Adult learners' perspectives on screening reading ability for patient teaching.

Abstract

The expectation of greater individual responsibility for health promotion practices and decision making in hospitals is dependent upon knowledgeable consumers. The heavy reliance on printed material for both gathering and disseminating information in hospitals has led to recommendations that literacy screening tests be considered to enhance the efficacy of patient teaching interventions for the significant number of adults with low literacy skills. A qualitative case study design was used to investigate the response of adults with low literacy skills to literacy screening. Data were collected through in depth interviews including an experience using the Rapid Estimate of Adult Literacy in Medicine (REALM) word recognition tool. Analysis was achieved using a constant comparison technique. A conceptual model of response to screening was developed and compared to the Health Belief Model and Knox's Proficiency Theory of adult learning. While all participants supported the principle of screening in the context of the hospital, response to the REALM experience was variable. Factors found to influence responses to screening included perceived risks of illiteracy exposure, perceived risks of non-disclosure during hospitalization and the attribution of characteristics to the hospital leading to it's designation as a "special" place. Specific responses to the REALM were found to be further influenced by a set of individual historic factors. The results have lead to several recommendations for health care professionals considering utilization of literacy screening instruments.