Integrated Health Literacy Program
“Improving the health literacy of the next generation is critical
to the adoption of healthier lifestyles and proper utilization of healthcare
services. Individuals have to understand basic health principles before
they can become active and effective partners in their own care. We’re
very pleased with the plan that has been put in place for the Worcester
County Public Schools.”
– Michael Franklin, CEO of Atlantic General Hospital
What is Health Literacy?
Health literacy is the ability to obtain, process, and understand basic
health information, allowing an individual to make appropriate health
According to the U.S. Department of Education’s National Assessment
of Adult Literacy, only 12 percent of adults have proficient health literacy.
The study found that individuals with a health literacy level below basic
were much more likely to report their health as being poor and less likely
to use preventive health services than their peers.
What are we doing about it?
The Integrated Health Literacy Program in Worcester County is an award
winning partnership created in 2014 between Atlantic General Hospital,
Worcester County Public Schools and the Herschel S. Horowitz Center for
Health Literacy at the University of Maryland College Park School of Public
Health. As of the 2017-2018 school year, the program has been integrated
county-wide in grades first through eighth.
Integrated Health Literacy Program (IHLP) standards will help guide teachers
in the developing lesson plans for math, reading and other subjects that
include basic health concepts.
The integrated lessons can vary depending on grade level – for example
having students calculate their calorie intake based upon information
on a food label or the proper medication dosage depending on their weight
during a math lesson.
To learn more about the Integrated Health Literacy Program, view our brochure
here. For more information about starting an Integrated Health Literacy Program
in your school district, please contact Julia Perrotta, Health Literacy
Email Us Here.
Our Journey toward Integrated Health Literacy Standards
2017-2018 School Year
With the completion of the 2017-2018 school year, the IHLP is now integrated
into every Worcester County Public School, first through eighth grade.
The results for the 2017-2018 school year demonstrate the positive impact
of the program.
In grade seven, the average health literacy scores increased from pre-test
to post-test. Both 7th and 8th grade showed increasing scores when asked mathematical questions regarding
health facts and nutrition labels. Other findings:
7th graders’ average health literacy score significantly increased from
pre-test to post-test.
There was a statistically significant increase in the percentage of 7th grade students who moved from lower health literacy to higher health literacy
from pre- to post-test.
At post-test, 72.1 percent of 7th grade students reported being extremely confident to say “no”
when a friend is pressuring them to drink alcohol or smoke cigarettes.
This represents a significant increase in confidence from the pre-test.
- Eighth grade had demonstrated improvement in their self-confidence for
making healthy decisions. At post-test, 64.3 percent of the students answered
the following question correctly: “if you could only eat 60 grams
of carbohydrates per day, what is the maximum amount of ice cream per
day you could eat?” This is an increase of nearly 10 percentage
points over pre-test scores.
8th graders showed a significant increase in talking about safety on the Internet
with family and friends from pre- to post-test.
The next steps for the program include a senior health literacy survey
for all 12th grade students of Worcester County Public Schools. The survey
is in development with our IHLP partners, UMD Herschel S. Horowitz Center
for Health Literacy and WCPS. The purpose of the survey is to determine
the long-term effectiveness of the IHLP. Improving health literacy for
the next generation will address the health needs in the community by
reducing their risk of poor health outcomes, decreasing unnecessary visits
to the emergency room and increasing their ability to access appropriate care.
2016-2017 School Year
The Integrated Health Literacy Program (IHLP) is now serving grades 1-6
county-wide and pilots in grades 7 and 8 at Stephen Decatur Middle School
are now taking place. The program is currently serving approximately 3,500 students.
2015-2016 School Year Wrap-Up
The Integrated Health Literacy Program (IHLP) welcomes Ms. Candy Edwards,
from the Maryland Governor's Office for Children, to help present to first
grade students "Lessons in a Lunchbox."
As of the 2015-2016 school year, the IHLP serves more than 2,400 students
(roughly one third of the entire Worcester County school district) in grades one through five. The program is being piloted in grade six
at one local middle school as well.
After a spring term pilot implementation of the IHLP lessons into the curriculum
for second through fifth grades students are post-tested on the topics
covered during those lessons and measurements of health literacy. These
lessons are integrated into their science, social studies, reading language
arts, and math classes. In the post-testing, the University of Maryland
Herschel S. Horowitz Center for Health Literacy (UM) found:
- Second grade students' awareness of food labels increased from 55.5% at
pre-test to 88% after receiving the curriculum.
- 57% of second grade students stated they had poor health literacy at pre-testing.
This dropped to 31% during the post-test evaluation.
- Third graders considered to have a high health literacy increased from
36% pre-test to 78% post-test. Other grades improved by 11% to 28%.
- The percentage of fourth-graders with low health literacy dropped from
14.6% at pre-testing to 4.5% post-test.
- Fifth grade students who reported being "sort of healthy" increased from
38% pre-test to 52% post-test.
Fall / Winter 2015
Pre-testing for second, third, fourth and fifth graders throughout the
county takes place. The roll-out is new to Showell, Buckingham, Snow Hill,
and Pocomoke Elementary and Snow Hill and Pocomoke Middle schools this
year. First grade does not receive testing due to the broad range in development
at this grade level, but they are being introduced to integrated health
Dawn Rogers, principal of Ocean City Elementary School and the school’s
second grade teachers are recognized by the Worcester County Council and
Maryland State Senator Jim Mathias for their efforts in a health literacy
curriculum integration collaborative with Atlantic General Hospital and
the University of Maryland’s School of Public Health.
Second graders at Ocean City Elementary receive a second assessment to
identify any changes in understanding of basic health concepts. The improvement
in health literacy is significant:
- 63% increase in the number of students able to recognize the term “heart
- 41% increase in the number of students that knew how to take their heart rate
- 100% of students were able to identify “My Plate,” a 20% increase
- 58% increase in the number of students reporting they know how to talk
to doctors or nurses about their health
- 76.5% of students believed that advertisements can change the way kids
think about food
Based upon these results, the health literacy partners decide to roll
out lesson plans to all second grade classes at Worcester County public
schools in the 2014-2015 school year. Integrated curriculum will also
be developed and piloted in grades 1, 3, 4, 5 at select schools in the
county. Teachers undergo training during the summer. The position of Health
Literacy Liaison is created at Atlantic General Hospital to coordinate
efforts between the hospital and school system. The goal is for the health
literacy standards to be adopted by the state and, eventually, the nation.
These standards are the first to be developed in the U.S.
Through the hard work and dedication of Atlantic General’s Community
Education Department, the University of Maryland, the Worcester County
Board of Education and the second grade teachers at Ocean City Elementary,
launch a pilot project that integrates the proposed health literacy standards
into daily curriculum.
The goal: to avoid adding another layer of education to their lesson plans.
For example, the teachers will be incorporating a lesson on healthy eating
from a story that they have been using in their language art programs
for several years.
Students are assessed before the new lessons begin to establish a baseline
of their understanding of basic health concepts. A second assessment will
be conducted at the end of the school year to measure improvement.
“The teachers’ knowledge and skill in incorporating these standards
into their existing lesson plans has been crucial to the success of this
program,” states Michael Franklin, AGH president and CEO, “These
teachers are truly laying the groundwork for a successful, sustainable
program. They are making history happen for the benefit of our children
and our community.”
The program is expected to expand to the second grade classes in all Worcester
County elementary schools next school year; the integration of health
literacy standards will also be introduced in all Worcester County elementary
and middle schools in varying grade levels. The data collected from the
expanded pilot will then be used to present the model for adoption into
the Maryland state curriculum changes in 2015.
Atlantic General Hospital receives a $40,000 grant from the Arthur W. Perdue
Foundation to further its efforts to improve the health literacy of Worcester
County’s youth. The Foundation is the charitable giving arm of Perdue Farms.
“At Perdue, we salute the commitment of these health care and education
partners in their efforts to enhance the health and quality of life for
children in Worcester County. This curriculum will engage children in
their formative years and provide valuable lessons for creating a foundation
for healthy living,” states Bill Hetherington, executive director
of the Arthur W. Perdue Foundation. “We’re proud to invest
in their future through this funding from the Foundation.”