Study Measures Literacy Skills Critical to Good Health
Half of all senior citizens at lowest level for reading and
using health materials
Wednesday, May 5, 2004
Boston, MA and Princeton, NJ -- With billions of dollars being spent
every year on health care, a new study from Educational Testing Service (ETS)
and Harvard School of Public Health identifies, for the first time, the
health-related literacy skills of U.S. adults and finds marked differences among
adults based on their education, age, wealth and country of birth.
The authors of the study argue that literacy is one of the major factors linking
health and education and contributes to existing disparities in health status,
access to care and the quality of health care for many individuals. The study
provides a benchmark for tracking changes in health-related literacy following
possible education efforts and improvements in health care communication.
"We can only make improvements in health literacy if we pay attention to
how people are expected to use health materials, not just to the way the
materials are written," said Rima Rudd, one of the co-authors and a member
of the faculty of Harvard School of Public Health.
The report, Literacy and Health in America, is the third in a series of
reports using information collected from existing surveys, the National Adult
Literacy Survey (NALS) and the International Adult Literacy Survey (IALS),
conducted by ETS for the U.S. Department of Education. For the first time,
the authors, Rima Rudd of Harvard School of Public Health, and Irwin Kirsch and
Kentaro Yamamoto of ETS, identified 191 health-related tasks among the survey
data and created a Health Activities Literacy Scale (HALS), a 0 to 500 scale
that reflects a progression of five levels of health literacy.
The most health-literate populations, comprising about half of adults, were
those who are more well-to-do and have more than a high school education. They
also report using the library; they vote and they tend to be healthier as a
group.
The researchers found that some 12 percent or 23 million of U.S. adults are
estimated to have skills in the lowest level (Level 1) on the HALS, while an
additional 7 percent or 13.4 million are not able to perform even simple health
literacy tasks with a high degree of proficiency (below Level 1). Those
performing below Level 1 are about evenly divided between U.S.-born and
foreign-born adults.
Results are alarming for at-risk and vulnerable populations. For example, among
adults who have not completed high school, almost half scored at or below the
lowest literacy level. Similarly, almost half of adults over the age of 65
performed at or below the lowest level. Minority populations, including adults
born outside the United States, scored significantly below white adults and
adults born in the United States, on average.
"Each day, millions of adults must make decisions, take actions, and
consider issues that influence not only their own well-being but that of their
family members and of their community," writes Rudd. "These actions
are not solely confined to traditional healthcare settings. They take place in
homes, at work, and in communities across the country.
This study has systematically examined tasks in everyday settings. These include
how well people use package labels found on household goods, appliances,
cleaning products, or even over-the-counter medicines. "There is a
mismatch," said Rudd. "We misjudge people's skills on one hand and
write very difficult materials on the other hand, not thinking about how people
need to use the materials."
Kirsch, of ETS's Center for Global Assessment, pointed out that "health
researchers would benefit from a rigorous measure of health literacy that goes
beyond word recognition or reading comprehension to differentiate between
understanding prose and understanding documents, to examine oral comprehension
and numerical skills."
"The health-related tasks used in this analysis range from simple to
complex and represent tasks undertaken in each of five health contexts,"
explained Yamamoto, principal research scientist in ETS's Center for Global
Assessment. "This study provides a national benchmark for looking at
health literacy and for examining changes over time, within multiple health
contexts, and for a variety of health-related tasks."
Download Literacy and Health in America for free at www.ets.org/research/pic.
Purchase copies for $15.00 (prepaid) by writing to the Policy Information
Center, ETS, MS 19-R, Rosedale Road, Princeton, NJ 08541-0001; by calling
609-734-5694; or by sending an e-mail to pic@ets.org.
For further information contact:
Robin Herman
Director of Communications
Harvard School of Public Health
617-432-4752
rherman@hsph.harvard.edu
Tom Ewing
Educational Testing Service (ETS)
609-734-1615
tewing@ets.org
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