Apropos of the previous item on patient-provider communication is the issue of adult literacy. The National Center for Education Statistics (NCES) on July 2, 2019 released information about the Program for the International Assessment of Adult Competencies (PIAAC), a large-scale global study of working-age adults (ages 16–65) that assesses adult skills in three domains (literacy, numeracy, and digital problem solving) and collects information on adults’ education, work experience, and other background characteristics. Data summarize the number of U.S. adults with low levels of English literacy and describe how they differ by nativity status and race/ethnicity. PIAAC reports five literacy proficiency levels: from below level 1 to level 4/5. Adults with low levels of literacy are defined, consistent with international reports (OECD 2013), as those performing on PIAAC’s literacy assessment at “level 1 or below” or those who could not participate in the survey.
Four in five U.S. adults (79%) have English literacy skills sufficient to complete tasks that require comparing and contrasting information, paraphrasing, or making low-level inferences, literacy skills at level 2 or above in PIAAC. In contrast, one in five U.S. adults (21%) has difficulty completing these tasks, which translates into 43.0 million U.S. adults who possess low literacy skills: 26.5 million at level 1 and 8.4 million below level 1, while 8.2 million could not participate in PIAAC’s background survey either because of a language barrier or a cognitive or physical inability to be interviewed. Adults classified as below level 1 may be considered functionally illiterate in English.
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