The Silent Epidemic — The Health Effects of Illiteracy

Marcus, Erin N.

doi:10.1056/nejmp058328

Cited by 103 publications

(59 citation statements)

References 4 publications

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“…The use of educational level has been reported as a surrogate marker of health illiteracy. 6,13 We defined limited health literacy as a reading level of 8th grade or below.…”

Section: Definition Of Health Literacymentioning

confidence: 99%

“…[2][3][4][5] Nearly half of the United States adult population has marginal (i.e., below basic or basic) health literacy. 6 The association between limited health literacy and poor health has been supported across acute and chronic diseases. 7,8 Limited health literacy has been consistently related to determinants of self-care behavior, poor performance of self-care behavior, and worse health outcomes.…”

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confidence: 99%

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Improving the Informed Consent Process for Research Subjects with Low Literacy: A Systematic Review

et al. 2012

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BACKGROUND: Inadequate health literacy may impair research subjects' ability to participate adequately in the informed consent (IC) process. Our aim is to evaluate the evidence supporting interventions, to improve comprehension of the IC process in low literacy subjects. METHODS: We performed a MEDLINE database search (1966 to November 2011) supplemented by manual searches of bibliographies of key relevant articles. We selected all studies in which a modification of the IC was tested to improve comprehension in low literacy populations. Study design, quality criteria, population, interventions and outcomes for each trial were extracted. The main outcome evaluated was comprehension, measured using a written test or verbal comprehension. RESULTS: Our search strategy yielded 281 studies, of which only six met our eligibility criteria. The six studies included 1620 research participants. The studies predominantly included populations that were older (median age 61, range 48-64), ethnic minority, and with literacy level of 8th grade or below. Only one study had a randomized design. The specific intervention differed in each study. Two of the studies included the teach-back method or teach to goal method and achieved the highest level of comprehension. Two studies changed the readability level of the IC and resulted in the lowest comprehension among study subjects. CONCLUSIONS: The evidence supporting interventions to improve the informed consent process in low literacy populations is extremely limited. Among the interventions evaluated, having a study team member spend more time talking one-on-one to study participants was the most effective strategy for improving informed consent understanding; however, this finding is based on the results of a single study.

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“…The use of educational level has been reported as a surrogate marker of health illiteracy. 6,13 We defined limited health literacy as a reading level of 8th grade or below.…”

Section: Definition Of Health Literacymentioning

confidence: 99%

mentioning

confidence: 99%

Improving the Informed Consent Process for Research Subjects with Low Literacy: A Systematic Review

et al. 2012

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“…Unfortunately, these factors characterize underserved populations who have high rates of the diseases addressed in the education materials (9).…”

Section: Unmet Behavioral Activation Criteriamentioning

confidence: 99%

Evaluation of Diabetes and Cardiovascular Disease Print Patient Education Materials for Use With Low–Health Literate Populations

Hill-Briggs

Smith

2008

Diabetes Care

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OBJECTIVE -Populations with the lowest literacy and health literacy in the U.S. are also among those disproportionately burdened by diabetes and its complications. Yet, suitability of publicly available diabetes and cardiovascular (CVD) patient education materials for these patients is not clear. We evaluated selected American Diabetes Association (ADA) and American Heart Association (AHA) print education materials for accessibility and usability characteristics.RESEARCH DESIGN AND METHODS -English-language, print patient education brochures addressing lifestyle/behavioral management of diabetes and CVD were obtained from the ADA (n ϭ 21) and the AHA (n ϭ 19). Materials were evaluated using 32 criteria, 23 addressing literacy demand and 9 addressing behavioral activation, compiled from authoritative sources on development of low-literacy consumer health information.RESULTS -Of the 32 criteria identified by two or more sources, ADA materials consistently met 11 (34%) and AHA materials consistently met 8 (25%). Criteria most frequently achieved were text case, use of cues (e.g., bullets) to emphasize key points, design of graphics/illustrations, some provision of "how to" information, and positive depiction of cultural images. The least consistently achieved criteria were reading grade, word usage (e.g., scientific jargon), sentence length, font size, line length, white space, visual organization, limited scope, clear and specific (e.g., step-by-step) behavioral recommendations, and demonstration of audience relevance and cultural appropriateness.CONCLUSIONS -Materials consistently met few criteria for usability by patients with low literacy, limited prior medical knowledge, and/or limited resource availability. Use of available criteria and methods for increasing reach of print education materials to these underserved patient populations is indicated.

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“…3,4 Yet, methods for adapting materials for low literacy are not clearly understood or widely disseminated, and there remains little empirical research testing the usability of literacy-adapted materials. 5,6 The purposes of this study were to develop a lower-literacy patient diabetes and cardiovascular disease (CVD) education and to pilot test its acceptability and usability in a sample of urban, African-American, type 2 diabetic adults with Below Average and Average literacy.…”

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confidence: 99%

Development and Pilot Evaluation of Literacy-Adapted Diabetes and CVD Education in Urban, Diabetic African Americans

et al. 2008

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The Silent Epidemic — The Health Effects of Illiteracy

Cited by 103 publications

References 4 publications

Improving the Informed Consent Process for Research Subjects with Low Literacy: A Systematic Review

Improving the Informed Consent Process for Research Subjects with Low Literacy: A Systematic Review

Evaluation of Diabetes and Cardiovascular Disease Print Patient Education Materials for Use With Low–Health Literate Populations

Development and Pilot Evaluation of Literacy-Adapted Diabetes and CVD Education in Urban, Diabetic African Americans

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