Background Document on Literacy and Health

Annex 1. Research by Sharon Brez

Brez's Adult Learners' Perspectives on Screening Reading Ability for Patient Teaching (1995) reports the findings of a study designed to investigate low-literate adult patients' reactions to literacy screening in hospital settings. As one of the first, and few, pieces of research to examine the needs and concerns of patients, Brez's study explores health education issues from a very unique perspective.

A qualitative, case-study design was employed for this study, and a sample of eight, English-speaking adults, enrolled in a college-based literacy program, was deliberately selected on the basis of recommendations made in the literature. Data was collected through semi-structured interviews, participant observation, and the administration of the REALM test in a simulated screening situation.

Participants' responses to interview questions, and the researcher's observation of patients' reactions to the REALM test, served to identify five major themes. These themes represented certain core issues of concern to the study's participants, and formed the basis for a conceptual model of the factors influencing patients' reactions to literacy screening. These were:

1. The risks of illiteracy exposure, and ways of minimizing exposure of low literacy skills.
2. The risks to health of non-disclosure during hospital stays/visits.
3. The perception of hospitals as "special" environments, where personal matters might be discussed, with an expectation of sensitivity and confidentiality.
4. The generally supportive responses of participants' towards the concept of literacy screening for patient teaching.
5. The mixed reactions of participants to literacy screening using the REALM tool.

The conceptual model derived from these themes was compared with other, established, decision-making frameworks, and found to correlate well with them. Brez's findings were also consistent with results anticipated by previous research in the field.

Based on her study's findings, Brez makes the following recommendations for future practice:

1. Patients should be assured of privacy and confidentiality, and these assurances should be strictly respected.
2. Patients should be clearly advised of the intended purpose of literacy screening.
3. Literacy screening should only be administered by those trained in communication skills and building therapeutic relationships.
4. Signs of diminished self-esteem - including changes in body language, tone of voice, and verbalization - should be closely monitored.
5. Health care professionals should follow through on their responsibilities to provide appropriate/alternative learning opportunities.