One of the things I found most fascinating with the NAAL data was the 
breakdown by education level.  13% of those with a bachelor's degree 
functioned at the below basic / basic levels (3% / 10%) and, in fact, 11% 
of those with a graduate degree or some graduate studies functioned at the 
below basic / basic levels (3% / 8%). 

I'd really like to see us move away from talking about grade level and 
focus on skill sets such as those described in the NAAL study.  I have 
found education level achieved a poor predictor of reading skills in my 
clinical experience.  This is supported by past research demonstrating 
that education level achieved does not correlate well with ability to read 
materials rated at that level on readability tests such as Flesch-Kincaid. 
 I've also seen huge variability in reading ability during 12 years of 
volunteering in my childrens' schools from kindergarten through high 
school and now am amazed at the range of average SAT scores for incoming 
freshmen at different colleges.   When we talk about the skills of someone 
in 3rd grade or 7th grade, it's kind of liking talking about dogs....I say 
'dog', you think 'chihauhau', she thinks 'Great Dane', he thinks 
'Labradoodle'!  If we focus on educating our colleagues on the skill sets 
in these four levels, I think we will have made a huge stride towards 
getting everyone on the same page. 

K

Kerry Harwood, RN, MSN
Director, Cancer Patient Education Program
Team Leader, Dept. of Advanced Clinical Practice 
Duke University Medical Center Box 3677
Durham, NC 27710
919-681-5288
kerry.harwood at duke.edu

A mind once stretched by a new idea never returns to its original 
dimensions.  A ship in the harbor is safe...but that's not what ships were 
made for.  Wisdom is knowing what path to take next...integrity is taking 
it. 



"Muro, Andres" <amuro5 at epcc.edu> 
Sent by: healthliteracy-bounces at nifl.gov
09/13/2006 04:39 PM
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Subject
[HealthLiteracy 405] NAAL health literacy summary with seniors over     65






Hi, I expanded the summary to include older adults after an email from 
Penny Glassman. I hope that his helps, 
 
Andres
 
National Assessment of Adult Literacy (NAAL) Health Literacy of America’s 
Adults 
 
Four levels:
 
1.      Below Basic: indicates no more than the most basic and concrete 
literacy skills.
2.      Basic: indicates skills to perform simple and everyday literacy 
activities.
3.      Intermediate: indicate skills to perform moderately challenging 
literacy activities
4.      Proficient: indicates skills to perform more challenging and 
complex literacy activities
 
I equate below level to reading skills and math skills of someone in the 
third grade. Basic would be someone with reading and math skills below 
seventh grade. Intermediate would be someone with the skills of a high 
school student. Proficient would define the skills of a high school 
graduate. Note that this in not a scientific comparison but my own 
estimation based on my years in the education field. 
 
Result of the health NAAL:
 

Percentage of adults in each literacy level
Percentage of males in each literacy level
Percentage of females in each literacy level
Percentage of adults over 65 years
of age
Below basic: 14%
Basic: 22%
Intermediate: 53%
Proficient: 12%
Below basic: 16%
Basic: 22%
Intermediate: 51%
Proficient: 11%
Below basic: 12%
Basic: 21%
Intermediate: 55%
Proficient: 12%
Below basic 29% 
Basic 30% 
Intermediate 38% 
Proficient 3% 
 
Note that women scored higher than males. This is not surprising since 
women are usually the health providers of the entire family. 
 
Also note that close to 60% of seniors have very limited understanding of 
health related print. This limitation may be related to limited vision. 
So, seniors may require extensive verbal support. However, many seniors 
also have hearing loss. This would require that health providers speak 
slowly, clearly and in a loud voice. However, considering that the average 
time that doctors spend with patients nationally is seven minutes, it is 
doubtful that seniors get the needed support. 
 

Percentage of Whites in each  literacy level
Percentage of Blacks in  each literacy level
Percentage of Hispanics each literacy level
Below basic: 9%
Basic: 19%
Intermediate: 58%
Proficient: 14%
Below basic: 24%
Basic: 34%
Intermediate: 41%
Proficient: 2%
Below basic: 41%
Basic: 25%
Intermediate: 31%
Proficient: 4%
 
Note the very high numbers of Hispanics below basic. This is likely 
because many are not native English speakers. 
 
Based on this assessment, one third to one half of all adults does not 
understand written information related to health well or at all. There is 
a third that understands information better. Only 14% of all adults can 
understand health related information well. 
 
For more info go to: http://nces.ed.gov/naal/
 
 
 
 
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