Table 2.

Case scenarios: tobacco use and the six literacy types

Case Study	Literacy Type(s) Required
A group practice has decided to provide smoking prevention resources for teens and their parents on its website. The resources are to be approved by a patient advisory committee. The three sites put forward are Phillip Morris USA’s smoking prevention material site [40], The Smoking Zine by TeenNet at the University of Toronto [41], and Health Canada’s Quit4Life program [42].	Media Literacy: Teens need to know the difference between the perspectives presented on each site to make an informed decision. One site belongs to a tobacco company with a vested interest in selling cigarettes, and it advocates prevention strategies not supported by the best evidence. The other two sites are from a teen-focused research project at a public university and from a government health agency. These three sites together encourage discussion about media issues and allow for exploration with patient-clients the ways in which information on one issue can be presented differently. The Media Awareness Network [37] has resources for working with children and youth in enhancing media literacy that can aid in fostering this discussion.
A 60-year-old man with little formal education and no experience using computers presents with concerns about continuing to smoke. He has made many unsuccessful quit attempts and has been told there are Internet resources available that can help him. He is interested in trying something different to help him stop using tobacco.	Traditional Literacy: A basic literacy assessment should be undertaken before recommending use of the Internet as a resource. This may be done by having the patient read a few simple text passages from consumer health materials or the newspaper or by asking the patient directly if he has difficulties reading. If basic text materials are difficult, the person is likely to require assistance in using the Web or other Internet resources even at a rudimentary level. Computer Literacy: If the man has limited experience with computers, specific training through a local library, community center, or other community program might be necessary to provide him with the means to use Web-assisted tobacco interventions. This requires that the practitioner arrange and assist the patient in connecting with one of these community resources or inquire if there are family members or friends who can assist him in getting online.
A 35-year-old woman presents with an interest in finding information on smoking to share with her teenage daughter. She uses email at work and regularly visits a local website for news, but otherwise does not surf regularly and does not know how to find Internet resources easily.	Information Literacy: A referral to the local library or on-staff librarian (if available) is the simplest strategy. A short tutorial on the use of search engines, search strategies, and health databases can provide the basics on how to navigate the Internet for health information. Once basic search strategies have been established, the patient may wish to use evidence-supported resources for evaluating consumer health information, available through tools such as the DISCERN Project websites [43,44].
A 24-year-old mother of two small children and current smoker challenges the claim that second- hand smoke is harmful to her children, citing research she found on the Internet.	Science Literacy: This scenario presents a teachable moment to outline some of the issues that address science literacy, such as how evidence changes over time and issues of quality. In this case, it may be useful to direct the patient to reference sources outlining contrary views and encourage a dialogue around what makes good science. It is possible the research she has referred to is out of date, contested, or heavily biased (eg, tobacco-industry sponsored).
A 45-year-old patient has been prescribed nicotine replacement therapy (NRT) using an inhaler. The patient is unsure when to use the inhaler and under what conditions and reports behaviors that indicate he is not using the inhaler as originally prescribed.	Health Literacy: The presenting patient is following the product instructions. It is worth exploring the context around this behavior to see if it is a matter of fit between the NRT delivery method and the person or whether it is an issue of literacy. Patient instructions should be reviewed to ensure that they are written in plain language. Practitioners may also wish to explore whether there are other media tools available from the manufacturer or local health unit that can be used to supplement the written instructions, such as visual aids or videos to reduce the amount of required reading.