag lunchtime videotape theater on a series of computer-related subjects as well as formal classes developed in a modular format. Each formal class is tailored to the specific needs of the target executive or middle-management group.

Administrative Personnel↗

PubMedDate not supplied

Building healthy public policy.

Policies in literacy and health need to address two perspectives: how basic literacy skills influence the health of populations and individuals; and health literacy--the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. There are three potential areas for action to improve literacy and health literacy: the health system, the education system, and within the broader sphere of culture and society. Despite some increasing attention in the last 20 years, low literacy levels remain a major problem in Canada. Policies need to be sensitive to culture, especially among Aboriginal peoples, Francophones and new Canadians. Public policies are needed to: Improve literacy outcomes (for example, support for a pan-Canadian literacy strategy, early childhood education and family literacy programs, and efforts to reduce high school drop out). Improve health literacy (for example, support integrated policy and program development across sectors, integrated research and knowledge translation initiatives, and efforts to build links between literacy and health networks). Reduce disparities by strengthening levels of literacy and health literacy among vulnerable groups.

Adolescent↗

PubMed2004

Development and pilot testing of a disease management program for low literacy patients with heart failure.

UNLABELLED: Development and pilot testing of a disease management program for low literacy patients with heart failure. BACKGROUND: Randomized trials have shown that disease management programs can reduce hospitalizations and improve symptoms for patients with congestive heart failure. We sought to create and pilot test such a program for patients with low literacy skills. METHODS: We used focus groups and individual cognitive response interviews (CRIs) to develop an educational booklet for low literacy patients with heart failure. We incorporated the booklet into a disease management intervention that also included an initial individualized 1-h educational session and scheduled supportive phone calls that were tapered over 6 weeks. We then conducted a 3-month before-after study on patients with low literacy skills (<9th grade literacy level) in a university internal medicine clinic to test the acceptability and efficacy of our program. Outcomes of interest included heart failure-related knowledge, self-care behavior and heart failure-related symptoms measured on the Minnesota Living with Heart Failure (MLwHF) scale. RESULTS: Twenty-five patients were enrolled and 23 (92%) completed 3-month follow-up. Mean age was 60 years (range 35-74), 60% were men, 60% were African-American, and 74% had household income under $15,000 per year. The median reading level was fifth grade with 32% reading at or below the third grade level. Mean knowledge score at baseline was 67% and did not improve after the intervention. The proportion of patients reporting weighing themselves daily increased from 32% at baseline to 100% at 12 weeks. Mean improvement on the MLwHF scale was 9.9 points over the 3-month trial (95% CI: 0.5, 19.2), which corresponds to an improvement in one class on the New York Heart Association heart failure scale. CONCLUSION: A heart failure disease management program designed specifically for patients with low literacy skills is acceptable and is associated with improvement in self-care behavior and heart failure related symptoms.

Adult↗

PubMed2003

Emergent literacy intervention for vulnerable preschoolers: relative effects of two approaches.

This study determined the relative efficacy of an experimental explicit emergent literacy intervention program for preschoolers experiencing multiple risk factors. Using an alternating treatment research design, children completed two 6-week waves of intervention in small groups; one wave featured the experimental explicit intervention program, whereas the other featured a comparison program. Emergent literacy assessment was conducted at pretest and at the end of each wave. Results indicated significant widespread gains in emergent literacy knowledge over the entire 12-week intervention program; growth was significantly greater during the experimental explicit intervention program compared to the comparison program. An examination of individual differences and intervention outcome showed oral language skills and literacy orientation to predict emergent literacy performance at the end of the program.

Child, Preschool↗

PubMedDate not supplied

Preparing young people in Canada for emancipation from child welfare care.

Reviewing preparation-for-independence programs operating in Canada at present yields a number of observations. 1. A well-developed range of preparation-for-independence programs exists across Canada despite regional differences in both mandate and resources. 2. The resources, however, do not meet the need. There are not enough for each young person to be assured of getting what he or she needs for a successful transition. 3. Failure to develop an adequate resource will be costly in the long run. Those whom child welfare, in its parenting role, fails to prepare for independence and support adequately during the transition will most likely come to the attention of social services again either as social assistance recipients before adult welfare, or as parents and families requiring the services of the child welfare system within which they themselves grew up. 4. At the field level, effective solutions have been demonstrated. What remains to be achieved is the development of both political will and financial commitment on the part of the government to support the maintenance of existing programs, and the proliferation of an adequate range of additional programs. It must be ensured that all children for whom the state assumes responsibility benefit from an adequately supported transition into productive adulthood. As pointed out in a literacy program proposal prepared by the Pape Adolescent Resource Centre in Toronto: Unless the problems were addressed effectively, the probability was that the teens would be discharged from children's aid society care without the ability to support themselves in the community either economically or practically. In the absence of familial or institutional supports, a street life awaited them. Many had begun to apprentice for that reality. [Martin 1986: 2] Where the state has intervened to rescue a youth from inadequate parenting, the obligation exists for the state to properly complete the undertaking.

Activities of Daily Living↗

PubMed1991

Prognosis: the adult with a learning disability.

Deficiencies in reading and writing appear to be major and lasting handicaps for learning-disabled college students. However, gains have been made in program modifications for learning-disabled students in many higher education institutions. Many adults with learning disabilities find that their handicap makes it difficult to obtain and keep jobs. Although they perceive a need for a wide range of educational and vocational services, there are few services available at most community agencies. Service providers and educators in vocational rehabilitation and adult education and literacy programs need to know more about learning disabilities in adults and how to identify such persons and provide them with more appropriate educational instruction and job counseling and training.

Adult↗

PubMed2003

New options for health care policy and health status insurance: citizens as customers.

Health education and health literacy programs have implications on health care policy and health care status insurance. There are many benefits of a transition from disease management to a health care system, which includes priorities in prediction, prevention, and health education. Health care and disease management could best be implemented by multiple-tier, market-oriented models of universal coverage allowing for competition among health status insurers and educational, pharmaceutical, nursing, and other health service providers. Promotion of health literacy will allow citizens to become educated customers and consumers of health care services. Internationally, health literacy might narrow the gap between economically richer and poorer countries.

Delivery of Health Care↗

PubMedDate not supplied

Enhancing the readability of materials describing genetic risk for breast cancer.

BACKGROUND: The number of individuals contemplating genetic testing is increasing, but the current materials and overall subject matter remain complex and not easily understood by many. The goal of this project was to evaluate efforts to revise and increase the readability of an existing information packet describing genetic risk for breast cancer. METHODS: Evaluation was conducted in two stages through two related studies. In Study 1, a focus group of multiethnic breast cancer survivors was assembled to obtain feedback on images included in the revised breast cancer genetics information packet. In Study 2, African American adult students in a literacy program evaluated the revised images (based on the feedback of the focus group in Study 1) and text of the information packet and provided ratings on readability, format, and appearance. RESULTS: Responses from Study 1 participants suggested that some of the images created for the packet needed to be clearer in the concepts they were intended to convey. In Study 2, ratings of adult learners suggested difficulty with word comprehension in spite of the inclusion of definitions and a glossary. The reading level achieved was markedly lower than the college reading level required by the original information packet and other patient-directed cancer genetics materials. CONCLUSIONS: Although efforts to clarify written materials in order to better serve patients with low literacy received generally favorable responses, continued efforts to create more user-friendly patient education materials are warranted.

Adult↗