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 acolter@gmail.com