Development of a tailored health communication resource for low literacy, precontemplation stage smokers using mixed research methods

Background: A widely used patient education method is the use of written health materials. However, 20% of American adults read at the 5th grade level or below. An estimated 90 million US adults have low literacy skills, including difficulty reading and understanding written information. Many of the same populations at risk for limited health literacy suffer from high prevalence of smoking, disparities in health status, illnesses and death.

Methods: A two-phase data collection process utilizing mixed research methods was implemented: 1) A focus group of 6 African American and Hispanic dental clinic smokers using a systematic interview protocol was audio-taped, and subjected to content and thematic analysis; 2) 41 dental clinic smokers completed two surveys: Test of Functional Health Literacy in Adults and Columbia University's Smoking Questionnaire.

Results: The focus group data yielded information related to smoking and its behavioral causes, barriers to smoking cessation, and effective motivators for change specific for this target population. Survey respondents were: 49% African American and 44% Hispanic; 54% had a high school education or less; 71% had adequate health literacy (59%-African American and 31%-Hispanic); stages of change: 35% Precontemplation, 32% Preparation, 15% Contemplation, 12% Action.

Implications: African American and Hispanic smokers with low literacy or motivation to change may benefit from tailored written health information that best fits their needs. This approach is generally effective in assisting individuals change health-related behaviors such as smoking, reducing communication barriers presented by inadequate health literacy, and is likely to enhance participation in smoking cessation programs.