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Canadian Journal of Public Health

, Volume 94, Issue 6, pp 408–412 | Cite as

Literacy in Primary Care Populations

Is it a Problem?
  • June L. SmithEmail author
  • Jeannie Haggerty
Article

Abstract

Background

Almost half of Canadians experience difficulty using print media, according to the 1994 International Adult Literacy Survey. Our objectives were to estimate the prevalence of low-literacy patients in our practice, to determine whether reading grade level is associated with self-perceived health status in primary care, and to evaluate the reading difficulty of commonly used patient education pamphlets.

Methods

We surveyed a random sample of 229 patients aged 18 to 85 years presenting for scheduled and walk-in care. Main outcome measures were reading ability as estimated by word decoding skill with the validated Rapid Estimate of Adult Literacy in Medicine (REALM) and self-perceived health status using COOP/WONCA functional health measures. We assessed the reading difficulty of 120 commonly used patient education pamphlets using the Simple Measure of Gobbledygook (SMOG) formula.

Results

The prevalence of low-literate patients was 9%. Poor reading ability in English was most likely among patients under 45 years of age not having completed high school, and among those whose maternal language was neither English nor French (immigrants). REALM scores and self-perceived health were weakly correlated but not significant statistically. The mean reading grade level of pamphlets was grade 11.5 (SD: 1.5). Seventy-eight percent of pamphlets required at least a high school reading level.

Conclusion

Literacy levels were higher than expected in our patient population; this finding may be due to the rapid assessment tool used, which may have underestimated the difficulty of using print media. Clearly, the vast majority of commonly used patient education materials would not meet the needs of low-literate patients, who may be more likely to experience poorer health. Providers need to be sensitive to the reading limitations of patients and patient education materials should be written at a lower reading level.

Résumé

Contexte

Selon l’Enquête internationale sur l’alphabétisation des adultes (1994), près de la moitié des Canadiens ont du mal à utiliser les médias imprimés. Nous avons voulu estimer la prévalence des patients faiblement alphabétisés dans notre clinique pour déterminer si la capacité de lecture est associée à l’état de santé autoperçu dans le domaine des soins primaires et pour évaluer la lisibilité des dépliants d’usage courant servant à l’éducation des patients.

Méthode

Nous avons sondé un échantillon aléatoire de 229 patients de 18 à 85 ans se présentant à la clinique, avec ou sans rendez-vous. Nos principales mesures étaient la capacité de lecture, estimée selon les compétences de décodage des mots obtenues par l’instrument REALM (Rapid Estimate of Adult Literacy in Medicine), et l’état de santé autoperçu selon les mesures fonctionnelles de santé de COOP/WONCA. Nous avons aussi évalué selon la formule SMOG (Simple Measure of Gobbledygook) la lisibilité de 120 dépliants d’usage courant destinés à l’éducation des patients.

Résultats

La prévalence des patients faiblement alphabétisés était de 9 %. Les patients les plus susceptibles d’avoir une piètre capacité de lecture en anglais étaient ceux de moins de 45 ans qui n’avaient pas terminé leurs études secondaires et ceux dont la langue maternelle n’était ni l’anglais, ni le français (les immigrants). Les scores obtenus par le REALM et l’état de santé autoperçu présentaient une corrélation faible, mais non significative. Le niveau de lecture moyen des dépliants était à mi-chemin entre la 11e et la 12e année (11,5) (déviation sensible: 1,5). Soixante-dix-huit p. cent des dépliants exigeaient au moins une capacité de lecture du niveau de l’école secondaire.

Conclusion

Les niveaux de littératie étaient plus élevés que prévu chez nos patients; cela pourrait s’expliquer par l’outil d’évaluation rapide que nous avons utilisé, qui a peut-être sous-estimé la difficulté d’utiliser les médias imprimés. De toute évidence, la grande majorité des documents d’usage courant servant à l’éducation des patients ne répondraient pas aux besoins de patients faiblement alphabétisés, qui ont parfois tendance à être en moins bonne santé. Les fournisseurs de soins doivent être sensibles aux difficultés de lecture des patients, et les documents d’éducation des patients devraient être rédigés à un niveau de lecture plus bas.

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Copyright information

© The Canadian Public Health Association 2003

Authors and Affiliations

  1. 1.Department of Family MedicineMcGill UniversityMontrealCanada
  2. 2.Herzl Family Practice Centre, Départements de Médecine familiale et de Médecine sociale et préventiveUniversité de MontréalCanada
  3. 3.Herzl Family Practice CentreSir Mortimer B. Davis Jewish General HospitalMontrealCanada

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