Syracuse Healthy Start, a federally funded infant mortality prevention project in Onondaga County, New York, has undertaken a range of interventions to address parental low literacy as a risk factor for infant mortality. A growing number of studies advocate for health-related information that is easy to read, of a low literacy level, and culturally appropriate. Creation of an evidence-based public health intervention involves analyzing local data, reviewing published studies, assessing available materials, initiating programmatic interventions, and evaluating the outcomes. Preparing health educational materials that are clear, culturally sensitive, and at appropriate reading levels follows Paulo Freire’s lead in empowering the disadvantaged to positively affect their health and the health of their infants toward the reduction of infant mortality.
Ad Hoc Committee on Health Literacy for the Council on Scientific Affairs, American Medical Association. (1999). Health literacy: report of the Council on Scientific Affairs. JAMA, 281, 552-557.
2.
Armar-Klemesu, M., Ruel, M. T., Maxwell, D. G., Levin, C. E., & Morris, S. S. (2000). Poor maternal schooling is the main constraint to good child care practices in Accra. Journal of Nutrition, 130, 1597-1607.
3.
Arnold, C. L., Davis, T. C., Berkel, H. J., Jackson, R. H., Nandy, I., & London, S. (2001). Smoking status, reading level, and knowledge of tobacco effects among low-income pregnant women. Preventive Medicine, 32, 313-320.
4.
Baker, D. W., Parker, R. M., Williams, M. V., Clark, W. S., & Nurss, J. (1997). The relationship of patient reading ability to self-reported health and use of health services. American Journal of Public Health, 87, 1027-1030.
5.
Brach, C., & Fraser, I. (2000). Can cultural competency reduce racial and ethnic health disparities? A review and conceptual model. Medical Care Research and Review, 57(1 Suppl), 181-217.
6.
Brody, J. E. (2000, January 25). With Tylenol and children, overdosing is perilously easy. The New York Times, Science Section, pp. 88.
7.
Brownson, R. C., Gurney, J. G., & Land, G. H. (1999). Evidencebased decision making in public health. Journal of Public Health Management Practice, 5(5), 86-97.
8.
Centers for Disease Control and Prevention. (2001). The Fry Readability Scale. Retrieved January 25, 2001 from http://www.cdc.gov/od/ads/fry.htm
9.
Cohen, E., & Goode, T. (1999). Policy brief 1: Rationale for cultural competence in primary health care. Washington, DC: National Center for Cultural Competence-Georgetown University Bureau of Primary Health Care Project, Child Development Center.
10.
Cross, C. (2001). School-family partners in literacy. Retrieved July 16, 2002, from http://www.schoolrenewal.org/strategies/iliteracycc.html
11.
Davis, T. C., Bocchini, J. A., Jr., Fredrickson, D., Arnold, C., Mayeaux, E. J., Murphy, P. W., et al. (1996). Parent comprehension of polio vaccine information pamphlets. Pediatrics, 97, 804-810.
12.
Davis, T. C., Holcombe, R. F., Berkel, H. J., Pramanik, S., & Divers, S. G. (1998). Informed consent for clinical trials: A comparative study of standard versus simplified forms. Journal of the National Cancer Institute, 90, 668-674.
13.
Davis, T. C., Michielutte, R., Askov, E. N., Williams, M. V., & Weiss, B. D. (1998). Practical assessment of adult literacy in health care. Health Education and Behavior, 25, 613-624.
14.
Department of Education and Department of Health and Human Services. (2000). A call to commitment: Father’s involvement in children’s learning. Retrieved July 22, 2002, from http://www.ed.gov/pubs/parents/calltocommit/chap1.html
15.
Dye, T., Lane, S. D., & Novick, L. F. (1998). A population-based, race-independent public health assessment for identifying pregnant women in need of Healthy Start Services. Atlanta, GA: Centers for Disease Control and Prevention.
16.
Elder, J. P., Candelaria, J. I., Woodruff, S. I., Criqui, M.H., Talavera, G. A., & Rupp, J. W. (2000). Results of language for health: Cardiovascular disease nutrition education for Latino English-as-a-second-language students. Health Education and Behavior, 27(1), 50-63.
17.
Federal Register. (2000). Assuring cultural competence in health care: Recommendations for national standards and an outcomesfocused research agenda. Retrieved April 2, 2001, from http://www.onhrc.gov/CLAS/finalcultural1A.htm
18.
Fisher, E. (1999). Low literacy in adults: Implications for patient education. Journal of Continuing Education inNursing, 30(2), 56-61.
19.
Fredrickson, D. D., Washington, R. L., Pham, N., Jackson, T., Witlshire, J., & Jecha, L. D. (1995). Reading grade levels and health behaviors of parents at child clinics. Journal of the Kansas Medical Society, 96, 127-129.
20.
French, K. S., & Larrabee, J. H. (1999). Relationships among educational material readability, client literacy, perceived beneficence, and perceived quality. Journal of Nursing Care Quality, 13, 68-82.
21.
Friere, P. (1970). Pedagogy of the oppressed. NewYork: Continuum.
22.
Frost, M. H., Thompson, R., & Thiemann, K. B. (1999). Importance of format and design in print patient information. Cancer Practice, 7(1), 22-27.
23.
Goode, T. (2001). Policy brief 4: Engaging communities to realize the vision of one hundred percent access and zero health disparities: a culturally competent approach. Washington, DC: National Center for Cultural Competence-Georgetown University Bureau of Primary Health Care Project, Child Development Center.
24.
Goode, T., Sockalingam, S., Brown, M., & Jones, W. (2001). Policy brief 2: Linguistic competence in primary health care delivery systems: Implications for policy makers. National Center for Cultural Competence.
25.
Guidry, J. J., & Fagan, P. (1997). The readability of cancer-prevention materials targeting African-Americans. Journal of Cancer Education, 12, 108-113.
26.
Hayes, K. S. (2000). Literacy for health information of adult patients and caregivers in a rural emergency department. Clinical Excellence for Nurse Practitioners, 4(1), 35-40.
27.
Kickbusch, I. S. (2001). Health literacy: Addressing the health and education divide. Health Promotion International, 16, 289-297.
28.
Lane, S. D., Cibula, D. A., Padro-Milano, L., Shaw, M., Bourgeois, B., Schweitzer, F., et al. (2001). Racial and ethnic disparities in infant mortality: risk in social context. The Journal of Public Health Management and Practice. 7(3), 30-46.
29.
Lee, P. P. (1999). Why literacy matters. Links between reading ability and health. Archives of Ophthalmology, 117, 100-103.
30.
Marwick, C. (1997). Patients’ lack of literacy may contribute to billions of dollars in higher hospital costs. Journal of the American Medical Association, 278, 971-972.
31.
Matson, S. C., & Haglund, K. A. (2000). Relationship between scholastic and health behaviors and reading level in adolescent females. Clinical Pediatrics, 39, 275-280.
32.
National Work Group on Literacy and Health. (1998). Communicating with patients who have limited literacy skills. Report of the National Work Group on Literacy and Health. Journal of Family Practice, 46, 168-176.
33.
Parker, R. M., Baker, D. W., Williams, M. V., & Nurss, J. R. (1995). The test of functional health literacy in adults: A new instrument for measuring patients’ literacy skills. Journal of General Internal Medicine, 10, 537-541.
34.
Parker, R.M., Williams, M.V., Baker, D.W., & Nurss, J.R. (1996). Literacy and contraception: exploring the link. Obstetrics and Gynecology, 88, 72S-77S.
35.
Plimpton, S., & Root, J. (1994). Materials and strategies that work in low literacy health communication. Public Health Reports, 109, 86-92.
36.
Powell, E. C., Tanz, R. R., Uyeda, A., Gaffney, M. B., & Sheehan, K. M. (2000). Injury prevention education using pictorial information. Pediatrics, 105, e16e16.
37.
Riffenburgh, A. (2000). Health literacy toolbox (Joint Commission of Accreditation of Healthcare Organizations). Retrieved July 30, 2002 from http://www.prenataled.com/healthlit/hlt2k/script/ht2_a_7.asp
38.
Root, J., & Stableford, S. (1999). Easy-to-read consumer communications: A missing link in Medicaid managed care. Journal of Health Politics, Policy and Law, 24(1), 1-26.
39.
Stableford, S. (n.d.) Write it easy-to-read, level 2: A training manual. Syracuse, NY: Syracuse University, Maxwell School of Citizenship and Public Affairs.
40.
Williams, M. V. (2002). Recognizing and overcoming inadequate health literacy, a barrier to care. Cleveland Clinic Journal of Medicine, 69, 415-418.
41.
Williams, M. V., Davis, T., Parker, R. M., & Weiss, B. D. (2002). The role of health literacy in patient-physician communication. Family Medicine 2002, 34, 383-389.
42.
Wilson, F. L. (1995). Measuring patients’ ability to read and comprehend: A first step in patient education. Nursingconnections, 8(4), 17-25.
