THE COMMUNICATION PROBLEM POSED BY ILLITERACYStatistics such as those taken from the International Adult Literacy Survey make the state of illiteracy clear. This section will offer some examples of the difficulty this poses for those who attempt to communicate to such audiences. The problem was recognised in a professional marketing publication examining effective, means of reaching consumers, specifically whether direct mail is more effective than phone surveys (Inguanzo, 1997). In the article, its author argues that phone surveys are cheaper than mail outs, when judged on "completions", or response rates. One reason he cites is that those who respond to direct mail self-select. Another, The article's author cites a Journal of the American Medical Association study, "The Test of Functional Health Literacy in Adults", used to measure the ability to read and understand medical instructions and health care information administered to patients in urban public hospitals. The study found that of 2659 patients, 41.6% could not understand directions for taking medicine, 26% were unable to understand information regarding their next appointment, and 59.5% could not understand a consent document (Inguanzo, 1997). He also points out that the numbers in the study were higher for the elderly: more than 80% of those over 60 could not understand directions written at a fourth-grade level for a specific procedure. The author concludes that direct mail rules out too large a percentage of the population (those who cannot read it) to be effective, and indeed that the replies generated may themselves be suspect due to the large percentage of those who receive them being unable to understand properly and therefore properly respond (Inguanzo, 1997). The problems of illiteracy may be most important when they affect health messages. As in the above case, it has been pointed out that basics such as instructions for taking medicine or information about appointments can be misunderstood by those with low level literacy skills.
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