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One problem encountered by many who work with nutrition and health education programs is the lack of curricular and instructional materials appropriate for adults with low literacy skills. In their seminal work, Doak et al. (1) clearly demonstrated the breadth and depth of this problem in patient education. Systematic methods for determining appropriate written materials for adults with low literacy skills are badly needed. A method that holds promise for identifYing and developing instructional materials for adults with low literacy skills is the Critical Incident Technique (CIT). Studies have shown the CIT to be a powerful approach to identifYing specific behaviors associated with effective and ineffective performance (2). This technique has been adopted by various professions as a strategy for developing educational and training programs. Few studies, however, have used the cq for groups with low levels of literacy. In addition, its application to the development of instructional materials remains unexplored. The purposes of this paper are to provide an overview of the CIT and to report on the use of the CIT in the development of nutrition information materials for adults with low literacy skills.

The purpose of this project was to develop nutrition materials based on bulletins HG 232(1–11), “The Dietary Guidelines and Your Diet”, for use by adults with low literacy skills. A booklet testing at the fifth grade level was designed and tested using qualitative research methods. Participants included 131 women and 21 men, 16 to 60 years of age (mean age 30 years). Sixteen percent were African American, 3% were Native American, 1% were Hispanic, and the remaining 80% were Caucasians. All possessed reading skills from the third to eighth grade levels, and years of education completed ranged from sixth grade to high school graduate (mean of tenth grade). Two sets of interviews were conducted. The booklet was revised based upon results from the first set of interviews. Participants were especially interested in “how to” and “did you know” information, and calorie and nutrient contents of food. Topics of interest included, “Tips on Feeding Young Children”, “Eat Less Fat”, and “Watch Your Weight”. Findings from the interviews provide evidence of the need for nutrition information among these low Uterate adults. Further research with low literate adults is needed to define typical dietary practices, beliefs and perceptions, and barriers to change.