A case study of support for girls' access to primary school in Ghana.

The Strategic Approach to Girls' Education (STAGE) project developed and implemented an intervention that helped marginalized out-of-school girls in the northern regions of Ghana enter and be successful in primary school. STAGE builds on the Government of Ghana's Complementary Basic Education policy, which supports an accelerated learning program that provides literacy and numeracy classes in mother tongue to out-of-school girls between 8 and 14 years of age. This article reviews the literature that informed the design of STAGE, describes the intervention, reports on the impact on its participants, and suggests a model for replicating this intervention in Ghana and adapting it for implementation in other countries.

Incorporating health literacy in education for socially disadvantaged adults: an Australian feasibility study.

BACKGROUND: Adult education institutions have been identified as potential settings to improve health literacy and address the health inequalities that stem from limited health literacy. However, few health literacy interventions have been tested in this setting. METHODS: Feasibility study for an RCT of the UK Skilled for Health Program adapted for implementation in Australian adult education settings. Implementation at two sites with mixed methods evaluation to examine feasibility, test for change in participants' health literacy and pilot test health literacy measures. RESULTS: Twenty-two socially disadvantaged adults with low literacy participated in the program and received 80-90 hours of health literacy instruction. The program received institutional support from Australia's largest provider of vocational education and training and was feasible to implement (100 % participation; >90 % completion; high teacher satisfaction). Quantitative results showed improvements in participants' health literacy skills and confidence, with no change on a generic measure of health literacy. Qualitative analysis identified positive student and teacher engagement with course content and self-reported improvements in health knowledge, attitudes, and communication with healthcare professionals. CONCLUSIONS: Positive feasibility results support a larger RCT of the health literacy program. However, there is a need to identify better, multi-dimensional measures of health literacy in order to be able to quantify change in a larger trial. This feasibility study represents the first step in providing the high quality evidence needed to understand the way in which health literacy can be improved and health inequalities reduced through Australian adult education programs.

Evaluation of an Australian health literacy training program for socially disadvantaged adults attending basic education classes: study protocol for a cluster randomised controlled trial.

BACKGROUND: People with low literacy and low health literacy have poorer health outcomes. Literacy and health literacy are distinct but overlapping constructs that impact wellbeing. Interventions that target both could improve health outcomes. METHODS/DESIGN: This is a cluster randomised controlled trial with a qualitative component. Participants are 300 adults enrolled in basic language, literacy and numeracy programs at adult education colleges across New South Wales, Australia. Each adult education institute (regional administrative centre) contributes (at least) two classes matched for student demographics, which may be at the same or different campuses. Classes (clusters) are randomly allocated to receive either the health literacy intervention (an 18-week program with health knowledge and skills embedded in language, literacy, and numeracy training (LLN)), or the standard Language Literacy and Numeracy (LLN) program (usual LLN classes, specifically excluding health content). The primary outcome is functional health literacy skills - knowing how to use a thermometer, and read and interpret food and medicine labels. The secondary outcomes are self-reported confidence, more advanced health literacy skills; shared decision making skills, patient activation, health knowledge and self-reported health behaviour. Data is collected at baseline, and immediately and 6 months post intervention. A sample of participating teachers, students, and community health workers will be interviewed in-depth about their experiences with the program to better understand implementation issues and to strengthen the potential for scaling up the program. DISCUSSION: Outcomes will provide evidence regarding real-world implementation of a health literacy training program with health worker involvement in an Australian adult education setting. The evaluation trial will provide insight into translating and scaling up health literacy education for vulnerable populations with low literacy. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12616000213448 .

Health literacy: exploring future directions and potential contributions from health psychology.

Health psychology has the potential to contribute meaningfully to our understanding of the concept, processes, and outcomes of health literacy. Three areas for discussion are presented here: (1) health literacy as a multimodal concept; (2) the role of the health-care system, the professional, and tools of the trade; and (3) the relevance of social context, participation, and empowerment. The three levels of health literacy proposed by Nutbeam are mapped onto the four evolving approaches in health psychology proposed by Marks to explore the synergy between these research areas. It is hoped that this Special Section on Health Literacy will generate more discussion and activity among health psychologists into health literacy research and practice.

Leave no one behind: improving health and risk communication through attention to literacy.

Twice in recent times, the federal government mailed critical health-related information to every household in the United States. The mailings, the 1988 brochure Understanding AIDS and the 2001 postcard A Message to Americans, were designed to provide the general public with important information about needed action. This paper compares the development process undertaken for each mailing. The authors assess content and format in light of communication principles and the functional literacy skills of average adults. The authors, noting that the reading grade level of the postcard exceeds the reading ability of the average adult, recommend that plain language guidelines be combined with health and risk communication principles in all future efforts to alert the public.