The 1993 National Adult Literacy Survey reported that over 40 million U.S. adults were functionally illiterate. Research on literacy and health suggests a strong relationship between low literacy and poor health status. Improving health literacy, the """"""""ability to read, understand, and act on health care information,"""""""" is therefore of great importance to low literate populations. This research will test the relative merit of the Integrated Family Approach Literacy (IFA) Even Start programs (with adults) to the Traditional Adult Literacy (AL) programs. In addition, the research design and theoretically directed health literacy curriculum will enhance both literacy and health literacy outcomes in Illinois participants. Fundamental gaps exist in the scientific literature regarding the relative merit of IFA v. AL programs. This study will address key issues in the literature by empirically testing the IFA and AL approaches using a randomized study design selected from 53 sites in Illinois. Separate but content equivalent health literacy curricula will be developed and tested, under both AL/IFA conditions for English Speakers of Other Languages (ESOL) and native English speakers (ABE/ASE). Established literacy measures required by the State of Illinois will be utilized to measure literacy gains, as well as other measures developed (from curriculum) based on Theory of Planned Action, Social Cognitive Theory, and process measures of curriculum fidelity and implementation. Four fundamental educational assumptions will be tested: (1) the IFA will prove more effective in addressing adult literacy needs than AL programs, (2) adult literacy curricula that include a health literacy component will prove more effective in improving adult literacy than adult literacy curricula that do not include a health literacy component, (3) IFA programs using a health literacy curriculum will be more effective in improving literacy than AL programs using the same curriculum or programs using a standard AL curriculum, and (4) in ESOL programs, the IFA will prove more effective in improving adult literacy than traditional AL programs when using the same health literacy curriculum.
