Culture, Health and Literacy
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Why is Health Literacy Important?
You Don't Have to be a Health Expert
Introducing Health in the Classroom

Adding an Action-Based Component

How to Engage Students
Using the Internet

Collaborating with Health Organizations

Preparing a Speaker
Local and National Health Organizations to Contact
For Health Educators:
How to Find Local Family Literacy Programs

Teacher Support Sevices

Many teachers feel anxious about intergrating health into their literacy classes for a variety of reasons. But, as teachers, you naturally use different kinds of content to teach basic skills and help adult learners gain the confidence they need to advocate for themselves and their families. Adults are more successful at learning if the content is meaningful and relevant to their lives (Knowles M, 1984)1. Health is relevant to everyone but even more so for families with young children, because they are constantly faced with scheduling doctor's visits, managing illnesses, and trying to take steps to keep their family healthy. Learners can dramatically improve their ability to manage these tasks by improving their communication skills, basic health knowledge, and strategies for finding and evaluating health information. The safe and supportive classroom is an ideal place to address these skills and build confidence. Take on the challenge of integrating health into your classes, and the results can be rewarding for teachers and learners alike!



Why is Health Literacy Important?

The most important reason to integrate health into literacy teaching is that health is a vitally important topic for learners to know about. This is especially important for those who must manage their children's health in addition to their own. Adult learners make health-related decisions every day, decisions that draw on their experience and knowledge of how to keep their families healthy, how to detect and deal with illnesses, and how to access health care services.

Addressing health concerns in the classroom also enhances literacy skills and language acquisition. Because health-related issues are connected to their everyday concerns, learners demonstrate high interest in exploring health topics. This high interest, in turn, increases learner motivation to work on reading, writing, critical thinking, and speaking skills. These skills will improve their ability to learn new information, communicate with health professionals, make decisions, and share their knowledge and experiences with family, friends, and community (Kurtz-Rossi S, Coyne C, Titzle J, 2004)2. When health topics are included in the curriculum, health issues are explored and language competencies are developed at the same time.

Integrating health issues into the curriculum is also important because literacy students are among those in the greatest need of better health knowledge and health care. Research shows that adults with limited education and literacy skills have more health problems, greater difficulty understanding health information, and less knowledge about available health care services than adults with higher literacy and education levels (AHRQ, 2004)3. Low-income families are also at risk. They are less likely to have health insurance, to visit a doctor regularly, or to report health problems than families with higher incomes (DHHS, 2000) 4.

The problem of poor health literacy is more serious than most people realize. The literacy skills required for navigating the U.S. health care system are immense, and increasingly more demands are being placed on patients to participate in decision-making and management of their own care. This makes it even moreimportant to have the skills to communicate clearly with health care providers, ask clarifying questions, and act on recommendations and care instructions.

It is especially important for families with young children to have the necessary skills to seek primary care and inform themselves about basic health care and healthy living.Many adults with low literacy tend to avoid seeking health care until they find themselves in the emergency room (Baker, et al, 2002)5. This is obviously not a good way to manage anyone's health, but it is completely untenable for young children and babies who need immunizations and frequent well-child visits. As you present your students with new ideas and practices to consider relating to their parenting, you can also present new ideas and practices that relate to seeking regular primary care and maintaining good health.



You Don't Have to be a Health Expert

You may be concerned that your own knowledge of health is not adequate to teach health in your classes. There are three easy ways to make this seem less worrisome.

  • Form a realistic plan for integrating health into your existing curriculum.
  • Examine your role as a literacy teacher.
  • Find an actual health expert to be the expert!

As you decide how to integrate health into your class, remember that you do not have to see this as a "health education" project. You do not have to be the health educator, imparting knowledge to your students. You may approach it as a project in gathering information, helping learners find answers to their own questions by searching for information and evaluating that information critically. You may approach it as a communication project, working to learn vocabulary, honing listening skills, and gaining confidence and fluency in dialogues with health care providers. Or you may see it as an in-depth group exploration of a question that grabs the interest of the class, for example, "How does healthy food help prevent children from getting sick all the time?" In this kind of project, you and your learners would explore the question together. During this process, you work in a variety of literacy skills as you read short articles, brainstorm questions, practice dialogues, do writings, and more.

Once you have decided how to integrate health, re-confirm your role as a teacher, what it is and what it is not. The main thing to remember is that your goal is to teach adult learners the skills they need to successfully navigate the demands of everyday life, including accessing health care.

Remember that your role as a teacher is to promote:

  • Language and vocabulary skills to communicate effectively with health care providers.
  • Students' confidence in their communication skills so that they can advocate effectively for their family's health care needs.
  • Methods of finding needed information, and critical thinking skills to evaluate the information they find.

It is also important to remember what is not your role. Here are some examples of roles that you may need to step back from:

YOU DON'T HAVE TO BE A COUNSELOR. It will be tempting for people to turn to you for more help with health issues than you are prepared to give. In these cases, you can guide them to ways of finding information themselves without taking on the task of finding the answer yourself. You can also provide a forum for discussing questions, problems, and possible solutions by tapping into the knowledge and experience of other learners.

YOU DON'T HAVE TO BE A JUDGE. How do you respond to the learner who smokes, feeds the kids junk food every day, or does not believe in preventive care? How do you cover healthy lifestyle habits without seeming judgmental? Again the answer is to continually clarify your role. Your role is not to deem a behavior or belief as bad or good. It is to help students to gain the tools they need to find their own answers, to learn basic facts, and to make informed decisions.

YOU DON'T HAVE TO BE A HEALTH EXPERT. One way to step back from this role is to work with real health experts. Make sure to have at least one health expert on board when you decide to integrate health into your class. It can be a speaker who comes to your class, or a health care provider who gives you a tour of the local clinic. They can be responsible for the factual, technical information, and they can also be sources of referrals for those learners who need more help, advice, or counseling. If there is no expert available to answer a question or clarify something, then you can do an activity that involves searching for information on the Web.



Introducing Health in the Classroom

A literacy classroom is an ideal place to give learners the opportunity to explore health issues in a safe and respectful environment. Learners should feel comfortable communicating at their own pace and expressing their thoughts and concerns about health. One way to introduce health and give each person a chance to voice their ideas is the "What is Good Health?" word mapping activity on the next page. This can also be a way to decide what topics to focus on, and what approach to health will work best for this group. The activity can then be expanded to promote further discussion of cultural differences, personal concerns, and students' own knowledge and practices. The concepts of staying healthy, dealing with illness, and interacting with health care providers can highlight some significant cultural differences. It is helpful to share and discuss individual beliefs at the beginning and in the context of good health so that you can reinforce the supportive environment of the classroom.

As this activity unfolds, you will see that the exploration of each individual's attitudes, experiences, and contribution to the group discussion is a dynamic and vital part of the learning process. Different teachers and different groups of learners will all engage in this component in their own way. This process of engaging each learner and drawing out their attitudes, beliefs, experiences, and knowledge serves many purposes related to your goals as a literacy teacher.

See Lesson Idea: What Is Good Health - PDF



Adding an Action-Based Component

The most successful examples we have seen of integrating health into adult literacy education usually culminate with some kind of action-based component. This can be a health fair that the students organize with the help of local health agencies, a cookbook of healthy ethnic recipes written by learners, or a presentation made to the class on what has been learned by using the Web to find information on a topic of their choice. There have also been some intriguing projects involving interviewing grandparents about health attitudes and sharing this with the class, creating a mural of art inspired by families' experiences in dealing with a disease, and teaming up with a buddy to go for a long-postponed screening or doctor's visit.

The action-based component serves two important purposes. The first purpose is to provide a concrete and meaningful experience to reinforce a variety of literacy skills. Students prepare by reading, making lists and charts, and practicing dialogues and vocabulary. They wrap up the project by writing about it, organizing the information, and presenting it in spoken and written forms. This improves their ability to acquire language and literacy skills because it uses these skills to accomplish something meaningful in their lives6.

The second purpose is to give them the experience of acting on new health knowledge and reinforcing what they have learned. For example, if people learn new vocabulary and some basic anatomy and use this knowledge immediately in a question-and answer session with a guest speaker, an actual doctor's visit, or a presentation to the class or community, the new information will become part of their knowledge more fully than if they completed a written assignment and filed it away. This is how people can learn the skills and gain the inspiration to take action to better care for themselves and their families. Furthermore, the act of presenting health information to others or interacting with a community resource can encourage students to share new health information with family, friends, and community.



How to Engage Students

When you integrate health and literacy you help students develop the skills and knowledge they need to make good decisions about their health and the health of their families. In order to achieve this goal you must create a classroom environment where students are eager to share what they know and think, value others' ideas, learn and evaluate new information, and incorporate new information into the decisions they make. The following suggestions can help you create a learning environment that engages students and integrates learning about health with developing valuable skills.

  • Involve students in choosing the health topics to explore. This will ensure that the selected topics meet students' needs and interests.
  • Have students speak or write about their knowledge and experiences, group and categorize their own and others' contributions, and prioritize topics by level of importance to them.
  • Ask students what they already know and think so that they may integrate what they know with the new information and suggestions they encounter.
  • Present information or situations that bring up both new and familiar points.
  • Choose materials appropriate to students' reading levels, materials that clearly explain basic information without giving too many details.
  • Facilitate discussions that encourage students to think critically about these points or ideas.
  • Provide opportunities for students to talk and write about past experiences, questions or concerns they have, information they have learned, and new practices they have tried. Students will remember information better and think more deeply about issues if they have to articulate it in their own way, in their own voice.
  • Ask students to share their knowledge and information with others in the class or program. The more students practice articulating their knowledge, the more skillfully they will use language when communicating with health professionals.
  • Use a variety of learning activities that actively engage students in ways that help them to learn. Examples include brainstorming, dramas, dialogues, skits, videos, reading factual information, reading personal experiences, reflective writing, pair conversations or exercises, written and oral summaries, using the Internet, factual quizzes, vocabulary exercises, interviews, and oral presentations.
  • Use speakers from community health organizations who have experience presenting concepts and information in language students will understand. Successful presentations will help students develop vocabulary and broaden their knowledge of resources available in the community.
  • Use speakers and other health professionals to help compile a list of community resources and service providers.
  • Encourage students to try out suggestions or new practices and then report back on the results.
  • Explore with students ways to share new information and ideas with family, friends, and the community.
  • Compile lists of new information, facts, ideas, and suggestions that students think are important to remember. Continue to review and add to these lists throughout the class session.
  • Be aware of ways that all of the above help build a classroom environment where students gain the confidence and skills they need to learn new information, communicate what they think, ask relevant questions, and make informed health care decisions for themselves and their families.


Using the Internet

Teachers are increasingly using the Internet as a dynamic and engaging learning tool in the classroom. Students also see that using computers, email, and the Internet are vital skills to learn. In this guide, you will find listings of Web sites with information on a variety of health topics. These sites can be used in many ways. They can help you and your students build basic health knowledge, or add to your knowledge about a specific health issue. They can help students develop computer skills to search for and evaluate new health information. Or they can be used to find readings for comprehension and grammar review.

You will also find a listing of Web sites where students can do online activities during class with your guidance, if you have this capacity. As you work through your plan for integrating health into your class, you can build lessons around these online activities, or around fact sheets or reference charts found on the information sites. If you use the principles of engaging learners and encouraging discussion that were described earlier, it will be easy to find ways to use these resources to enrich your curriculum. "How I Learn About Health," on the following page, is an example of a lesson integrating health, literacy, and the Internet.

WEB TIP
Have you clicked your way to oblivion?

Here’s a tip to get you back. Click on the little downward arrow next to the “back” button. – OR – Right-click on the “back” button. You’ll get a list of the last several Web pages you visited. Now click on the page you want to get back to.



Collaborating with Health Organizations

Collaborating with local health organizations will greatly enhance your experience integrating health and literacy education. There are many reasons for this.

WORKING WITH A LOCAL HEALTH ORGANIZATION PROVIDES OPPORTUNITIES FOR REAL-LIFE EXPERIENCES. It is always enriching to provide a tangible, out-ofthe- ordinary experience for students. Field trips, speakers, projects, or anything outside of the usual classroom routine helps learners to stay interested and excited about the material. These experiences will strengthen the new health information learned, and will also be a focus of literacy and language skills practice.

WORKING WITH REAL HEALTH EXPERTS TAKES THE PRESSURE OFF YOU TO KNOW ALL THE ANSWERS. As learners learn new information, raise questions, and consider new health practices, it is useful to have a connection with a local health organization or professional who can answer questions and provide in-depth health information as needed. This gives students access to a reliable source of accurate and complete information without relying on you, the literacy teacher, to provide that knowledge.

COLLABORATING WITH LOCAL ORGANIZATIONS CONNECTS FAMILIES WITH HEALTH CARE SERVICES. Ultimately, families need to connect with local health care providers, and feel comfortable communicating with them in order to get the health care services they need. If learners connect with local health care organizations through their literacy class it can improve their confidence, skills, and knowledge of available services.

WHEN LITERACY TEACHERS AND HEALTH EDUCATORS COLLABORATE, YOU SUPPORT EACH OTHER'S WORK. When you collaborate with a health professional you gain access to expertise on health and information about services and resources that your learners need. You also have a chance to bring a meaningful experience into the curriculum, around which to create activities to teach and reinforce literacy and language skills. The health professional gets a chance to connect with immigrants, new speakers of English, and adults with newly emerging literacy skills, who may not be connected to health services.Many health organizations are mandated to direct outreach efforts to these populations, and for this reason, public health professionals are often eager to develop meaningful collaborations with literacy programs.

MOST IMPORTANTLY, STUDENTS AND THEIR FAMILIES GAIN FROM LITERACY AND HEALTH COLLABORATIONS. Students gain and reinforce a variety of literacy, language acquisition, and communication skills by using these skills in the real world for the very motivating purpose of keeping their families healthy. They also become familiar with local resources and services, gain confidence in finding information they need, and move toward using these resources independently.

Collaborations can be simple or complex, long term or short term, and they can involve just one class or be integrated into the activities of an entire program. The following are some examples of collaborations that we have seen work well.

  • Have a speaker come to your class to talk about health topics that interest your students.
  • Take a tour of a local health clinic, guided by the clinic's outreach or educational staff.
  • Schedule a mobile van to do health screenings. Vans can do mammograms, blood pressure checks, and glucose and cholesterol screenings.
  • Arrange with a nearby medical or nursing school to have students come and give "mini-exams" to your class.
  • Team up with a good outreach worker from a local health clinic who can facilitate a variety of events and speakers from different departments such as pediatrics, OB/GYN, primary care, and free care/insurance advocacy.
  • Plan a health fair with help from your local hospital, community health center, department of public health, or national organization with a local chapter.

Whatever the event or interaction, make sure to prepare learners well in advance, plan time for questions and clarifications, and plan follow up activities to reinforce new ideas and practice skills. The lesson on page 22, "Keeping Your Child Healthy at Home," developed by Lally Stowell, a family literacy teacher, and Dr. Lisa Dobberteen, a local pediatrician, is an example of a successful health and literacy collaboration you might want to try. This lesson uses a 20-minute video of Dr. Dobberteen talking to an Even Start ESOL class about how to care for a sick child at home. The video is divided into 5 sections: (1) what to do when your child eats or drinks something poisonous, (2) what to do when your child has a fever, cold, or flu, (3) what to do when your child is dehydrated or constipated, (4) what to do when your child has a minor cut or scrape, and (5) what to do when your child has a bad sunburn. Viewing and discussing this video helps prepare learners for a live visit from a local pediatrician or family practice provider.With this preparation, the learners and health care professional are better able to communicate their questions and answers and have a meaningful exchange. In the process, learners gain confidence discussing health issues with professionals.



Preparing a Speaker

One of the easiest ways to collaborate with a health professional is to invite a guest speaker to your class. Speakers can answer students' questions about specific health conditions, symptoms, preventive measures, and treatments. They can provide information about services available, access to these services, and students' rights and responsibilities. But many health professionals and even health educators are not used to presenting information in ways that adult learners will understand.

Here is a list of tips for ensuring clear communication between your guest speaker and your class.

  • Get recommendations for good speakers from other literacy teachers.
  • Try to find speakers who have worked with adult learners before.
  • Meet with the speaker in advance to give them tips for communicating clearly: use simple vocabulary, define new words as you go, break the information into sections, have a simple written outline displayed as you talk, and display pictures and refer to them as you talk.
  • Describe the language and literacy skills of the class to the speaker in advance.
  • Encourage the speaker to ask questions and get input from the students during the presentation.
  • Encourage the speaker to include a hands-on activity.
  • Preview the written materials to be handed out and make sure that they are at an appropriate literacy level.
  • Preview the information to be covered and make sure it is at an appropriate level of detail for your class.
  • Present some form of the information to your class in advance and let them generate questions for the speaker.
  • Plan the class visit so that there are breaks for questions and clarifications frequently during the talk.
  • Plan a way for each student to have a chance to speak or ask a question.

WEB TIP
What if I have no computers for my students to use?

You can go a long way with a color printer and some creativity! Anything you see can be printed out and used as handouts. You can print out slide shows, tutorials, parts of online games and quizzes, and, of course, the colorful health brochures.

 

See Lesson Idea: Keeping Your Child Healthy at Home - PDF



Local and National Health Organizations to Contact

Public or private hospitals, local health clinics, and medical, dental, or nursing schools are local organizations you may want to contact. You will need to find the right person within these organizations to speak with. First, ask people you know for recommendations. Perhaps other teachers or coordinators from your program have worked with someone who was helpful. Otherwise, call the organizations and ask which departments or staff members deal with outreach, education, communication, or public relations. Teaching hospitals and medical, dental, or nursing schools may have projects that involve outreach to underserved populations. Remember, health professionals are often trying to connect with immigrants, low-income families, and those without health insurance. As you forge these connections, present the opportunity as a two-way street.

THE FOLLOWING IS A LIST OF NATIONAL HEALTH ORGANIZATIONS. These organizations work to educate the public about a variety of health issues. Each one has state or regional offices, and should have a contact person who is charged with education and outreach. Some of these organizations publish educational information which is available online or in hard copy to be distributed free of charge. Some offer free posters or small incentive prizes, and some have organized educational programs which include teaching kits and guidance. Some, including your state or regional Department of Public Health, may be involved in outreach efforts aimed at underserved populations. Find a local or regional contact person and ask what types of health campaigns are being promoted in your area.

5 A Day Fruit and Vegetable Campaign
Phone: (800) 311-3435
State Coordinators:
www.cdc.gov/nccdphp/dnpa/5aday/
coordinators/coordinators.htm

Programs and Campaigns:
www.cdc.gov/nccdphp/dnpa/programs/index.htm

Home Page:
www.cdc.gov/nccdphp/dnpa/5aday/index.htm

American Cancer Society
Phone: (800) 227-2345
Home Page:
www.cancer.org
(Go to "In My Community" for local information.)

American Diabetes Association
Phone: (800) 342-2383
Community Programs adn Local Events:
www.diabetes.org/communityprograms-and-localevents/whatslocal.jsp
Home Page:
www.diabetes.org

American Heart Association
Phone: (800) 242-1793
Local Offices:
www.americanheart.org/
presenter.jhtml?identifier=10000028

Home Page:
www.americanheart.org

Centers for Medicare and Medicaid Services
Phone: (877) 267-2323
State Programs:
www.cms.hhs.gov/medicaid/statemap.asp

Medicaid Consumer Information: www.cms.hhs.gov/medicaid/consumer.asp
Home Page:
www.cms.hhs.gov

Community Voices
Phone: (404) 752-1977
Local Contacts:

www.communityvoices.org/Contacts.aspx
Home Page:
www.communityvoices.org

Departments of Public Health
State-by-State Listing of Health Agency Websites:
www.fda.gov/oca/sthealth.htm

Head Start Program
Phone: (866) 763-6481
Local Contacts:
www.acf.hhs.gov/programs/hsb/contacts/index.htm

Home Page:
www.acf.hhs.gov/programs/hsb

Home Safety Council
Phone: (202) 330-4900
Fire Safety Literacy Project:
www.homesafetycouncil.org/expert_network/ en_literacy_w001.aspx
Local Contacts:
www.homesafetycouncil.org/
contact/contact.aspx

Home Page:
www.homesafetycouncil.org

National Breast and Cervical Cancer Early Detection Program
Phone: (888) 842-6355
State Contacts:
http://apps.nccd.cdc.gov/cancercontacts/
nbccedp/contacts.asp

Home Page:
www.cdc.gov/cancer/nbccedp/about.htm

National Center for Farmworker Health
Phone: (800) 531-5120
Directory of Centers:
www.ncfh.org/00_ns_doc.php
Home Page:
www.ncfh.org

National Fire Protection Association
Phone: (800) 344-3555
Fire Safety Educators: www.nfpa.org/riskwatch/advocate_stbyst.html
Risk Watch Program:
www.nfpa.org/riskwatch/home.html

Home Page:
www.nfpa.org

National Library of Medicine
Phone: (800) 338-7657
National Network of Libraries of Medicine: www.nlm.nih.gov/nno/nnlmlist2.html

Home Page:
www.nlm.nih.gov

Safe Kids Coalition
Phone: (202) 662-0600
Coalition Coordinators:
www.usa.safekids.org/tier2_rl.cfm?folder_id=182
Home Page:
www.safekids.org

Women, Infants, and Children (WIC) Special Supplimental Nutrition Program
Phone: (703) 305-2746
Local Nutrition and Breastfeeding Coordinators:
www.fns.usda.gov/wic/Contacts/ContactsMenu.htm
Home Page:
www.fns.usda.gov/wic



For Health Educators: How to Find Local Family Literacy Programs

If you are a health educator or practitioner, contact a local adult literacy program to see if they are interested in working on a joint project. Each state offers adult literacy services differently. Some states offer literacy classes, others offer one-on-one tutoring. Most offer a combination of adult literacy, English for speakers of other languages (ESOL), and preparation for a high school equivalency diploma (GED). Services are offered through schools, community-based organizations, correctional facilities, family literacy programs, and other settings. Your state may have a literacy resource center or statewide literacy coalition that can help you. Or contact your state department of education to find out about literacy services and programs. You can also try one of the national literacy resources listed below.

Department of Education - Office of Vocational and Adult Education
Phone: (800) 872-5327
Direct Link:
www.ed.gov/about/offices/list/ovae/index.html
(Click on State Resources to find adult education contacts in your state.)
Home Page: www.ed.gov

National Institute for Literacy - America's Literacy Directory
Phone: (800) 228-8813
Direct Link:
www.literacydirectory.org
(Enter your zip code, city, or state to search for literacy programs near you.)
Home Page:
www.nifl.gov

Teacher Support Resources

These are a few unique resources to help guide teachers through the process of integrating health into literacy education.

Health Education and Adult Literacy: Breast and Cervical Cancer
The teacher support companion piece to the Breast and Cervical Cancer Curriculum includes information on the process of connecting health with literacy education. Direct Link:
heal.worlded.org/teachersupport.htm

Home Page:
heal.worlded.org

Health Literacy Study Circles: Skills for Health Care Access and Navigation
This 15-hour study circle prepares teachers to help their students develop basic skills needed for accessing health services and navigating health care systems.
Direct Link:
www.ncsall.net/index.php?id=891
Home Page:
www.ncsall.net

It's Not Just an Earache That I Have
This is one teacher's poignant account of the emotional process she and her learners went through as they explored cancer within their literacy class.
Direct Link:
heal.worlded.org/earache.htm
Home Page:
heal.worlded.org

System for Adult Basic Education Support Health Page (SABES)
This site includes information on connecting health and literacy education and fostering community collaborations, and shows examples of student health projects.
Direct Link:
www.sabes.org/health

Home Page:
www.sabes.org

Virginia Health Literacy Toolkit
This toolkit has helpful, concrete advice for adult educators who want to better understand health literacy and creatively integrate health into their literacy instruction.
Direct Link:
www.aelweb.vcu.edu/publications/healthlit

Home Page:
www.aelweb.vcu.edu

What is Health Literacy?
This is an overview of health literacy and its place in adult education. It includes examples of health literacy needs and ideas for forming collaborations with health entities.
Direct Link:
www.healthliteracy.worlded.org/muro.htm

Home Page:
www.healthliteracy.worlded.org/


1 Knowles, M. (1984). The art and science of helping adults learn. In: Knowles, M. and Associates (Eds.), Andragogy in action: applying modern principles of adult learning. San Francisco, CA: Jossey-Bass Publishers.

2 Kurtz-Rossi S, Coyne C, and Titzle J. (2004). Using research to inform health and literacy program development: Results from the HEAL:BCC evaluation study. Literacy Harvest. 11, 35-39.

3 Agency for Health Care Quality. (2004). Literacy and Health Outcomes. Evidence Report/Technology Assessment No. 87. (AHRQ Pub. No. 04-E0007-1).Washington, DC: US Government Printing Office.

4 U.S. Department of Health and Human Services. (2000). Healthy People 2010: Understanding and Improving Health. Washington, DC: US Government Printing Office.

5 Baker DW, Gazmarian J,Williams M, et al. (2002). Functional health literacy and the risk of hospital admission among Medicare Managed Care enrollees. Am J Public Health. 92, 1278-1288.

6 Jacobson E, Degener S, and Purcell-Gate V. (2003). Creating Authentic Materials and Activities for the Adult Literacy Classroom: A Handbook for Practioners. Boston, MA: NCSALL.

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World Education
2006