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PubMed1998

Health literacy and the risk of hospital admission.

OBJECTIVE: To determine the association between patient literacy and hospitalization. DESIGN: Prospective cohort study. SETTING: Urban public hospital. PATIENTS: A total of 979 emergency department patients who participated in the Literacy in Health Care study and had completed an intake interview and literacy testing with the Test of Functional Health Literacy in Adults were eligible for this study. Of these, 958 (97.8%) had an electronic medical record available for 1994 and 1995. MEASUREMENTS AND MAIN RESULTS: Hospital admissions to Grady Memorial Hospital during 1994 and 1995 were determined by the hospital information system. We used multivariate logistic regression to determine the independent association between inadequate functional health literacy and hospital admission. Patients with inadequate literacy were twice as likely as patients with adequate literacy to be hospitalized during 1994 and 1995 (31. 5% vs 14.9%, p <.001). After adjusting for age, gender, race, self-reported health, socioeconomic status, and health insurance, patients with inadequate literacy were more likely to be hospitalized than patients with adequate literacy (adjusted odds ratio [OR] 1.69; 95% confidence interval [CI] 1.13, 2.53). The association between inadequate literacy and hospital admission was strongest among patients who had been hospitalized in the year before study entry (OR 3.15; 95% CI 1.45, 6.85). CONCLUSIONS: In this study population, patients with inadequate functional health literacy had an increased risk of hospital admission.

Adolescent↗
PubMed2002

Enhancing literacy development through AAC technologies.

There is a critical need to understand teaching and technology supports that enable students who use augmentative and alternative communication (AAC) systems to engage in meaningful literacy experiences and foster conventional literacy skills. To thrive in classroom environments, they must have access to tools that can support them in active and independent literacy learning. These students need technology that allows them to move seamlessly between reading, writing, and communicating. They require technology that takes into account access needs, individual learning needs, the learning demands of technology, and literacy development across grades. Families and school teams need information that will assist them in providing the best tools and the most appropriate content within these tools throughout the school day. Teachers need information that supports them in providing exemplary literacy instruction to students who use AAC systems. This article explores and summarizes factors impacting literacy learning, including literacy capabilities of school-age students who use AAC, communication in literacy learning and use, reading and writing instruction in general education classrooms, and technology to support literacy learning. It is important that future technology tools provide a platform for levels of literacy learning: The power of technology will be reflected in its ability to provide access to and display the right content at the right time for students who use AAC. This article summarizes current factors thought to influence literacy learning and discusses priorities for future research and technology development.

Communication Devices for People with Disabilities↗
PubMedDate not supplied

Early literacy achievement of children with a history of speech problems.

BACKGROUND: There are conflicting reports in the research literature of the literacy outcome of children with speech disorder. The link between phonological awareness and literacy in typically developing and literacy delayed children is well established, but there is less research specifically into children with an isolated speech disorder (i.e. with age-appropriate language skills). There is a clinical need for clarification on their likely outcome as a group and for a means of predicting those individuals who might need support in literacy development. AIMS: To assess literacy and phonological awareness skills at age 6;6-7;6 years in children with a history of speech disorder, and to identify factors in their early profile that were predictive of later achievement. METHODS & PROCEDURES: Thirty-five children who had participated in an earlier therapy research study agreed to further assessment of their speech, language and literacy abilities. The children had originally been recruited between the ages of 3;6 and 5;0 years as having a moderate-to-severe speech disorder, and there were measures at that time of their non-verbal, language, phonological output and phonological awareness abilities. Follow-up assessments of phonological awareness, speech and early literacy were undertaken. OUTCOMES & RESULTS: As a group, the children had made good progress in speech and showed phonological awareness and literacy development at an age-appropriate level. However, a small number of children had phonological awareness and literacy delay. Phonological awareness at 3;6-5;0 years was the best predictor of literacy achievement. CONCLUSIONS: Speech and language therapists can be confident about the early literacy achievement of most children with isolated speech disorder, but should undertake assessment of phonological awareness to identify those children whose phonological awareness skills after speech intervention continue to be low.

Child↗
PubMed2001

Health literacy and shared decision making for prostate cancer patients with low socioeconomic status.

Quality of life (QOL) considerations are important in the treatment decision making process for prostate cancer patients. Although patient involvement in the treatment decision process has been encouraged, low health literacy can limit patient understanding of the complex information about treatments and their probable QOL outcomes and is a barrier to patient participation in the decision-making process. The objectives of the study were to evaluate (i) knowledge, level of satisfaction, and treatment preferences and intentions of men newly diagnosed with prostate cancer after participation in a CD-ROM shared decision making program; and (ii) the relationship between prostate cancer knowledge and health literacy. Thirty newly diagnosed prostate cancer patients from two Veteran's Administration (VA) hospitals in Chicago completed a demographic questionnaire and participated in an interactive CD-ROM shared decision making program. Subsequently, knowledge of prostate cancer, satisfaction with the information in the computer CD-ROM program, treatment preferences, and likelihood of following treatment preferences were assessed using interviewer-administered questionnaires. Health literacy was assessed using the Rapid Estimate of Adult Literacy in Medicine (REALM). The Pearson correlation test was used to assess the relationship between health literacy and prostate cancer knowledge. The chi2 test and the Fischer exact test were used to evaluate relationships between patient demographics and other variables. More than three-quarters of the patients rated the information in the CD-ROM as "very satisfactory" (highest possible rating). Two-thirds of the patients (21 of 30) selected a treatment after participation in the CD-ROM program and 90.5% of these patients stated that they were very or somewhat likely to adhere to their selection. However, prostate cancer knowledge was variable, with one-third of the patients scoring 69.9% or lower. Participants' health literacy was equivalent to a 7th-8th grade reading level (mean = 57.1+/-10.9), and more than one-third of participants (36.7%) had lower than 9th grade literacy levels. Participants' prostate cancer knowledge was correlated with health literacy (Pearson correlation rhor = 0.65, rhop = 0.0001). Patients were satisfied with the interactive shared decision making CD-ROM program, and two-thirds of patients were able to select a preferred treatment based on the information presented in the program that they intended to follow. However, prostate cancer knowledge scores varied among participants after participation in the CD-ROM program, raising doubts that patients were adequately informed to make appropriate choices regarding their treatment. Lower prostate cancer knowledge scores corresponded to lower literacy scores, indicating that low literacy may have hindered patient understanding of the shared decision making program. The development of shared decision making tools should include collaborative efforts with the target population to improve the success of shared decision making programs among patients with low health literacy.

Aged↗
PubMed2000

Functional health literacy is associated with health status and health-related knowledge in people living with HIV-AIDS.

BACKGROUND: Poor health literacy is a prevalent barrier to medical care and people with lower health literacy experience greater illness severity than people with higher health literacy. Health literacy may therefore be an important factor in the health and treatment of people living with HIV-AIDS. METHODS: A community-recruited sample of 339 HIV-infected men and women completed surveys and interviews that assessed functional health literacy, health status, AIDS-related disease and treatment knowledge, and health care perceptions and experiences. Medical records were available for chart abstraction of health status for a subsample of participants. RESULTS: About 1 of 4 people living with HIV-AIDS demonstrated difficulty comprehending simple medical instructions and therefore lower health literacy. HIV-infected people with lower health literacy had lower CD4 cell counts, higher viral loads, were less likely to be taking antiretroviral medications, reported a greater number of hospitalizations, and reported poorer health than those with higher health literacy. In addition, after adjusting for years of formal education, lower health literacy was associated with poorer knowledge of one's HIV-related health status, poorer AIDS-related disease and treatment knowledge, and more negative health care perceptions and experiences. CONCLUSIONS: Health literacy is a significant factor in the health and treatment of persons living with HIV-AIDS. Interventions are needed to improve medical care and the health status of people with lower health literacy that are living with HIV-AIDS.

Adult↗
PubMed2005

Low health literacy is associated with HIV test acceptance.

BACKGROUND: The Centers for Disease Control and Prevention has proposed increasing the proportion of people who learn their HIV serostatus. The health care setting represents a logical site to accomplish this goal. However, little is known about factors that determine acceptability of HIV testing in health care settings, particularly patients' health literacy. OBJECTIVE: To evaluate the association between patients' health literacy and acceptance of HIV testing among individuals at an urgent care center (UCC). METHODS: As part of a prospective study that sought to increase HIV testing at a UCC located in an inner-city hospital serving an indigent population, we surveyed patients who had been offered an HIV test by their providers and had accepted or refused testing. Pretest counseling was provided using a low-literacy brochure given to patients upon registration into the clinic. We measured health literacy level using the Rapid Estimate of Adult Literacy in Medicine (REALM) scale. RESULTS: Three hundred seventy-two patients were enrolled in the study. In univariate analysis, no statistically significant difference between HIV test acceptors or refusers was found for gender, race/ethnicity, marital status, income, type of health insurance, educational level, or type of test offered. Acceptors were more likely to have a low literacy level (odds ratio [OR], 1.763; 95% confidence interval [CI], 1.084 to 2.866) and be less than 40 years old (OR, 1.639; 95% CI, 1.085 to 2.475). In multivariate analysis, low health literacy was shown to be a predictor of HIV test acceptance controlling for age and education (OR, 2.017; 95% CI, 1.190 to 3.418). CONCLUSIONS: Low health literacy was shown to be a predictor of HIV test acceptance. Patients presenting to a UCC with poorer health literacy appear more willing to comply with health care providers' recommendations to undergo HIV testing than those with adequate health literacy when an "opt-out" strategy combined with a low-literacy brochure is used.

Adult↗
PubMed2006

Impact of health literacy on longitudinal asthma outcomes.

BACKGROUND: The impact of health literacy on longitudinal asthma outcomes is not known. OBJECTIVES: To measure the association between health literacy and asthma outcomes and to assess how health literacy affects outcomes through covariates. DESIGN: Longitudinal cohort. PATIENTS: One hundred and seventy-five adult asthma patients. MEASUREMENTS: Independent variables measured at enrollment included demographic and asthma characteristics, depressive symptoms, self-efficacy, and asthma knowledge. Health literacy was measured with the Test of Functional Health Literacy in Adults. Outcomes were Asthma Quality of Life Questionnaire and SF-36 scores and emergency department utilization for asthma measured every 3 to 6 months for 2 years. The effects of health literacy on outcomes and interactions between health literacy and covariates were measured with multivariable models. RESULTS: The mean age of study participants was 42 years, and 83% were women. Less health literacy was associated with worse quality of life, worse physical function, and more emergency department utilization for asthma over 2 years (P< or = .05 for all comparisons). In multivariable analysis, health literacy did not remain statistically significant with any of the outcomes. Although the magnitude of its effect on emergency department utilization remained relatively intact, its effects on quality of life and functional status became attenuated with the sequential addition of covariates, particularly asthma knowledge. CONCLUSIONS: Less health literacy was associated with poor longitudinal asthma outcomes. This relationship was both direct and indirect through effects on other independent variables, particularly patients' knowledge of asthma and self-management. Efforts to improve asthma outcomes should focus on improving literacy skills that are required to learn, understand, and implement effective self-management.

Adult↗
PubMedDate not supplied

The relationship between literacy and glycemic control in a diabetes disease-management program.

PURPOSE: This study examined the role of literacy in patients with poorly controlled diabetes who were participating in a diabetes management program that included low-literacy-oriented interventions. METHODS: A before-after analysis was performed of a pharmacist-led diabetes management program for 159 patients with type 2 diabetes and poor glycemic control (hemoglobin A1c [A1C] > or = 8.0%). Clinic-based pharmacists offered one-to-one education and medication management for these patients using techniques that did not require high literacy. Literacy was measured by the Rapid Estimate of Adult Literacy in Medicine (REALM) test and dichotomized at the 6th-grade level. The A1C values were collected prior to enrollment, at enrollment, and approximately 6 months after enrollment. RESULTS: Of the 111 patients with follow-up data, 55% had literacy levels at the 6th-grade level or below. Lower literacy was more common among African Americans, older patients, and patients who required medication assistance. There was no significant relationship between literacy status and A1C prior to enrollment or at enrollment. Over the 6-month study period, patients with low and high literacy had similar improvements in A1C. CONCLUSIONS: This diabetes care program, which used individualized teaching with low-literacy techniques, significantly improved A1C values independent of literacy status.

Age Factors↗
PubMed2005

Identifying and assisting low-literacy patients with medication use: a survey of community pharmacies.

BACKGROUND: Nearly one-half of adult Americans have limited functional literacy skills. Low patient literacy is associated with poor medication adherence and health outcomes. However, little is known about how pharmacies address literacy-related needs among patrons. OBJECTIVE: To determine the frequency with which pharmacies identify and provide appropriate assistance to patients with limited literacy skills and provide specific recommendations to help improve pharmacists' recognition of low health literacy, as well as strategies to improve adherence in this population. METHODS: Through a telephone-based survey of Atlanta-area pharmacies, we obtained information on (1) whether the pharmacy attempted to identify patients with limited literacy skills, (2) what measures were taken by the pharmacy to optimize the health care of low-literacy patients, especially with regard to medication adherence, and (3) what services the pharmacy offered to improve adherence in general. RESULTS: The response rate among eligible pharmacies was 96.8% (N = 30). Only 2 (7%) pharmacies reported attempting to identify literacy-related needs among their patrons. One of these facilities provided additional verbal counseling to assist low-literacy patients, and the other pharmacy involved family members, provided verbal counseling, and had patients repeat instructions to confirm comprehension. Most pharmacies reported availability of adherence aids that could help low-literacy patients if such patients were identified and targeted to receive additional assistance. These included verbal and written counseling (offered at 73% of pharmacies), packaging or organizing aids (27%), refill services (17%), and graphic or multimedia aids (13%). CONCLUSIONS: Pharmacies infrequently attempt to identify and assist patients with limited literacy skills.

Adult↗
PubMed2002

The role of health literacy in patient-physician communication.

BACKGROUND AND OBJECTIVES: Patients' health literacy is increasingly recognized as a critical factor affecting patient-physician communication and health outcomes. We reviewed research on health literacy, examined its impact on patient-physician communication, and offer recommendations to enhance communication with patients who have poor health literacy. METHODS: We conducted a literature review using the MEDLINE database for January 1966 through July 2001. The keywords "literacy" and "health literacy" were searched independently and in combination with the medical subject headings (MeSH) "physician-patient communication," "communication," and "reading." RESULTS: Poor health literacy is common, especially among elderly patients. More than 33% of patients ages 65 and older have inadequate or marginal health literacy, as do up to 80% of patients in public hospital settings. Patients with poor health literacy have a complex array of communication difficulties, which may affect health outcomes. Such patients report worse health status and have less understanding about their medical conditions and treatment; they may have increased hospitalization rates. Professional and public awareness of the health literacy issue must be increased, beginning with education of medical students and physicians and improved patient-physician communication skills. CONCLUSIONS: Future research needs to address identification of optimal methods for communicating with patients who have low literacy skills. This should focus on the effect of poor health literacy on patients' ability to communicate their history and physicians' ability to solicit information, as well as identifying the most-effective techniques to educate patients.

Audiovisual Aids↗
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↗
PubMed1998

Relationship of functional health literacy to patients' knowledge of their chronic disease. A study of patients with hypertension and diabetes.

BACKGROUND: Inadequate functional health literacy is common, but its impact on patients with chronic diseases is not well described. OBJECTIVE: To examine among patients with hypertension or diabetes the relationship between their functional health literacy level and their knowledge of their chronic disease and treatment. METHODS: We conducted a cross-sectional survey of patients with hypertension and diabetes presenting to the general medicine clinics at 2 urban public hospitals. Literacy was measured by the Test of Functional Health Literacy in Adults. Knowledge of their illness was assessed in patients with diabetes or hypertension using 21 hypertension and 10 diabetes questions based on key elements in educational materials used in our clinics. RESULTS: A total of 402 patients with hypertension and 114 patients with diabetes were enrolled. Mean (+/- SD) knowledge scores for patients with hypertension with inadequate (n = 189), marginal (n = 49), or adequate (n = 155) literacy were 13.2 +/- 3.1, 15.3 +/- 2.2, and 16.5 +/- 2.3, respectively (range, 4-20; P < .001). A total of 92% of patients with hypertension and adequate literacy levels knew that a blood pressure reading of 160/100 mm Hg was high compared with 55% of those in the lowest reading level (P < .001). Mean (+/- SD) knowledge scores for patients with diabetes with inadequate (n = 50), marginal (n = 13), or adequate (n = 51) literacy were 5.8 +/- 2.1, 6.8 +/- 1.9, and 8.1 +/- 1.6, respectively (range, 1-10; P < .001). A total of 94% of patients with diabetes and adequate functional health literacy knew the symptoms of hypoglycemia compared with 50% of those with inadequate literacy (P < .001). CONCLUSIONS: Inadequate functional health literacy poses a major barrier to educating patients with chronic diseases, and current efforts to overcome this appear unsuccessful.

Adult↗
PubMed1996

Shame and health literacy: the unspoken connection.

Illiteracy is a well known national crisis, yet relatively little research has focused on how low literacy affects patients' health care experiences. The purpose of this study was to determine the relationship between shame and low functional literacy in the health care setting. It hypothesized that many patients with low literacy may not admit they have difficulty reading because of shame. Patients who presented for acute care at a large, public hospital in Atlanta, Georgia were interviewed. A total of 202 predominately indigent African-American patients completed a demographic survey, the Test of Functional Health Literacy in Adults (TOFHLA) and answered questions about difficulty reading and shame. Of the 202 patients interviewed, 42.6% had inadequate or marginal functional health literacy. Patients with low literacy were more likely to be male (P < 0.05), have less than a high school education (P < 0.01) and be over the age of 60 (P < 0.01). Of those patients with low literacy, 67.4% admitted having trouble reading and understanding what they read. Almost 40% (n = 23) of patients with low functional literacy who acknowledged they have trouble reading admitted shame. Of the 58 patients who had low functional health literacy and admitted having trouble reading, 67.2% had never told their spouses, and 53.4% had never told their children of their difficulties reading. Nineteen percent of patients had never disclosed their difficulty reading to anyone. Many patients with reading problems are ashamed and hide their inability to read. Shame is a deeply harbored emotion that plays an important role in understanding how low literate patients interact with health care providers. Further research is needed to understand how providers should deal with the shame associated with low literacy.

Adaptation, Psychological↗
PubMed2006

Health literacy, antiretroviral adherence, and HIV-RNA suppression: a longitudinal perspective.

BACKGROUND: Low health literacy has been associated with worse adherence to antiretroviral therapy (ART) and higher HIV-RNA levels, but these relationships have not been evaluated in longitudinal analyses. METHODS: We evaluated literacy using the Rapid Estimate of Adult Literacy in Medicine (REALM) (< or = 6th grade, 7th to 8th grade, > or = 9th grade) in the HIV-Alcohol Longitudinal Cohort study of HIV-infected persons with a history of alcohol problems, conducted from 1997 to 2001. We tested HIV-RNA levels and administered a standardized questionnaire regarding demographics, substance use, receipt of ART, and adherence with ART, every 6 months for up to 7 occasions. Among the 235 subjects on ART, we investigated the relationship between literacy and 2 outcomes: 100% 3-day self-reported adherence and HIV-RNA suppression (<500 copies). RESULTS: Subjects' literacy levels were the following: 14% < or = 6th grade, 29% 7th to 8th grade, and 57% > or = 9th grade. In 66% of the observations (478/725), subjects reported 100% 3-day adherence with ART. Of the 685 HIV-RNA assays from these subjects, 62% had <500 copies. In unadjusted analyses, subjects with the lowest literacy level (< or = 6th grade) had a higher odds of adherence (odds ratio [OR] 2.23, 95% confidence interval 1.15 to 4.30) and HIV-RNA suppression (OR 2.01, 95% confidence interval 1.03 to 3.90) compared with those with > or = 9th grade literacy. This trend persisted but was no longer statistically significant in adjusted models of adherence (AOR 1.93, 95% confidence interval 0.86 to 4.31) and HIV-RNA suppression (AOR 1.70, 95% confidence interval 0.79 to 3.65). CONCLUSION: Contrary to our hypothesis, low literacy was not associated with a lower odds of adherence or virologic suppression in this longitudinal analysis of HIV-infected patients with a history of alcohol problems. Indeed, trends in these data suggest the possibility that low literacy may be associated with a higher odds of adherence and virologic suppression. These counterintuitive findings underscore the need to pursue a fuller understanding of the mechanisms by which literacy affects health outcomes.

Adult↗
PubMed2006

Importance of adult literacy in understanding health disparities.

BACKGROUND: In several recent studies, the importance of education and race in explaining health-related disparities has diminished when literacy was considered. This relationship has not been tested in a nationally representative sample of U.S. adults. OBJECTIVE: To understand the effect of adult literacy on the explanatory power of education and race in predicting health status among U.S. adults. DESIGN: Using the 1992 National Adult Literacy Survey, logistic regression models predicting health status were estimated with and without literacy to test the effect of literacy inclusion on race and education. SUBJECTS: A nationally representative sample of 23,889 noninstitutionalized U.S. adults. MEASURES: Poor health status was measured by having a work-impairing condition or a long-term illness. Literacy was measured by an extensive functional skills test. RESULTS: When literacy was not considered, African Americans were 1.54 (95% confidence interval, 1.29 to 1.84) times more likely to have a work-impairing condition than whites, and completion of an additional level of education made one 0.75 (0.69 to 0.82) times as likely to have a work-impairing condition. When literacy was considered, the effect estimates of both African-American race and education diminished 32% to the point that they were no longer significantly associated with having a work-impairing condition. Similar results were seen with long-term illness. CONCLUSIONS: The inclusion of adult literacy reduces the explanatory power of crucial variables in health disparities research. Literacy inequity may be an important factor in health disparities, and a powerful avenue for alleviation efforts, which has been mistakenly attributed to other factors.

Adolescent↗
PubMed2005

The invisible barrier: literacy and its relationship with oral health. A report of a workgroup sponsored by the National Institute of Dental and Craniofacial Research, National Institute of Health, U.S. Public Health Service, Department of Health and Human Services.

Although oral health in the United States has improved significantly over time, preventable and treatable oral diseases remain common, especially among the poor and underserved. Limited literacy skills among adults are hypothesized to be one of many barriers to better oral health outcomes. Adults must be able to understand, interpret, and act on health information, whether it is communicated in spoken or in written form, to maintain their oral health and manage disease. While the body of health literacy research has grown in recent years, little is known about oral health literacy. Research is needed to build an understanding of oral health literacy and its impact on a variety of outcomes, including adoption of effective disease prevention regimens and actions, adherence to treatment regimens, effectiveness of caregivers and ultimately, improved oral health status. In addition, the effect of oral health literacy on the validity of clinical research such as response to surveys and adherence to research protocols is another area that is important to investigate. This paper defines oral health literacy and offers a framework for studying relationships between oral health literacy and other points of intervention for improving health outcomes. Findings of existing health literacy research are summarized, and a research plan for oral health literacy is proposed. A broad-based collaborative effort will be required to develop a detailed agenda for research, one that is aimed at reducing literacy barriers to oral health and ensuring that the information and insights emanating from new oral health research are more widely adopted.

Adult↗
PubMed2003

Beliefs and practices of itinerant teachers of deaf and hard of hearing children concerning literacy development.

A qualitative case study examined beliefs and practices of itinerant teachers of deaf and hard of hearing students concerning literacy development, the match between these teachers' beliefs and practices, and the impact of itinerant settings. Five itinerant teachers and 15 students participated. Hearing losses were mild to profound. The research addressed 5 areas: sociocultural aspects of literacy development; effects of hearing loss on literacy development; beliefs about teaching and literacy development; practices used to develop literacy; the impact of itinerant settings on literacy development of deaf and hard of hearing learners. Five themes emerged from the data: Itinerant teachers used a variety of practices to develop literacy; itinerant teachers played a supporting role in developing literacy; most of the teachers' beliefs about literacy development were matched in their practices; the itinerant teachers were lifelong learners; the impact of itinerant settings on literacy development took many forms.

Education of Persons with Hearing Disabilities↗
PubMedDate not supplied

Number of children's books in the home: an indicator of parent health literacy.

BACKGROUND: One in 4 US adults have poor health literacy, unable to read and understand written medical information. Current tools that assess health literacy skills are too lengthy to be useful in routine clinical encounters. OBJECTIVE: To determine which of 7 screening questions is most useful for identifying parents with adequate health literacy. DESIGN/METHODS: A cross-sectional study of an ethnically diverse sample of 163 parents of children aged 12 to 24 months presenting for routine care at 1 of 6 inner-city clinics. Literacy was measured by performance on the Short Test of Functional Health Literacy for Adults, which was categorized as "adequate" or "inadequate or marginal." The 7 screening questions concerned parents' educational achievement, educational expectations for the child, and home literacy environment. RESULTS: Eighty-three percent of respondents had adequate health literacy, which was highest among those who were African American, were born outside the United States, spoke English primarily at home, and had completed high school. Only 2 factors, however, were independently associated with adequate health literacy: more than 10 adults' books or more than 10 children's books in the home. "More than 10 children's books" had a positive predictive value of 91%. CONCLUSIONS: Having more than 10 children's books in the home is a useful, independent indicator of adequate parent health literacy. More research is needed, however, to find a better screening tool for identifying parents with increased health literacy needs.

Adult↗