Lessons from the Intersection of Adult Literacy and Health Literacy John Comings Principal International Technical Advisor Education Development Center Newton, Massachusetts USA

Percent of UK Adults (16+) by IALS Literacy Level (1994-1995) Percent Score Range Level 1 22.5% 0-225 Level 2 28.7% 226-275 Level 3+ 48.8% 276-500 Difficulty of Text and Difficulty of Task

Abilities at Each Level Level 1: can locate a single piece of information Level 2: can locate several pieces of information   Level 3: can locate several pieces of information and use the information to accomplish a task. For example, using a flight schedule to plan travel arrangements. High probability of accomplishing task at or below your level and low probability of accomplishing tasks above your level

Literacy is… Component skills, print skills (alphabetics and fluency) and meaning-making skills (vocabulary, background knowledge, and comprehension) Practices in which adults employ all of the component skills to accomplish tasks (enjoyment, work, health, religion, politics, academic learning, etc.) with text (books, memos, pamphlets, notes, websites, etc.)

Meaning-making and Print Skills at IALS Literacy Level Cut Score

Reasons for Level Score Level 1: Reading Disabled (print and meaning-making skills) Physical, Mental, or Cognitive Barrier Limited English Skills Age Level 2: Under Educated (fluency, vocabulary, and background knowledge) Lack of Reading Practice Level 3+: Sufficient (domain specific vocabulary and background knowledge) Academically Successful

Same Comprehension Score but Different Reading Profiles (by grade equivalents)

IALS Document Literacy by Age (USA data corrected for education & disabilities)

What Have We Learned about the Age-related Decline in IALS Score What Have We Learned about the Age-related Decline in IALS Score? (secondary school dropouts in the USA) Most secondary school dropouts continue to improve their literacy skills into their thirties After that, some, but not all, dropouts decline in skill each year Both increases and declines in skills are related to the amount and variety of practices Adult education program participation can lead to increases in both test scores and amount and variety of practices or to only one

A Comprehensive Health Literacy Approach (Disability Discrimination Act or Universal Design) Level 3+: Plain, Clear Language Access to additional information Level 2: Simple Language (readability) Reading Support, particularly access to definitions and background knowledge Level 1: Assistive Technology

Technology May Be the Answer IALS level 1 and 2 adults are rapidly increasing their access to information and communications technology Technology is rapidly becoming less expensive and easier to use In the U.S., 80% of high school dropouts make some effort to improve the basic skills or acquire a secondary school credential

Adult Education System System has a significant number of students in programs; students have been tested for literacy and math skills, and most students face health literacy barriers Teachers know a lot about the population Use of authentic content in the classroom leads to more literacy practices outside the classroom Students rate health as one of the most important domains of authentic content.

Implications Build a comprehensive set of technology tools that anyone can learn how to use to accomplish health literacy tasks Form a partnership between public health and adult literacy programs that benefits both

Web Resources National Research and Development Centre for adult literacy and numeracy http://www.nrdc.org.uk/ Skills for Life Support Programme http://www.excellencegateway.org.uk/sflsp