I learned about several facts during the second week in relation to blogs, the Read/Write Web, e-mail, discussion groups via e-mail, and the World Wide Web.  Concerning blogs I learned from 7 Things You Should Know About Blogsthe basics about blogs: how to use a blog, what it is used for, and who uses them. The chapter entitled Read/Write Web in the Richardson text provided information about the World Wide Web from its creation until now and information about how computers are being used more by students. According to Richardson,  “Today’s students, of almost any age, are far ahead of their teachers in computer literacy. They prefer to access subject information on the Internet, where it is more abundant, more accessible, and more up-to-date”.

In weeks three and four I  learned about collaborative editing, wiki basics, and RSS from separate articles that answered the following questions: What is it? Who’s doing it? How does it work? Why is it significant? What are the downsides? Where is it going? What are the implications for teaching and learning? In addition, I learned how to contribute to Wikipedia, that wikis are supposedly able to  “enhance the teaching and learning experience” by providing “students and teachers with a new and flexible means by which to communicate collaboratively in order to create web sites that are “content-specific”, and RSS.  In addition, I rediscovered the knowledge and skills necessary for developing a research question and I learned how to create a wiki. Finally, at the end of week 3 I developed my initial essential question and the foundational questions meant to support it. 

In weeks five, six and seven I learned about social bookmarking, virtual meetings, virtual worlds, how to evaluate a website, how to use “tapped-in” to participate in a virtual meeting, and how to register for the social bookmarking site called delicious.   These three weeks were also critical periods of research for the topic I had chosen, and it was at the end of these three weeks that I decided I had no clue what was the best topic on which for me to base my topic. 

In weeks eight, nine and ten I learned how to use “tapped-in” to exit one virtual meeting and enter another group meeting and more about reproduction literacy skills, socio-emotional literacy skills, and photo-visual literacy skills.  Across these three weeks I also settled on the perfect research topic, health literacy, after 3 revisions of my original essential question and 2 topic modifications.   I learned more about poor health literacy and its high prevalence in at risk populations, such as African Americans and Hispanics.  I acquired a better understanding about the relationship between education, race, and ethnicity.  Unfortunately, I also learned that ASHA does not have a documented solution and/or guideline for SLPs to follow to alleviate the adversity that is poor health literacy.  However, this fact made my research more exciting and provided me with much more free will. 

Across the final five weeks of the course, weeks 11 through 15, I spent hours upon hours researching my topic and developing my research paper and multimedia project in Microsoft Movie Maker.  This was by far the most interesting part of the course and I feel as though I learned more from researching my topic than from all tje  information I learned in the first two-thirds of the class combined.  It was not only relevant to the field of speech-language pathology, but was challenging and thought provoking, as well. 

There were six course objectives for this course that must be addressed to complete the requirements for the class.  The following text addresses each of them:

1. A Love of Learning 

If any portion of this course was meant to foster in me a love of learning my research paper was most definitely it.  Sure, I love gaining new and exciting knowledge, but unless I am very interested in the topic or find it useful, I do not love learning.  This is what occurred over much of the course, but when I was able to choose a topic that interested me and run away with it I enjoyed the learning process.  It was not only intriguing, but challenging, and I believe I learned a great deal. 

2. Culture of Inquiry

I am, by nature, a very inquisitive person.  Some may interpret this to be that I am a person who questions authority, but this is simply not the case.  I love asking “why?” and creating possible answers.  Prior to this course, I already  enjoyed a challenge and had a will to learn.  However, during this course my desire for inquiry only truly occurred while writing my research paper. 

3. Theoretical and Practical Aspects of the Discipline

I thought about what this course objective meant for a while before I came back to address it and I am still uncertain of its purpose.  Nevertheless, I am going to assume that it refers to how the course materials related to the field of speech-language pathology.  Assuming this, I can say that I do not feel as though much related to speech-language pathology.  Looking back, the realization that literacy is more broad a definition than I had originally conceptualized,  the different types of literacy about which I learned, and the knowledge I gained from writing my reserach paper appear to be the only portions of this course that I could truly use as an SLP.

4. Different Ways of Being, Knowing, and Doing

This course objective was met when I accepted a new definition for literacy, learned about different types of literacy, and became hyper-aware of health literacy in general and as it relates to speech-language pathology after my research.

5. Promote Learning Partnerships and Learning Communities

For the class as a whole this objective was met when we learned how to use tapped-in, social bookmarking, wikis, and RSS. While using tapped-in we all participated in a group that collaborated on the concept of copyrights. We also learned about netiquette to aid us in writing e-mails and participating in a mailing list.

6. Facilitate Improvement in Communicating Effectively in both Oral and Written Formats

This course facilitated improvement in communicating effectively in both oral and written formats because the research paper and the multimedia project demanded the abilities to do so.  Not only was I required to write an informative paper on a topic, but to condense it so as to efficaciously present it in an oral form over video. 

11-28-07

           First, I would like to thank all of those people who have instilled in me a passion for those who are different, less fortunate, or require extra assistance to succeed in daily living tasks. Without them I would not be so concerned about others, and would not have chosen to research health literacy from an angle that included such people.                        I would also like to thank Kelli, my roommate, study buddy, and friend, for without her I would have been even more stressed out than I already was while completing my citations.  For me, citations have always been the most frustrating component of writing a research paper, and the task I despise most about being a student.                        Finally, I thank Mrs. McComas, my professor, who took the time to answer questions I had before the final revision of my paper.

11-25-07

Declarative Knowledge           

Although I had learned much over the course of my research, while wrapping up the final draft of my paper I found portions of it that demanded either evidence or stronger evidence.  Thus, I conducted just a bit more research to complete my paper and learned a little while doing so.  Pieces of information I discovered while searching for the number of people in the U.S. who speak English as a second language were the four main groups of languages, how many people in the U.S. speak them as their primary language, and how many of them speak English “very well”, “well”, “not very well”, or “not at all”.             

I also learned about citations.  Although I find them tedious and annoyances that attempt to destroy the enjoyable process of composing a paper, I spent a large amount of time trying my best to use them correctly.  I am almost certain that despite the time and effort I put into the citations for my paper I still typed some incorrectly, but I do have a better knowledge of APA format.  For instance, I learned that if there are two citations from the same source within one paragraph and that source has three or more authors, the second citation includes the first author only with “et al.,” after it followed by the year.  If the same is true but there are three citations in the same paragraph rather than three, then the third citation does not include the year. 

Procedural Knowledge            

I do not believe I gained any new procedural knowledge.  Yes, I learned how to correctly cite references I had either forgotten about or had never learned, but I believe this knowledge to be declarative. 

Conditional Knowledge

            Both the knowledge I acquired from the data pertinent to my research paper as well as the APA format of the citations will most definitely benefit me in the future.  The overall knowledge that I obtained while researching for and writing my paper will stay with me as a speech-language pathologist not only when I interact with patients who may have poor health literacy, but will assist me in thinking from different perspectives on many areas of the field.  Gaining knowledge about this topic, one that only has three studies from the year 1986 to 2003 available, has given me confidence that I can effectively conduct research.  It excites me to think that I could contribute unique and needed information to the field in the future. 

11-18-07

11-21-07

        My name is Marissa Slack.  I am a senior in the Department of Communication Disorders at Marshall University.  In January of 2008 I will begin applying to several schools in the state of Tennessee in addition to Marshall University to pursue my graduate work in speech-language pathology.  I hope to find my niche in this wonderful field somewhere along the way and to devote my time and effort to being an effective service provider as an speech-language pathologist.  My ultimate ambition in life is to help others, and I have chosen a field full of opportunity to do so.  

11-16-2007 

Agency for Healthcare Research and Quality. (2004, January). Literacy and health outcomes. Rockville, MD: Berkman, N. D., DeWalt, D.A., Pignone, M. P., Sheridan, S. L., Lohr, K. N., & Sutton S. F. 

Andrulis, D.P. & Brach, C. (2007). Integrating literacy, culture, and language to improve health care quality for diverse populations. American Journal of Speech Behavior, 31(Suppl 1), S122-S133. Retrieved October 11, 2007 from the Academic Search Premier. 

Educational Testing Service. (2004, April). Literacy and health in america. Princeton, NJ: Rudd, R., Kirsch, I., & Yamamoto, K.Health Literacy (2006). Retrieved October 26, 2007, from http://www.asha.org/members/slp/healthlitearcy.htm 

Hester, E. J. & Benitez-McCrary, M. (2006, December). Health literacy: Research directions for speech-language pathology and audiology. The ASHA Leader, 11(17), 33-34. 

Manning, K.D. & Kripalani, S. (2007). The use of standardized patients to teach low-literacy communication skills. American Journal of Speech Behavior, 31(Suppl 1), S105-S110. Retrieved October 11, 2007 from the Academic Search Premier. 

Muphy-Knoll, L. (2007). Low health literacy puts patients at risk: The joint commission proposes solutions to national problem. Journal of Nursing Care Quality, 22 (3), 205-209. Rao, P. R. (2007, May).

Rao, P. R. (2007, May). Health literacy: The cornerstone of patient safety. The ASHA Leader, 12(6), 8-9. 

Schwartzberg, J.G., Cowett, A., VanGeest, J., & Wolf, M.S. (2007). Communication Techniques for Patients with Low Health Literacy: A survey of physicians, nurses, and pharmacists. American Journal of Speech Behavior, 31(Suppl 1), S96-S104. Retrieved October 11, 2007 from the Academic Search Premier. 

Shea, J.A., Beers, B.B., McDonald, V.J., Quistberg, D.A., Ravenell, K.L., & Asch, D.A. (2004). Assessing health literacy in african american and caucasian adults: Disparities in rapid estimate of adult literacy in medicine (REALM) score. Special Articles: Health Literacy and Family Medicine, 36 (8), 575-581. Retrieved October 11, 2007 from the Academic Search Premier. 

US Census Bureau. (2003, October). Language Use and English-Speaking Ability: 2000. Retrieve November 11, 2007, from www.census.gov/population/www/socdemo/lang_use.html

11-16-2007

Introduction/Questioning           

The primary concern speech-language pathologists (SLPs) have is the successful habilitation or rehabilitation of their client’s speech, language, and hearing.  This concern is certainly appropriate considering the SLP’s job description, and in no way should it be deemed otherwise. However, an issue that I would argue as an equally essential component to the success of therapy is the comprehension of information given to the client and/or the client’s parents/guardians/family by the SLP.  Without the understanding of what one’s disorder entails regarding its challenges, prognosis, and expectations of the client and or parents/guardians/family of the client for successful treatment, therapy is not as effective as it could be.                        

Before I decided to research health literacy as it applies to the field of speech-language pathology, I considered investigating a couple of other topics related to literacy.  After discovering a lack of resources for my first two topics, low socioeconomic status and its effects on literacy and literacy in Appalachia, I stumbled upon health literacy.   I had little knowledge about health literacy, but was fairly certain that part of it was an individual’s ability to understand vocabulary related to health.  Aside from knowing this, I had not previously thought about health literacy, especially not as an obstacle that SLPs must overcome to effectively treat the clients they serve.  I quickly found seven pieces of literature to use as references, so I committed to the topic. Obviously, I had a great deal of research to accomplish because of my restricted  knowledge about health literacy. However, only once I had committed myself to this issue did I learn just how little research there was to explore.            

Research indicates that poor health literacy, or lack of “the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions”, is a serious adversity in the United States (“Health Literacy,” 2006).  Only over the past five years has the problem that is health literacy been addressed at the national level (Andrulis & Brach, 2007), and literature related to health literacy within the profession of speech-language pathology is scarce, with only three studies conducted between the years 1984 and 2003 (Hester & Benitez-McCrary, 2006).  Before SLPs can compensate for the presenting problem, the factors that put people at greatest risk for this adversity and the activities that those who have limited health literacy may have difficulty with must be addressed.  Hence, the objectives of this paper are to delineate and discuss some of the factors that affect a client’s health literacy skills, to examine the activities individuals may have difficulty with, and to provide a basic strategic outline that speech-language pathologists can use to better ensure each client’s understanding of their speech and language health.  To achieve these objectives it was necessary to ask the following five questions: What is health literacy? What populations are at greatest risk for poor health literacy? What are the implications for poor health literacy? Regarding speech-language pathology, what activities may be difficult for a client with limited health literacy? What strategies do other medical professionals utilize to ensure their patients’ understanding of health information?

Searching               

Recent studies have shown that the primary factors that can influence an individual’s health literacy include, but are not limited to, race, language, and education.  Because these are also factors that can have a significant impact on the traditional notion of literacy, recently defined as “an individual‘s ability to read, write, and speak in English and compute and solve problems at levels of proficiency necessary to function on the job and in society, to achieve one‘s goals, and to develop one‘s knowledge and potential”, that they impress on health literacy is not far-fetched  (Berkman, et al., 2004). The data regarding these factors and their relationship with limited health literacy confirms the need for consideration and action by SLPs to research and employ effective techniques to improve their client’s understanding of their speech and language health.            

Findings across several studies have indicated that race plays a noteworthy role in predicting an individual’s health literacy.  For instance, a study assessing health literacy in African American versus Caucasian adults showed African Americans scoring significantly lower on the Rapid Estimate of Adult Literacy in Medicine (REALM) than Caucasians, except for groups that had a college education (Shea, et al., 2007).  According to another article, Integrating Literacy, Culture, and Language to Improve Health Care Quality for Diverse Populations, when the National Assessment of Adult Literacy (NAAL) 2003 statistics were released, black Americans and Hispanics had the highest number of people with poor health literacy skills, 58% and 66% respectively, while those classified as white only had 28% with low health literacy (Andrulis & Brach, 2007).                      

Literature on the affects that aspects of language can have on health literacy reveals alarming statistics.  A significant challenge that a clinician may confront concerning language and health literacy is the barrier created by a foreign language.  On the Health Activities Literacy Scale (HALS), a component of the National Adult Literacy Survey (NALS) that ranges in score from 0 to 500, natives of the United States had an average HALS proficiency of 278.  However, “adults who were born in Spanish-speaking countries had an average HALS proficiency of 170”, a score that is “more than 100 points, or 1.75 standard deviations, below the average HALS proficiency of adults born in the United States” (Rudd, Kirsch, & Yamamoto, 2004). Additionally, Census 2000 indicated that there were 47 million people amongst 262.4 million who spoke a language other than English in the home.  Also found in Census 2000 was the number of those people who spoke a language besides English in the home who reported speaking it “very well”, “well”, “not very well”, or “not at all” (United States Census Bureau [USCB], 2003).  Those who described their ability to speak English as “very well” in Spanish was 14.3 of 28.1 million, in other Indo-European languages was 6.6 of 10 million, of Asian and Pacific Island languages was 3.4 of 7 million, and of all other languages was 1.3 of 1.9 million.  These statistics not only show the number of people who speak English “very well”, but also reveal the number of people who do not speak English “very well”.  This demonstrates the need for an alternative and/or supplement to verbal language when SLPs communicate with patients who speak a language other than English in the household (USCB, 2003).             

An additional aspect of language that can prevent adequate comprehension includes the existence of a communication disorder in the client.  Unless a parent, guardian, or family member is responsible for the information, an SLP converses with the client whose reason for visiting the SLP is his/her communication disorder.  Thus, special attention and alternative means of communication may be required to effectively send a message to a client (“Health Literacy,” 2006).             Education is yet another facet that can affect one’s health literacy.  A recent policy information report conducted by the Educational Testing Service (ETS) showed that the average score on the HALS for those people who had not finished high school or obtained a General Equivalency Degree (GED) was 220, who had graduated from high school or obtained a GED was 271, and who had education after high school was 306 (Rudd, Kirsch, & Yamamoto, 2004). To further stress the significance of these findings, in the 1990s there were roughly 52 million adults who had not completed high school or earned their GED, suggesting that each of these adults have poor health literacy (Rudd, Kirsch, & Yamamoto, 2004).              Furthermore, limited health literacy does not only affect an individual client, but can also be examined from an economic perspective.  For instance, a study conducted at the University of Arizona at Tucson discovered that “healthcare costs for patients enrolled in Medicare, who were identified with low literacy skills, were more than four times as high as costs for patients with high literacy ability-roughly $13,000 per year vs. $3,000 per year” (“Health Literacy,” 2006).  The National Academy on Aging Society estimated that in the year 1998 an astounding $50 billion to $70 billion dollars was what poor health literacy cost society (Rao, 2007).  Due to lack of research in this area as it relates to speech-language pathology, the implications have yet to be identified.  For other medical professions, “longer and more frequent hospital stays, ineffective uses of prescriptions, and lack of comprehension of treatment plans” are the results of poor health literacy (Rao). Therefore, the consequences for speech-language pathology could be similar, in which case clients may be in therapy longer, fail to follow through with speech and language homework, have a lack of comprehension of treatment plans, and/or have a greater chance of needing services on multiple occasions.           

To address the problem at hand, it is not enough to know what factors are red flags for limited health literacy.  It is also critical to be familiar with what skills comprise health literacy specific to the field of speech-language pathology.  Because there is a lack of research concerning this issue, the following are only suggestions as to what skills make up health literacy in speech-language pathology: the ability to successfully fill out a case history form, to understand a diagnosis, to comprehend treatment plans and the prognosis of a disorder, to understand the most current research in order to make an educated decision, and to carry out speech and/or language homework.           

Currently, there is no formal test with which to assess health literacy skills within the field of speech-language pathology.  There is also no formal inventory of possible strategies for SLPs to employ to better ensure clients’ understanding of their speech and language health.  Inside the boundaries of this paper, it is impractical to develop a standardized assessment with which to provide SLPs.  However, with knowledge of the populations at greatest risk sufficing for the lack of a formal assessment to classify individual clients, it is certainly possible to modify strategies employed by other medical professionals to provide alternatives to sufficient health literacy in speech-language pathology.                         

Aside from the more obvious and less complicated strategies to apply, such as speaking more slowly and in simple language, other options include writing down the instructions for the patient, asking the patient to go through the instructions with office personnel as a review, and asking the patient how they will implement the instructions once at home.  Although each of these are valuable methods, in a recent study examining the frequency of use and effectiveness of communication techniques, specific approaches were rated by physicians, nurses, and pharmacists as most effective.  These techniques include the teach-back technique, following up with a phone call, and use of models and pictures (Schwartzberg, Cowett, Vangeest, & Wolf, 2007).  Ironically, although these methods were ranked as highly effective, they were also reported as those used the least (Schwartzberg, et al., 2007).                        

Results of one particular study reported on the teach-back technique, or when a clinician asks a patient to repeat information to verify understanding. Using the teach-back method was rated as 92.8% effective by physicians, nurses, and pharmacists, suggesting that the teach-back technique can compensate for limited health literacy not only in patients receiving services from these professionals, but from SLPs, as well. (Schwartzberg, et al.).  For instance, a clinician could inform a parent about how to conduct speech homework with his/her child by giving three or four basic directions.  These directions could include guidelines on how often to review homework, appropriate setting in which to conduct homework, amount of cueing to use, and when to reinforce correct target behavior.  After stating these directions the clinician could then ask the client to repeat them to ensure the client processed the information.            

Research has also shown that following up with the patient via telephone is a very constructive choice, as physicians, nurses, and pharmacists rated this strategy as 84.8% effective (Schwartzberg, et al.).  For example, if an SLP provided a parent with verbal and written instructions on how to assist his/her child in practicing oral motor exercises at home, the SLP could call the parent to ask if he/she had any questions or needed clarification.  I am definitely an advocator for this strategy because I have witnessed a parent enter the end of a therapy session with questions that should have been previously addressed.  The parent said that her daughter was working on oral motor exercises at home but that she neither knew how to help her perform them correctly, nor did she have a clue as to what purpose they served.  Thus, a simple phone call after important information has been relayed to a client or a client’s parent/guardian/family member can be productive.           

Using models and pictures to assist a client in understanding information about a disorder could be very effective (Shwartzbher, et al.).  For instance, if a client has a voice disorder, rather than relying solely on written text as a supplement to explain the disorder, a clinician could use a picture or model of a larynx while describing what is wrong.  A second instance in which using a model or picture could be helpful is with a patient who has a traumatic brain injury. If the patient or a patient’s family wishes to understand why he/she has difficulty with language or has had a change in personality, a clinician could use a model or picture of the brain showing where damage occurred and why the patient was exhibiting certain deficits or traits.                          

Learning about the aforementioned techniques is essential to overcoming limited health literacy in clients, yet it is not enough to simply be aware of them.  An SLP must possess the ability to implement these strategies.  Thus, I present a final method to put to use. Over 40 years ago the “programmed” patient was developed to provide students training to be doctors with realistic patients on which to practice their newly acquired skills and knowledge (Manning & Kripalani, 2007).  After two term modifications, first “simulated” patient and now “standardized” patient, the use of this learning technique is implemented today, and I believe it to be highly adaptable to speech-language pathology (Manning & Kripalani).  If future SLPs had the opportunity to experience a realistic client-clinician interaction they could have the chance to improve their skills and grow comfortable with executing these techniques.  As a result, when an authentic patient has difficulty with health literacy clinicians who had the opportunity to work with a “standardized” patient could be better prepared and more effective in overcoming the barrier to successful treatment. 

Conclusion/Answering               

After researching health literacy I gained knowledge of its general definition, what factors can negatively impact one’s health literacy, the economic implications of poor health literacy in patients, and techniques used by medical professionals that can be modified to compensate for limited health literacy in speech-language pathology.  Because research on the relationship between limited health literacy and health disparities in speech-language pathology has yet to exist, I learned that there is a vast amount of data that demands exploration.  The influences of language, race, and education on health literacy, in addition to factors such as culture and income not mentioned in this text, must be further investigated to better guarantee efficacious speech and language treatment of clients.  It is not sufficient to only know who is at greatest risk for poor health literacy, but why and how to overcome the challenges that emerge as a result of it.             

Somewhere during the long hours of digging through data in search of information pertinent to health literacy and the late nights that consisted of examining the minute amount of literature that does exist, I grew passionate about this topic.  True, there is a never-ending list of issues for speech-language pathologists to explore, but this fact does not suggest that research on health literacy is any less critical to the success of speech-language therapy. Investigations of the best techniques to use to substitute for clients’ limited health literacy, as well as the long-term implications of limited health literacy, are necessities to the advancement of the field I am currently pursuing.  

11-11-07

Aims and Objectives
In addition to finishing the required writing about socio-emotional literacy skills for this week, my main goal was to complete the second rough draft of my research paper as if it were my final so that my meeting with Mrs. Mccomas on Monday would be as helpful as possible. Although it is Sunday night and I am still working on it (partly because I am a perfectionist), I have yet to grow disinterested in the topic.

Declarative Knowledge
I didn’t learn as much this week as I learned last week, but I still gained knew knowledge about my topic. I learned more about the populations that are at greatest risk for having limited health literacy as I concentrated heavily on the aspects of foreign language and its effects. I also learned that there have only been three studies about health literacy as it relates to speech pathology between the years of 1984 and 2003. I also relearned information about socio-emotional skills.

Procedural Knowledge
I cannot say that I learned much in terms of procedures. However, I have continued to regain some abilities in writing a research paper. Again, in the Department of Communication Disorders there has not been much opportunity or requirement to write research papers, so this project is certainly challenging my brain. And, as crazy as this may sound, writing this paper is a relief from the stressors of typical class work and tests — especially Mccomas tests! ) –because I love to write.

Conditional Knowledge
Ultimately, the knowledge I have gained this week through research has shaped the way I think about foreign language and limited English proficiency (LEP) as it relates to speech language pathology. It makes me appreciate those people I can call on to be interpreters as well as those bilingual clinicians to which I can refer patients who speak a different language than me. Regarding socio-emotional literacy skills, I use those every day when I delete suspicious e-mails and use different fonts and texts to more accurately give a message to a friend, professor, or boss.

It does not surprise me in the least that there are specific skills referred to as socio-emotional literacy skills in this era.  The use of computers for every day work, education, and recreation purposes is increasing at an exponential rate, and the better an individual can sort through the extensive amount of information available on the web the more equipped they are to access all that the computer provides.  Education is currently being transformed to incorporate instruction on digital literacy skills, although I am uncertain if the teaching of socio-emotional literacy skills is yet required in the school system .

11-05-07 

Introduction/Questioning

The primary concern speech-language pathologists (SLPs) have is the successful habilitation or rehabilitation of speech, language, and hearing in their clients.  This concern is certainly appropriate considering the SLPs job description, and in no way should it be deemed otherwise. However, an issue that I would argue as an equally essential component to the success of therapy is the comprehension of information given to the client and/or the client’s parents/guardians/family by the SLP.  Without the understanding of what a client’s disorder entails in terms of its challenges, expectations of the client, parent and/or family member for successful treatment, as well as prognosis, therapy is not as effective as it could be.            

Research indicates that poor health literacy, or lack of “the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions”, is a serious adversity in the United States (Health Literacy, 2006).  Only over the past five years has the problem that is health literacy been addressed at the national level (Andrulis & Brach, 2007), and the literature on poor health literacy within the profession of speech-language pathology has yet to be published.  Hence, the objectives of this paper are to delineate the factors that affect a client’s health literacy skills as well as to provide a basic strategic outline that speech-language pathologists can use to better ensure each client‘s understanding of their speech and language health.        

Searching   

Key variables that influence an individual’s health literacy include, but are not limited to, race, language, income, and education.  Across several studies examining health literacy, findings have indicated that race plays a noteworthy role in predicting an individual’s health literacy.  For instance, a study assessing health literacy in African Americans versus Caucasian Adults showed a significantly lower score on the Rapid Estimate of Adult Literacy in Medicine (REALM) than Caucasians, except for groups that had college education (Shea, Beers, McDonald, Quistberg, Ravenell, & Asch, 2007).  According to another article, Integrating Literacy, Culture, and Language to Improve Health Care Quality for Diverse Populations, when the National Assessment of Adult Literacy (NAAL) 2003 statistics were released, black Americans and Hispanics had the highest number of people with poor health literacy skills, 58% and 66% respectively, while those classified as white only had 28% with low health literacy.              

Currently, there is no formal test with which to assess health literacy skills within the field of speech-language pathology.  There is also no formal inventory of possible strategies for SLPs to employ to better ensure a client’s understanding of their speech and language health.  Inside the boundaries of this paper, it is impractical to develop a standardized assessment with which to provide speech-language pathologists.  However, with knowledge of the populations at greatest risk sufficing for the lack of a formal assessment, it is certainly possible to alter the strategies employed by other medical professionals meant to make up for limited health literacy to fit the needs of SLPs.             

Aside from the more obvious and simple strategies to employ, such as speaking more slowly and in simple language, other options include writing down the instructions for the patient, asking the patient to go through the instructions with office personnel as a review, and asking the patient how they will implement the instructions once at home.  Although each of these are valuable methods, in a recent study examining the frequency of use and effectiveness of communication techniques, specific approaches were rated by physicians, nurses, and pharmacists as most effective.  These techniques include the teach back technique, following up with a phone call, and use of models and pictures. Ironically, although these methods were ranked as some of the most effective, they were also reported as those used the least.            

Results of the study entitled Communication Techniques for Patients with Low Health Literacy: A Survey of Physicians, Nurses, and Pharmacists reported on the teach-back technique, or when the clinician asks the patient to repeat information to verify understanding, as well as a follow-up telephone call. Using the teach-back method was rated as 92.8% effective by physicians, nurses, and pharmacists, suggesting that the teach-back technique can compensate for limited health literacy in patients receiving services from a speech-language pathologist as well.  For instance, a clinician could inform a parent about how to conduct speech homework with his/her child by giving three or four basic directions.  These directions could include guidelines on how often to review homework, appropriate setting, amount of cueing, and when to reinforce correct target behavior.  After stating these directions the clinician would ask the client to repeat them to ensure the client processed the information. Using the follow-up telephone call was considered very positive; the strategy was rated as 84.8% effective.                                                

Using models and pictures assist a client in understanding the information about their disorder could be very effective (Shwartzbher, Cowett, VanGeest & Wolf, 2007).  For instance, if a client has a voice disorder, rather than relying solely on written text as a supplement to explain the disorder a clinician could use a picture or model of a larynx while describing what’s wrong.  A second example is a patient with a traumatic brain injury who wants to know why the patient or the patient’s family now has difficulty with language or has had a change in personality. A clinician could use a model or picture of the brain showing where damage occurred and why the patient was exhibiting certain deficits or traits.               

 Over 40 years ago the “programmed” patient was developed to provide students training to be doctors with realistic patients on which to practice their newly acquired skills and knowledge.  After two term modifications, first “simulated” patient and now “standardized” patient, the use of this learning technique is implemented today, and I believe it to be highly adaptable to speech-language pathology (Manning & Kripalani, 2007).               

Conclusion/Answering   

Because research on the relationship between limited health literacy and health disparities has yet to begin, there is a vast amount concerning this issue demanding exploration.  The influences of language, race, income, and education that make up socioeconomic status in addition to factors such as culture and gender that were not mentioned in this text, must be investigated to better guarantee efficacious speech and language treatment of clients.

To Courtney and Katie: I recognize that I still need to expand on language, income, and education as it relates to health literacy as I with race.  I know that I must enlarge my conclusion.  Frankly, please realize that this is a rough draft.  I become very nervous when other people read a rough draft of mine.  I know that I have more work to do (and thought I would get more done but I am so frustrated at the moment because I lost almost an hour of work.  I had to rewrite all of my sources and the citations within the body of my paper in addition to other aspects of my paper because it did not save!  I tried to save it and it closed!!!) 

Shea, J.A., Beers, B.B., McDonald, V.J., Quistberg, D.A., Ravenell, K.L., &Asch, D.A. Assessing Health Lieteracy in African American and Caucasian Adults: Disparities in Rapid Estimate of adult Literacy in Medicine (REALM) Score. Special Articles: health Literacy and Family Medicine, 36 (8), 575-581. Retrieved October 11, 2007 from the Academic Search Premier.

Schwartzberg, J.G., Cowett, A., VanGeest, J., & Wolf, M.S. Communication Techniques for Patients with Low Health Literacy: A Survey of Physicians, Nurses, and Pharmacists. American Journal of Speech Behavior, 31 (Suppl 1), S96-S104. Retrieved October 11, 2007 from the Academic Search Premier.

Manning, K.D. & Kripalani, S. The Use of Standardized Patients to Teach Low-literacy Communication Skills. American Journal of Speech Behavior, 31 (Suppl 1), S105-S110. Retrieved October 11, 2007 from the Academic Search Premier.

Andrulis, D.P. & Brach, C. Integrating Literacy, Culture, and Language to Improve Health Care Quality for Diverse Populations. American Journal of Speech Behavior, 31 (Suppl 1), S122-S133. Retrieved October 11, 2007 from the Academic Search Premier.

Muphy-Knoll, L. Low Health Literacy Puts Patients at Risk: The Joint Commission Proposes Solutions to National Problem. Journal of Nursing Care Quality, 22 (3), 205-209.

Health Literacy (2006). Retrieved October 26, 2007, from http://www.asha.org/members/slp/healthlitearcy.htm

Hester, E. J., & Benitez-McCrary, M. (2006, Dec. 26). Health literacy: Research directions for speech-language pathology and audiology. The ASHA Leader, 11(17), 33-34.