LITERACY IN THE

ADULT PATIENT
POPULATION
Literacy
◦ an umbrella term used to describe socially required and
expected reading and writing abilities
◦ “the ability to use print and written information to function
in society, to achieve one’s goals, and to develop one’s
knowledge and potential”
Health literacy
◦ refers to how well an individual can read, interpret, and
comprehend health information for maintaining an optimal
level of wellness
Low literacy
◦ also termed marginally literate or marginally illiterate, refers
to the ability of adults to read, write, and comprehend
information between the fifth- and eighth-grade level of
difficulty
◦ Low-literate persons have trouble using commonly printed
and written information to meet their everyday needs such as
reading a TV schedule, taking a tele- phone message, or filling
out a relatively simple application form
Functional illiteracy
◦ means that adults have reading, writing, and
comprehension skills below the fifth-grade level; that is,
they lack the fundamental education skills needed to
function effectively in today’s society
Reading
◦ or word recognition as “the process of transforming letters
into words and being able to pronounce them correctly”
Readability
◦ is defined as the ease with which written or printed
information can be read
Comprehension
◦ is the degree to which individuals understand what they
have read
◦ It is the ability to grasp the meaning of a message—to get
the gist of it.
During assessment, the nurse should take note of the
following clues that illiterate patients may
demonstrate:
◦ Reacting to complex learning situations by withdrawal, complete
avoidance, or being repeatedly noncompliant
◦ Using the excuse that they were too busy, too tired, too sick, or too
sedated with medication to maintain attention span when given a
booklet or instruction sheet to read
◦ Claiming that they just did not feel like reading, that they gave the
information to their spouse to take home, or that they lost, forgot, or
broke their glasses
◦ Camouflaging their problem by surrounding themselves
with books, magazines, and newspapers to give the
impression they are able to read
◦ Circumventing their inability by insisting on taking the
information home to read or having a family member or
friend with them when written information is presented
◦ Asking you to read the information for them under the
guise that their eyes are bother- some, they lack interest, or
they do not have the energy to devote to the task of
learning
◦ Showing nervousness as a result of feeling stressed by the threat of
the possibility of “getting caught” or having to confess to illiteracy
◦ Acting confused, talking out of context, holding reading materials
upside down, or expressing thoughts that may seem totally
irrelevant to the topic of conversation
◦ Showing a great deal of frustration and restlessness when
attempting to read, often mouthing words aloud (vocalization) or
silently (subvocalization), substituting words they cannot decipher
(decode) with meaningless words, pointing to words or phrases on
a page, or exhibiting facial signs of bewilderment or defeat
◦ Standing in a location clearly designated for “authorized
personnel only”
◦ Listening and watching very attentively to observe and
memorize how things work
◦ Demonstrating difficulty with following instructions about
relatively simple activities such as breathing exercises or
with operating the TV, electric bed, call light, and other
simple equipment, even when the operating instructions
are clearly printed on them
◦ Failing to ask any questions about the information they
received
◦ Revealing a discrepancy between what is understood by
listening and what is under- stood by reading
TEACHING STRATEGIES
FOR LOW-LITERATE
PATIENTS
1. Establish a trusting relationship before
beginning the teaching–learning process.

◦ Start by getting to know the patients and helping to reduce

their anxiety.
2. Use the smallest amount of information possible to
accomplish the predetermined behavioral objectives

◦ Stick to the essentials, paring down the information you

teach to what the patient must learn.
3. Make points of information as vivid
and explicit as possible.
◦ Explain information in simple terms, using everyday
language and personal examples relevant to the patient’s
background
4. Teach one step at a time
◦ Teaching in increments and organizing information into
chunks help to reduce anxiety and confusion and give
enough time for patients to understand each item before
proceeding to the next unit of information
5. Use multiple teaching methods and
tools requiring fewer literacy skills
◦ Oral instruction contains cues such as tone, gestures, and
expressions that are not found in written materials.
6. Allow patients the chance to restate information in their
own words and to demonstrate any procedures being taught.

◦ Encouraging patients to explain something in their own

words may take longer and requires patience on the part of
the educator, but feedback in this manner can reveal gaps
in knowledge or misconceptions of information.
7. Keep motivation high
◦ It is important to recognize that illiterate persons may feel
like failures when they cannot work through a problem.
◦ Reassure patients that it is normal to have trouble with new
information and that they are doing well, and encourage
them to keep trying.
8. Build in coordination of procedures.
◦ Tailoring refers to coordinating patients’ regimens into
their daily schedules rather than forcing them to adjust
their lifestyles to regimens imposed on them.
◦ Cuing focuses on the appropriate combination of time and
situation using prompts and reminders to get a person to
perform a routine task
9. Use repetition to reinforce information
◦ Repetition, in the form of saying the same thing in
different ways, is one of the most powerful tools to help
patients understand their problems and learn self-care.