Page 95 - Nutrition Counseling and Education Skills: A Guide for Professionals

Practitioners probably encounter illiterate clients more often than they realize, as such individuals hide the
fact that they cannot read. The nutrition professional should be aware of the following comments expressed by
clients in an effort to hide their illiteracy: “I don’t have my glasses with me and will read this later,” or “I broke
my glasses.” Another technique to identify such individuals is to hand them written materials upside down.
Readers normally turn the paper right-side up, whereas nonreaders may not. Another approach is to ask the
person to select a food from a list on the paper and read the word aloud. If the client cannot read the word,
then it is unlikely that he or she knows how to read.

The average reading level of US adults is around eighth-grade level, but among enrollees in Medicaid, it is
only at the fifth-grade level. Typically, health education print materials are written at the tenth-grade level or
higher instead of an appropriate level for the audience—generally fifth-grade level.5 To rectify this imbalance,
nutrition and dietetics professionals may need to test written materials for readability and incorporate more
visuals (graphics and pictures) when educating people with low literacy. They should also keep language
simple and repeat important information. “Dietary cholesterol” and “blood glucose,” for example, are
challenging terms to understand and are inappropriate for this audience. Another suggestion is to keep
sentences short (10–15 words) and use one- and two-syllable words when possible (see Chapter 14).
Paragraphs should also be limited to three or four sentences. To ensure that clients understand the words, the
counselor should ask them to repeat what was said. This is called the “teach-back” method. Actual practice,
such as planning a menu or a grocery shopping list, and role-playing are helpful activities in helping clients
connect words to language. Literacy assessment tools are available for evaluation of written materials. These
and other tools can help professionals promote nutritional literacy among their clients who are illiterate or
have limited literacy (see Chapter 14 for more suggestions on how to develop lower literacy materials).

The principle to remember is to be sensitive to the fact that many clients may have literacy problems that
they may attempt to hide during the assessment process. If the issue of literacy is not properly diagnosed,
addressed, and remedied, the chances of successfully counseling the individual will be greatly reduced. You
also must not assume that clients of a specific culture can read the language commonly used in that culture.
The clients may be nonreaders in their native language, thus requiring the use of more visuals and examples
than written materials.

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