Joanne R. Nurss

The test of functional health literacy in adults : a new instrument for measuring patients' literacy skills

AbstractOBJECTIVE: To develop a valid, reliable instrument to measure the functional health literacy of patients. DESIGN: The Test of Functional Health Literacy in Adults (TOFHLA) was developed using actual hospital materials. The TOFHLA consists of a 50-item reading comprehension and 17-item numerical ability test, taking up to 22 minutes to administer. The TOFHLA, the Wide Range Achievement Test-Revised (WRAT-R), and the Rapid Estimate of Adult Literacy in Medicine (REALM) were administered for comparison. A Spanish version was also developed (TOFHLA-S). SETTING: Outpatient settings in two public teaching hospitals. PATIENTS: 256 English- and 249 Spanish-speaking patients were approached. 78% of the English- and 82% of the Spanish-speaking patients gave informed consent, completed a demographic survey, and took the TOFHLA or TOFHLA-S. RESULTS: The TOFHLA showed good correlation with the WRAT-R and the REALM (correlation coefficients 0.74 and 0.84, respectively). Only 52% of the English speakers completed more than 80% of the questions correctly. 15% of the patients could not read and interpret a prescription bottle with instructions to take one pill by mouth four times daily, 37% did not understand instructions to take a medication on an empty stomach, and 48% could not determine whether they were eligible for free care. CONCLUSIONS: The TOFHLA is a valid, reliable indicator of patient ability to read health-related materials. Data suggest that a high proportion of patients cannot perform basic reading tasks. Additional work is needed to determine the prevalence of functional health illiteracy and its effect on the health care experience.

The relationship of patient reading ability to self-reported health and use of health services.

OBJECTIVES This study examined the relationship of functional health literacy to self-reported health and use of health services. METHODS Patients presenting to two large, urban public hospitals in Atlanta, Ga, and Torrance, Calif, were administered a health literacy test about their overall health and use of health care services during the 3 months preceding their visit. RESULTS Patients with inadequate functional health literacy were more likely than patients with adequate literacy to report their health as poor. Number of years of school completed was less strongly associated with self-reported health. Literacy was not related to regular source of care or physician visits, but patients in Atlanta with inadequate literacy were more likely than patients with adequate literacy to report a hospitalization in the previous year. CONCLUSIONS Low literacy is strongly associated with self-reported poor health and is more closely associated with self-reported health than number of years of school completed.

A randomized trial of a brief HIV risk reduction counseling intervention for women

There is an urgent need for the development and implementation of effective and feasible behavioral HIV and STD interventions. The purpose of the present randomized controlled trial was to evaluate the effectiveness of a single-session, skill-based sexual risk reduction intervention for women. Participants were assessed at baseline and at 1 month and 3 months following the intervention on measures of AIDS knowledge, behavioral intentions, self-efficacy, and sexual risk behavior. Compared with women in an AIDS-education-only condition, women receiving the skill-based intervention reported significantly higher rates of condom use at 3-month follow-up. Results suggest that brief sexual risk reduction programs are feasible and effective within a community setting.

Literacy and contraception: exploring the link.

Objective To describe what is known about the relation of literacy skills to contraceptive use and to suggest directions for future research. An overview of what is known about the literacy skills of Americans and the prevalence of inadequate functional health literacy is presented. Information about reading requirements for various methods of contraception and advice from health educators on dealing with low-literate populations are described. Data Sources MEDLINE, PsychInfo, and ERIC searches for the last 20 years were completed using the terms literacy, literacy and health, family planning, health status, educational status, risk factors, contraception, and pregnancy. Methods of Study Selection The primary literature searches identified 125 articles. After reviewing abstracts for these articles, we excluded 79 because they contained no specific mention of literacy or educational status relating to contraception. Tabulation, Integration, and Results We were unable to identify any study specifically devoted to the relation between functional literacy and actual use of contraceptives. Forty-six with relevant background or related information were identified: literacy and health (19), adult literacy (nine), literacy and contraception (11), and literacy and family planning (seven). Over one-third of English-speaking and 62% of Spanish-speaking patients had inadequate or marginal functional health literacy in a study conducted at two urban public hospitals. Studies by health educators have demonstrated that information for many types of contraceptives is frequently above the patients reading level. Available epidemiologic information on the relation between educational status and unplanned pregnancy is also presented. Conclusions Although no study has specifically addressed how functional health literacy affects contraceptive use, it is reasonable to hypothesize that functional health literacy influences contraceptive knowledge, attitudes, and behaviors. Future research should focus on the relation between functional health literacy and actual use of various contraceptives.

Imitation, comprehension, and production of grammatical structures

The purpose of the study was to gather baseline data from 147 Southern urban higher status white and lower status white and black 4-year-old boys and girls on measures of their ability to imitate, comprehend, and produce selected grammatical structures. The children were given the Brown, Fraser, Bellugi Test of Grammatical Contrasts. The higher status white group performed significantly better on all three tasks than did either of the lower status groups. The tasks ordered in difficulty: comprehension = imitation > production. An alternate scoring system was devised to account for possible dialect differences between the test and the lower status children.

Children's toy preferences revisited: Implications for early childhood education

A study of contemporary kindergarten childrens toy preferences indicated that they were as rigidly stereotyped by sex as those of children of previous decades. In view of social and legal changes and growing professional concerns about sex-role stereotyping, the authors present implications of sex-typed play and offer suggestions for combatting stereotyping and sex discrimination.

Young Children's Oral Language: Effects of Task.

AbstractFive language-eliciting situations were presented to 48 kindergarten and primary-grade children to identify developmental trends and task effects in the complexity of language structures, vocabulary, functions, and story conventions used. Limited developmental differences (between kindergarten and primary children but not within primary groups) were found. Significant task effects were found. Telling an original story with no picture stimulus produced the most mature language structures and functions; the wordless picture book task elicited more mature narrative structures; and the single picture tasks elicited more varied vocabulary. Classroom instructional implications are suggested.

Development of Written Communication in Norwegian Kindergarten Children 1

Abstract Nurss, J. R. 1988. Development of Written Communication in Norwegian Kindergarten Children. Scandinavian Journal of Educational Research 32, 33‐48 Forty‐eight Norwegian kindergarten children with ages ranging from 3 to 6 years drew pictures, wrote their names, and wrote a caption under their pictures three times during one school year. Their written language was rated on a 0 to 8 point scale. The results showed strong age‐related developmental trends and some within‐age group growth over the school year. No gender‐related differences were found. Six‐year‐olds also read common logos and the same word in decontextualized print. The language/ print environment of the classrooms was evaluated. Results are compared with those of other studies in several different cultures and are discussed in relation to Norwegian kindergarten philosophy and curriculum. 1The research described in this article was completed while the author was fulbright Professor at the Institute of Education, University of Trondheim/...

Written language environments for young children: Comparison of Scandinavian, British, and American Kindergartens

In 1985–1987 observations2 were made in kindergartens in Scandinavia (Norway, Sweden, Denmark), Great Britain, and the United States. Based upon these observations, the written language environments are described and comparisons are made. In Scandinavia, the kindergartens for 6-year-olds are generally environments that emphasize social development, oral language, and creative expression through play. Essentially no written language is found. In Great Britain (and in British schools elsewhere), the same interactive play environment also includes written language. Five-year-olds in the reception class of the infant, or first school are introduced to reading within the context of story books and to writing via story dictation and copying. In the United States, public school kindergartens for 5-year-olds have become increasingly more academic over the past 25 years. However, some developmentally appropriate kindergartens still exist many of which include a print-rich, written language environment in which the 5-year-olds acquire written language naturally. Current research from several cultures suggests that a natural use of written language as a part of children’s social play environment might be a valuable addition to the kindergarten programs in all of these countries.RésuméEntre 1985 et 1987, des observations dans des écoles maternelles de Scandinavie (Norvège, Suède et Danemark), de Grande-Bretagne et des Etats-Unis ont été menées. A partir de ces observations, les milieux de langage écrit sont décrits et comparés. En Scandinavie, les maternelles pour les enfants de 6 ans sont généralement des environnements qui favorisent le développement social, le langage oral et l’expression créative à travers le jeu. Essentiellement, on ne retrouve pas de langage écrit. En Grande-Bretagne (et ailleurs dans les écoles britanniques) le même milieu de jeu interactif inclus également le langage écrit. Quant aux enfants de cinq ans, dans la classe de réception, ils sont introduits à la lecture dans le cadre des livres de contes et à l’écriture par le biais de la dictée et de la copie d’histoires. Aux Etats-Unis, ces vingt-cinq dernières années, les écoles maternelles publiques pour les enfants de 5 ans sont devenues progressivement plus académiques. Cependant, quelques maternelles de type développemental existent encore dont la plupart incluent un enrichissement de l’écriture, des milieux de langage écrit dans lesquels les enfants de 5 ans acquirèrent le langage de façon naturelle. Des recherches courantes provenant de diverses cultures suggèrent que l’utilisation naturelle d’un langage écrit comme étant partie de l’environnement de jeu social des enfants pourrait être un complément valable aux programmes de tous ces pays.ResumenEntre 1985 y 1987 se hicieron observaciones en jardines infantiles de Escandinavia (Noruega, Suecia, Dinamarca), Gran Bretaña Estados y Unidos. En base a estas observaciones se describen y se comparan los medios de lenguaje escrito. En Escandinavia, los jardines infantiles para los niños de 6 años son generalmente medios que acentúan el desarrollo social, el leguaje oral y la expresión creativa a través del juego. En esencia, no se encuentra lenguaje escrito. En Gran Bretaña (y en las otras escuelas británicas) el mismo medio interactivo de juego incluye también lenguaje escrito. Se introduce al niño de cinco anõs a la lectura dentro del contexto de libros de cuentos y a la escritura por intemedio del dictado y de la copia de cuentos. En Estados Unidos, en estos últimos 25 años, los jardines infantiles de las escuelas públicas, para los nińos de cinco ańos, se han convertido progresivamente en más académicos. Sin embargo, todavía existen algunos jardines preocupados por el desarrollo del nińo; muchos de ellos incluyen un enriquecimiento del idioma escrito en el cual el niño de cinco años lo adquiere en forma natural. Investigaciones actuales hechas en diferentes culturas sugieren que el uso natural del idioma escrito como parte del medio de juego social del niño podría ser un aditivo válido en los programas de jardin infantil en todos estos paises.

Prereading/Language Development in Two Day Care Centers.

The purpose of this study was to analyze the language of eight 4-year-old children from two day care centers as they described a picture and told a story from pictures in a wordless picture book. The childrens oral language was analyzed for vocabulary, syntax, completeness, and accuracy. Their stories were assessed for Applebees narrative conventions and structure. Comprehension of the picture and the book was assessed by questions. The childrens descriptions and stories, although short, contained a variety of vocabulary words and an above average number of words per T-unit for their age. However, their stories did not contain any narrative conventions nor did the children demonstrate that they had achieved a sense of the story. The childrens descriptions were only partially accurate, and they demonstrated limited comprehension of the picture and story. These results are discussed in relation to the day care and pre-school language curriculum and environment. Implications are drawn for the childrens prereading development and their readiness for beginning reading instruction.