Let's Bring it Down a Level or Two

I found the readings for this past week to be important and relevant to our practice in health promotion. I particularly liked the JAMA (1999) article on Health Literacy, emphasizing the surprisingly poor literacy rate of the general public and how this translates into issues with health literacy also. Interestingly, the authors of the article cite cultural differences and English as a second language as a major contributing factors to the low literacy rates in the U.S., given the increasing numbers of immigrants who are in the country. I am especially attuned to this issue as a result of my teaching experiences at a bilingual elementary school in Mexico. I taught first grade students English in the subject areas of reading, phonics, spelling, math, and science. First grade is a pivotal learning year as it is the time when these young students are not only learning rudimentary tasks for the first time, such as sitting quietly in a desk, reading, writing, and following instructions. In the case of my first graders, they were doing this for the first time not only in their native language, but also in English! I learned through this experience, however, how to break language down into its most simple pieces and I quickly was aware of what my students would be able to grasp and what would go straight over their heads. This skill and understanding has helped me communicate with other individuals who have limited English as well. While the general public has a much greater literacy level beyond the first grade (the article cited an 8th grade level) making sentences simpler, with fewer syllable words, short sentences, and basic vocabulary, are all important ways of making both speech and written materials easier to comprehend.

The SMOG readability formula is a very effective tool for health promoters to ensure that materials that are produced are easy to understand. While it may be easier to utilize the online version that calculates the readability for you, the written version could also be implemented. For a project in the Motivating Health Behavior class last semester my group produced a manual for elderly persons and their caregivers to educate about diabetes and physical activity. When we ran the SMOG readability formula, we exceeded our simplicity goal: a reading level at about the 2nd grade! I think that as long as the writing style is mature and not child-like, the simpler the better. I compared my group's success to some of the others who tended to have reading levels of their materials beyond the college level. Certainly, then, writing "readable" materials is not always second nature for advantaged folks such as ourselves.

Finally, I think the next most beneficial point I took away from the readings was that we must include the physicians and other health professionals who relay important health information to patients by highlighting the importance of not making assumptions about what patients understand. A lack of literacy is often embarrassing, and most people don't want to admit that they don't understand. Therefore, it's important that physicians, nurses, pharmacists, etc. take the initiative to review health information with the patient and ensure that the patient understands what to do.