Thanks, Andrew, for shedding some light on my question about how the
definition affects what we do to address health literacy. If, as you
say, "broader definitions of health literacy will further the potential
for collaborations between the 'health' camp ...and the 'literacy' camp,
then I think there is value in that. In my experience, these
collaborations have proven to help further the goals of both camps in a
very exciting way.

Sabrina's definition adds a new camp: the healthcare workforce. If we,
as she suggests, help adult learners break into the healthcare field and
climb the ladder, will the resulting workforce be more diverse and more
attuned to the communication needs of lower literacy patients because
they will have been there themselves?

What do others think?

Julie


Julie McKinney
Discussion List Moderator
World Education/NCSALL
jmckinney at worlded.org


>>> sabrina_kurtz-rossi at worlded.org 10/16/06 10:19 AM >>>

I've been adding workforce readiness to my working definition of health
literary.  I include supporting adult learners interested in health
careers and employment as a way of creating a more culturally and
linguistically diverse health care delivery system which I see would
improve the health literacy or health care system's ability to
communicate with an increasingly diverse patient population.  Does that
make sense to folks.  It's along the lines of health literacy training
for providers but not really.  It's more like health literary training
for community members that increases an individual's  health literacy
skills and workplace readiness skills.   I'm working with the East
Boston Community Health Center to develop a health literacy training for
community members interested in becoming a Certified Nurse Assistant
(CNA).  The is need for a training focused on health oriented reading
and comprehension, vocabulary and problem solving skills, and the
application of these skills to the CNA training entrance exam and ones
future career.  We're also looking at provide on-going support for
learners as they progress through their CNA training to ensure their
success in getting certified and obtaining a job.  Are others looking at
health literacy from this angle?  I'd be interested in hearing what
others are doing in this regard.  

- Sabrina

-------------------------------------------------
Sabrina Kurtz-Rossi
World Education
44 Farnsworth Street
Boston, MA  02210
617-482-9485
skurtz at worlded.org


>>> pleasant at aesop.rutgers.edu 10/12/2006 1:36 PM >>>

Hi all,

Glad to see this topic being addressed.

Definitions matter in sometimes subtle but very important ways. For 
instance, they can directly influence funding streams, and thus 
create research, practice, and publication communities (some call 
these epistemic communities) which work to self-reinforce and often 
'circle the wagons' when encountering new or opposing ideas. That can 
work to slow down, but also possibly validate, progress and 
development of best practices and new solutions.

I keep encountering more and more folks who think this is one of the 
issues the field of health literacy faces. In short,  that the 
emphasis has been unduly placed on the clinical setting and often 
blames patients. Alternatively, a richer definition casts health 
literacy as a multi-dimensional concept that includes public health 
issues and sees (as has been well-expressed in this thread) health 
literacy as an issue for both providers (of information, of health 
care, etc.) and the 'public'(s). This goes far beyond depicting 
health literacy as an important issue only when people are in a 'sick 
role' (a concept from the '50s). I'd argue that this more inclusive 
and less top-down approach to health literacy is not only more robust 
conceptually but will also increase validity and utility of technical 
measures when they begin to reflect the newer definitions being 
advanced.

Additionally, and I believe very importantly, these broader 
definitions of health literacy will further the potential for 
collaborations between the 'health' camp (physicians, nurses, public 
health professionals) and the 'literacy' camp (ABE/ESOL teachers, 
linguists, communication folks for example). Those sorts of 
collaborative projects which will be in a stronger position on the 
ground in communities and in individual's lives to address the role 
of health literacy as a social determinant of health.

as they say online .. fwiw,

Andrew Pleasant






>Thanks, Andres, Cynthia and Bob.

>

>I tend to think that the definition matters less than what we promote

as

>a way to improve the situation, and I think that the Quick Guide that

>Cynthia mentioned is a great step in addressing solutions with health

>care professionals, as are the strategies that Bob mentioned.

>

>However, when we get used to a certain definition, then we tend to

use

>it in ways that narrow our focus of who to target for interventions.

For

>example, when we talk about people as having "high or low health

>literacy", we are talking about patients, and assuming the following

>definition:

>

>"the capacity to obtain, process and understand basic health

information

>and services needed to make appropriate health decisions."

>

>Andres' and Anthony's definitions (below) include the following

>additions that allow us to also talk about health providers and

>educators as having "high or low health literacy."

>

>"...the ability of health workers to create and share health

information

>so that community members can make informed health decisions. " 

-Andres

>

>"...the capacity of professionals and institutions to communicate

>effectively so that community members can make informed decisions and

>take appropriate actions to protect and promote their health."  -

>Anthony (NYC Mayor's Office of Adult Education)

>

>I think we are all on the same page in thinking that we need to

address

>both groups (patients and providers). How important is it to have

this

>dual focus as part of the definition? What do others think?

>

>Please note that I've changed the SUBJECT LINE so people can find

this

>thread in the archives!

>

>Julie

>

>Julie McKinney

>Discussion List Moderator

>World Education/NCSALL

>jmckinney at worlded.org 

>

>>>>  DICKERR2 at ihs.org 10/10/06 6:45 PM >>>

>I've been watching the discussion on the health literacy definition.

I

>would have to agree with Cynthia Baur's comments. We need to be

careful

>when defining health literacy that the definition is not too

limiting.

>We also need to make sure the definition itself is understandable.

>

>While I very much appreciate that Andres is emphasizing the

>multicultural and multilingual aspects of understanding, her

definition

>limits health literacy to communities that are multicultural and

>multilingual. "The capacity of individuals in a multicultural and

>multilingual community...". By having narrowing the definition are we

>going to exclude communities that are homogeneous? People new to

health

>literacy may.

>

>I have had several discussions (e-mail) with a very prominent

physician

>in our state who vehemently argues none of his patients have problems

>with health literacy. He insists they all understand what he tells

them.

>With a definition such as this I can very well see this individual

>making the assumption that health literacy is limited to people who

do

>not speak English and/or come from cultures different than our own.

>

>The HHS definition does not limit health literacy to any one type of

>patient or community.

>

>Creating easy to understand materials and communicating clearly are

>strategies to improve health literacy. The role of the health care

>provider and health worker in doing this, to me has always been

implied.

>In the many presentations I have given on health literacy, difficult

to

>understand materials and poor communication are always things that I

>discuss as contributing to low health literacy and clear

communication.

>Using easy to understand materials are strategies I outline for

>enhancing health literacy. These are essential to a complete

discussion

>of health literacy but do not define it. As such I think it does not

>really fit in the definition of health literacy but is essential to

>enhancing it.

>

>During my presentations I have found people sometimes have difficulty

>clearly understanding the HHS definition of health literacy on the

>initial read. After we talk very briefly about what it is saying they

>have been able to read it and have it make sense. In the true nature

of

>making things easy to understand it truly is not written at an easy

to

>understand level (it is long and has several difficult to understand

>terms). However, it seems to have been universally accepted and as

such

>I would urge caution developing differing definitions. Adding to it

only

>makes it less reader friendly, more difficult to understand and

>potentially limited.

>

>I respect opinions may differ. By having a common definition that is

not

>limited to specific patient populations and clearly identifying and

>employing similar strategies to enhance health literacy we can present

a

>common front. By creating varying definitions we become too

fragmented

>in what we trying to improve and risk loosing sight of what our aim

is.

>I believe, if I am not mistaken, our aim with health literacy is

>something to the effect of improving communication and

understandability

>of health related information for all people.

>

>Thanks very much,

>Bob

>

>Bob Dickerson, MSHSA, RRT

>Clinical Resource Coordinator, Clinical Quality

>Iowa Health - Des Moines

>Des Moines, Iowa

>Phone: (515) 263-5792

>Fax: (515) 263-5415

>E-mail: DICKERR2 at ihs.org 

>Website: www.ihsdesmoines.org 

>   

>

>-----Original Message-----

>From: healthliteracy-bounces at nifl.gov 

>[mailto:healthliteracy-bounces at nifl.gov] On Behalf Of Baur, Cynthia

>(HHS/OPHS)

>Sent: Tuesday, October 10, 2006 1:01 PM

>To: The Health and Literacy Discussion List

>Subject: [HealthLiteracy 441] Re: Your presentation on health

literacy

>

>I appreciate the lively discussion of the meaning of health literacy.

>The HHS Health Literacy Workgroup has always used the broadest

possible

>definition of health literacy, and we already recognize health

>professionals as part of the problem and solution. All types of

health

>professionals work at HHS, and we have always been very clear that

>improving health literacy is everyone's responsibility. For an

>elaboration of the role that we see health professionals playing,

please

>see our Quick Guide to Health Literacy that was developed for HHS

>employees. We have made this available on our web site for anyone to

>use. www.health.gov/communication, in the health literacy section.   



>

>Cynthia Baur, Ph.D.

>Senior Health Communication and e-Health Advisor Office of Disease

>Prevention and Health Promotion U.S. Department of Health and Human

>Services

>1101 Wootton Parkway, LL

>Rockville, MD 20852

>240-453-8262

>Cynthia.Baur at hhs.gov 

>

>

>

>-----Original Message-----

>From: healthliteracy-bounces at nifl.gov 

>[mailto:healthliteracy-bounces at nifl.gov] On Behalf Of Muro, Andres

>Sent: Tuesday, October 10, 2006 12:42 PM

>To: The Health and Literacy Discussion List

>Subject: [HealthLiteracy 440] Re: Your presentation on health

literacy

>

>Hey Anthony, that is great. Now, if we can get HHS to adopt the

>definition. Cynthia, are you there ;-)

>

>Andres

>

>-----Original Message-----

>From: healthliteracy-bounces at nifl.gov 

>[mailto:healthliteracy-bounces at nifl.gov] On Behalf Of Tassi, Anthony

>Sent: Tuesday, October 10, 2006 9:04 AM

>To: The Health and Literacy Discussion List

>Subject: [HealthLiteracy 439] Re: Your presentation on health

literacy

>

>I agree that Andres has succinctly captured what many of us have been

>thinking for years.  Here in NYC, we have incorporated this approach

in

>the definition that we are using:

>

>http://www.nyc.gov/html/adulted/html/health/health.shtml 

>

>Anthony Tassi

>Director, Adult Education

>Office of the Mayor

>City of New York

>atassi at cityhall.nyc.gov 

>

>

>

>www.nyc.gov/adult-ed 

>

>

>-----Original Message-----

>From: healthliteracy-bounces at nifl.gov 

>[mailto:healthliteracy-bounces at nifl.gov] On Behalf Of Julie McKinney

>Sent: Friday, October 06, 2006 1:42 PM

>To: healthliteracy at nifl.gov 

>Subject: [HealthLiteracy 437] Re: Your presentation on health

literacy

>

>Thanks Andres,

>

>I like the way your new definition of health literacy (at the end)

>includes skills for health workers to achieve in order to be health

>literate. It is a new way of looking at it! Please let us know about

the

>response you get from the presentation, if you could.

>

>Thanks again,

>

>Julie

>

>Julie McKinney

>Discussion List Moderator

>World Education/NCSALL

>jmckinney at worlded.org 

>

>>>>  amuro5 at epcc.edu 10/06/06 1:10 PM >>>

>Julie:

>

>

>

>It is my own presentation. However, it is attached. Let me know if

you

>have questions.

>

>

>

>Andres

>

>

>

>________________________________

>

>From: healthliteracy-bounces at nifl.gov 

>[mailto:healthliteracy-bounces at nifl.gov] On Behalf Of

jbaker3439 at aol.com 

>Sent: Friday, October 06, 2006 10:37 AM

>To: healthliteracy at nifl.gov 

>Subject: [HealthLiteracy 434] Your presentation on health literacy

>

>

>

>  Andres,

>

>

>

>Although I would love it, I am not able to attend the Health Literacy

>Conference next week.  However, I was wondering if your presentation

is

>available for those of us who are unable to attend. 

>

>

>

>Are you part of a group from NCES or DOE that is disseminating

>information about NAAL, or is this a presentation that you have

designed

>yourself?

>

>

>

>Thanks for your time.

>

>

>

>Julie Baker

>

>

>

>

>

>Julie N. Baker

>

>Workforce Skills Development

>

>13805 Shaker Blvd., #4A

>

>Cleveland, OH 44120

>

>216-561-1629

>

>jbaker3439 at aol.com <mailto:jbaker3439 at aol.com>

>

>

>

>

>-----Original Message-----

>From: amuro5 at epcc.edu 

>To: healthliteracy at nifl.gov 

>Sent: Thu, 5 Oct 2006 1:08 PM

>Subject: [HealthLiteracy 430] health literacy conference San Antonio

>

>There is a health literacy conference in San Antonio next week. I'll

be

>doing a presentation about NAAL results and other things. The website

is

>listed below,

>

>

>

>http://www.sahealthlit.org/save2006.pdf 

>

>

>

>Andres

>

>________________________________

>

>

>

>----------------------------------------------------

>

>National Institute for Literacy

>

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