Recent assessments suggest that 43 million adults in the United States have difficulty completing basic reading tasks. Although the federal Workforce Innovation and Opportunities Act (WIOA) prioritizes education for adults with the greatest needs, there is long-standing concern that federally-funded programs might not serve lower-performing students well. This study sought the perspectives of state administrators of WIOA-funded adult education to identify challenges in serving adults who have difficulty reading and areas for future research. Identifying challenges and creating a robust evidence base can center adults who have difficulty reading as important participants in the field of practice and support the creation of effective strategies for their inclusion and success in WIOA-funded programming.

This essay describes the decline in the number of participants enrolled in federally-funded adult basic education (ABE), adult secondary education (ASE), and adult English Language (EL) programs.Enrollment data since 1965 indicate a steep and consistent downward trend in the number of adults enrolling in these programs since the 1990s.Importantly, since program year 2000-2001, the first year reflecting standardized reporting, there has been a 65.8% reduction in the number of ABE/ASE students enrolling in federally-funded programs and a 49.2% reduction in the number of EL students.The purpose of this article is to highlight the long-term nature of these trends, ask critical questions, and promote further engagement with the topic.

Keywords adult literacy, adult basic education, systemic racism, anti-Blackness, adult education, grade-level equivalencies, assessment

Federal accountability policies requiring rapid, measurable outcomes have increasingly shaped the nature and type of public literacy services available to adults. However, little empirical research has explored the impact of accountability policies on program practice in adult basic education, and almost no research has focused on the effect on services for adults who have difficulty reading. This ethnographically grounded research article explores one publicly funded adult basic education program’s efforts to comply with federal accountability policy and the impact these efforts had on services for adults with difficulty reading. Findings suggest that efforts to comply with accountability policies resulted in instructional practices that limited students’ opportunities for substantive engagement with reading and in program policies that excluded students who did not produce outcomes from participation. The findings also suggest that in the context of accountability pressures, student marginalization became normalized as an ordinary part of practice.

This qualitative research article explores barriers experienced by a group of African American and Latinx adults who sought to enroll and stay enrolled in a publicly funded literacy class and how these barriers were related to policy. Barriers included (a) an inadequate number and type of available classes, (b) a lack of community awareness of classes, and (c) institutional procedures that determined class eligibility. Barriers were created as practitioners attempted to comply with government accountability policy and funding requirements. These findings provoke questions about whether accountability policies promote inequitable access to public adult literacy services for racially minoritized adults.

This research synthesis analyzed qualitative depictions of adult literacy learners and identified five ways in which they are typically characterized: the Heroic Victim, the Needy (Problem) Child, the Broken (but Repairable) Cog, the Pawn of Destiny, and the Capable Comrade. These types do not capture the diversity or complexity of all adult literacy learners, and we do not argue that they are comprehensive. Rather they are representative of the ways in which adult literacy learners are portrayed in the research literature. We argue that each type, like characters in a narrative, drive the action in research, policy, and practice arena. The ways in which they populate research may have very real consequences for how adult literacy learning opportunities are provided and the outcomes that can be expected.

The rate of student departure from adult literacy programs is as high as 80% within the first 12 months (Porter, Cuban, & Comings, 2005). An examination of the literature reveals two perspectives concerning learner persistence: a control perspective and an acknowledgement and accommodation perspective. The control perspective emphasizes the role of programmatic barriers and learners' dispositional attitudes as influences on learner persistence and seeks to remediate the 'problem' of low learner persistence. The acknowledgement and accommodation perspective views low learner persistence as the result of a complex web of factors that includes the lived experiences of individuals in cultural and community contexts, negative systemic social forces such as gender inequality and poverty, and values/goals disjunctures between students and programs. T INTRODUCTION he rate of student departure from adult literacy programs is as high as 80% within the first 12 months (Porter, Cuban, & Comings, 2005). In seeking to understand this phenomenon. 114 Journal of Research and Practice for Adult Literacy, Secondary, and Basic Education • Volume 2, Number2, Summer2013

OBJECTIVE:It is not known how often physicians use metaphors and analogies, or whether they improve patients' perceptions of their physicians' ability to communicate effectively. Therefore, the objective of this study was to determine whether the use of metaphors and analogies in difficult conversations is associated with better patient ratings of their physicians' communication skills.DESIGN:Cross-sectional observational study of audio-recorded conversations between patients and physicians.SETTING:Three outpatient oncology practices.PATIENTS:Ninety-four patients with advanced cancer and 52 physicians.INTERVENTION:None.MAIN OUTCOME MEASURES:Conversations were reviewed and coded for the presence of metaphors and analogies. Patients also completed a 6-item rating of their physician's ability to communicate.RESULTS:In a sample of 101 conversations, coders identified 193 metaphors and 75 analogies. Metaphors appeared in approximately twice as many conversations as analogies did (65/101, 64% versus 31/101, 31%; sign test p < 0.001). Conversations also contained more metaphors than analogies (mean 1.6, range 0-11 versus mean 0.6, range 0-5; sign rank test p < 0.001). Physicians who used more metaphors elicited better patient ratings of communication (rho = 0.27; p = 0.006), as did physicians who used more analogies (Spearman rho = 0.34; p < 0.001).CONCLUSIONS:The use of metaphors and analogies may enhance physicians' ability to communicate.

OBJECTIVES:To determine whether inpatient palliative consultation services improve outcomes of care.DESIGN:Retrospective telephone surveys conducted with family members of veterans who received inpatient or outpatient care from a Department of Veterans Affairs (VA) medical facility in the last month of life.SETTING:Five VA Medical Centers or their affiliated nursing homes and outpatient clinics.PARTICIPANTS:Veterans had received inpatient or outpatient care from a participating VA in the last month of life. One family member completed each survey.MEASUREMENTS:The telephone survey assessed nine aspects of the care the patient received in his or her last month of life: the patient's well-being and dignity (4 items), adequacy of communication (5 items), respect for treatment preferences (2 items), emotional and spiritual support (3 items), management of symptoms (4 items), access to the inpatient facility of choice (1 item), care around the time of death (6 items), access to home care services (4 items), and access to benefits and services after the patient's death (3 items).RESULTS:Interviews were completed with 524 respondents. In a multivariable linear regression model, after adjusting for the likelihood of receiving a palliative consultation (propensity score), palliative care patients had higher overall scores: 65 (95% confidence interval (CI)=62-66) versus 54 (95% CI=51-56; P<.001) and higher scores for almost all domains. Earlier consultations were independently associated with better overall scores (beta=0.003; P=.006), a difference that was attributable primarily to improvements in communication and emotional support.CONCLUSION:Palliative consultations improve outcomes of care, and earlier consultations may confer additional benefit.

OBJECTIVESTo evaluate the FATE (Family Assessment of Treatment at End of Life) Survey for use as a nationwide quality measure in the VA health care system.DESIGNNationwide telephone survey.SETTINGFive VA medical centers.PARTICIPANTSEligible patients received inpatient or outpatient care from a participating VA facility in the last month of life. One respondent/patient was selected using predefined eligibility criteria and invited to participate.MEASUREMENTSThe FATE survey consists of 32 items in 9 domains: Well-being and dignity (4 items), Information and communication (5 items), Respect for treatment preferences (2 items), Emotional and spiritual support (3 items), Management of symptoms (4 items), Choice of inpatient facility (1 item), Care around the time of death (6 items), Access to VA services (4 items), and Access to VA benefits after the patient's death (3 items).RESULTSInterviews were completed with 309 respondents. The FATE showed excellent psychometric characteristics, with good homogeneity (e.g., Cronbach (alpha = 0.91) and no evidence of significant ceiling effects. The FATE also demonstrated good discriminant validity. For instance, FATE scores varied across facilities (range 44-72; Kruskal Wallis test p < 0.001). Patients who were seen by a palliative care service had better scores (mean 66 versus 52; rank sum test p < 0.001), as did patients who were referred to hospice (67 versus 49; rank sum test p < 0.001).CONCLUSIONSThe FATE survey offers an important source of quality data that can be used to improve the end-of-life care of all veterans, regardless of the type of care they receive or their site of death.

To identify aspects of end-of-life care in the U.S. Department of Veterans Affairs (VA) health care system that are not assessed by existing survey instruments and to identify issues that may be unique to veterans, telephone interviews using open-ended questions were conducted with family members of veterans who had received care from a VA facility in the last month of life. Responses were compared to validated end-of-life care assessment instruments in common use. The study took place in four VA medical centers and one family member per patient was invited to participate, selected from medical records using predefined eligibility criteria. These family members were asked to describe positive and negative aspects of the care the veteran received in the last month of life. Interview questions elicited perceptions of care both at VA sites and at non-VA sites. Family reports were coded and compared with items in five existing prospective and retrospective instruments that assess the quality of care that patients receive near the end of life. Interviews were completed with 66 family members and revealed 384 codes describing both positive and negative aspects of care during the last month of life. Almost half of these codes were not represented in any of the five reference instruments (n=174; 45%). These codes, some of which are unique to the veteran population, were grouped into eight categories: information about VA benefits (n=36; 55%), inpatient care (n=36; 55%), access to care (n=33; 50%), transitions in care (n=32; 48%), care that the veteran received at the time of death (n=31; 47%), home care (n=26; 40%), health care facilities (n=12; 18%), and mistakes and complications (n=18; 27%). Although most of the reference instruments assessed some aspect of these categories, they did not fully capture the experiences described by our respondents. These data suggest that many aspects of veterans' end-of-life care that are important to their families are not assessed by existing survey instruments. VA efforts to evaluate end-of-life care for veterans should not only measure common aspects of care (e.g., pain management), but also examine performance in areas that are more specific to the veteran population.

Objective To determine how soap operas Portray, and possibly misrepresent, the likelihood of recovery for patients in coma.Design Retrospective cohort studySetting Nine soap operas in the United States reviewed between 1 January 1995 and 15 May 2005.Subjects 64 characters who experienced a period of unconsciousness lasting at least 24 hours. Their final status at the end of the follow-up period was compared with pooled data from a meta-analysis.Results Comas lasted a median of 13 days (interquartile range 7-25 days). Fifty seven (89%) patients recovered fully, five (8%) died, and two (3%) remained in a vegetative state. Mortality for non-traumatic and traumatic coma was significantly lower than would be predicted from the meta-analysis data (non-traumatic 4% v 53%; traumatic 6% v 67%; Fisher's exact test both P < 0.001). On the day that patients regained consciousness, most (49/57; 86%) had no evidence of limited function, cognitive deficit, or residual disability needing rehabilitation. Compared with meta-analysis data, patients in this sample had a much better than expected chance of returning to normal function (non-traumatic 91% v 1%; traumatic 89% 7%; both P < 0.001).Conclusions The portrayal of coma in soap operas is overly optimistic. Although these programmes are presented as fiction, they may contribute to unrealistic expectations of recovery.

Most adults have been infected with EBV. Many studies have indicated that antibodies against specific EBV antigens, particularly IgA antibodies, can be predictive or prognostic of EBV-associated malignancies, such as NPC. We hypothesized that healthy individuals from families with a history of multiple members affected with NPC (who therefore might be genetically susceptible to NPC themselves) might have an EBV antibody profile that is distinct from that seen in healthy individuals from the community at large. To explore this possibility and examine determinants of anti-EBV antibody levels in healthy, high-risk individuals, we evaluated data from 2 parallel studies of NPC in Taiwan, which included 1,229 healthy members of families in which 2 or more individuals were affected with NPC and 320 controls from the community at large. Blood collected from participants was tested for IgA antibodies against EBV VCA and EBNA-1 and for neutralizing antibodies against EBV DNase using standard assays. We observed evidence of familial aggregation of EBV seroreactivity among individuals from high-risk, multiplex NPC families. Anti-VCA IgA and anti-EBNA-1 IgA antibody seroprevalence in unaffected family members of NPC cases was 5-6 times higher than in members of the community (p < 0.01). This elevated seroprevalence among unaffected individuals from high-risk families was observed regardless of the relationship of the unaffected individual to the closest affected relative (siblings, parents, children or spouses). No sociodemographic or environmental factors examined were found to strongly and consistently correlate with elevated seroprevalence, but patterns emerged of increasing seroprevalence among older individuals and among females. Unaffected individuals from high-risk NPC families have elevated anti-EBV IgA antibody titers. The etiologic and clinical implications of this finding remain to be established.

This qualitative research synthesis of portrayals of adult literacy learners identified five types of “characters” that can have a powerful impact on how the “action” of practice, policy, and research are shaped. The 2013 results of the Programme for the International Assessment of Adult Competencies, (PIAAC) found that only 12% of adults scored at the highest literacy level and 1 in 6 scored at the two lowest levels. Statistics can be parsed into meaningful demographic information to establish, for example, the relationship between literacy level and age, gender, educational attainment, and race/ethnicity. Yet statistics tell us little about who these learners are, including what experiences and resources they bring to the classroom and what challenges they face that may impede learning. Quigley (1997) advanced our descriptive knowledge of how low literate adults are portrayed in popular culture and political discourse, but to date there has been no similarly systematic analysis of the research literature to synthesize descriptions of adult literacy learners. Such an analysis is important because it can clarify and problematize assumptions that drive how we address the needs of learners in practice, research, and policy. We engaged in this process by identifying qualitative studies that describe adult literacy learners as either their primary purpose or as background to research with other purposes. We focused on what they said about who learners are and what experiences, resources, and skills, as well as challenges and struggles they bring to the classroom. We came to realize that our search told us more about the ways in which researchers portray adult literacy learners than about the learners themselves. Therefore, the question that guided our analysis of the literature became, “In what ways are adult literacy learners portrayed in the research literature?” We argue here that these portrayals are important to analyze because they play a meaningful, if indirect, role in influencing practice, research, and policy. Theoretical Framework Street’s (1984) socio-cultural view of literacy played a seminal role in articulating the ideological notion that conceptions of literacy are socially constructed, mediated by history, culture, and the dynamics of power and class. This suggests that how and what people read and write is specific to the setting, the task, the text, the reader/writer, and the intended audience. In this conception of literacy, what the reader/writer brings to the task is of significance, as is the social context in which literacy events (Barton, 1994) occur. What Street called an autonomous view of literacy, in contrast, assumes that literacy is a set of neutral and discrete skills uninfluenced by social context. Research Methods In order to address our research question, we believed a qualitative research synthesis was appropriate as a way to move beyond the rather two-dimensional portrait that can be generated through demographic analysis. While a literature review is summative and descriptive, Sandelowski and Barroso (2007) distinguish the purpose of a research synthesis as