Green and Kreuter (1999) reported that simple acquisition of knowledge does not necessarily produce change: there may be motivational and informational gaps. In other words, “getting the message out” does not mean that people will act on the information. There is a need for better understanding of how people learn, as well as what factors influence information-seeking and how literacy contributes to health behaviors. Theories of learning and health education principles can offer explanations for health behaviors and actions and can point to promising ways to create meaningful messages (Meade, 2001). Learning theories can aid in recognizing the mechanisms whereby knowledge, attitudes, and behaviors can be potentially modified and adopted (Bandura, 1977; Becker, 1974; Becker et al., 1977; Bigge, 1997; Hochbaum, 1958; Pender, 1996; Rosenstock, 1966). Freire (1973) suggests that knowledge about health issues can be gained through participatory methods. This approach, called problem-solving education, encourages learners to be critical thinkers about health issues: the process encourages ongoing learner participation and input. This perspective of involving consumers in the educational process is consistent with literacy solutions that value the voice of the people.

Incorporating Health Content into Adult Education Programs

Most classes for adults studying for their high school equivalence are narrowly focused on the requirements of the GED test or other certification system. However, health content has always been part of basic skills and English language services. About 10 years ago, a number of professionals in the field became interested in expanding health content in the ABEL curriculum. This interest arose out of a need to find content that was compelling for adults so as to increase their motivation to practice the language, literacy, and math skills learned in class, and health is a topic of high interest to almost all students. Initial efforts focused on specific diseases, such as breast cancer, and traditional school health topics, such as nutrition. Work by NCSALL has expanded this focus to include the issues of access, navigation, prevention, screening, and chronic disease management (Rudd, 2002).

Adult literacy researchers have begun to empirically examine the effects of using authentic (real-life) materials and activities for teaching adults to read and write. For example, Howard-Pitney et al. (1997) tested the effect of dietary intervention for low-literacy, low-income adults and found an increase in nutrition knowledge. A federally funded study, using a nationwide sample of adult literacy classes and students, found that students whose teachers incorporated texts for real-life purposes (like reading newspapers to learn the news rather than underline the verbs) began to read and write more often in their lives and to read and write more complex texts



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