Literacy of Young Adults and Effects on Nursing Introduction

Literacy, often termed the “silent epidemic” or “silent disability,” represents a critical but underappreciated challenge within educational and healthcare systems. Despite considerable progress in education, many adults in the United States struggle with literacy issues that impact their everyday lives, including their ability to navigate the healthcare system effectively. This issue is particularly relevant in nursing education, where understanding and addressing literacy levels can significantly influence patient outcomes and the effectiveness of care. This article explores the relationship between literacy and health, particularly in young adults, and examines how literacy levels are measured and their implications for nursing education and practice.

Terms Related to Literacy

Literacy encompasses more than just the ability to read and write; it includes the capacity to understand, interpret, and use information effectively in various contexts. Terms such as the “silent epidemic,” “silent barrier,” and “dirty little secret” highlight the pervasive and often unnoticed nature of literacy challenges in modern societies (Conlin & Schumann, 2002; Doak & Doak, 1987; Kefalides, 1999; Wedgeworth, 2007). These terms underscore the critical need to address literacy issues as they impact a wide range of socio-economic and health-related outcomes. Despite the significant strides made in educational reforms, the United States continues to rank poorly in adult literacy compared to other industrialized nations (Kogut, 2004).

Assessment of Adult Literacy

The assessment of adult literacy in the United States has been systematically approached through various national surveys. The first major assessment, conducted by the U.S. Department of Education in 1985, was known as the Young Adult Literacy Survey. This was followed by several comprehensive assessments, including the National Adult Literacy Survey (NALS) in 1992 and the National Assessment of Adult Literacy (NAAL) in 2003. These surveys have provided critical insights into the state of literacy among American adults.

The 1992 NALS offered a detailed profile of literacy in the U.S. It categorized literacy into three domains: prose, document, and quantitative skills. The survey revealed alarming statistics, with approximately 21% to 23% of adults scoring at the lowest level of literacy, indicating functional illiteracy. Another 25% to 28% were categorized at Level 2, demonstrating low literacy skills (Fisher, 1999; Weiss, 2003). This suggested that nearly half of the adult population had significant deficiencies in reading, writing, and math.

In 2003, the NAAL provided an updated assessment and introduced a health literacy component. The findings were sobering: 43% of adults were classified as below basic or basic in literacy skills, with significant disparities observed among different demographic groups (National Center for Education Statistics, 2006). Notably, older adults and individuals without high school diplomas were more likely to fall into the lowest literacy categories.

Link between Literacy and Socioeconomic Status

The relationship between literacy and socioeconomic status is profound. Individuals with lower literacy skills are often disproportionately from minority groups and lower socioeconomic backgrounds (Andrus & Roth, 2002; Fisher, 1999; Weiss, 2003). The NAAL highlighted that literacy levels are strongly correlated with socioeconomic factors, including income, employment status, and educational attainment. This correlation underscores the broader implications of literacy deficits, as those with lower literacy often face compounded challenges related to health and well-being.

In 2003, the NAAL’s health literacy component found that 36% of adults had basic or below basic health literacy, with older adults exhibiting the lowest levels of health literacy (Baer, Kunter, & Sabatini, 2009; National Center for Education Statistics, 2006). This indicates that low literacy can adversely affect an individual’s ability to understand and manage their health, leading to poorer health outcomes.

Measurement of Literacy Levels

The measurement of literacy has evolved over time, with various tools and assessments providing insights into adult literacy levels. The NAAL categorized literacy skills into four levels: below basic, basic, intermediate, and proficient. The 2003 assessment revealed that 43% of U.S. adults fell into the lowest two categories, indicating significant challenges in literacy (National Center for Education Statistics, 2006).

The Program for the International Assessment of Adult Competencies (PIAAC), conducted in 2012 and 2014, provided a global perspective on literacy. The PIAAC assessed literacy on a scale from 0 to 500, with categories including below Level 1, Level 1, Level 2, Level 3, and Level 4/5. The findings showed that American adults generally scored below the international average, with only 13% achieving the highest levels of proficiency (ProLiteracy, 2017; Rampey et al., 2016). The PIAAC also assessed problem-solving skills involving technology, revealing that only 5% of U.S. participants scored at the highest proficiency level, further highlighting literacy and technology gaps (Rampey et al., 2016).

Link between Literacy and Health in Nursing Education

The link between literacy and health is critical, particularly in the context of nursing education and practice. Limited literacy is a significant predictor of poor health outcomes, often surpassing other factors such as income, employment status, and education level (Weiss, 2007). Individuals with low literacy skills tend to have less knowledge about their health conditions, higher rates of hospitalization, increased emergency department visits, and poorer overall health (Eichler et al., 2009; Weiss, 2007; Weiss et al., 2005).

A study by McNaughton et al. (2015) found that patients with low health literacy scores were at a higher risk of death after hospital discharge, underscoring the critical need for effective literacy interventions in healthcare settings. The impact of low literacy on health is exacerbated by various trends, including the increasing complexity of healthcare information and the growing reliance on digital health tools. Addressing literacy issues in nursing education is essential for improving patient outcomes and ensuring that healthcare providers can effectively communicate with and support their patients.

Implications for Nursing Education

Nursing education plays a crucial role in addressing literacy challenges and improving health outcomes. Educators must be aware of the literacy levels of their students and patients and tailor their teaching strategies accordingly. This involves integrating literacy assessment into nursing curricula, emphasizing the importance of clear communication, and developing strategies to support patients with low literacy skills.

Key strategies for nursing education include:

1. Incorporating Literacy Assessments: Nursing programs should include literacy assessments as part of their curriculum to ensure that students are equipped to identify and address literacy challenges among patients. This involves training nurses to recognize signs of low literacy and providing them with tools and strategies to improve patient education.
2. Developing Clear Communication Skills: Nurses must be trained to communicate complex health information in simple, understandable terms. This includes using plain language, visual aids, and interactive tools to enhance patient comprehension.
3. Creating Supportive Environments: Nursing educators should foster supportive learning environments that address diverse literacy needs. This involves providing resources and accommodations for students and patients with varying literacy levels and ensuring that educational materials are accessible and engaging.
4. Emphasizing Health Literacy: Health literacy should be a key focus in nursing education, with an emphasis on teaching students how to assess and address health literacy challenges. This includes understanding the impact of literacy on health behaviors and outcomes and developing strategies to improve patient engagement and self-management.
5. Utilizing Technology: As technology plays an increasingly important role in healthcare, nursing education must address the digital literacy skills required for effective use of health information technology. This involves training students to use digital tools and resources to support patient education and self-care.

Conclusion

The intersection of literacy and nursing education is critical for improving health outcomes and addressing the challenges faced by individuals with low literacy skills. By incorporating literacy assessments, developing clear communication strategies, and emphasizing health literacy, nursing education can play a pivotal role in enhancing patient care and outcomes. Addressing literacy issues is not only a matter of educational reform but also a fundamental aspect of providing equitable and effective healthcare. As we continue to navigate the complexities of modern healthcare, it is essential to prioritize literacy as a key component of nursing education and practice.