Shane Desautels is the director of NewWays learning. He has worked in the field of social services for over 30 years. As a literacy consultant to the South Side Health and Vitality Studies, he has provided expertise in the areas of technology literacy, adult and youth learning, empowerment strategies, and communication with traditionally marginalized groups.

1. NewWays Learning www.newwayslearning.weebly.com Literacy & The Well Being of Our CommunityChicago Humanities Festival October 24, 2010 (Statistics taken from The National Assessment of Adult Literacy) 1

2. The National Literacy Act of 1991 defined General Literacy as an individual’s ability to read, write and speak in English, compute and solve problems at levels of proficiency necessary to function on the job and in society, to achieve one’s goals and develop one’s knowledge and potential. The National Institute of Health defines Health Literacy as the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. The U.S is 11th in the percentage of adults with a high school diploma. We are the only country where younger adults are now less educated than the previous generation. Every year, one in three young adults drops out of high school. Adults 16 and older in the U.S (The National Assessment of Adult Literacy) 22% have Below Basic skills: can only perform the most simple and concrete literacy skills 29% have Basic skills: can only perform simple and everyday literacy activities 44% have Intermediate skills: can perform moderately challenging literacy activities Only 13% have Proficient literacy: can perform complex and challenging literacy activities Over 43% of 18- to 60-year-olds in prison lack a high school diploma or GED. 2

3. Chicago’s literacy Crisis Chicago: 53% of adults have limited literacy skills. 20% read at or below the 5th grade level 50% of those receiving public assistance did not graduate from high school and do not have a GED. 70% of those incarcerated lack a high school diploma or GED. 28.2% have less than a high school education 12.4% have only an elementary education 52.2% of H.S. students graduated in 2006. Students entering City Colleges in 2006, 69% not prepared for college reading, 79% were not prepared for writing, 95% were not prepared for math. 3

4. In the U.S. Low levels of education are linked to high levels of poverty 1 in 4 working families is low-income 1 in 5 children lives in poverty. Parents and caregivers in many of these households lack the education and skills to earn a Family-sustaining wage. 36% of job applicants lack the reading and math skills to do the job they seek. Adults with limited literacy skills earn 42% less than high school graduates. 4

5. Low literacy and Poverty Leads to Serious Health Problems. Literacy is said to be the single best predictor of health status, more than age, income, employment status or racial and ethnic group. Being unemployed or under-employed often means no health care or preventive care and the ability to live a healthy life style. Healthy food is expensive. Poor neighborhoods are food deserts without affordable healthy grocery stores. Poor children go to school hungry or with bad nutrition and are unable to focus leading to academic failure. 61% of low income families do not have books in their home for their children. Only 7% of poor children are able to recognize all the letters of the alphabet. In America there is a generational circle of poor health, poverty and illiteracy. 5

6. 50% of the people who go to a medical office, clinic or hospital may be at risk. May not comprehending what is said or what they are reading, making mistakes, having excess hospitalizations, possible being misdiagnosed and having poor health outcomes. Low Health Literacy equals Problems with medications, appointment slips, informed consents, discharge instructions, health education materials, and insurance applications. Low literacy often means low critical thinking skills and not understanding the steps of instruction and problem posing. Healthcare professionals need to keep this in mind when asking people to use equipment, figure out problems on a computer, know what to do in an emergency, or to understand and answer questions from their doctor. 6

7. People with low literacy struggle every day Reading their mail or a brochure on diabetes or safe sex Using the bus, the train, or finding your way in a building such as a hospital Recognizing the name of a doctor, teacher or government official Filing out income tax forms, a job application, a medical form Following directions on a map, vending machine or other equipment Reading instructions and information on cleaning products or medication labels Helping their child with homework, reading notes and report cards 7

8. Today we have more medications, more tests and more procedures and growing self-care requirements. Health literacy is the demands placed on people by their condition, the language of the medical culture, and a health care system that often assumes health literacy and often requires people to find their own health care solutions. Health literacy is not only a patient’s literacy skills but it is also the complexity of everything involved in the health care system. 8

9. Poor health literacy has profound financial consequences on the health care system. People with low functional health literacy have higher health care costs and are more likely to receive health care services through publicly financed programs or walk into an emergency room as their only and last resort for care. Emergency room patients with inadequate literacy are twice as likely to be hospitalized as those with adequate literacy. From 2006 -2007 the percent of adults, age 18–65, reporting their health status as “fair or poor” was highest among high school dropouts (20%) and lowest among those with a bachelor’s degree or higher (4 to 5%). According to the National Adult Literacy Survey 75% of Americans who reported having a long-term illness (six months or more) had limited literacy. 9

10. We Can Enhance Health Literacy Patients with limited reading ability often feel ashamed, embarrassed, anxious, angry and may believe “Something is wrong with me”. Low level readers will not always let people know of their low skills and do a very good job of hiding their literacy challenges. This leads to patient materials that are too difficult and people not understanding the information needed to live a healthy lifestyle. They will protect themselves in Health Care Settings. They may bring someone who can read, watch other people/do what they do, pretend they can read, use humor, Detour and let the doctor or nurse miss the concern, make excuses, be demanding, ask other patients, never ask for help or seek help only when illness is advanced. They may be quiet, passive or just walk out of the waiting room. 10

11. Use “Teach Back” Techniques. Ask patients to demonstrate understanding. Asking, “Do you understand?”does not encourage people to dialogue but only to respond with one word answers that do not show comprehension. People who recognize all the words do not necessarily comprehend the text. People can lose overall meaning when they are working so hard to decipher individual words. Patient-Centered Visits. Healthcare Professionals should engage in a dialogue with patients, and encourage questions in a shame-free environment. 11

12. Jan bought a stecker at the hardware store. She needed a stecker for her minkle. A minkle won’t dreep if it doesn’t have a good stecker. What did Jan buy? What did she need it for? What would happen if she did not buy it ? It is possible to answer questions correctly even if do not understand the meaning of the text or what is being said. 12

13. Explain Things Clearly Using Plain everyday Language.No medical jargon. Define new words. Use words with a single meaning. Focus on key points and emphasize what the patient should do. Use medication reviews to identify and address problems. Include patient’s families and be aware of cultural issues. Provide a reader or interpreter. Ask how they prefer to get information. Make sure assistance is confidential. Give patients easy-to-follow instructions for appointments, referrals, tests, & self-care and be sure there is a follow-up call. Be alert for “red flags” Excuses and paperwork difficulties. 13

14. Be aware of individual Learning Styles. People also differ in what kind of environment helps them learn the most. The time of day, setting, session length, noise, lighting, and temperature all have an influence on how effectively people will learn When creating health materials be consistent in the way material is organized and formatted. Use visuals to explain important information. Avoid abbreviations, contractions, and acronyms that can make a document confusing and hard to read. Keep it short and omit needless words. You communicate more clearly if sentences are short, direct, and clear. People differ in which of the five senses they depend on most when learning. I have never heard anyone say, “this brochure is too simple and easy to read, do you have anything more complicated or at a higher grade level.” 14

15. We must be sure that those whose lives we want to improve, truly understand what is being said, what is being done and what their choices are. A patient/learner centered dialogue and Patient-Friendly Educational Materials will enhance Interaction, it will ensure informed consent and it will ensure the health and vitality of the community we serve. True informed consent is the result of a process of communication. It is a caring conversation between a patient and their doctor that should results in the patient’s total understanding of the situation. 15