Efficacy evaluation of the Expecting the Best health literacy curriculum: A pilot study

Background: Low health literacy affects almost half of our national population and is linked to poor health outcomes and higher medical costs. Adults with limited English proficiency are disproportionately affected. Expecting the Best is a fourteen-lesson curriculum designed to increase health literacy among English as a Second Language (ESL) students. We evaluated the efficacy of Expecting the Best among high-beginner ESL students in the community college setting. Methods: Fourteen classrooms from 11 community colleges were randomly assigned to Expecting the Best or comparison (usual curriculum) conditions. Self-administered pre- and post-test outcome measures were collected: a curriculum-based health literacy survey which measured knowledge and skills, and the Short Test of Functional Health Literacy in Adults (STOFHLA). SAS SURVEYREG was used to assess differential change in measures across intervention and comparison classrooms from baseline to post-test over a 16-week period. Results: 177 students enrolled in the study. Regression analyses on students present at both pre- and post- test (n=52) revealed the intervention group had significantly higher improvement than the comparison group on the curriculum-based health literacy measure, while change scores on the STOFHLA were the same for both groups. Gender moderated the relationship between treatment condition and curriculum-based health literacy after controlling for attendance, with only females in the intervention group making significant gains (change score 5.8 (95% CI 5.1, 6.5), p<.0001). Conclusion: Female students exposed to Expecting the Best had greater improvement in health literacy compared to females exposed to usual ESL curriculum. Adult education classes offer a feasible intervention setting.