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The Impact of Health Literacy
Lectures, project presentations, and collaborative class discussion throughout this course have opened my eyes to the topic of health literacy. Health literacy encompasses the ability to comprehend and absorb medical and safety information. This type of information can be found in documents like insurance benefit explanations, hospital discharge instructions, prescription medication administration instructions, and even safety procedures for public transportation.
While the ability to understand health and safety information is impacted by an individual’s reading level, experience, and culture, it is also significantly impeded by the way this information is presented. These documents are routinely written at a dense, complex level of difficulty and are overwhelming to look at. For example, explanations of insurance benefits directly impact an individual’s understanding of their medical benefits but are uniformly distributed to individuals of all ages and education backgrounds with language that is so difficult, they are rarely read or understood.
Throughout this course, I learned the importance of making health information accessible and easily understood to all. This issue is especially relevant to individuals who have communication disorders. A study by Mõttus, et al. (2014) showed a link between poor literacy and poor health outcomes which is due at least in part to low comprehension of medical information. This makes it difficult for a patient to properly take their medication or manage their symptoms independently.
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The role of the speech-language pathologist (SLP) in that case is to remediate these difficulties as much as possible. For example, the client and clinician can incorporate important medical documents into sessions to promote understanding or implement a support system. This might include educating a caregiver or loved one about how to most effectively convey necessary information. This leads to an increase in the individual’s participation in their care as well as their independence which can improve recovery outcomes as well as quality of life.
The Matthew Effect in Literacy
Studies have shown that children who are struggling with reading will continue to fall further behind their peers if they are not provided with appropriate intervention (Kempe, 2011). One factor that can contribute a child’s poor performance in literacy at an early age is the low socioeconomic status of the child’s caregivers. A study by Adams (1990) investigated the frequency of shared book reading in families of varying socioeconomic status. Shared book reading is an example of an emergent literacy promoting activity that helps children build a strong foundation for learning to read in school. It improves a child’s print awareness, vocabulary, and social skills. It also associates reading with pleasure which creates motivation to learn more.
Adams found that children from middle class families entered first grade with approximately one thousand hours of shared book reading under their belt, while children from low income families received approximately 25 hours. When children enter school with little experience with reading, low print awareness, and a poor vocabulary, they are already at a disadvantage. Additionally, when a child begins to struggle with a subject in school, it is difficult to create motivation to improve. Children who are excelling with literacy will continue to push to improve their abilities, and children who are falling behind will tend to withdraw. The disparity between these two groups, without intervention, will continue to grow as the demands of school performance increase with age.
Emergent literacy can also be complicated by factors such as language or developmental delay, dyslexia, and specific comprehension deficits. A child who is falling behind due to one of these diagnoses, will continue to deal with the adversity of poor performance in school, low motivation to participate in literacy activities, with the additional hurdles presented by their delay or disorder.
Early identification and intervention for children with poor literacy performance is crucial to their success. I found this to be one of the most important points discussed throughout this course because learning the skills to develop literacy sets a child up for success for the rest of their life. The longer children are left to struggle in this arena, the wider the gap between them and their peers becomes, and the more difficult it will be for them to catch up. However, this can be avoided with appropriate intervention and education for caregivers and teachers.
The Role of Motivation in Literacy
A child’s success in reading is largely reliant upon their skill set. Examples of necessary skills include phonemic awareness, vocabulary, sight word recognition, among others. However, throughout this course I have learned that in order to participate in the types of literacy enhancing activities that build these skills, children must have motivation. School-age children exhibit three types of motivations: interest, confidence, and dedication. Students who are motivated by interest derive pleasure from reading. Students who are motivated by confidence pursue reading because they know that they are good at it. Finally, students who are motivated by dedication understand that reading is an important skill that will help them to reach their goals.
When a child possesses motivation to engage in a reading activity, their skills typically improve. Similarly, a child who is struggling with their skill level may have difficulty maintaining motivation to read. I believe that rekindling motivation in a child who is experiencing difficulty with reading is crucial to helping them develop the skills that they need to succeed. In order to do this, the three types of motivation can provide guidance. Reading material should have content that is individualized (as much as possible), relevant, and engaging in order to spark the child’s interest. Reading material should also be at a comfortable difficulty level in order to boost the child’s confidence. When a text is too complex or difficult, it is easy for children to become frustrated and want to withdraw. If the text is simplified, the child’s success in reading will build confidence and encourage further participation.
Promoting Early Reading Skills at Home
In the same way that children who are initially behind in their literacy skills will continue to fall behind, children who are initially advanced in their literacy skills will continue to excel. Before children even begin school, caregivers can promote early reading and writing skills at home to set their child up for success. This is an important takeaway for me because I learned that parents (regardless of their education background) can engage their children in simple activities that will introduce important literacy building skills with the added benefit of creating a strong social connection.
Some examples of these activities include reading out loud, picture walks, and print referencing. Reading out loud with a child has endless benefits in the development of reading, writing, cognitive, and social skills. In terms of literacy, this activity helps children to build a strong vocabulary, advance their knowledge of syntax, learn story structure, and develop phonemic awareness and print awareness. Participation will also help a child to develop the social, attention, and memory skills that are required to attend and engage in this activity.
Picture walks entail an adult utilizing the illustrations in a story book to guide the child through the story by using context clues, and then reading the text (if available). Similar to reading out loud, picture walks are a great way to engage a child in learning story structure and challenging them to self-regulate. Print referencing consists of drawing the child’s attention to written language. This can include comments about print, questions about print, or demonstratively tracking the print to show the pattern of reading left to right. Both of these approaches directly teach the organization, function, and forms of print and help children to develop an understanding of how written language works. This understanding is crucial to the development of more advanced literacy skills.
SLPs can assist in this arena by educating caregivers and encouraging them to incorporate these activities at home as a supplement to instruction provided during school hours. This will increase the child’s exposure to literacy and improve their skills and confidence and comfort level in participating in reading and writing.
The Correlation Between Fluency and Reading Comprehension
When a student is reading out loud, the amount of fluency that they exhibit is often a good indicator of how well they are comprehending the text (Treptow, 2007). Fluency is measured by automaticity, accuracy, and prosody. This is a useful tool for SLPs when deciding whether or not a text is too difficult for the student to work with. Motivation is an important factor in developing strong literacy skills and one source of motivation is confidence. If assigned texts are routinely too difficult for a child, they will not develop confidence or motivation to continue practicing. Adjustments can be made to make materials more accessible to students when frustration becomes apparent.
There are three reading fluency levels. The highest level is independent at which a reader exhibits 98-100% accuracy (Treptow, 2007). At this level, the student is not challenged to improve but is continuing to practice their skills and demonstrate competency. Additionally, it is likely that they are comprehending what they are reading. The second level of fluency is instructional, during which the reader is 91-97% accurate. At this level, the student is challenged just enough so that they are reading comfortably but their comprehension requires some support. Below the level of instruction is frustration. The margin between independent, instructional, and frustration are very slim with frustration occurring at less than or equal to 90% accuracy. Students at the frustration level read with little to no expression, multiple errors, and poor comprehension.
I believe that understanding the differences between these levels of fluency is an important step in tailoring reading material to optimize a child’s growth in the realm of reading and comprehension. A child demonstrating frustration (or independence) should build confidence at the independent level and then be challenged at the instructional level, while avoiding the frustration level. Intervention options may include implementing treatment with harder/easier texts, practicing and performing for readers’ theater, or segmenting text into phrases and focusing on prosody.
