| Summary: | Abstract Introduction The curriculum combines health literacy content and English language instruction and has been specifically designed for Spanish-speaking Hispanic adults with a low-to-intermediate level of English proficiency. One goal is to familiarize students with the particular literacy demands of health care settings so that they are better able to navigate these settings and the reading/writing/communication required within them. This audience-centered curriculum includes content and materials that match the cultural values, communication systems, and rhetorical patterns of the participating audience in order to facilitate the learning process. The curriculum was first presented to a small group of ESL (English as a second language) teachers and students who provided feedback on content and format. It was then piloted over a 2-week period with a group of 12 ESL students. Classes were observed, and notes on curriculum administration and class dynamics were compiled. This information was used to modify the curriculum, for instance, by adjusting the time allotted for classroom activities and adding captions to handouts. A preliminary evaluation with Hispanic immigrants indicated that the curriculum was effective in improving health literacy levels and English proficiency. Methods The 12-unit curriculum can be implemented over 6 or 12 weeks; one unit may be covered weekly, or if implemented as an intensive class, two units may be covered per week. Potential changes in English proficiency, health literacy, and cardiovascular health may not be detected within a shorter implementation period. Each unit is designed to last approximately 3.5 hours, for a total of 42 hours of instruction. Results One hundred fifty-five Hispanic adults completed the intervention and posttest (77 intervention, 78 control). Independent-sample ttests for the unadjusted analysis compared average Test of Functional Health Literacy in Adults (TOFHLA) scores in the intervention and control groups. The intervention group had a mean posttest TOFHLA score of 72.79 (SD = 12.387, N = 77), and the control group had a mean posttest TOFHLA score of 73.69 (SD = 12.437, N = 78). The independent-sample t test produced a p value of .652. The intervention group had an average change score on TOFHLA before and after intervention of 9.4675 (SD = 18.92, N = 77), and the control group had an average change score on TOFHLA of 8.16 (SD = 11.91, N = 78). However, an independent-sample t test for the change scores led to a p value of .61. We further conducted an adjusted analysis using multiple linear regression with postintervention TOFHLA as the dependent variable and group membership as an independent variable adjusted for two covariates, preintervention TOFHLA and length of English class, which were not balanced at the baseline. The adjusted analysis led to a p value of .973 for the group membership. To analyze the change of TOFHLA before and after intervention, we conducted an adjusted analysis using multiple linear regression with change score as the dependent variable and group membership as an independent variable adjusted for another covariate, length of English class, which was unbalanced at the baseline. This adjusted analysis yielded a p value of .025 for group membership. To summarize our analysis, there was no statistically significant difference in the average postintervention TOFHLA scores between intervention and control groups even after adjusting for baseline TOFHLA and length of English classes. There was a statistically significant difference between change in TOFHLA between intervention and control (p = .025) after adjusting for length of English classes at the baseline. Discussion The development and evaluation of this curriculum were funded by the National Heart, Lung, and Blood Institute (National Institutes of Health). Preliminary evaluation results indicate that the curriculum is effective in improving both health literacy and English proficiency among Hispanic adults.
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