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Advancing Health Literacy: A Framework for Understanding and Action

ISBN: 978-1-118-42974-7
396 pages
July 2012, Jossey-Bass
Advancing Health Literacy: A Framework for Understanding and Action (1118429745) 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 xi

Preface xv

The Authors xxiii

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

Definitions of Key Terms 4

Medical Information 6

The Relationship Between Health and Literacy 10

Characteristics of People as Language Users 16

Wrapping Up 18

Exercises 18

2. Advancing Health Literacy: Getting Here from There 21

Historical Considerations 21

A Brief History: How Did We Get to Health Literacy? 23

Early Public Health Promotion and Education 27

Social Movements and Advocacy in the 1960s and 1970s 34

Informed Consumer Decision Making and Community Collaboration in the 1980s and 1990s 35

The 21st Century 38

Wrapping Up 43

Exercises 43

3. Defining Health Literacy 45

Literacy: Defining Terms 45

Reality Bytes 46

The Evolving Field of Health Literacy 49

A Multidimensional Model of Health Literacy 55

Wrapping Up 67

Exercises 67

4. Literacy at Work 69

How Language Works 69

Reading 75

Spoken Language 82

Implications for Spoken and Written Health Messages 90

Wrapping Up 91

Exercises 91

5. The Traditional Mass Media 93

Introduction to Mass Media 94

Media Content: Challenges and Opportunities to Advance Health Literacy 103

Wrapping Up 115

Exercises 115

6. Health Literacy and the Internet 117

Internet Use in Health Care 118

Potential Disadvantages and Barriers to the Internet for Conveying Health-Related Information 127

Wrapping Up 136

Exercises 136

7. Baby Basics: A Prenatal Program Focusing on Developing Health Literacy 141

Healthy Beginnings: Infant and Maternal Health 142

The Baby Basics Book and Program 146

The Baby Basics Program Model 159

Wrapping Up 162

Exercises 163

8. Anthrax: A Missed Opportunity to Advance Health Literacy 165

The American Public Reacts 170

The U.S. Postal Service Postcard: A Mixed Success 172

Seeking Anthrax Answers on the Internet 175

Scientific Uncertainty: A Consistent Challenge 177

Wrapping Up 180

Exercises 182

9. Genomics and Health Literacy 183

Why Genomics? 183

Understanding and Misunderstanding Genomics: A Review 186

Wrapping Up 203

Exercises 203

10. Highlighting the Role of Civic Literacy: The Massachusetts Tobacco Control Program 205

Smoking and Health: The Threat 205

Smoking and Health Literacy 207

Massachusetts Tobacco Control Program 207

Wrapping Up 220

Exercises 220

11. Highlighting the Role of Cultural Literacy, Part 1: The Changing Face of HIV/AIDS 223

HIV/AIDS in the United States 225

The Public Dialogue 227

The Conflict in Communicating About HIV/AIDS 228

Community Planning: The San Francisco AIDS Foundation 236

Wrapping Up 240

Exercises 241

12. Highlighting the Role of Cultural Literacy, Part 2: Diabetes and Native Americans 243

How to Be Culturally Relevant 244

Diabetes and Native Americans: An Epidemic of Culture 245

The Role of Culture in Diabetes Prevention and Care 248

The Sioux San Hospital Diabetes Program 250

Listening to the Community 257

Wrapping Up 260

Exercises 261

13. Program Evaluation: World Education’s Breast and Cervical Cancer Project 263

Adult Basic Education and Health Literacy 264

Targeting Breast and Cervical Cancer 266

What Is Evaluation? 271

HEAL:BCC Implementation and Evaluation 273

Lessons Learned from the Evaluation 283

Wrapping Up 284

Exercises 285

14. Guidelines for Advancing Health Literacy 287

Guideline 1: General 288

Guideline 2: Vocabulary 291

Guideline 3: Sentences 293

Guideline 4: Text Structure 299

Guideline 5: Giving Instructions 302

Guideline 6: Field Testing 303

Guideline 7: Spoken Language 305

Guideline 8: Language Translation 306

Guideline 9: Web Design 309

Guideline 10: Graphics and Layout of Print Materials 310

Guideline 11: Media 311

References 315

Name Index 341

Subject Index 349

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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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