What is also needed is a more detailed systems map for thinking about health literacy, because what works in one area may not work in another, as just illustrated by the exchange between Evans and Dillaha. Evans says that the whole country is going to be on Internet, while Dillaha says this will not be true of Arkansas. A way is needed to figure out what kind of approach is best tailored for the community being addressed and that relates to priorities in communities. For example, health literacy is not a priority in the prevention community. Neuhauser agreed that the time is right to develop a more detailed, public health literacy systems approach. There are many models out there that can be used or linked, she said, however much work remains.

Yolanda Partida, Roundtable member, asked Neuhauser if, in the programs she described, there was an effort made to standardize translation of terms that have no counterpart in the language into which they are being translated. Neuhauser responded that adaptation of materials for different cultural and linguistic groups can require extensive work. For example, no word exists in various Chinese linguistic groups for some items relevant to Medicaid. An entirely new glossary had to be developed. A participatory process was used to develop new terms and to explain those in the materials in a very simple way.

Ratzan said, given the different understandings of what health literacy is, would it help to develop a term for health literacy that is simple and easily understood? Dr. Evans replied that it would be ideal to have a clearer notion of what health literacy is, as it is not entirely understood even in the public health world, and that branding health literacy in a simple way will lead people to demand it. Dr. Dillaha commented that in Arkansas there is no need to generate demand or to convince people they need it. The challenge is to provide them with the skills they need.

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