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A Proposed Disaster Literacy Model

  • Lisa M. Brown (a1) (a2), Jolie N. Haun (a1) (a2) and Lindsay Peterson (a1) (a2)


Although numerous government, nonprofit, and relief organizations have endeavored to educate and prepare the American public for disasters, adults with physical, mental, and educational disabilities remain among the most vulnerable and least prepared subgroups of the population. The lack of alignment between the literacy demands of existing disaster preparedness and recovery materials and the literacy skills of many vulnerable subgroups limits their ability to understand and effectively use potentially life-saving information. We review the literature on literacy and vulnerable populations, propose a new model for disaster literacy, and describe opportunities for incorporating best practices into planning and preparedness activities. Disaster literacy is defined here as an individual's ability to read, understand, and use information to make informed decisions and follow instructions in the context of mitigating, preparing, responding, and recovering from a disaster. Recommendations are made for developing and evaluating disaster communication materials for vulnerable populations. To meet and improve the disaster literacy of vulnerable populations we suggest pilot-testing and evaluation be routinely used to inform selection of media type, message, and point of contact. (Disaster Med Public Health Preparedness. 2014;0:1–9)


Corresponding author

Correspondence and reprint requests to Lisa M. Brown, PhD, School of Aging Studies, College of Behavioral and Community Sciences, MHC 1318, University of South Florida, 13001 Bruce B. Downs Blvd, Tampa, Florida 33612-3899 (e-mail:


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1.Centers for Disease Control and Prevention. Crisis Emergency Risk Communication: 2012 Edition. Washington, DC: US Department of Health and Human Services. Accessed February 2, 2014.
2.Light, PC. Preparing for the Unthinkable: A Report on the State of Citizen Preparedness. New York, New York: New York University Center for Catastrophe Preparedness and Response; 2005.
3.Veil, SR, Littlefield, RS, Rowan, KE. Dissemination as success: local emergency management communication practices. Public Relat Rev. 2009; 35:449-451.
4.The Council for Excellence in Government. Are we Ready? Introducing the Public Readiness Index: A Survey-based Tool to Measure the Preparedness of Individuals, Families and Communities. Washington, DC: Council for Excellence in Government; 2006.
5.Rothman, M, Brown, LM. The vulnerable geriatric casualty: medical needs of frail older adults during disasters. Generations. 2007; 31:16-20.
6.Altevogt, B, Pope, A, Hill, M, Shine, KI. eds. Research Priorities in Emergency Preparedness and Response for Public Health Wystems: A Letter Report. Washington DC: Institute of Medicine; 2008.
7.Brown, LM, Shiang, J, Bongar, B. Crisis intervention: theory and practice. In: Weidger TA, Stricker G, eds. Comprehensive Handbook of Psychology. New York, New York: John Wiley & Sons, Inc; 2003: 431-451.
8.Brown, LM, Cohen, D, Kohlmaier, JR. Older adults and terrorism. In: Bongar B, Brown LM, Beutler L, Breckenridge J, Zimbardo P, eds. Psychology of Terrorism. New York, New York: Oxford University Press; 2007: 288-310.
9.Institute of Medicine. Speaking of Health: Assessing Health Communication Strategies for Diverse Populations. Washington, DC: National Academies Press; 2002.
10.Brown, LM, Rothman, M, Norris, F. Issues in mental health care for older adults after disasters. Generations. 2007; 31:21-26.
11.O'Brien, N. Emergency Preparedness for Older People. New York, New York: International Longevity Center-USA; 2003.
12.Inter-Agency Standing Committee. Humanitarian Action and Older Persons: An Essential Brief for Humanitarian Actors. New York, New York: Inter-Agency Standing Committee; 2008.
13.Burton, A, Breen, C. Older refugees in humanitarian emergencies. Lancet. 2005; 360:S47-S48.
14.Duggan, S, Deeny, P, Spelman, R, Vitale, CT. Perceptions of older people on disaster response and preparedness. Int J Older People Nurs. 2010; 5:71-76.
15.HelpAge International. Older People in Disasters and Humanitarian Crises: Guidelines for Best Practice. London, United Kingdom: HelpAge International; 2005.
16.Wells, J. Protecting and Assisting Older People in Emergencies. Network Paper No. 53. London, United Kingdom: Humanitarian Practice Network: Overseas Development Institute; 2005.
17.Rudd, RE, Anderson, JE, Oppenheimer, S, Nath, C. Health literacy: an update of public health and medical literature. In: Comings JP, Garner B, Smith C, eds. Review of Adult Learning and Literacy. Mahwah, New Jersey: Lawrence Erlbaum Associates; 2007: 175-204.
18.Federal Interagency Forum on Aging-Related Statistics. Older Americans 2012: key indicators of well-being. Washington, DC: US Government Printing Office; July 2012. Accessed January 31, 2014.
19.Kutner, M, Jin, Y, Paulsen, C. The Health Literacy of America's Adults: Results From the 2003 National Assessment of Adult Literacy. Washington, DC: US Department of Education; 2006.
20.Baker, DW, Parker, RM, Williams, MV, et al.The health care experience of patients with low literacy. Arch Fam Med. 1996; 5:329-334.
21.Bawden, D. Origins and concepts of digital literacy. In: Lankshear C, Knobel M, eds. Digital Literacies: Concepts, Policies and Practices. New York: Peter Lang; 2008: 17-32.
22.Cutter-Mackenzie, A, Smith, R. Ecological literacy: the missing paradigm in environmental education. Environ Edu Res. 2003; 9:497-524.
23.Hogarth, JM. Financial literacy and family and consumer sciences. J Fam Consum Sci. 2002; 94:14-28.
24.Lusardi, A, Mitchell, OS. Financial literacy and retirement preparedness: evidence and implications for financial education. Bus Econ. 2007; 42:35-44.
25.Madi, N, Kamaluddin, A, Janggu, T, Ibrahim, MBA, Samah, ABA, Jussof, K. Tax literacy among employees. Intl J Econ Finance. 2010; 2:218-223.
26.White, JB. The invisible discourse of the law: reflections on legal literacy and general education. Michigan Q Rev. 1982: 420-438.
27.Pegrum, M. I link, therefore I am: network literacy as a core digital literacy. E-Learn Digital Media. 2010; 7:346-354.
28.Prakash, MS. Ecological literacy for moral virtue: Orr on [moral] education for postmodern sustainability. J Moral Educ. 1995; 24:3-18.
29.Savolainen, R. Network competence and information seeking on the internet: from definitions towards a social cognitive model. J Doc. 2002; 58:211-226.
30.Shapiro, JJ, Hughes, SK. Information literacy as a liberal art? Educom Rev. 1996; 31:31-35.
31.US Government Accountability Office. Disaster Preparedness: Limitations in Federal Evacuation Assistance for Health Facilities Should Be Addressed. Report to Congressional Committees (GAO-06-826). Washington, DC: US Government Accountability Office; 2006.
32.Rowel, R, Sheikhattari, P, Barber, TM, Evans-Holland, M. Introduction of a guide to enhance risk communication among low-income and minority populations: a grassroots community engagement approach. Health Promot Pract. 2012; 13:124-132.
33.Savoia, E, Lin, L, Viswanath, K. Communications in public health emergency preparedness: a systematic review of the literature. Biosecur Bioterror. 2013; 11:170-184.
34.US Department of Health and Human Services. Healthy People 2020: health communication and health information technology objectives; 2010. Accessed January 19, 2014.
35.Simonds, SK. Health education as social policy. Health Educ Monogr. 1974; 2:1-25.
36.Berkman, ND, Sheridan, SL, Donahue, KE, Halpern, DJ, Crotty, K. Low health literacy and health outcomes: an updated systematic review. Ann Intern Med. 2011; 155:97-107.
37.Von Wagner, C, Steptoe, A, Wolf, M, Wordle, J. Health literacy and health actions: a review and a framework from health psychology. Health Educ Behav. 2009; 36:860-877.
38.Saha, S. Improving literacy as a means to reducing health disparities. J Gen Intern Med. 2006; 21:893-895.
39.Institute of Medicine. Health Literacy: A Prescription to End Confusion. Washington, DC: National Academies Press; 2004.
40.Baker, DW, Gazmararian, JA, Williams, MV, et al.Functional health literacy and the risk of hospital admission among Medicare managed care enrollees. Am J Public Health. 2002; 92:1278-1283.
41.Koh, HK, Berwick, DM, Clancy, CM, et al.New federal policy initiatives to boost health literacy can help the nation move beyond the cycle of costly ‘crisis care’. Health Affairs (Millwood). 2012; 31:434-443.
42.Abel, T. Measuring health literacy: moving towards a health-promotion perspective. Int J Public Health. 2008; 53:169-170.
43.Sentell, TL, Halpin, HA. Importance of adult literacy in understanding health disparities. J Gen Intern Med. 2006; 21:862-866.
44.American Medical Association. Health literacy: report of the Council on Scientific Affairs. JAMA. 1999; 281:552-557.
45.Brown, LM, Haley, C, Bryant, C. The role of social marketing in developing disaster behavioral health programs. In: Framingham JL, Teasley M, eds. Behavioral Health Response to Disasters. Boca Raton, FL: Taylor & Francis Group; 2012.
46.Kayman, H, Ablorh-Odjidja, A. Revisiting public health preparedness: incorporating social justice principles into pandemic preparedness planning for influenza. J Public Health Manag Pract. 2006; 12:373-380.
47.Brodie, M, Weltzien, E, Altman, D, Blendon, RJ, Benson, LM. Experiences of Hurricane Katrina evacuees in Houston shelters: implications for future planning. Am J Public Health. 2006; 96:1402-1408.
48.US Department of Health and Human Services. Just in Case: Emergency Readiness for Older Adults and Caregivers. Accessed October 27, 2013.
49.Florida Department of Elder Affairs. Disaster Preparedness Guide for Elders. Tallahassee, Florida: State of Florida; 2013.
50.Tanner, A, Friedman, DB, Barr, D, Koskan, A. Preparing for disaster: an examination of public health emergency information on local TV web sites. Electronic News. 2008; 2:218-234.
51.Friedman, DB, Tanwar, M, Richter, JVE. Evaluation of online disaster and emergency preparedness resources. Prehosp Disaster Med. 2008; 23:438-446.
52.Owens, JK, Warner Stidham, A, Owens, EL. Disaster evacuation for persons with special needs: a content analysis of information on YouTube. App Nurs Res. 2013; 26:273-275.
53.Keselman, A, Slaughter, L, Patel, VL. Toward a framework for understanding lay public’s comprehension of disaster and bioterrorism information. J Biomed Inform. 2005; 38:331-344.
54.Friedman, DB, Tanwar, M, Yoho, DW, Richter, JVE. Disaster preparedness information needs of individuals attending an adult literacy center: an exploratory study. Commun Literacy J. 2010; 4:55-73.
55.Joint Committee on National Health Education Standards. National health education standard. Atlanta, Georgia: Centers for Disease Control and Prevention; February 27, 2013. Accessed February 2, 2014.
56.Nutbeam, D. The evolving concept of health literacy. Soc Sci Med. 2008; 67:2072-2078.
57.Paasche-Orlow, MK, Wolf, MS. The causal pathways linking health literacy to health outcomes. Am J Health Behav. 2007; 31:S19-S26.
58.Prochaska, JO, DiClemente, CC. Stages and processes of self-change in smoking: towards an integrative model of change. J Consult Clin Psych. 1983; 51:390-395.
59.Baker, DW, Gazmararian, JA, Sudano, J, Patterson, M. The association between age and health literacy among elderly persons. J Gerontol B Psychol Sci Soc Sci. 2000; 55:S368-S374.
60.Chou, WS, Hunt, YM, Beckjord, EB, Moser, RP, Hesse, BW. Social media use in the United States: implications for health communication. J Med Internet Res. 2009; 11:e48.
61.Centers for Disease Control and Prevention. Improving Health Literacy for Older Adults: Expert Panel Report 2009. Atlanta, Georgia: US: Department of Health and Human Services; 2009.
62.Austin, PE, Matlock, R II, Dunn, KA, Kesler, C, Brown, CK. Discharge instructions: do illustrations help our patients understand them? Ann Emerg Med. 1995; 25:317-320.
63.Michielutte, R, Dignan, MB, Schroeder, EM. The use of illustrations and narrative text style to improve readability of a health education brochure. J Cancer Educ. 1992; 7:251-260.
64.Ngoh, LN. Design, development, and evaluation of visual aids for communicating prescription drug instructions to nonliterate patients in rural Cameroon. Patient Educ Couns. 1997; 31:245-261.
65.Dowse, R. Pictograms in pharmacy. Int J Pharm Pract. 1998; 6:109-118.
66.Houts, PS, Doak, LG, Loscalzo, MJ. The role of pictures in improving health communication: a review of research on attention, comprehension, recall, and adherence. Patient Educ Couns. 2006; 61:173-190.
67.Houts, PS, Witmer, JT, Tringali, CA, Tringali, CA, Bucher, JA, Localio, RA. Using pictographs to enhance recall of spoken medical instructions. Patient Educ Couns. 1998; 35:83-88.
68.Kripalani, S, Love-Ghaffari, MH, Henderson, LE, et al.Development of an illustrated medication schedule as a low-literacy patient education tool. Patient Educ Couns. 2007; 66:368-377.
69.Mansoor, LE. Effect of pictograms on readability of patient information materials. Ann Pharmacother. 2003; 37:1003-1009.
70.Mayer, RE. Cambridge Handbook of Multimedia Learning. New York, New York: Cambridge University Press; 2005.
71.Choi, J. Literature review: using pictographs in discharge instructions for older adults with low-literacy skills. J Clin Nurs. 2011; 20:2984-2996.
72.Zeng-Treitler, Q, Kim, H, Hunter, M. Improving patient comprehension and recall of discharge instructions by supplementing free texts with pictographs. AMIA Ann Symp Proc. 2008; Nov 6; 849-853.
73.Lujan, J, Acevedo, S. Development and testing of a communication card for emergency and disaster preparedness for monolingual Spanish-speaking individuals with low literacy. Internet J Rescue Disaster Med. 2009: 8.
74.National Institute on Aging. Making your website senior friendly. US Health and Human Services website. Accessed October 15, 2013.
75.National Cancer Institute. Clear and simple: developing effective print materials for low-literate readers. National Institutes of Health website. Accessed on October 15, 2013.
76.Brown, KM, Lindenberger, JH, Bryant, CA. Using pretesting to ensure messages and materials are on strategy. Health Promot Pract. 2008; 8:116-122.
77.Frank, RG, Pindyck, T, Donahue, SA, et al.Impact of a media campaign for disaster mental health counseling in post-September 11 New York. Psychiatr Serv. 2006; 57:1304-1308.
78.Haddow, KS, Haddow, G. Disaster Communications in a Changing Media World. Boca Raton, Florida: Taylor and Francis Group; 2011.
79.Weiss, S. Review of communicating emergency preparedness: strategies for creating a disaster resilient public. J Homeland Security Emergency Manage Sci. 2009; 6(9).
80.Brach, C, Keller, D, Hernandez, LM, et al.Ten Attributes of a Health Literate Health Care Organization. Institute of Medicine Roundtable on Health Literacy. Washington, DC: National Academies of Sciences; June 2012.
81.Doak, CC, Doak, LG, Friedell, GH, Mead, CD. Improving comprehension for cancer patients with low literacy skills: strategies for clinicians. CA Cancer J Clin. 1998; 48:151-162.
82.Nutbeam, D. Health literacy as a public health goal: a challenge for contemporary health education and communication strategies into the 21st century. Health Promot Int. 2000; 15:259-267.
83.Löckenhoff, CE, Carstensen, LL. Socioemotional selectivity theory, aging, and health: the increasingly delicate balance between regulating emotions and making tough choices. J Pers. 2004; 72:1395-1424.
84.Aldrich, N, Benson, WF. Disaster preparedness and the chronic disease needs of vulnerable older adults. Prev Chronic Dis. 2008; 5:A27.
85.Elmore, DL, Brown, LM. Emergency preparedness and response: health and social policy implications for older adults. Generations. 2007; 31:66-74.
86.Gibson, MJ, Hayunga, M. We Can Do Better: Lessons Learned for Protecting Older Persons in Disasters. Washington, DC: AARP; 2006.
87.Baker, SM. Vulnerability and resilience in natural disasters: a marketing and public policy perspective. J Public Pol Mark. 2009; 28:114-123.


A Proposed Disaster Literacy Model

  • Lisa M. Brown (a1) (a2), Jolie N. Haun (a1) (a2) and Lindsay Peterson (a1) (a2)


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