Literacy Studies at The Ohio State University

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Course Title:

Course Number:

Credit Hours:

Quarter Offered:

Pre-requisites:

Meeting Time & Place:

Course Coordinator:

Participating Faculty:

Course Description:

Learning Objectives:

Teaching/Learning Opportunities:

Required Text:

Additional Readings From Texts:

Assigned Readings:

Selected Handouts:

Health Literacy

710 Nursing, Medicine, Allied Medicine; 709 Arts & Sciences, Pharmacy

3 credit hours

Spring Quarter

Graduate level in Health Sciences Professions; Graduate level in Literacy Studies Specialization (ASC); or permission of faculty coordinator.

Mondays 3:30-6:30 PM, B 120 Graves Hall

Sandra Cornett, Ph.D., RN.
Director, AHEC Clear Health Communication Program
Office of Outreach & Engagement - College of Medicine
052 Meiling Hall
688-3327 (Tuesday / Thursday)

Taught by faculty in the health professions Names and contact information will be specified later

Examine and analyze issues of low health literacy, including populations at risk, research, measurement tools, writing in plain language; health communication techniques; and organizational approaches.

At the conclusion of this course, the students will be able to:

Discuss the definitions and implications of literacy / health literacy, the national / international statistics on literacy, populations at risk for low health literacy, and forces for a national plain language agenda.
Examine factors that affect health literacy: communication skills, culture, context, health system demands, language, etc.
Analyze the methods and measures used in health literacy research, and the findings linking literacy and its impact on health knowledge, health promoting behaviors, health outcomes/status, and health utilization / costs.
Compare and contrast the characteristics, behaviors, and coping techniques of those with limited literacy skills.
Assess and analyze the reading and comprehension levels of a client, using current measurement tools, and the degree of reading difficulty of a piece of health education material.
Incorporate key elements of plain language when developing a piece of health material and field test the material using audience reaction techniques.
Formulate organizational and interdisciplinary strategies to improve plain language efforts and health outcomes in clients.

Multiple teaching / learning strategies will be used for the course experience:

Lecture with class discussion
Student presentation of final paper or the developed piece of health information material
Group activities focusing on interdisciplinary approaches to improving health outcomes in clients with low literacy
Clinical or field experiences with clients and in facilities
Case studies
Videotapes

Schwartzberg JC, VanGeest JB, Wang CC, editors. (2005). Understanding Health Literacy: Implications for Medicine and Public Health. Chicago: AMA Press.
www.amapress.com

Nielsen-Bohlman L, Panzer AM, Kindig DA, editors. (2004). Health Literacy: A Prescription to End Confusion. Washington DC: The National Academies Press. www.iom.edu

Doak CC, Doak LC, Root JH. (2nd edition, 1996) Teaching Patients with Low Literacy Skills. Philadelphia: J.B. Lippincott Company. Out of print. Chapters available at: http://www.hsph.harvard.edu/healthliteracy/doak.html

Zarcadoolas C, Pleasant AF, Greer DS. Advancing Health Literacy: A Framework for Understanding and Action. San Francisco: Jossey-Bass, 2006.

Required readings for each week will be from the text, an assembled package of selected articles, articles or book chapters on electronic reserve at Prior HSL, and website downloads

Distributed by speakers at class

Evaluation of Learning:

Activities	% of Grade/Points
Assignments Students will be given individual assignments or interdisciplinary group assignments consisting of activities to do and summarize in writing. The assignments will facilitate the students' understanding and perspective of topics discussed in class	25 (5 points for each of 5 assignments)
Development & Testing of a Health Information Piece A piece of written health information and a field-testing plan is to be developed for a specified audience between Weeks 6 and 9. Students will be asked to do a 10 minute presentation on why they developed the piece and the field testing plan as they did OR a summary of the topic they chose for the final paper Presentations will be done during the second hour of Week 9 or on Week 10.	35
Final Paper Paper will focus on a specialized area of inquiry based on issues related to: a specific population (e.g. elderly, ethnic groups, prisoners, ESL, etc.) a health condition (e.g. diabetes, HIV/AIDS, heart disease, etc) a public health communication issue (e.g. informed consent, rights / responsibilities, eligibility for health care, disclosures, etc.) Guidelines for paper will be distributed in class.	40
Total	100

Grading Scale:

Academic Misconduct:

Disability Services:

Attendance and Participation:

Final Paper:

Course Schedule:

The course is letter graded. The following point system will be used to award final grades.

Points	Letter Grade
93-100	A
90-92.9	A-
87-89.9	B+
83-86.9	B
80-82.9	B-
77-79.9	C+
73-76.9	C
70-72.9	C-
67-69.9	D+
63-66.9	D
< 62.9	E

Academic misconduct is defined as any activity that compromises the academic integrity of The Ohio State University or subverts the educational process. Academic misconduct of any nature will not be tolerated and will be reported to the OSU Committee on Academic Misconduct (COAM) following the procedures and policies outlined at http://oaa.osu.edu/coam/home.html

Students who feel they need an accommodation based on the impact of a disability should contact the instructor to arrange an appointment with the OSU Office for Disability Services. At the appointment, it will be determined if reasonable accommodations can be made to facilitate your learning. http://www.ods.ohio-state.edu/

Students are expected to attend all scheduled sessions and be prepared to participate in group discussions and activities with speakers, and in field observations and assignments.

An 8-10 page double spaced paper to focus on a specialized area of inquiry based on issues related to a specific population, health condition, public health communication issue, literacy and health disparities, or communication methods or techniques to enhance health communication. The following criteria will be required for examination of this issue:

Statement of the problem / issue
Current research on the issue
Gaps in research and recommendations for further studies on the issue
Implications for professional practice

Health literacy research findings – part 2

Impact on health promoting behaviors
Impact on health utilization / costs
Gaps in research

Methods and measurements used in health literacy research (Prose, Document, Quantitative comprehension)

Research methods
Cloze
TOFHLA / STOFHLA – Test of Functional Health Literacy in Adults
REALM – Rapid Estimate of Adult Literacy in Medicine

Week 1
Topic	Course Overview Literacy, Myth, and Legacies: Lessons from the History of Literacy A Conceptual Framework for Health Literacy Definition of health literacy 1992 National Adults Literacy Survey (NALS) 2003 International Adult Literacy and Lifeskills Survey (ALL) 2003 National Assessment of Adult Literacy (NAAL) Populations at risk for low health literacy
Readings	Graff HJ. The Labyrinths of Literacy. (1995). The University of Pittsburgh Press, pp. 318-349. Schwartzberg JG: Ch1 Understanding Health Literacy, 3-16 Ch 2 Epidemiology of Low Health Literacy, pp. 17-23 Ch 3 Literacy Skills of US Adults, pp. 43-53 Ch 4 What Does Low Literacy Mean? pp. 55-68 The Health Literacy of America's Adults: Results from the 2003 National Assessment of Adult Literacy, Sept. 2006. (Exec. Summary) http://nces.ed.gov/NAAL/ Highlights From the 2003 International Adult Literacy and Lifeskills Survey (ALL) http://nces.ed.gov/surveys/all/
Learning Activities & Assignment	Lecture / discussion / group activity Videotape: In Plain Language (Harvard School of Public Health) or Help Patients Understand: Health Literacy & Patient Safety (AMA) Simulation of new reader experience
Week 2
Topic	Forces for change and plain language agenda Factors that affect health literacy Reasons for low health literacy Health literacy research findings – part 1 Impact on health-related knowledge Impact on health outcomes / status
Readings	Schwartzberg JG: Ch 2 Epidemiology of Low Health Literacy pp. 23-32 Ch 12 Health Literacy & Health Outcomes: Overview of the Literature pp.205-224 Ch 11 A Conceptual Framework for the Relationship Between Health Literacy & Health Care Outcomes: The Chronic Disease Exemplar pp. 181-196 Ch 5 Literacy Demands in Health Care Settings pp. 69-81 Agency for Healthcare Research & Quality, Literacy and Health Outcomes (summary), January 2004. http://www.ahrq.gov/clinic/epcsums/litsum.htm
Learning Activities & Assignment	Lecture / discussion Search internet for websites (1) about plain language and (2) that provide materials written in plain language for clients. Write a one-page summary of findings.
Week 3
Topic	Health literacy research findings – part 2 Impact on health promoting behaviors Impact on health utilization / costs Gaps in research Methods and measurements used in health literacy research (Prose, Document, Quantitative comprehension) Research methods Cloze TOFHLA / STOFHLA – Test of Functional Health Literacy in Adults REALM – Rapid Estimate of Adult Literacy in Medicine
Readings	Schwartzberg JG: Ch 10 Literacy Testing in Health Care Research pp. 157-176 Nielsen-Bohlman L. Health Literacy: A Prescription to End Confusion (IOM Report) 2004. http://www.nap.edu/catalog/10883.html#toc Measures Used in Health Literacy Research pp. 43-55 Appendix C pp.301-322.- Sample Materials from Selected Assessment of Literacy and Health Literacy Doak, Doak, Root: Ch 3 Testing Literacy Skills of Patients pp. 27-39. http://www.hsph.harvard.edu/healthliteracy/doak.html
Learning Activities & Assignment	Lecture / discussion Develop in class a Cloze Test for a health information piece
Week 4
Topic	Assessment of reading ability and understanding of health information in clients Clues of low literacy Screening questions / observations Listening test Newest Vital Sign (NVS) Listening Test Characteristics of poor readers, behaviors, coping techniques Competencies for Cross-Cultural Communication
Readings	Cornett S. Module 2: You Can’t Tell By Looking: Assessing a Person’s Ability to Read and Understand Health Information. http://medicine.osu.edu/ahec/6272.cfm Doak, Doak, Root: Ch 1 The Literacy Problem pp. 1-9 http://www.hsph.harvard.edu/healthliteracy/doak.html Bass PF, Wilson JF, Griffith CH (2003). A shortened instrument for literacy screening. J. Gen Intern Med, 18:1036-1038. Weiss BD, Mays MZ, Castro KM, et. al. (2005). Quick assessment of literacy in primary care: The newest vital sign. Annals of Family Medicine. 3(6):514-522. Chew LD, Bradley KA, Boyko EJ, (2004), Brief Questions to Identify Patients With Inadequate Health Literacy, Family Medicine, 36(8):588-94. Schouten BC, & Meeuwesen L, (2006), Cultural Differences in Medical Communication: A Review of the Literature, Patient Education and Counseling, 64(2006) 21-34.
Learning Activities & Assignment	Lecture / discussion Video Develop in class a list of questions for a listening test. Visit an Adult Education Center, Neighborhood Health Center, or Community Pharmacy Site and use the REALM, STOFHLA, or Newest Vital Sign to determine a client’s reading ability. Use assessment clues for low literacy. Write up brief report of findings for class discussion.
Week 5
Topic	Analyzing reading levels and degree of difficulty of health information Readability formulas: SMOG, Fry, Flesch Reading Ease, Computer based formulas Suitability Assessment of Materials (SAM) Studies on reading levels of health education materials Usability of health information on the internet
Readings	Doak, Doak, Root: Ch 4 Assessing Suitability of Materials pp. 41-60 http://www.hsph.harvard.edu/healthliteracy/doak.html DuBay WH. The Principles of Readability. Impact Information: Costa Mesa, CA. http://www.impact-information.com/ Schwartzberg J. Ch 8 The Challenges of Informed Consent for Low-Literate Populations pp. 119-133. Ch 9 Using the Internet to Move Beyond the Brochure and Improve Health Literacy pp. 141-151. Wallace LS, Lennon ES, American Academy of Family Physicians Patient Education Materials: Can Patients Read Them? (2004). Family Medicine, 36(8):571-4. Kang E, Fields HW, Cornett S, Beck FM, "An Evaluation of Pediatric Dental Patient Education Materials Using Contemporary Health Literacy Measures," Pediatric Dentistry, 27:5, 2005, 409-413. Foster DR, Rhoney DH. (2002). Readability of printed patient information for epileptic patients. The Annals of Pharmacotherapy, 3(12): 1856-61. Eysenbach G, Powell JP, Kuss O, Sa E. (2002). Empirical studies assessing the quality of health information for consumers on the World Wide Web. Journal of the American Medical Association, 287(20): 2691-2700.
Learning Activities & Assignment	Lecture / Discussion Discussion on Center/ Clinic visit, observations, and use of assessment tools Practice doing a readability index and review of materials in class Class to develop criteria for assessing the usability of health information on the internet. Using the assessment criteria, compare and contrast 2 health-related websites of your choice. Write a one-page summary of findings for discussion next class
Week 6
Topic	Framework for design of health materials Key elements for writing easy-to-read materials Writing style Organization Appearance and Design
Readings	Doak, Doak, Root: http://www.hsph.harvard.edu/healthliteracy/doak.html Ch 2 Applying Theory In Practice pp. 21-24. Ch 6 Writing the Message pp. 73-88 Ch 7 Visuals and How to Use Them pp. 91-127 Pfizer Principles for Clear Health Communication (2nd edition): A Handbook for Creating Patient Education Materials that Enhance Understanding and Promote Health Outcomes: http://www.pfizerhealthliteracy.com/physicians-providers/chc-principles.html Ch 3 Planning Consumer Pieces to Meet Goals of Clear Health Communication pp. 9-16 Ch 4 The Principles for Easy-to-Read Health Care Materials pp. 17-47.
Learning Activities & Assignment	Lecture / discussion Report findings of usability of health information on internet. Group exercises in class to apply key elements Examples of materials demonstrating key elements Do a SMOG or Fry Index and use the SAM or other tools distributed in class to do an analysis of the reading difficulty of health education material. Edit / revise the material, based on plain language criteria.
Week 7
Topic	Steps in planning easy-to-read materials Field testing health materials
Readings	OSU AHEC Guide to Planning Easy-to-Read Materials (2005) Doak, Doak, Root: http://www.hsph.harvard.edu/healthliteracy/doak.html Ch 10 Learner Verification and Revision of Materials pp. 167-185 Appendix D – Learner Verification and Revision pp. 203-206
Learning Activities & Assignment	Visit a health care facility and make observations of the literacy demands placed on people navigating the system. Write a one-page summary of your observations and possible solutions for these challenges for class discussion next week. Use the OSU AHEC Planning Guide for Writing Easy to Read Health Materials to develop a one-fold brochure or a one-page piece of material on a health information topic of choice. Material to be presented in class Week 9 or Week 10, if that option chosen by student. Develop a field-testing method for the piece of health information material being developed. Submit field-testing plan with health education piece on Week 9 or Week 10.
Week 8
Topic	Guiding principles for effective health communication Opportunities to improve health literacy Organizational strategies for meeting the challenge of low health literacy
Readings	Schwartzberg J: Ch 6 Health Literacy and the Patient-Provider Relationship pp. 87-98 Ch 7 Participatory Decision-Making in the Medical Encounter and Its Relationship to Patient Literacy pp. 101-113. Nielsen-Bohlman L. Health Literacy: A Prescription to End Confusion (IOM Report) 2004. Ch 4 Culture and Society pp. 108-136. http://www.nap.edu/catalog/10883.html#toc Doak, Doak, Root: http://www.hsph.harvard.edu/healthliteracy/doak.html Ch 5 The Comprehension Process pp. 61-70 Cornett S. Organizational Strategies for Meeting the Challenge of Low Health Literacy (2005).
Learning Activities & Assignment	Lecture / discussion Discussion of "navigating the system" field trip to health care facility Case studies in class Video with vignettes for group activity Case study - Group plan for organizational strategies
Week 9
Topic	Student presentations on issue paper or health education piece
Learning Activities	Discussion Peer critique of presentations
Week 10
Topic	Student presentations on issue paper or health education piece
Learning Activities	Discussion Peer critique of presentations Planning guide, health education material, and field-testing plan due Final paper due

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