READABILITY AND LITERACY LITERACY RELATIVE TO ORAL

INSTRUCTION
DEFINITION OF TERMS
● Little attention has been paid to the
Literacy - ability of adults to read, write, and role of oral communication in the
comprehend information at the 8th-grade assessment of illiteracy
level or above
Iloralacy - the inability to comprehend
Illiteracy - the total inability of adults to simple oral language communicated
read, write, and comprehend information through speaking of common vocabulary,
phrases, or slang words
Low Literacy - ability of adults to read,
write, and comprehend the information LITERACY RELATIVE TO COMPUTER
between the 5th to 8th grade level of INSTRUCTION
difficulty. Synonymous with the terms
marginally literate or marginally illiterate ● The ability to use computers for
communication is an increasingly
Health Literacy - ability to read, interpret, popular issue with respect to literacy
and comprehend health information to of learner
maintain optimal wellness ● As an educational tool, the potential
for computers is increasingly being
Functional Illiteracy - inability of adults to realized and appreciated healthcare
read, write, and comprehend information providers
below the 5th grade level of difficulty in ● Computers are used to convey as
order to use information as it is intended for well as to access information
effective functioning in today’s society ● The opportunity to expand the
knowledge base of learners through
Readability - the ease with which written or telecommunications requires nurse
printed information can be read educators to attend to computer
literacy levels
Comprehension - the degree to which ● The negative effects of illiteracy and
individuals understand and accurately low literacy in the use of computers
interpret what they have read in similar to the literacy issues with
the use of printed materials and oral
Numeracy - the ability to read and interpret instruction
numbers
TRENDS ASSOCIATED WITH LITERACY
Reading - ability to transform letters into PROBLEMS
words and pronounce them correctly (word
recognition) ● A rise in the number of immigrants
● Aging of our population
● Increasing complexity of information
● Added number of people living in
poverty

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 ● Changes in policies and funding for ● Possible signs of poor or nonexistent
public education reading ability include:
● Disparity of opportunity between - Reacting to complex learning
minority versus non-minority situations by withdrawal or
populations avoidance
- Using the excuse of being
THOSE AT RISK too busy, not interested, too
tires, or not feeling well
● Economically disadvantaged enough to read instructional
● Elderly materials
● Immigrants (particularly illegal ones) - Claiming they lost, forgot, or
● High school dropouts broke their glasses
● Racial minorities - Surrounding themselves with
● Unemployed books, magazines, and
● Prisoners newspapers to give the
● Inner city and rural residents impression that they are able
● Those with poor health status to read
- Insisting on reading the
MYTHS, STEREOTYPES, AND information at home or with a
ASSUMPTIONS spouse or friend present
- Asking someone to read
Myth #1 - People who are illiterate have information for them
below normal IQs - Becoming nervous when
asked to read
Myth #2 - People who are illiterate can be - Acting confused or talking
recognized by their appearance out of context about the topic
of conversation
Myth #3 - The number of years of schooling - Showing signs of frustration
completed correlated with literacy skills when attempting to read
- Having difficulty following
Myth #4 - People who are illiterate come directions
from similar socioeconomic, racial, and - listening and watching
ethnic minority backgrounds attentively to try to memorize
information
Myth #5 - People who are illiterate freely - Failing to ask questions
admit to having problems with reading, - Revealing a discrepancy
writing, and comprehension between what they hear and
what is written
ASSESSMENT: CLUES TO LOOK FOR

● Most people with limited literacy

abilities are masters of concealment

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 IMPACT OF ILLITERACY ON MEASUREMENT TOOLS TO TEST
MOTIVATION AND COMPLIANCE READABILITY

● People with poor literacy skills think ● The most widely used standardized
in very concrete, specific, and literal readability formulas rate high on
terms reliability and predictive validity
● Characteristics of thinking ● Formulas evaluate readability levels
- Disorganization of thoughts using the average length of
- Limited perception of ideas sentences and the number of
- Slow rate of vocabulary and multisyllabic words in a passage
language development ● Computerized readability analysis
- Poor problem solving skills has made evaluation of written
- Difficulty analyzing and materials quick and easy
synthesizing information
- Difficulty formulating READABILITY FORMULAS
questions
- Struggles when handling 1. Spache Grade-Level Score - it is
more than one piece of unique because it evaluates
information at a time materials written for children at
elementary grades 1-3 (kindergarten
READABILITY OF PRINTED EDUCATION level through third grade)
MATERIALS
2. Flesch-Kincaid Formula -
● Research findings indicate that most measures materials written between
PEMs are written at grade levels that the 5th grade and the college level
far exceed the reading ability of the
majority of patients COMPREHENSION TESTS
● The readability level of PEMS is
between the 10th and 12th grade, 1. Cloze Procedure - specifically
yet the average reading level of recommended for assessing health
adults falls between the 5th and 8th literature. Every 5th word is
grade systematically deleted from a portion
● People typically read at least two of a text and the reader has to fill in
grades below their highest level of the blanks with the appropriate
schooling words
● PEMs serve no useful teaching
purpose if patients are unable to 2. Listening Test - a passage selected
understand them from instructional materials written at
approximately the 5th grade level, is
read aloud and then the listener is
asked questions on key points
relevant to the content

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 READING SKILLS TESTS STEPS TO TAKE PRIOR TO WRITING OR
REWRITING A TEXT
1. WRAT (Wide Range Achievement
Test) - measures the ability of a ● Decide on what the learner should
person to correctly pronounce words do or know (the outcome to be
from a graduated list of 100 words. It accomplished)
tests word recognition, not ● Choose information that is relevant
vocabulary or comprehension of text and needed to achieve behavioral
material objectives
● Select other forms of media to
2. REALM (Rapid Estimate of Adult supplement written information
Literacy in Medicine) - measures a ● Organize topics into logically
person’s ability to read and sequenced chunks of information
pronounce medical and ● Determine the reading level of
health-related vocabulary from three material and write the text 2 to 4
lists graduated in order from the grades below the average reading
most simple words to the most grade-level score of the intended
complex words audience

3. TOFHLA (Test of Functional SIMPLIFYING READABILITY OF

Health Literacy in Adults) - PRINTED EDUCATION MATERIALS
measures literacy skills using actual
hospital materials ● Elements such as technical format,
concept demand, legibility, literacy
4. LAD (Literacy Assessment for level, and accuracy and clarity of a
Diabetes) - specifically developed to message also affect the readability
measure word recognition in adults of printed material
with diabetes ● To reduce the discrepancy between
the literacy demand of written
5. SAM (Instrument for Suitability materials and the reader’s actual
Assessment of Materials) - reading and comprehension skills,
includes evaluation criteria to identify the nurse educator must attend to
deficiencies in such factors as basic linguistic, motivational,
content, literacy demand, graphics, organizational, and content
layout, typography and cultural principles
appropriateness of print illustration,
video, and audio instructional
materials

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TECHNIQUES FOR WRITING EFFECTIVE ● Use color to emphasize key points
EDUCATIONAL MATERIALS and to organize topics
● Limit length if document to cover
● Write in conversational style with an only essential information
active voice using the personal ● Select paper with non glossy finish
pronouns “you” and “your” and color that contrasts with
● Use short, familiar words with only typeface
one or two syllables ● Use bold line drawings and simple
● Spell words rather than using diagrams for clarity of message
abbreviations or acronyms
● Use short, familiar words with only DEVELOPING PRINTED EDUCATIONAL
one or two syllables MATERIALS
● Spell words rather than using
abbreviations or acronyms A. ORGANIZATIONAL FACTORS
● Use numbers and statistics only ● Include a short but
when necessary descriptive title
● Keep sentences short, preferably 20 ● Use brief headings and
words or less subheadings
● Define any technical or unfamiliar ● Incorporate only one idea per
words paragraph and be sure that
● Use words consistently throughout the 1st sentence is the topic
text sentence
● Use advance organizers ● Divide complex instructions
● Limit use of connective words into small steps
● Make the first sentence of a ● Consider using a question or
paragraph the topic sentence answer format
● Reduce concept density by limiting ● Address no more than three
each paragraph to a single message or four main points
or action ● Reinforce main points with
● Include a summary paragraph to summary at the end
review key points of information
● Use a question and answer format to B. LINGUISTIC FACTORS
present information simply and in ● Keep the reading level at
conversational style grade 5-6 to make the
● Allow for plenty of white space for material understandable to
ease by reading and to reduce most low literate patients
density of information ● Use mostly one or two
● Design layouts that give direction to syllable words and short
the reader sentences
● Select simple type style (serif) and ● Use a personal and
large font (14-18 size). Avoid using conversational style
italics and all capital letters
● With bold type or underlining.
Highlight important ideas or words

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 C. APPEARANCE STYLE
● Avoid a cluttered appearance
by including enough white
space
● Include simple diagrams or
graphics that are well labeled
● Use upper and lower case
letters. All capitals are
difficult for everyone to read
● Use 10 - 14 point type in a
plain font
● Place emphasized words in
bold or underline them but do
not use capital because they
are difficult to read
● Use lists when appropriate
● Try lists when appropriate
● Try to limit line length to not
more than 50-60 characters

TEACHING STRATEGIES FOR LOW

LITERATE LEARNERS

● Establish a trusting relationship

● Use the smallest amount of
information to achieve behavioral
objectives
● Make points of information vivid and
explicit
● Teach one step at a time
● Use multiple teaching methods and
tools
● Give learners the chance to restate
information in their own words and to
demonstrate procedures
● Keep motivation high by using praise
and rewards
● Build in coordination of information
and procedures by using techniques
of tailoring and cuing
● Use repetition to reinforce
information

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