Date Presented 03/26/20
Functional literacy is the ability to interpret written words to carry out instrumental activities of daily living, including money and health management, public transportation use, and meal preparation. This study demonstrated that a functional literacy program, embedded in community-based daily activities, could enhance the occupational participation of a group of sheltered homeless adults. OT practitioners can address functional literacy in similar clients with poor literacy skills resulting from disability.
Primary Author and Speaker: Sharon Gutman
Additional Authors and Speakers: Lenin Grajo, Hannah Gelb, Katie Langan, Karen Marx, Devon Paciello, Christie Santana, Ashley Sgandurra, Krysti Teng
Many homeless adults are functionally illiterate as a result of lower educational levels and factors that disrupt the transition from secondary education (e.g., childhood homelessness, successive foster care placements, and the onset of mental illness in late adolescence). Functional literacy, a subset of functional cognition, is the ability to interpret written words/symbols to carry out IADLs including money management, health management, public transportation use, and shopping. Although services have been developed to teach homeless adults reading skills, such programs have traditionally been divorced from literacy skills embedded within IADLs.
PURPOSE: To address this gap, we developed and assessed a functional literacy program for a convenience group of 23 sheltered homeless adults having difficulty with IADLs needed to transition to supported housing (as determined by the shelter director). The intervention was administered in a group setting, held twice weekly in 1.5 hour sessions over 8 weeks, and took place in the shelter and surrounding community. The 16 sessions addressed the interpretation of (1) food package and nutrition labels; (2) package instructions for clothing care and household products; (3) store aisle and community signage; (4) ATM and transportation directions, (5) utility bills, bank statements, and check writing; (6) monthly/weekly budgets, (7) medication labels; and (8) leisure activities. Control group participants did not receive intervention but completed the same pre- and post-measures.
RESEARCH QUESTION: Can a functional literacy program enhance participation in desired IADLs requiring literacy skills with regard to frequency, effectiveness, efficiency, performance, satisfaction, importance, and level of support needed for participation, compared to a control group?
DESIGN: Two group, pretest-posttest with control.
METHOD: The Canadian Occupational Performance Measure (COPM) and the Inventory of Reading Occupations-Adult (IRO-A) were used as pre- and post-assessments to determine whether intervention enhanced reading participation in desired IADLs. A Mann Whitney U test was used to determine whether statistically significant differences existed between the intervention and control group on COPM and IRO-A measures at post-intervention. Effect sizes were calculated using Cohen’s d. Data were analyzed using SPSS version 25; significance level was set at α<.05.
RESULTS: A statistically significant difference was found between intervention and control group COPM performance (Z=-4.075, p<.0001, d=1.02) and satisfaction scores (Z=-4.113, p<.0001, d=1.40) with large effect sizes, indicating that the intervention group reported improved participation in IADLs requiring functional literacy skills, compared to the control group. Statistically significant differences with moderate to high effect sizes were found between intervention and control group IRO-A scores with regard to reading participation frequency (Z=-3.594, p<.0001, d=0.48), effectiveness (Z=-10.673, p<.0001, d=0.68), level of support (Z=-10.410, p<.0001, d=1.81), efficiency (Z=-10.297, p<.0001, d=1.83), satisfaction (Z=-10.359, p<.0001, d=1.84), and importance (Z=-3.459, p<.001, d=0.53). Limitations: small sample size; lack of randomization and follow-up measures.
CONCLUSION: This study demonstrated that a functional literacy program, in which learning was embedded in the IADLs that participants reported as most desired, helped them enhance occupational participation compared to a control group. Impact statement: Functional literacy skills for adults may be best learned when they are embedded in the daily occupations in which they are needed; therapists should address functional literacy skills needed to optimize desired occupational participation.
References
Grajo, L., & Candler, C. (2016a). An occupation and participation approach to reading intervention (OPARI) part I: Defining reading as an occupation. Journal of Occupational Therapy, Schools, and Early Intervention, 9(1), 74-85. http://dx.doi.org/10.1080/19411243.2016.1141082
Grajo, L., & Gutman, S. A. (2019). The role of occupational therapy in functional literacy. Open Journal of Occupational Therapy, 7(1), Article 13. https://doi.org/10.15453/2168-6408.1511
Juchniewicz, M. M. (2012). Visible voices: Literacy identity and the invisible homeless. Journal of Adolescent and Adult Literacy, 55(6), 505-515. doi:10.1002/JAAL.00060
Law, M., Polatajko, H., Pollock, N., Mccoll, M. A., Carswell, A., & Baptiste, S. (1994). Pilot testing of the Canadian Occupational Performance Measure: Clinical and measurement issues. Canadian Journal of Occupational Therapy, 61(4), 191-197. doi:10.1177/000841749406100403
