Advancing Readability for Education and Health Equity

Being able to effectively engage with and read digital documents is now a necessity. Research shows that subtle differences in text formatting create dramatic changes in reading speed, comprehension, and accuracy for readers of all ages and levels.

Since 2019, the EdTech Center @ World Education has partnered with Adobe and The Readability Consortium to advance the field of digital text readability. Our work helps to mitigate the challenges faced by those who access information on smartphone devices. Over the past five years, we have field-tested Liquid Mode, a feature of the free Adobe Acrobat Reader which reflows digital text in PDF documents. Liquid Mode reorganizes text, changing its presentation and making it possible for users to control how they view it. This work has spanned continents and continues to grow and evolve to expand the impact of educators and health workers.

In the United States

In the fall of 2020, we collected data on the use of Liquid Mode by practitioners and adult learners. Over the course of two years, we introduced Liquid Mode to 350 adult education teachers and program administrators through professional learning events at national conferences, webinars, and information sessions in four states. Our goal was to support the use of Liquid Mode to improve the readability of PDFs for adult learners whose only access to WiFi and digital information is through a smartphone.

Throughout this research, we heard from adult learners and their teachers that their reading speed, comprehension, and comfortability increased when they could control the PDF’s digital text format. Because of this increased ease using Liquid Mode, and the fact that learners could download PDFs when connected to wifi and use them offline, learners were able to read diverse texts (e.g., school information, health records, restaurant menus, and personal reading) anywhere (e.g., on public transportation, at home, at work).

With the success of this initial field testing and through recognition of the offline functionality of the Adobe Acrobat Reader app, we saw promise in environments with unstable, limited, and/or no connectivity. This led our team to expand research and field-testing to sub-Saharan Africa to learn more about the use of the app and Liquid Mode in these contexts.

In Malawi

World Education’s EdTech Center and Bantwana Initiative teams worked together to field-test Liquid Mode in Malawi from 2023-2024 as part of the USAID funded Ana Patsogolo Activity, which works to reach children and adolescents living with HIV and surround them with integrated social protection supports and health services. In this work, community case workers (CCWs) share vital health information through home visits to their caregivers. Before our field test, CCWs carried large binders of paper documents, called job aids, filled with information on topics like HIV treatment, abuse and neglect prevention, financial literacy, and the importance of education. Maintaining and updating paper job aids was expensive and logistically challenging, so we set out to digitize them, making it possible for CCWs to read them as PDFs on smartphones provided by the initiative.

Our team introduced Liquid Mode to 896 CCWs across eight districts through digital versions of their job aids. At the onset of this project we saw Liquid Mode as a valuable tool to help adults with limited access to the internet engage with digital text in PDFs. Through field-testing, we learned how optimizing reading for digital formats increased not only access and productivity, but privacy as well.

Maintaining privacy was a recurring priority of CCWs because caregivers of children and adolescents living with HIV had not always disclosed their status to their community, or even within their own households. The CCWs shared that the digital job aids afford more confidentiality for clients than the paper binders.

The adoption of Liquid Mode in this community health setting indicates that users can leverage the tool to enhance health service delivery and support both digital and health equity in communities who need it most. This success led us to consider how we could expand our work in new countries and with new Adobe tools.

Where We’re Headed

World Education’s EdTech Center and Adobe have partnered to support JSI India’s work in the Gujarat state to develop just-in-time health media for childcare workers using Adobe Express. Our teams are collaborating to train childcare workers and local staff in Adobe Express to develop this media that supplements their current nutrition and maternal health education resources. We aim to build local expertise to sustain use of Adobe Express to produce resources and help other programs make use of this approach in their work. Our work in India has been supported by Adobe CSR and our non-profit partnership.

We look forward to continuing our partnership with Adobe to support education and health outcomes while advancing digital equity around the world.