Poor and illiterate individuals may understand complex health related topics. However, in order to sustain the knowledge they will need to reinforce it. Handouts and pamphlets may not be useful. Illustrative pamphlets may not be adequate. Audiovisual tools will be beyond affordability. How can such a population self- reinforce and revise the education provided to them?
Excellent question, Ankur!
I would suggest that these individuals first be assessed for their level self-efficacy as well as level of health literacy. These are valuable markers as starting points and guides throughout the process. The logic being that as an individual's self-efficacy increases, they are more likely to improve their health literacy, and thereby improve their health outcomes (these would thereby serve as the mediators on the causal pathway to better outcomes).
I am attaching a recent paper that discusses the self-efficacy for chronic illness scale. I am also including some references for health literacy:
Kutner, M., Greenburg, E., Jin, Y., & Paulsen, C. (2006). The Health Literacy of America's Adults: Results from the 2003 National Assessment of Adult Literacy. NCES 2006-483. National Center for Education Statistics.
Norman, C. D., & Skinner, H. A. (2006). eHEALS: the eHealth literacy scale. Journal of medical Internet research, 8(4).
Baker, D. W. (2006). The meaning and the measure of health literacy. Journal of General Internal Medicine, 21(8), 878-883.
Thanks Ariel.
I went through the literature that you have provided. The concept of a self efficacy questionnaire to assess level of self efficacy is good, however it is extremely culture specific and it is really difficult to have a single questionnaire that covers the determinants of self efficacy in all the different population groups that differ in religion, caste, class, social beliefs and practices in a multicultural society like India. People in different groups with same self efficacy will answer such a questionnaire differently.
Further, it will still not fulfil the need of a self-reinforcement aid in people who are illiterate and have reasonable level of self efficacy.
Dear Ankur, your question is quite valid, because most of the illiterate belong to low socio - economic status, such people can be educated and empower them to tackle their problem. Here we can apply steps of behaviour change , start to assess about the problem they know or not, if know then how much they know about the problem, they are concerns, if they concerns , then they want to change this behaviour to healthy behaviour, if interested to change then the medium we can use for change , for this message & medium should according to the target specific. One message should be at onetime.I think if we want for sustaining effect of various methods for change, then both audiovisual medium is effective and along with we can use other methods e.g., pictorial. Other ways are we can select peer educator among the target group, then trained the peer educator. These peer educator are more effective,as they are from the same community and know the socio- cultural factors which become the barriers for communication.
Pictures are a great idea. The other form is tactile mats, with various tools on them eg rope, bell buttons, button holes etc
What is the level of mobile phones in the target population? I'm wondering, really outside the box, but what about a pictorial card that has various numbers for recorded messages or downloadable MP3 files for explicit in-depth information.
I believe all of the above suggestions are good. I would recommend consulting with the http://www.nlm.nih.gov/medlineplus/all_easytoread.html-which provides several easy to read/understand materials for health-(National Library of Medicine/NIH). The goal would be to focus on one or two concepts, use large fonts (e.g. 14 pt), etc. A pictorial app would also be great for a phone but this of course depends on availability of phones in the target population. Nothing also substitutes for clear instructions/information from healthcare providers with follow-up. It is always good if a companion accompanies the patient also for all visits/instruction.
Pictorial is great. illiterate people cannot read regardless of the size of the font.
I agree but there are degrees of readability and a person may not be able to read complex materials but might be able to handle simpler information. This is functional illiteracy.
Pictoral card with extension numbers for a particular topic is a great alternative. I feel, mobile phones may be useful, but free hotline numbers with vocal instructions would be a better alternative (people who don't have a cellphone may use public phones). However, the population need to be highly motivated to use it.
Pune based CEHAT and MASUM have already ample material for their project implementation for various groups of persons including illiterate for health and development. Please contact Dr. Ramesh Awasthi and Manisha Gupte of MASUM going through MASUM website. Also Dr. Avhay Shukla of CEHAT going through CEHAT Website.
Dear Ankur
Your exclusion of audio-visual tools almost stopped me from replying to your extremely globally relevant question, but following the discussion persuaded me to try.
I have developped - and still bent on improving- an open source freeware program www.phenomenalog.dk , both for mac and windows laptops. It is a highly user-adaptable digital diary, - presently with english interface (potentially translatable to any other language, if cooperation can be established). Its force as to almost illiterate target groups is its built-in resource of pictograms/glyphs permitting the user to click in as shorthand, automatically timestamped - or alternatively at user selected previous hours the same day. A few, like cigarette,alcohol and medicine will count-up during the day, and there are fields for entering numbers e.g. for bloodpresure, temperature, weight etc.
A special window from the daycard shows the distribution of glyphs over the 24 hours and user can here browse back to inspect the distribution on precious days.
The resource of "glyphs" - which are characters in special fonts - contains only 450 and many of them are clumsy and ill-designed. But the idea is to establish collaboration with users and care-persons to fit the needs of various handicaps and diagnoses.
I will be open to any collaboration which could lead to use and enrichment of the glyph vocabulary, potentially also in new apps, e.g. fit for mobiles.
p.s. I would like to recommend dr Rakesh Biswas and his contribution as editor of a volume: "User-driven Healthcare and narrative medicine" , where he kindly published my dimensions paper.
http://www.phenomenalog.dk
Article Dimensions of the patient journey Contribution to: User-Driv...
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