ABSTRACT
Literacy is generally defi ned as an individual’s ability to read, write, compute, and solve problems at levels of profi ciency necessary to function in society and achieve one’s goals (National Literacy Act, 1991). As many as half of Americans have at least some diffi culty reading and one in fi ve adults demonstrate only rudimentary reading and writing skills. One in fi ve high school graduates demonstrate poor literacy skills, with poorer literacy found in the southern United States than in other regions of the country. Th e U.S. National Literacy Survey showed that as many as 44 million Americans are functionally illiterate, with another 50 million having marginal literacy skills (Kirsh, Jungeblut, Jenkins, & Kolstad, 1993). As many as 90 million people in the United States lack adequate literacy for understanding health information (i.e., health literacy; Institute of Medicine, 2004). Even individuals with adequate literacy for familiar material can experience considerable diffi culty understanding unfamiliar material, such as informed consent and health instructions (American Medical Association [AMA], 1999).
