Literacy – reading level, basic computation and problem solving, and the ability to recognize the need for

information and to locate needed information.

Literacy Levels:

Level 1 – below basic, non-literate in English / can perform simple math such as addition
Level 2 – basic, understands information in short prose / can compare two prices
Level 3 – Intermediate, understands and can locate information / can solve quantitative problem w/o steps
Level 4 – Proficient, understands complex prose and documents / can solve multi-step arithmetic problem

At high risk of low prose literacy:

- Less educated people
- Members of ethnic or racial minority group
- Disabled people

PEMs – printed educate materials

Factors contributing to reading difficulty of PEMs:

1. Uses long sentences and polysyllabic words
2. Complex sentence and paragraph structure
3. Use of technical terminology
4. Inclusion of abstract concepts
5. Print size and type
6. Color contrast
7. Density of the text

Pamphlet/brochure - to supplement oral teaching that is done

Instruction sheet - for taking medications or carrying out treatments

Importance of adequate literacy:

a. Materials are of little value if clients cannot comprehend
b. May avoid learning all together, with resulting noncompliance
c. Make a guess about what they don’t understand with disastrous health results
d. Contributes to increasing health care cost
e. May work incorrectly, resulting in possible negative outcomes for the agency/employee

Clues of people with low literacy:

1. Not even attempting to read printed material
2. Asking to take PEMs home to discuss with significant others claiming that eyeglasses were left home
3. Cannot read because they’re too tired of they do not feel well
4. Avoiding discussion of written material or not asking questions bout it
5. Mouthing words as they try to read
Tests to measure literacy:
REALM (Rapid Estimate of Adult Literacy in Medicine) – reading test that requires patient to pronounce 66
common medical and anatomical words.
WRAT (Wide Range Achievement Test) – reading aloud from list of 42 words of increasing difficulty. After 10
mispronounced words, the test is stopped.

Process of health education:

a. Assessing reading ability
b. Planning an approach to teaching

Approaches to teaching:
1. Set objectives that are realistic
2. Choose information that will meet the objectives and pare it down to the minimum necessary
3. Keep instructions simple by breaking them down into smaller units
4. Use more than one teaching method to reinforce learning
5. Use examples and analogies that client can relate
6. Be creative in the way you evaluate learning

DEVELOPING PEMs
Organizational factors:
a. Short but descriptive title
b. Brief headings/subheadings
c. One idea per paragraph
d. Divide instructions into small steps
e. Question-answer format
f. Address 3 or 4 main points
g. Reinforce main points with a summary at the end
Linguistics factors:
a. Reading level at grade 5 or 6
b. Use 1 or 2 syllable words and short sentences
c. Use personal and conversational style
d. Define technical terms
e. Use words consistently throughout
f. Avoid use of idiom
g. Use graphics and language that suit your intended audience
h. Use active rather than passive words
i. Incorporate example and simple analogies to illustrate concepts
Appearance factors:
a. No cluttered appearance
b. Include diagrams that are well labeled
c. Use upper and lower cases
d. Use 12 or 14-point type in plain (serif is preferred)
e. Bold or underline emphasized words
f. Use list when appropriate
 g. Limit line length to 50 or 60 characters

Readibility formulas used:

1. Flesch (by Rudolph Flesch) – for 5th to 12th grade reading level
2. Fog (by Gunning) – for 4th grade to college
3. SMOG (by McLaughlin) – to simplify process of measuring readability

Suggestions for teaching information:

a. Encourage learners to use their home computers frequently and to explore various functions and
control processes
b. Enlist the university or hospital librarian to help teach learners about available scholarly databases, both
free and fee-based
c. Teaching of information literacy skills must be built into each level of undergraduate and graduate
curriculums

Characteristics of Culture:
1. Gender
2. Race
3. Age
4. Physical ability
5. Ethnicity
6. Religion
7. Social differences
8. Sexuality identity

Culture is learned.
Culture is localized.
Culture is patterned.
Culture is evaluative.
Culture has continuity, with change.

Promoting cultural knowledge

Approaches: fact-centered, attitude-centered and ethnographic approach to cultural competence

Cultural competence – ability to work effectively in a cross-cultural situation

Campinha-Bacote competence model – allows nurses to see themselves as becoming culturally competent,
rather than being culturally competent

Aspects of cultural competence:

a. Cultural awareness – process where nurse becomes respectful, appreciative and sensitive to client’s
culture
b. Cultural knowledge – obtaining factual knowledge about different cultures
c. Cultural encounters – engaging in cross-cultural encounters with people from other cultures
 d. Cultural skill – collecting relevant cultural data about a client’s health history and accurately performing
culturally specific physical assessment
e. Cultural desire - wanting to engage in learning cultural competence

Ethnocentrism – behavior in which a person is totally unaware of others’ cultural beliefs and values

Cultural Imposition – tendency to impose your own beliefs, values, practices and patterns of behavior upon
another

Ethnorelativism – an attitude who value, respect and integrate cultural differences into their practice

Davidhizar, Down, and Giger model for assessing differences between people in cultural groups.
Factors:
1. Communication
2. Space
3. Social organization
4. Time
5. Environment control
6. Biological vibrations

Explanatory Model (Kleinman) - client to explain his or her viewpoint or perspective on health and illness

Learning styles (Keane)– characteristic cognitive, affective, and physiological behaviors that serve as relative
stable indicators of how learners perceive, interact with, and respond to the learning environment