Health Communication in Multilingual Contexts: A Study of Reading Preferences, Practices, and Proficiencies Among Literate Adults in Zambia

Abstract

Comprehension of health materials and messages is a necessary, though not sufficient, condition for the development of health literacy; in the case of print materials, reading comprehension is elemental. Assessments of the population's ability to read and comprehend written materials are complex and highly salient in multilingual countries, such as Zambia, particularly when an excolonial language is but one of multiple official languages. Yet no study has contrasted adult Zambians' reading comprehension of health materials in the major Zambian languages with comparable English-language materials. This article reports the results of a survey of 2,009 literate Zambian adults who were tested for reading comprehension of health materials written at fourth- and eighth-grade levels. The analysis found that respondents who had not gone beyond primary school scored significantly higher on Zambian- than on English-language reading comprehension tests. Respondents with at least an eighth-grade education scored equally well or better on English-language compared with Zambian-language tests. Overall, respondents were more likely to pass the grade-four than the grade-eight reading comprehension tests. In the multilingual context of Zambia it is vital to produce health communication print materials written at or near a grade-four readability level in English and, when warranted, in appropriate Zambian languages.

Notes

¹Funding was provided by the United States Agency for International Development (USAID) under the terms of Cooperative Agreement No. 690-A-00-99-00014-00 through the Zambia Integrated Health Programme Community and Community Partnerships.

²These findings were reported in an unpublished manuscript.

∗Adjusted data.

Note: Percentages add to more than 100 since multiple responses were allowed.

³Some newly arrived immigrants to the region were unable to converse in the local language.

^aThese scores are for those who took the local language tests in their mother tongue. The balance took local language tests in a Zambian language other than their mother tongue.

∗p < .05, ∗∗p < .01, ∗∗∗p < .001, ∗∗∗∗p < .0001.

∗Differences by educational attainment all significant (p < .0001).

∗p < .05, ∗∗p < .01, ∗∗∗p < .001, ∗∗∗∗p < .0001.

^aStatical significance: ∗∗P < 0.01, ∗∗∗∗P < 0.0001.

⁴Again, the research team defined “literacy” for purposes of this study as the ability to read, and correctly answer a question about, a grade-2 level sentence in either a Zambian language or in English. It would be more accurate to refer to this attribute as “minimal literacy.” Yet, that term then would relegate all respondents, including those who are highly literate, to a category that surely underestimates the reading proficiency of many participants in this research.

⁵We use the adjective “objective” for all actions that could have been observed, even if they were not actually observed, by the interviewers. Thus, we avoid privileging the perspective of the observer at the expense of the actor.