Nearly half of the adult population in the U.S. have low literacy skills. Including these participants in usability studies is important, but they are notoriously hard to recruit. Learn strategies for recruiting participants with poor reading skills and methods for estimating their reading level.

1. Recruiting
Participants with
Low Literacy Skills
Angela Colter (@angelacolter)
UPA 2010
Munich

2. In the United States
44 %
%
of adults have low
literacy skills
2003 National Assessment of Adult Literacy

3. Rate of adults with low literacy skills
Sweden 25%
Netherlands 36%
Germany 42%
Australia 44%
Switzerland 47%
United Kingdom 50%
Ireland 57%
Hungary 67%
Portugal 80%
1998 International Adult Literacy Survey (OECD)

4. People with low literacy
skills likely:
• are older
• have less education
• work low-paying jobs
• are ashamed of their poor reading skills
• hide their reading difficulties from others

5. Reading, like typing, is a skill

6. Do you have low
literacy skills?
Sorry, you can’t ask that

7. Recruiting Process
➊
➋
➌
FIND SCREEN CONFIRM

8. NEVER
tell participants you’re
looking for people with
low literacy skills

9. FIND

10. Where to start
looking
• Adult education
programs
• Friends of qualified
participants
• Public health clinics
• Ex-offender email lists
Photo © 2008 Traci Paris

11. Adult Basic
Education ≠ Adult
Literacy
7th grade & above 6th grade & below
Groups One-on-one
Associated with Free-standing
public schools/ volunteer
community colleges
May have to go No IRB
through school’s
institutional review
board

12. Working with adult education
• Find a program on proliteracy.org
• Build relationships
• Be respectful
• Pay participants
• Pay the literacy program

13. SCREEN

14. How confident are you
filling out medical forms
by yourself?
Extremely
Quite a lot
Somewhat
A little bit Predicts low literacy
83% of the time
Not at all
Wallace L, Rogers E, et al
Screening items to identify patients with limited health literacy skills
Journal of General Internal Medicine. 2006; 21: 874-877

15. CONFIRM

16. REALM
Rapid Estimate of Adult Literacy in Medicine
• Word recognition test fat
flu
fatigue
pelvic
allergic
menstrual
• Quick and easy to administer pill
dose
jaundice
infection
testicle
colitis
• Participant says each word out eye
stress
exercise
behavior
emergency
medication
loud. Scored on number smear prescription occupation
pronounced correctly nerves
germs
notify
gallbladder
sexually
alcoholism
61-66: not low lit meals calories irritation
disease depression constipation
45-60: grade 7-8 cancer miscarriage gonorrhea
19-44: grade 4-6 caffeine pregnancy inflammatory
0-18: grade 3 or below attack arthritis diabetes
kidney nutrition hepatitis
• Doesn’t matter if they know hormones menopause antibiotics
the word’s meaning herpes appendix diagnosis
seizure abnormal potassium
bowel syphilis anemia
asthma hemorrhoids obesity
Davis T, Long S, et al
rectal nausea osteoporosis
Rapid estimate of adult literacy in medicine: a shortened screening instrument
Fam Med. 1993; 25: 391-395 incest directed impetigo

17. Two incentives
• One to qualify ($25)
• One to participate ($25 + $75)

18. To sum up:
• Recruit from sources likely to
include low lit users
• Screen for low lit characteristics
• Confirm literacy level in person
• Pay separate incentives for
confirmation and participation

19. Q&A
Angela Colter
angelacolter.com/lowliteracy
acolter@gmail.com