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Recruiting
Participants with
Low Literacy Skills
Angela Colter (@angelacolter)
UPA 2010
Munich
In the United States



   44       %
            %
of adults have low
   literacy skills
             2003 National Assessment of Adult Literacy
Rate of adults with low literacy skills
       Sweden     25%

   Netherlands    36%

      Germany     42%

      Australia   44%

   Switzerland    47%

United Kingdom    50%

        Ireland   57%

      Hungary     67%

      Portugal    80%
                        1998 International Adult Literacy Survey (OECD)
People with low literacy
skills likely:
•   are older
•   have less education
•   work low-paying jobs
•   are ashamed of their poor reading skills
•   hide their reading difficulties from others
Reading, like typing, is a skill
Do you have low
literacy skills?




          Sorry, you can’t ask that
Recruiting Process


 ➊
         ➋
        ➌
	   FIND	   SCREEN	   CONFIRM
NEVER
 tell participants you’re
looking for people with
    low literacy skills
FIND
Where to start
looking
•   Adult education
    programs
•   Friends of qualified
    participants
•   Public health clinics
•   Ex-offender email lists

                       Photo © 2008 Traci Paris
Adult Basic	
 	 Education	           ≠   Adult
                            Literacy
 7th grade & above          6th grade & below
             Groups         One-on-one
    Associated with         Free-standing
     public schools/        volunteer
community colleges
    May have to go          No IRB
   through school’s
 institutional review
                board
Working with adult education
•   Find a program on proliteracy.org
•   Build relationships
•   Be respectful
•   Pay participants
•   Pay the literacy program
SCREEN
How confident are you
filling out medical forms
by yourself?
Extremely
Quite a lot
Somewhat
A little bit                         Predicts low literacy
                                     83% of the time
Not at all
                                                           Wallace L, Rogers E, et al
               Screening items to identify patients with limited health literacy skills
                           Journal of General Internal Medicine. 2006; 21: 874-877
CONFIRM
REALM
Rapid Estimate of Adult Literacy in Medicine
• Word recognition test                                                             fat
                                                                                    flu
                                                                                              fatigue
                                                                                               pelvic
                                                                                                             allergic
                                                                                                            menstrual

• Quick and easy to administer                                                      pill
                                                                                   dose
                                                                                             jaundice
                                                                                             infection
                                                                                                             testicle
                                                                                                              colitis

• Participant says each word out                                                   eye
                                                                                  stress
                                                                                             exercise
                                                                                             behavior
                                                                                                           emergency
                                                                                                           medication
  loud. Scored on number                                                          smear     prescription   occupation

  pronounced correctly                                                            nerves
                                                                                  germs
                                                                                               notify
                                                                                            gallbladder
                                                                                                             sexually
                                                                                                            alcoholism
     61-66: not low lit                                                           meals       calories       irritation
                                                                                 disease    depression     constipation
     45-60: grade 7-8                                                             cancer    miscarriage     gonorrhea
     19-44: grade 4-6                                                            caffeine   pregnancy      inflammatory
      0-18: grade 3 or below                                                      attack      arthritis      diabetes
                                                                                  kidney     nutrition       hepatitis
• Doesn’t matter if they know                                                    hormones   menopause       antibiotics

  the word’s meaning                                                              herpes     appendix       diagnosis
                                                                                  seizure    abnormal       potassium
                                                                                  bowel       syphilis       anemia
                                                                                  asthma    hemorrhoids      obesity
Davis T, Long S, et al
                                                                                  rectal      nausea       osteoporosis
Rapid estimate of adult literacy in medicine: a shortened screening instrument
Fam Med. 1993; 25: 391-395                                                        incest     directed       impetigo
Two incentives
•   One to qualify ($25)
•   One to participate ($25 + $75)
To sum up:
• Recruit from sources likely to
  include low lit users
• Screen for low lit characteristics
• Confirm literacy level in person
• Pay separate incentives for
  confirmation and participation
Q&A
Angela Colter
angelacolter.com/lowliteracy
acolter@gmail.com

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Recruiting Participants with Low Literacy Skills

  • 1. Recruiting Participants with Low Literacy Skills Angela Colter (@angelacolter) UPA 2010 Munich
  • 2. In the United States 44 % % of adults have low literacy skills 2003 National Assessment of Adult Literacy
  • 3. Rate of adults with low literacy skills Sweden 25% Netherlands 36% Germany 42% Australia 44% Switzerland 47% United Kingdom 50% Ireland 57% Hungary 67% Portugal 80% 1998 International Adult Literacy Survey (OECD)
  • 4. People with low literacy skills likely: • are older • have less education • work low-paying jobs • are ashamed of their poor reading skills • hide their reading difficulties from others
  • 6. Do you have low literacy skills? Sorry, you can’t ask that
  • 7. Recruiting Process ➊ ➋ ➌ FIND SCREEN CONFIRM
  • 8. NEVER tell participants you’re looking for people with low literacy skills
  • 10. Where to start looking • Adult education programs • Friends of qualified participants • Public health clinics • Ex-offender email lists Photo © 2008 Traci Paris
  • 11. Adult Basic Education ≠ Adult Literacy 7th grade & above 6th grade & below Groups One-on-one Associated with Free-standing public schools/ volunteer community colleges May have to go No IRB through school’s institutional review board
  • 12. Working with adult education • Find a program on proliteracy.org • Build relationships • Be respectful • Pay participants • Pay the literacy program
  • 14. How confident are you filling out medical forms by yourself? Extremely Quite a lot Somewhat A little bit Predicts low literacy 83% of the time Not at all Wallace L, Rogers E, et al Screening items to identify patients with limited health literacy skills Journal of General Internal Medicine. 2006; 21: 874-877
  • 16. REALM Rapid Estimate of Adult Literacy in Medicine • Word recognition test fat flu fatigue pelvic allergic menstrual • Quick and easy to administer pill dose jaundice infection testicle colitis • Participant says each word out eye stress exercise behavior emergency medication loud. Scored on number smear prescription occupation pronounced correctly nerves germs notify gallbladder sexually alcoholism 61-66: not low lit meals calories irritation disease depression constipation 45-60: grade 7-8 cancer miscarriage gonorrhea 19-44: grade 4-6 caffeine pregnancy inflammatory 0-18: grade 3 or below attack arthritis diabetes kidney nutrition hepatitis • Doesn’t matter if they know hormones menopause antibiotics the word’s meaning herpes appendix diagnosis seizure abnormal potassium bowel syphilis anemia asthma hemorrhoids obesity Davis T, Long S, et al rectal nausea osteoporosis Rapid estimate of adult literacy in medicine: a shortened screening instrument Fam Med. 1993; 25: 391-395 incest directed impetigo
  • 17. Two incentives • One to qualify ($25) • One to participate ($25 + $75)
  • 18. To sum up: • Recruit from sources likely to include low lit users • Screen for low lit characteristics • Confirm literacy level in person • Pay separate incentives for confirmation and participation