Exploring nutrition literacy: Attention to assessment and the skills clients need

Heather Gibbs, Karen Chapman-Novakofski

Department of Family & Consumer Sciences, Olivet Nazarene University, Bourbonnais, USA.
Department of Food Science and Human Nutrition, University of Illinois, Urbana, USA.

DOI: 10.4236/health.2012.43019                

Abstract

This exploratory study examines nutrition literacy in two parts: 1) the level of attention to health literacy among nutrition professionals, and 2) the nutrition professional’s perspective of skills/ knowledge needed to understand nutrition education. Part 1 included an online survey in which RD participants (n = 206), recruited from three dietetic practice groups, identified use of health literacy assessments during client education. Most participants (79%) did not use a validated health literacy assessment. There was a significant difference in response to having written materials for different health literacy levels depending on time spent providing nutrition education, with those sending less time in education responding they more often had more materials (Chi-square 8.6, p = 0.035) and depending on job description, public health more often than outpatient dietitian (p = 0.006). Part 2 utilized key informant interviews (n = 8), administered by telephone. Content analysis revealed a significant theme among answers that the skills required for understanding diet education is dependent on the type of diet instruction provided, with diabetes frequently noted as a disease requiring greater knowledge and skills. Nutrition educators need an instrument to assess client nutrition literacy. Potential instruments should assess skills related to portion size estimation, macronutrient knowledge, interpretation of food labels, and food grouping.

Keywords

Nutrition; Literacy; Education; Counseling Skills

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Neilson-Bowman, L. Institute of Medicine (2004) Health literacy: A prescription to end confusion. National Academies Press, Washington DC.
[2]	U.S. Department of Education (2006) The health literacy of America’s adults: Results from the 2003 national assessment of adult literacy. http://nces.ed.gov/naal/
[3]	Flegal, F.M., Carroll, M.D., Ogden C.L. and Curtin, L.R. (2010) Prevalence and trends in obesity among US adults, 1999-2008. Journal of the American Medical Association, 303, 235-241. doi:10.1001/jama.2010.518
[4]	Patton, M.Q. (1990) Qualitative evaluation and research methods. Second Edition, Sage, Newbury Park.
[5]	Patton, M.Q. (1987) How to use qualitative methods in evaluation. Sage, Newbury Park.
[6]	Davis, T.C., Long, S.W., Jackson, R.H., Mayeaux, E.J., George, R.B., Murphy, P.W. and Crouch, M.A. (1993) Rapid estimate of adult literacy in medicine: A shortened screening instrument. Family Medicine, 25, 391-395.
[7]	Parker, R.M., Baker, D.W., Williams, M.V. and Nurss, J.R. (1995) The test of functional health literacy in adults: A new instrument for measuring patients’ literacy skills. Journal of General International Medicine, 10, 537-541. doi:10.1007/BF02640361
[8]	Baker, D.W., Williams, M.V., Parker, R.M., Gazamararian, J.A. and Nurss, J.R. (1999) Development of a brief test to measure functional health literacy. Patient Education and Counseling, 38, 33-42. doi:10.1016/S0738-3991(98)00116-5
[9]	Weiss, B.D., Mays, M.Z., Martz, W., Castro, K.M., DeWalt, D.A., Pignone, M.P., Mockbee, J. and Hale, F.A. (2005) Quick assessment of literacy in primary care: The newest vital sign. Annals of Family Medicine, 3, 514-522. doi:10.1370/afm.405
[10]	Diamond, J.J. (2007) Development of a reliable and construct valid measure of nutritional literacy in adults. Nutrition Journal, 6, 5. http://www.nutritionj.com/content/pdf/1475-2891-6-
[11]	Williams, M.V., Baker, D.W., Parker, R.M. and Nurss, J.D. (1998) Relationship of functional health literacy to patients’ knowledge of their chronic disease. Archives of Intern Medicine, 158, 166-172. doi:10.1001/archinte.158.2.166
[12]	Schillinger, D., Grumbach, K., Piette, J., Wang, F., Osmond, D., Daher, C., Palacios, J., Sullivan, G.D. and Bindman, A.B. (2002) Association of health literacy with diabetes outcomes. Journal of the American Medical Association, 288, 475-482. doi:10.1001/jama.288.4.475
[13]	Sarkar, U., Karter, A.J., Liu, J.Y., Moffet, H., Adler, N.E. and Schillinger, D. (2010) Hypoglycemia is more common among type 2 diabetes patients with limited health literacy: The diabetes study of northern California (DISTANCE). Journal of General Internal Medicine, 25, 962-968. doi:10.1007/s11606-010-1420-z
[14]	American Diabetes Association (2010) Standards of medical care in diabetes 2010. Diabetes Care, 33, S11-S61.
[15]	American Diabetes Association (2008) Nutrition recommendations and interventions for diabetes. Diabetes Care, 31, S61-78. doi:10.2337/dc08-S061
[16]	Pandit, A.U., Tang, J.W., Bailey, S.C., Davis, T.C., Bocchini, M.V., Persell, S.D., Federman, A.D. and Wolf, M.S. (2009) Education, literacy, and health: Mediating effects on hypertension knowledge and control. Patient Education and Counseling, 75, 381-385. doi:10.1016/j.pec.2009.04.006
[17]	Sanders, L.M., Shaw, J.S., Guez, G., Baur, C. and Rudd, R. (2009) Health literacy and child health promotion: Implications for research, clinical care and public policy. Pediatrics, 124, S306-S314. doi:10.1542/peds.2009-1162G
[18]	Devrag, R. and Gordon, E.J. (2009) Health literacy and kidney disease: Toward a new line of research. American Journal of Kidney Disease, 53, 884-889. doi:10.1053/j.ajkd.2008.12.028
[19]	Cook, C., Heath, F. and Thompson, R.L. (2000) A meta- analysis of response rates in web- or internet-based surveys. Educational and Psychological Measurement, 60, 821-836. doi:10.1177/00131640021970934
[20]	Marley, S.C., Carbonneau, K., Lockner, D., Kibbe, D. and Trowbridge, F. (2011) Motivational interviewing skills are positively associated with nutritionist self-efficacy. Journal of Nutrition Education and Behaviour, 43, 28-34. doi:10.1016/j.jneb.2009.10.009
[21]	Townsend, M.S., Sylva, K., Martin, A., Metz, D. and Wooten-Swanson, P. (2008) Improving readability of an evaluation tool for low-income clients using visual information processing theories. Journal of Nutrition Education and Behaviour, 40, 181-186. doi:10.1016/j.jneb.2007.06.011