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
