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Advancing Health Literacy: A Framework for Understanding and Action

ISBN: 978-0-7879-8433-5
396 pages
June 2006, ©2006, Jossey-Bass
Advancing Health Literacy: A Framework for Understanding and Action (0787984337) cover image


Advancing Health Literacy addresses the crisis in health literacy in the United States and around the world. This book thoroughly examines the critical role of literacy in public health and outlines a practical, effective model that bridges the gap between health education, health promotion, and health communication. Step by step, the authors outline the theory and practice of health literacy from a public health perspective. This comprehensive resource includes the history of health literacy, theoretical foundations of health and language literacy, the role of the media, a series of case studies on important topics including prenatal care, anthrax, HIV/AIDS, genomics, and diabetes. The book concludes with a series of practical guidelines for the development and assessment of health communications materials. Also included are essential techniques needed to help people make informed decisions, advocate for themselves and their community, mitigate risk, and live healthier lives.
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Table of Contents

List of Tables, Figures, and Exhibits.


The Authors.

1. Health Literacy: Why Is It a Public Health Issue?

Definitions of Key Terms.

Medical Information.

The Relationship Between Health and Literacy.

Characteristics of People as Language Users.

Wrapping Up.


2. Advancing Health Literacy: Getting Here from There.

Historical Considerations.

A Brief History: How Did We Get to Health Literacy?

Early Public Health Promotion and Education.

Social Movements and Advocacy in the 1960s and 1970s.

Informed Consumer Decision Making and Community Collaboration in the 1980s and 1990s.

The 21st Century.

Wrapping Up.


3. Defining Health Literacy.

Literacy: Defining Terms.

Reality Bytes.

The Evolving Field of Health Literacy.

A Multidimensional Model of Health Literacy.

Wrapping Up.


4. Literacy at Work.

How Language Works.


Spoken Language.

Implications for Spoken and Written Health Messages.

Wrapping Up.


5. The Traditional Mass Media.

Introduction to Mass Media.

Media Content: Challenges and Opportunities to Advance Health Literacy.

Wrapping Up.


6. Health Literacy and the Internet.

Internet Use in Health Care.

Potential Disadvantages and Barriers to the Internet for Conveying Health-Related Information.

Wrapping Up.


7. Baby Basics: A Prenatal Program Focusing on Developing Health Literacy.

Healthy Beginnings: Infant and Maternal Health.

The Baby Basics Book and Program.

The Baby Basics Program Model.

Wrapping Up.


8. Anthrax: A Missed Opportunity to Advance Health Literacy.

The American Public Reacts.

The U.S. Postal Service Postcard: A Mixed Success.

Seeking Anthrax Answers on the Internet.

Scientific Uncertainty: A Consistent Challenge.

Wrapping Up.


9. Genomics and Health Literacy.

Why Genomics?

Understanding and Misunderstanding Genomics: A Review.

Wrapping Up.


10. Highlighting the Role of Civic Literacy: The Massachusetts Tobacco Control Program.

Smoking and Health: The Threat.

Smoking and Health Literacy.

Massachusetts Tobacco Control Program.

Wrapping Up.


11. Highlighting the Role of Cultural Literacy, Part 1: The Changing Face of HIV/AIDS.

HIV/AIDS in the United States.

The Public Dialogue.

The Conflict in Communicating About HIV/AIDS.

Community Planning: The San Francisco AIDS Foundation.

Wrapping Up.


12. Highlighting the Role of Cultural Literacy, Part 2: Diabetes and Native Americans.

How to Be Culturally Relevant.

Diabetes and Native Americans: An Epidemic of Culture.

The Role of Culture in Diabetes Prevention and Care.

The Sioux San Hospital Diabetes Program.

Listening to the Community.

Wrapping Up.


13. Program Evaluation: World Education’s Breast and Cervical Cancer Project.

Adult Basic Education and Health Literacy.

Targeting Breast and Cervical Cancer.

What Is Evaluation?

HEAL:BCC Implementation and Evaluation.

Lessons Learned from the Evaluation.

Wrapping Up.


14. Guidelines for Advancing Health Literacy.

Guideline 1: General.

Guideline 2: Vocabulary.

Guideline 3: Sentences.

Guideline 4: Text Structure.

Guideline 5: Giving Instructions.

Guideline 6: Field Testing.

Guideline 7: Spoken Language.

Guideline 8: Language Translation.

Guideline 9: Web Design.

Guideline 10: Graphics and Layout of Print Materials.

Guideline 11: Media.


Name Index.

Subject Index.

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Author Information

Christina Zarcadoolas, Ph.D., is associate clinical professor in the Department of Community and Preventive Medicine, Mount Sinai School of Medicine, in New York City. She is a sociolinguist who has spent thirty years studying language and literacy of vulnerable populations.

Andrew F. Pleasant, Ph.D., is an assistant professor in the Department of Human Ecology and the Extension Department of Family and Community Health Sciences at Rutgers, the State University of New Jersey in New Brunswick, New Jersey. He previously served as a temporary advisor to the World Health Organization in Geneva, Switzerland, and actively conducts research both in the United States and internationally.

David S. Greer, M.D., is dean of medicine emeritus, and professor of community health emeritus at the Division of Biology and Medicine, School of Medicine, Brown University. Greer has been a family doctor, researcher, medical school leader, community leader, and mentor to countless health professionals for many decades. He was a founding director of International Physicians for the Prevention of Nuclear War, which won the Nobel Peace Prize in 1985.

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The Wiley Advantage

•       Leading Edge: This project was supported by a grant from the National Institutes of Health (NIH) causes and responses to the growing problem of health literacy as a threat to public health.

•       Need: Fulfills need for a textbook with perspective on health literacy that addresses the most pressing public health issues.

•       Breadth: The three authors bring substantial breadth of experience in research, program evaluation, public health, and preventive medicine.

•       Methodical: Takes a step-by-step approach to the theory and practice of health literacy from a public health perspective. Chapters cover the history of health literacy, theoretical foundations of health and language literacy, the role of media, analysis of cases, and practical guidelines for development and assessment of health communications materials.

•       Ready for the Classroom: Can be a course text for teachers who wish to bring a fresh resource to their classes in health literacy, foundations of health education, health education practice, and other topics, the chapters include exercises for classroom discussion, essays, and activities, all driving home the lessons of that chapter.


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"…an important book because it teaches us lessons from the history of health communications and moves us forward." (PsycCritiques, 08/08/2007)

"This is one of the most understandable, useful, and practical texts available to assist with developing, implementing, and evaluating community health programs." (Choice, February 2007)

"We recommend that public health directors make this book required reading for everyone in their communications department." (New England Journal of Medicine, February 15, 2007)

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