History of Health Literacy – Part 1

I have been passionate about Health Literacy most of this decade.    One of the areas I have been exploring are the roots of HL.     I was going back through some April, 2009 posts on the Health Literacy Listserv and found several contributions on the topic of the history of Health Literacy.    It is always good to look back to see how far we have come and realize where we need to go.      I thought I would share some of the information posted, for this column.

Len and Ceci Doak are well known expects in the area of Health Literacy.     Their work goes back over 35 years.  Two landmark publications were written by the Doaks in collaboration with other authors.

Teaching patients with low literacy skills
http://www.hsph.harvard.edu/healthliteracy/doak.html
Author: Doak, Cecilia Conrath.; Doak, Leonard G.; Root, Jane H. Publication: Philadelphia : J.B. Lippincott, 1996

 

Pfizer principles for clear health communication:  a handbook for creating patient education materials that enhance understanding [and] promote health outcomes /
Author: Doak, Leonard G.; Doak, Cecilia Conrath. Publication: [New York , N.Y.] : Pfizer, 2004

They shared a number of facts, represented with this time line …

1973 Ceci (a USPHS Health Educator) asked, “But what do these people do when they don’t understand their health care instructions?”  Len (a volunteer adult literacy tutor) answered, “They fake it. If asked if they understand they will likely say “yes”. This led eventually to our collaboration on a small contract from the USPHS to assess the reading skill levels of 100 patients at the Norfolk, PHS hospital, and compare the results with the readability demands of 100 written patient instructions in use there.  (Published in Patient counseling and education, Winter 1979-80)

1970s –literature search found only five papers related to this subject. A paper in Nursing Research in 1964 by Mohammed cited just four such papers.

1970s and early 80s little interest shown

1978 paper presented at Western Branch APHA conference on Closing the Comprehension Gap – a link between health and literacy.

Beginning in the late 1970s the Doaks gave over 200 one and two day workshops in collaboration with other pioneers in the field.

1985 Interest in health literacy began to grow with the Lippincott publication of their first book, Doak, Doak, Root, Teaching Patients with Low Literacy Skills.

Beginning in the mid-1980s, NIH’s National Cancer Institute established a working group on health and literacy led by Wendy Mettger.  The group included members from diverse fields, including government agencies, academia, pharma, and others. Results of the group’s deliberations were published in medical journals, which further increased awareness.   NIH’s NHLBI let a number of contracts to increase our knowledge about health and literacy. Several universities, notably the University of North Carolina, Harvard, Johns Hopkins and Emory, were involved in work related to health literacy.

Several government agencies sponsored training in health literacy, notably the Bureau of Indian Affairs, the Veterans Administration Hospitals, and DHHS.  Pfizer pharma sponsored annual conferences and gave dozens of grants for studies about health literacy. And Canadian literacy organizations included this subject at national conferences.  Broader international awareness was fostered by  Voice of America segments on health literacy they recorded with us and translated into 43 languages.

In the 1990’s and beyond, health literacy took off.  Research work  by Barry Weiss, Schillenger, Ruth Parker, Terry Davis and so many others have moved the field forward immensely.”

The Doaks can be heard giving a 30-year overview about the history of health literacy in a Health Literacy Out Loud podcast, “Len & Ceci Doak Discuss Health Literacy’s Past, Present, and Future.”   Here is the link, http://www.healthliteracyoutloud.com/2009/03/23/hlol-13-len-ceci-doak-discuss-health-literacy%e2%80%99s-past-present-and-future/

…more later.

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