Recruiting Participants with Low Literacy SkillsAngela Colter (@angelacolter)UPA 2010Munich
In the United States
44%
of adults have low literacy skills
%
2003 National Assessment of Adult Literacy
Rate of adults with low literacy skills
Sweden 25%
Netherlands 36%
Germany 42%
Australia 44%
Switzerland 47%
United Kingdom 50%
Ireland 57%
Hungary 67%
Portugal 80%
1998 International Adult Literacy Survey (OECD)
People with low literacy skills likely:
• are older • have less education • work low-paying jobs• are ashamed of their poor reading skills• hide their reading difficulties from others
Reading, like typing, is a skill
Do you have low literacy skills?
Sorry, you can’t ask that
Recruiting Process
➊ ➋ ➌ FIND SCREEN CONFIRM
NEVER
tell participants you’re looking for people with
low literacy skills
FIND
• Adult education programs
• Friends of qualified participants
• Public health clinics • Ex-offender email lists
Where to start looking
Photo © 2008 Traci Paris
Adult Basic Adult Education Literacy7th grade & above
GroupsAssociated with public schools/
community collegesMay have to go
through school’s institutional review
board
6th grade & belowOne-on-oneFree-standing volunteer
No IRB
≠
Working with adult education
• Find a program on proliteracy.org• Build relationships• Be respectful• Pay participants• Pay the literacy program
SCREEN
How confident are you filling out medical forms by yourself?
Extremely
Quite a lot
Somewhat
A little bit
Not at all
Predicts low literacy 83% of the time
Wallace L, Rogers E, et alScreening items to identify patients with limited health literacy skills
Journal of General Internal Medicine. 2006; 21: 874-877
CONFIRM
REALM Rapid Estimate of Adult Literacy in Medicine
• Word recognition test
• Quick and easy to administer
• Participant says each word out loud. Scored on number pronounced correctly61-66: not low lit45-60: grade 7-819-44: grade 4-6 0-18: grade 3 or below
• Doesn’t matter if they know the word’s meaning
fat fatigue allergic
flu pelvic menstrual
pill jaundice testicle
dose infection colitis
eye exercise emergency
stress behavior medication
smear prescription occupation
nerves notify sexually
germs gallbladder alcoholism
meals calories irritation
disease depression constipation
cancer miscarriage gonorrhea
caffeine pregnancy inflammatory
attack arthritis diabetes
kidney nutrition hepatitis
hormones menopause antibiotics
herpes appendix diagnosis
seizure abnormal potassium
bowel syphilis anemia
asthma hemorrhoids obesity
rectal nausea osteoporosis
incest directed impetigo
Davis T, Long S, et alRapid estimate of adult literacy in medicine: a shortened screening instrumentFam Med. 1993; 25: 391-395
Two incentives
• One to qualify ($25)• One to participate ($25 + $75)
To sum up:
• Recruit from sources likely to include low lit users
• Screen for low lit characteristics
• Confirm literacy level in person
• Pay separate incentives for confirmation and participation
Q&A Angela Colter angelacolter.com/lowliteracy [email protected]