Keywords: health literacy, language literacy, education, intervention, low socioeconomic status (SES), asthma, parents
Given the relation between language and health literacy, designing educational interventions to improve health and health literacy outcomes based on individuals' language literacy abilities may be beneficial. This randomized pretest/posttest control group pilot study evaluated the health and language literacy abilities of 24 parents with low socioeconomic status (SES) who had at least one child with a documented diagnosis of reactive airway disease or asthma and explored the ability of a language literacy adjusted education program to improve parents' asthma-related health literacy. Parents' perceptions of program benefits were also measured. Results revealed that the majority of the parents presented with compromised general and asthma-related health or language literacy abilities (or both), providing support for the need for a language literacy-adjusted education program for low SES parents of children with asthma. Post-versus pretest asthma-related health literacy was significantly improved in the intervention group of parents and was unchanged in the control group. Parents who participated in the intervention group perceived the group as beneficial. Although these results show promise, further research of this speech-language pathology based health literacy intervention model is needed.
Health literacy, as defined by Healthy People 2010, is "the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions" (U.S. Department of Health and Human Services, 2000). In 2004, the Institute of Medicine (IOM) estimated that 90 million adults in the United States may have decreased health literacy with a large number consisting of African American, Latino, elderly, and low socioeconomic status (SES) populations. Individuals with reduced health literacy skills are at risk of experiencing poorer health outcomes than individuals with adequate health literacy skills (e.g., Berkman et al., 2004; Gazmararian et al., 1999; Mika, Kelly, Price, Franquiz, & Villarreal, 2005). Regarding parents' health literacy abilities and their children's health-related outcomes, reduced parental health literacy has been found to be associated with decreased breastfeeding (Kaufman et al., 2001) and with a greater incidence of emergency department visits, hospitalizations, and days missed from school in children with asthma (DeWalt, Dilling, Rosenthal, & Pignone, 2007).
LITERACY, HEALTH LITERACY, AND HEALTH OUTCOMES
Literacy is the foundation of health literacy and includes the following skills: listening, speaking, reading, writing, and calculating (TOM, 2004; Kirsch, 2001). Because of the relationship between literacy and health literacy, when (language) literacy skills are decreased, functional (i.e., everyday) health literacy may also be decreased. For example, an adult with newly diagnosed chronic obstructive pulmonary disease may not understand his pulmonologist's explanation of his short-acting bronchodilator treatment and may self-administer the treatment multiple times daily instead of only when he is symptomatic. A mother with decreased reading abilities may misread the directions for her daughter's nebulizer and assemble it improperly. In addition to being associated with decreased health literacy, poor health outcomes, including increased frequency of hospitalizations and mortality, are also associated with decreased literacy (Mika et al., 2005; Wittich, Mangan, Grad, Wang, & Gerald, 2007).
LOW SOCIOECONOMIC STATUS, HEALTH, AND LITERACY
Low SES is associated with decreased health and health literacy (e.g., Andrulis & Brach, 2007; Borrell & Hatch, 2005; Kutner, Greenberg, Jin, & Paulsen, 2006; U.S. Department of Health …