Studies which compare the difference between higher literacy users and lower literacy users in health communication have been comparatively rare during the past decade. There has only been sporadic research into comparative studies of the different behaviour of higher literacy users and lower literacy users in searching for information, such as the difference between the reading and navigational strategies of high literacy users and those with lower literacy
skills (Summers and Summers, 2005; Meyanathan et al., 2012), and the differences in information-seeking behavioural strategies between low and high literacy users (Kodagoda & Wong, 2008 ; Kodagoda et al., 2009).
Unlike their higher literacy counterparts, lower literacy readers may read most or all of the words in an instruction and still understand few points or derive no meaning from the text. Doak et al. (1996) explored the difference between the reading behaviour and managing ability of skilled and poor readers and suggested the following strategies to help health practitioners to manage these literacy problems:
Skilled Readers Poor Readers Manage the Problems
Interpret meanings Take words literally Explain the meaning Read with fluency Read slowly, missing the
meaning
Use common words and examples
Get help for uncommon words Skip over the words Use examples, review Grasp the context Misunderstand the context Explain context first using
visuals
Persistent readers Tire quickly Shore segments, easy layout
Table 4 The different reading behaviour and managing ability between skilled readers and poor readers (Doak et al., 1996, p4)
The skill in searching for information is significantly different between higher literacy and lower literacy users. Skilled readers scan the relevant information quickly and resume the search task, whereas poor readers read word-for- word slowly and tend to give up searching in a short time. Meyanathan et al.
navigating behaviour of skilled readers and less skilled readers in the following table:
Skilled Readers Less Skilled Readers
Reading Web Pages
Can quickly scan text and visuals to find essential ideas.
Re-read each word carefully or skip over most information and visuals, especially if the website offers lengthy navigation options.
Scrolling Can scan and scroll through text and go below the “fold” to the next page or computer screen.
Find it difficult to scan the text. Can lose visual concentration when scrolling down.
Searching Can enter search words accurately and make sense of search results, including those that present shortened or chopped text.
Have difficulty spelling search words and interpreting search results.
Attention Span
Attention span is sufficiently long to scan, scroll, and search text
Shorter attention span, leading to a quick decision to stop reading and close the page.
Table 5 The contrast between the reading experience and navigating behaviour of skilled readers and less skilled readers (Meyanathan et al., 2012, p4)
What are the weaknesses of low literacy that hinder users when searching for information? Lower literacy users took eight times longer than higher literacy users to complete an information search task, spent one-third more time on a web page than higher literacy users, visited eight times more web pages in total than higher literacy users in their search for the specific information they needed, used the browser’s back button 13 times more frequently than higher literacy users, and were 13 times more likely to become lost than higher literacy users (Kodagoda & Wong, 2008). Moreover, Kodagoda et al. (2009)
investigated the differences between the information-seeking behavioural strategies of lower and higher literacy users of an on-line social service system. Ten volunteers enrolled in the study, five of whom were classified as having high literacy, while the other five were classified as having low literacy. All the participants were asked to think aloud while undertaking the information search using the “Advice guide” website. The following table shows the results of the investigation:
High- Literate Users Low-literate Users Verification Had 100% verification for medium
and difficult levels
Did not verify the correctness of the information found
Reading Performed a 100% scan of information on easy and medium- difficult levels
Did not scan information at all, but read it word by word
Recovery Identified incorrect or irrelevant information at medium and difficult levels, and were able to recover from a mistake.
Were unable to identify incorrect or irrelevant information in the easy and medium levels, and were unable to recover from a mistake.
Trajectories Presented 100% similar trajectories at the easy level
Showed dissimilar trajectories, except for only 40% of the time if the task was easy.
Abandon Did not abandon their search. Were able to find the necessary
information
Showed a higher tendency to give up the search. Were unable to find the necessary information
Table 6: The differences between the online information-seeking behavioural strategies of lower and higher literacy users (based on Kodagoda et al., 2009)
Based on a review of relevant literature, the reading strategies, information- seeking behaviour, and interface design needs of higher and lower literacy
users are significantly different. It is essential to train health providers to deliver care information which is sensitive to the needs of diverse individuals with varying degrees of health literacy. However, most past studies seem to have two major limitations, one of which is the use of small probability sampling, while the other is the literacy level of participants. It was difficult to recruit participants because of the long duration of testing, while some feedback from the questionnaire may have been distorted because of literacy issues. Any small change in the data may have influenced the results because of the small sample size. Thus, it is important to analyse and validate a larger sample size. Future studies need to recruit a larger sample size and incorporate solutions to literacy issues in order to effectively optimise health intervention.