Model Reflective Conversation on Limited Literacy
& Referral to Literacy-Enhancing Services
A parents’ limited literacy translates to limited options
and opportunities to maintain a healthy lifestyle, obtain the full
benefit of healthcare, and support their child’s development.
MCH home visitors, other community health workers and many
clinicians can identify parents with limited basic
literacy skills (reading) without testing, embarrassing or
alienating them. See Blog of May 18.
Once you’ve identified a parent at high risk for low reading skill,
it is time for a reflective conversation. For potentially
difficult-to-discuss topics like this, it is useful to have a
Model Reflective Conversation as a guide.
But wait! Before you have this conversation, it is essential to
become familiar with the literacy-enhancing services in your
area and establish mutually supportive referral relationships with
community partners. Your partner(s) may be a public library family
literacy program, literacy tutors, an adult basic education or English
language learning program. It is not enough to simply have a list of
resources. Visit them. Learn just what you are suggesting parents
participate in. Find out how you can collaborate with program staff
to support parents’ participation.
If you have no literacy services in your community, direct your
attention to advocacy.
Model Reflective Conversation on Literacy
Home Visitor: You are going to get a lot of information about
pregnancy and babies from your doctor, your insurance plan, and
from me. Most of it will be in writing. Many people have trouble
understanding some of the technical and medical words and ideas.
Have you had any problems reading and understanding information
from your doctor or clinic or other places?
Visitor: OK good. (Leave the door open for further discussion) I’m
always happy to review information with you and help figure out what
is important and what it means for you and your family.
OR Parent: Yes
Visitor: (Reassure) Don’t worry; lots of people do.
(Set up the referral) Is it just the medical terms, or do
you think your reading could be better?
Parent: It’s just the medical stuff.
Visitor: OK good. (Leave the door open) I’m always happy to
review information with you and help figure out what is important
and what it means for you and your family. (Give a practical strategy)
When the doctor or nurse, or I use a word you do not understand,
you can just repeat the word, like this:
“Ultrasound?” Or “Ultra what?”
OR Parent: My reading could be better.
Visitor: (Reflect. Discover motivations, desired outcomes)
How would life be different for you and Baby if you were a good
reader? Wait and listen. (Set up the referral) Would you like to
get some help with your
Parent: No, not now
Visitor: (Discover barriers, fears. Plan a baby step toward
participation in a literacy program.) OK, on a scale of 1-10 where
10 is Can’t-wait-to-learn-to-read-well and 1 is not-even-thinking-about-it, where are you now?
What would it take to get to (next number)? How will you know you are
OR Parent: Yes, I’d like help with reading.
Visitor: (Offer Information. Keep the learner in charge of the
learning.) There are some good programs in the area that other
parents I know have really liked. Shall I bring you information
Next: Supporting follow-up and participation in a literacy program.
Note: The two referral questions in bold above are follow up
questions to the ELF Literacy Screen. Yes answers are indicators
of limited basic literacy.
Reference:Bennett,I.M., Robbins, S. & Haecker, T. (2003).
Screening for low literacy among adult caregivers of pediatric patients.
Family Medicine, 35, 585-590.