Knowledge Is Not Enough: Advancing Health Literacy Through Lessons from History

Abstract

Research that produces nothing but books will not suffice --Kurt Lewin Health literacy is all area of practice and study that is expanding so quickly in the United States and Canada that it is difficult to keep up with the literature--not to mention the steady stream of conference notices. While this is an exciting new development for both adult education and the health professions, the history of adult literacy is crisscrossed with the tracks of bandwagons (Quigley, 1997). seems that few in the current health literacy race are pausing to ask what adults with low literacy skills have actually experienced, or need, or will accept. Even fewer are seeking to hear their voices. Is this the best forward? The findings of a 2001 medical study are instructive. After reviewing 72 controlled experiments concerned with training for self-management of Type 2 Diabetes, the researchers concluded: It is apparent that factors other than knowledge are needed to achieve long-term behavioral change [emphasis added] (Norris, Engelgau, & Narayan, p. 1). Likewise, literature on adult learning tells us that adults need to be part of the learning process--that knowledge is not enough. We should be asking: How can we approach adult learning in health settings and, in turn, enhance health learning in literacy practice to achieve a lasting impact with individuals and with the systems that are intended to serve them? This question is discussed in this article by first looking back at the rich history of adult literacy. Then, the lessons we learned through a health literacy study in Nova Scotia are presented as a possible way for addressing health literacy issues. Literacy as School or Tool? For almost two centuries, adult literacy education has been divided between those who believe literacy education is best delivered through programs using a schooling model and those who believe literacy education should be one of many learning tools for adults. In the literacy-as-schooling tradition, literacy education has typically been constructed with pedagogical curricula influenced by the host profession and/or the sponsoring organization. Conscious of it or not, literacy-as-schooling typically brings ideological goals with its content. These, in turn, are typically founded on assumptions about learners. Although such underlying ideologies have changed as the sponsors have changed through time, such deficit-perspective assumptions have stayed about the same. On the other hand, literacy is approached as a learning tool for adults--a tool to achieve their goals and address life problems. While both approaches effectively seek three objectives, skills development, knowledge acquisition, and values clarification, there is typically more learner input in the learning process with the literacy-as-tool model. The differences between the two models have immediate, critical implications for how health literacy will find its in the 21st century world of adult learning and health. Both models have strengths but, in this article, a third based on the Nova Scotia experience will be suggested to gain the best from both. Literacy-as-School The pattern for the classic literacy-as-schooling model was set as early as 1816, when Dr. Thomas Pole made his argument for the establishment of what became the first documented, sustained English-language adult education literacy program in the Western world. In what is today known as Pole's History (1816), he argued that the many adults who were unable to read the Scriptures--and consequently were doomed to eternal damnation--needed to be taught to read using the Bible itself. As Pole argued, if illiterate adults could read the Scriptures, Industry, frugality, and economy will be their possession. They will also have learned better to practice meekness, Christian Fortitude, and resignation (Verner, 1812/1967, p. …