It is the position of the Canadian Association of Occupational Therapists (CAOT) that health information in plain language is necessary to support equitable access to health services for all clients, including those with low literacy. CAOT supports the use of plain language strategies as a way of organizing and presenting information to ensure that clients understand health communication. CAOT recognizes the major impact of low literacy on the health of Canadians, particularly older adults. The ability to understand, interpret and apply written and oral information is necessary for clients to accomplish daily living tasks, and maintain their independence and self-esteem. CAOT accepts responsibility to share information on health literacy with its members to enable occupational therapists to respond to literacy issues in health communication. As well, CAOT maintains a policy to use plain language in all written materials reaching the general public.
The Canadian results of the International Adult Literacy and Skills Survey (IALSS) released in November 2005, focused on differences in literacy within Canada. Literacy and numeracy were conceptualized “along a continuum of proficiency that indicates how well adults use information in today’s society” (Human Resources and Skills Development Canada and Statistics Canada, 2005, p. 12). Over 23,000 individuals aged 16 and over from each of the provinces and territories responded to the survey. Proficiency results were obtained for four types of literacy: prose literacy, document literacy, numeracy, and problem solving, expressed in 5 levels of proficiency. Level 3 proficiency is considered the minimal skills level for coping with the demands of everyday life and working in today’s complex knowledge and information economy (ABC Canada, 2005). The IALSS findings revealed that 48% of adults had the lowest levels of prose and document literacy and 55% of adults had numeracy scores below level 3. The survey found differences in skill level among provinces and territories, older adults, and immigrants, as well as Anglophone, Francophone and Aboriginal populations. Those respondents who reported poor health scored lower on the document literacy scale than those reporting fair, good or excellent health. The IALSS findings have implications for individuals’ ability to participate in social, political and economic activities of their community, and their ability to access health care and understand health information.
Impact of Low Literacy on Health and Well-Being
Low literacy has a significant impact on health underlying many determinants of health including education, income, social support, personal health practices and employment. Literacy is an important predictor of employment, active participation in the community and health status (Government of Canada, 1999). Health literacy is defined as the ability to “read, understand and act on health care information” (Ad Hoc Committee on Health Literacy for the Council on Scientific Affairs, 1999, p. 552). Health literacy affects the spectrum of health care including clients’ ability to understand information about consent, prevention, diagnoses, and treatment (Ad Hoc Committee on Health Literacy for the Council on Scientific Affairs, 1999). Persons with low literacy skills “often feel alienated and have difficulty finding and understanding health information and services” (Government of Canada, 1999, p. 52). Those with the greatest need for health care, older adults and individuals with chronic disease, have the least ability to read and comprehend health-related materials required to function as a patient. Persons with higher literacy skills may maintain better health because of their ability to understand health information, practice preventive health, and make appropriate choices among health care options.
People with low literacy have limited opportunities and resources to make informed choices about healthy lifestyle practices. The influence of low literacy on health may result in misuse of medication, misunderstanding of health information or instructions, and exposure to safety risks at home, work and in the community (Public Health Agency of Canada, 2003). The indirect impacts of low literacy include poverty, unhealthy lifestyle practices, dangerous environments (such as higher rate of occupational injuries, higher rates of pollution, crime), low self-esteem, higher levels of stress and lack of, or inappropriate use of, health services (Public Health Agency of Canada, 2003).
In summary, literacy is related to multiple aspects of health including health knowledge, health status and use of health services (Ad Hoc Committee on Health Literacy for the Council on Scientific Affairs, 1999). CAOT supports efforts to promote literacy in occupational therapy with all clients; individuals, groups, and organizations.
ABC Canada. (2005). International Adult Literacy and Skills Survey (IALSS). Report summary. ABC Canada, 1-5.
Ad Hoc Committee on Health Literacy for the Council on Scientific Affairs, American Medical Association. (1999). Health literacy: Report of the Council on Scientific Affairs. Journal of the American Medical Association, 281(6), 552-557.
Canadian Public Health Association (1998). Easy Does It! Plain Language and Clear Verbal Communication Training Manual. Ottawa, ON: CPHA.
Government of Canada (1999). Toward a Healthy Future. Second report on the health of Canadians. Ottawa, ON: Health Canada Publications.
Griffin, J., McKenna, K., & Tooth, L. (2006). Discrepancy between older clients’ ability to read and comprehend and the reading level of written educational materials used by occupational therapists. American Journal of Occupational Therapy, 60(1), 70-80.
Human Resources and Skills Development Canada and Statistics Canada. (2005). Building on our Competencies: Canadian results of the International Adult Literacy and Skills Survey (IALLS). Retrieved October 23, 2006 from http://www.statcan.ca/english/freepub/89-617-XIE/89-617-XIE2005001.pdf
National Literacy and Health Program. (2006). NLHP Literacy and health fact sheet. Ottawa, ON: Canadian Public Health Association.
Public Health Agency of Canada. (2003). How does literacy affect the health of Canadians? Retrieved October 4, 2006 from
Position statements are statements on political, ethical and social issues that impact on client welfare or the role and practice of occupational therapy, or that affect the Association. They are frequently time-limited and persons wishing to use them more that two years after publication should confirm their current status by contacting the CAOT Director of Professional Practice by e-mail: firstname.lastname@example.org
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