A Two-Pronged Approach to Health Literacy

By Tom Sticht, International Consultant in Adult Education (Ret.)

Improving adults’ health literacy by teaching them reading and writing while also teaching them about good health behavior has been around for a long time. During World War II, the military published a newspaper, Our War, for soldiers who were learning how to read. The September 1945 issue included a cartoon strip featuring the fictitious soldiers Private Pete Smith and his buddy, Daffy. This strip talked about the importance of keeping one’s feet healthy. Here is an extract from the September 1945 edition of Our War:


Daffy: I’m glad that march is over, Pete!
Pete: So am I. But if we keep fit marches won’t be hard for us. The first thing is to look for blisters.
Sergeant: That’s right, Smith. Blisters can cripple any soldier unless he takes care of them.  Every man is taught how to care for his feet.  That is part of first aid. 
Daffy: When do we use this foot powder, Pete?
Pete: We should use it after the shower, Daffy. It will keep us from getting athlete’s foot. 
Daffy (in the shower): Ah! Plenty of soap and hot water … this feels fine.
Pete (after his shower): It certainly does. I’m glad to get into clean clothes again. 
Daffy: The lieutenant says clean clothes are part of keeping fit.
(After a night’s sleep.)
Daffy: Pete, I think I could lick the world this morning.
Pete: It is all a matter of keeping fit. I feel the same way.

A Two-Pronged Approach to Literacy Problems

Twenty-two years later, during the Vietnam War in 1967, I directed R & D teams in a two-pronged approach to the training and utilization of less literate young adults serving in the military. In one approach, we looked at how the adults might be modified through literacy education. This approach led to the development of the Functional Literacy (FLIT) program, which, like the World War II literacy programs, integrated the teaching of reading (decoding written words, sentences, paragraphs) with important content knowledge, including health information such as first aid in battle, surviving chemical and biological warfare, etc. (Sticht, 2018). 
The second approach we followed to improve the training and utilization of less literate adults involved looking at how to modify job materials to make them easier to read and use on the job. This led to the development of a guidebook that discussed the uses of readability formulas and other methods for assessing and redesigning documents and other materials to make them easier to comprehend and use (Kern, Sticht, Welty, & Hauke,1975).

Applications to Contemporary Health Literacy Activities

In 1981, Cecilia C. Doak from Patient Learning Associates, Inc. visited me and we discussed the two-pronged approach to addressing the needs of less literate adults, i.e. modifying the people through functional context education that integrates basic skills (literacy, numeracy) and health knowledge and modifying literacy demands through the redesign of materials. Later, I sent Ceci and her husband, Len, books by colleagues and myself, which discussed this two-pronged approach (Sticht, 1975; Sticht,, Beck, Hauke, Kleiman, &  James, 1974); Kern,  Sticht, Welty, & Hauke,1975). In 1985, these materials were used by Ceci and Len Doak and Jane Root in the first edition of their seminal book Teaching Patients With Low Literacy Skills. Over the following decades, work by Ceci and Len stimulated a large number of initiatives in health literacy.                                                                                                                       

In 1999, National Health Literacy Month was founded by Helen Osborne, who in 2009 presented a podcast about the work of the Doaks, lauding their seminal work in health literacy. Today, National Health Literacy Month is observed annually in October to remind all of us about the importance of being able to read and comprehend information about our health and to better communicate with health providers.

By 2016, the health literacy movement was worldwide. For example, an Australian report (Muscat et al., 2016) once again called attention to the work I had shared with the Doaks and noted that: “The Being Healthy, Staying Healthy program embedded key Learning, Literacy and Numeracy skill development into 29 health-related topics using Functional Context Education methods (an approach to adult learning that embeds functional basic skills within topics that are of relevance and interest to adult learners) (Sticht, 2005).”

With millions of adults in poor health, suffering from poor literacy, and in many cases being poor economically, health literacy advocates have much information to use during this National Health Literacy Month for educating policymakers, private foundations, and businesses about the importance of health literacy education for adults and the use of plain language and other document design techniques for producing more readable and usable health-related informational materials.
Here’s to your health!

Doak, C., Doak, L., & Root. J. (1985). Teaching Patients With Low Literacy Skills. Philadelphia, Pa., Lippincott. 
Kern, R., Sticht, T., Welty, D. & Hauke, R. (1975). Guidebook for the Development of Army Training Literature. (Available online using a Google search).
Muscat et al (2016). Incorporating health literacy in education for socially disadvantaged adults: an Australian feasibility study. . International Journal for Equity in Health. (Available online using a Google search). 
Sticht, T. (1975). Reading for Working: A Functional Literacy Anthology. Alexandria, VA: Human Resources Research Organization. (Available online using a google search)
Sticht, T., Beck, L., Hauke, R., Kleiman, G., &  James, J. (1974).Auding and Reading: A Developmental Model. Alexandria, VA.: Human Resources Research Organization. (Available online using a Google search)
Sticht T. (2005). Functional Context Education: Making Learning Relevant in the
21st Century. (Online at:

Sticht, T. (2018). Mainstreaming Marginalized Adults: The Transformation of Adult Basic Skills Education in the United States. (Online at:


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