Examining the relationship between demographic variables and perceived health literacy challenges in Tasmania, Australia.

ISSUE ADDRESSED: Whilst there is a relationship between health literacy and health outcomes, the importance of social and personal demographic characteristics remains understudied., Identifying the factors responsible for creating health literacy challenges would help ensure that responses are tailored to individual or community needs. METHODS: This survey included questions from five domains from the Health Literacy Questionnaire. Descriptive analyses and hierarchical regression were used to explore the relationship between the demographic characteristics and health literacy. Qualitative questions were subjected to thematic analysis, to identify the current barriers and proposed solutions. RESULTS: A total of 255 participants completed the survey. Demographic characteristics that significantly predicted lower Health Literacy Questionnaire scores were having one or more chronic health conditions and living in an area of more socioeconomic disadvantage. Participants found 'navigating the health care system' the most difficult of the five elements measured. A total of 276 individual barriers to health literacy were identified and 162 solutions proposed. CONCLUSIONS: This study provides an overview of our sample's health literacy and how their social demographic characteristics may predict their health literacy challenges. Findings from this study can be used to develop targeted interventions to respond to specific health literacy challenges identified within this population. SO WHAT?: Distinct from other research, whereby solutions are proposed by researchers, the participants in this study were encouraged to share their health literacy challenges and outline potential solutions to address these in their local context.

HealthLit4Kids: Supporting schools to be health literacy responsive organisations.

ISSUE ADDRESSED: To reduce inequity, services and community organisations must respond to the health literacy needs and strengths of each individual accessing their services. As a social determinant, health literacy is compounded by interactions between the service provider, the individual, and their wider community. Schools provide a critical nexus between the teacher (as service provider), the student (as learner) and their family (carers and wider community) to support the development of children's health literacy. METHODS: Five Tasmanian primary schools (84 teachers) completed an assessment of their school in relation to the domains of a health literate organisation using the HeLLOTas! (HEalth Literacy Learning Organisations Tasmania) Self-Assessment Checklist, before and after taking part in the HealthLit4Kids program. RESULTS: While the differences between pre- and post-intervention ratings were not large, they moved in a positive direction for all six domains. There was a significant main effect of time, F (1, 4) = 83.9, P < .001, ƞ2  = 0.99, showing that overall ratings increased from before to after the intervention. Teacher-recommended actions across all schools were grouped for insight into their interpretation and application of the tool in the school context. CONCLUSION: Using the HeLLOTas! Self-Assessment Checklist served a dual purpose. Teachers developed a shared understanding of the characteristics of a health-literate organisation to produce a schoolwide action plan. Simultaneously, we gained valuable insights into the processes required to support the development of organisational health literacy in schools, and we share ten propositions applicable to other schools locally, nationally and internationally. SO WHAT?: To the best of our knowledge, this is the first time that a school's health literacy responsiveness has been measured. Our key propositions will support future efforts by policy makers, researchers and school principals.

Risk factors for executive function difficulties in preschool and early school-age preterm children.

AIM: To investigate the relationship between executive functioning and social and perinatal risk factors in four- to five-year-old preterm children. METHODS: Using standardised measures of general intelligence and performance-based executive function (EF) tests prior to starting kindergarten, 141 children born preterm (<33 weeks of gestation) and 77 term comparison children were assessed. Parental and teacher reports of executive functioning were completed when the children commenced kindergarten. The preterm and the term comparison groups were compared on measures of intelligence and EFs using independent-groups t-tests, and multivariate regression analyses were performed to identify factors predictive of intelligence and executive functioning in the preterm group. RESULTS: The preterm group performed significantly more poorly than the comparison group on all intelligence and EF tests. The parental reports of the preterm and term comparison children's EF did not differ significantly, but the teachers reported elevated EF difficulties for the preterm group. Higher social risk, in particular lower educational level of the main caregiver, was the strongest predictor for the preterm children's intelligence and EF results. CONCLUSION: Social risk factors are strongly associated with impaired early EF outcomes in preterm children.

Public health agencies' use of social media for communication during pandemics: a scoping review of the literature.

Public health agencies (PHAs) have increasingly incorporated social media into their communication mix during successive pandemics in the 21st century. However, the quality, timing, and accuracy of their health messages have varied significantly, resulting in mixed outcomes for communication, audience engagement, and pandemic management. This study aimed to identify factors influencing the effectiveness of pandemic-related health messages shared by PHAs on social media and to report their impact on public engagement as documented in the literature. A scoping literature review was conducted following a predefined protocol. An electronic search of 7 relevant databases and 5 grey literature repositories yielded 9,714 papers published between January 2003 and November 2022. Seventy-three papers were deemed eligible and selected for review. The results underscored the insufficiency of social media guidance policies for PHAs. Six themes were identified: message source, message topic, message style, message timing, content credibility and reliability, and message recipient profile. These themes encompassed 20 variables that could inform PHAs' social media public health communication during pandemics. Additionally, the findings revealed potential interconnectedness among the variables, and this study concluded by proposing a conceptual model that expands upon existing theoretical foundations for developing and evaluating pandemic-related health messaging.

The imperative to develop health literacy: An ethical evaluation of HealthLit4Kids.

An imperative exists to promote health literacy (HL) development in today's young people. Included in curricula worldwide, health literacy has been recognised as a social determinant in its own right, which has the potential to redress inequity and positively impact health and educational outcomes. While it has been shown that schools provide an ideal setting to support HL development, available evidence suggests that health may be undertaught in primary schools, and further resources are required to support educators' inclusion of HL in their lessons. The aims of this paper were to (1) highlight the ethical imperative to promote HL through schools and (2) provide an ethical evaluation of an existing HL intervention. Spike's (2018) four principles for public health ethics were employed as a framework for evaluating a program's ethical status and suitability in the school setting. In this paper, one program, HealthLit4Kids, is evaluated according to Spike's framework, and shown to be an ethically acceptable approach to foster HL in young people. These results model how other HL programs may be evaluated and offer critical insights concerning how HL could be promoted in an ethically acceptable manner in the classroom.

An International Review to Characterize the Role, Responsibilities, and Optimal Setting for Health Literacy Mediators.

Health literacy is a critically important determinant of health and is influenced by access to supportive social networks and services. Global investment in education throughout the life course is required to support health literacy development. The aim of this review is to characterize the role, responsibilities, and the optimal setting for the emergent role of a Health Literacy Mediator (HLM). A scoping review of recent literature was conducted. The review revealed a lack of consensus on who should be teaching health literacy, and variability in confidence when teaching health literacy. Professionals reported facing barriers such as a lack of time, a lack of knowledge, and recognized that the health literacy needs of children worldwide are not being met. Further research into the role of HLM is required to determine who is best suited to this role and what their responsibilities will be to ensure consistent health literacy education.

Parent and teacher reporting of executive function and behavioral difficulties in preterm and term children at kindergarten.

The aim of the study was to compare parent and teacher ratings of executive function and behavioral difficulties of kindergarten-age preterm and term children. Parents of 82 and kindergarten teachers of 105 preterm (<33 weeks' gestation) children and parents of 49 and kindergarten teachers of 46 term four- to five-year-old children completed executive function (EF) and behavior questionnaires. The preterm children were rated to have more EF difficulties than the term children by parents and teachers. On the behavior scales, the preterm children were reported as having more attention control difficulties than the term group, but no other behavioral problems. The parents reported higher levels of EF and behavioral difficulties than the teachers when both child groups were combined. The overall interrater reliability between parents and teachers in terms of children being in the clinical vs. non-clinical range for EF and behavioral problems was low for the preterm and term groups. Conclusion: Based on this study, some young preterm children need EF supports when commencing kindergarten, and preterm children should be screened for EF difficulties. Noncongruent parent and teacher reporting nevertheless make it challenging to identify the preterm children most at need of such supports. Further studies are needed to determine the factors impacting on reporting patterns, and also the best combination of EF and behavior assessment tools.

Phonological and orthographic spelling in high-functioning adult dyslexics.

Despite a history of reading or spelling difficulties, some adults attain age-appropriate spelling skills and succeed at university. We compared the spelling of 29 such high-functioning dyslexics with that of 28 typical students, matched on general spelling ability, and controlling for vocabulary and non-verbal intelligence. Participants wrote derived real and pseudo words, whose spelling relationship to their base forms was categorized as phonologically simple (apt-aptly), orthographically simple (deceit-deceitful), phonologically complex (ash-ashen), or orthographically complex (plenty-plentiful). Dyslexic participants spelled all word and pseudoword categories more poorly than controls. Both groups spelled simple phonological words best. Dyslexics were particularly poor at spelling simple orthographic words, whose letter patterns and rules must likely be memorized. In contrast, dyslexics wrote more plausible spellings of orthographic than phonological pseudowords, but this might be an artefact of their more variable spelling attempts. These results suggest that high-functioning dyslexics make some use of phonological skills to spell familiar words, but they have difficulty in memorizing orthographic patterns, which makes it difficult to spell unfamiliar words consistently in the absence of sufficient phonological cues or orthographic rules.

Examining the relationship between performance-based and questionnaire assessments of executive function in young preterm children: Implications for clinical practice.

The aim of this study was to determine whether specific performance-based executive function assessment tools were associated with executive functioning in everyday life as reported by parents and teachers of four- to five-year-old preterm and term children. At the age of 4 years, 141 preterm children born <33 weeks' gestation and 77 term children were assessed using performance-based intelligence (WPPSI-III) and executive function (EF) assessment tools (NEPSY-II, Day-Night and Shape School tasks). The assessment results were compared with the parent and teacher completed questionnaires of EF (BRIEF-P) when the children started kindergarten at the age of 4 to 5 years. The performance-based intelligence and EF assessment results were not consistently associated with the parent and teacher reports of EF in everyday life for either preterm or term groups. Clinical implications of using and interpreting performance-based EF assessment tools and EF questionnaires are discussed with a particular focus on young preterm children at the commencement of formal schooling.

Young children's knowledge of the "determiner" and "adjective" categories.

Children's understanding of the grammatical categories of "determiner" and "adjective" was examined using 2 different methodologies. In Experiment 1, children heard novel nouns combined with either a or the. Few 2-year-olds, but nearly all 3- and 4-year-olds, subsequently produced the novel nouns with a different determiner from the modeled combination. Experiment 2 used a priming methodology. Children age 2, 3, 4, and 6 years repeated descriptions of pictures, before describing target pictures themselves. When the primes consisted of a varied determiner + noun, all age groups produced more determiner + noun descriptions. When the primes consisted of a determiner + adjective + noun, 2-year-olds showed no priming. Three- to 6-year-olds showed item-specific priming, but only 6-year-olds (and to a limited extent 4-year-olds) showed both item-specific and structural priming. These results suggest that children build an understanding of determiners and adjectives gradually, perhaps from individual lexical items, over a number of years, and that pragmatic correctness may be attained particularly late.

Face-to-face or face-to-screen? Undergraduates' opinions and test performance in classroom vs. online learning.

As electronic communication becomes increasingly common, and as students juggle study, work, and family life, many universities are offering their students more flexible learning opportunities. Classes once delivered face-to-face are often replaced by online activities and discussions. However, there is little research comparing students' experience and learning in these two modalities. The aim of this study was to compare undergraduates' preference for, and academic performance on, class material and assessment presented online vs. in traditional classrooms. Psychology students (N = 67) at an Australian university completed written exercises, a class discussion, and a written test on two academic topics. The activities for one topic were conducted face-to-face, and the other online, with topics counterbalanced across two groups. The results showed that students preferred to complete activities face-to-face rather than online, but there was no significant difference in their test performance in the two modalities. In their written responses, students expressed a strong preference for class discussions to be conducted face-to-face, reporting that they felt more engaged, and received more immediate feedback, than in online discussion. A follow-up study with a separate group (N = 37) confirmed that although students appreciated the convenience of completing written activities online in their own time, they also strongly preferred to discuss course content with peers in the classroom rather than online. It is concluded that online and face-to-face activities can lead to similar levels of academic performance, but that students would rather do written activities online but engage in discussion in person. Course developers could aim to structure classes so that students can benefit from both the flexibility of online learning, and the greater engagement experienced in face-to-face discussion.

Exploring the longitudinal relationships between the use of grammar in text messaging and performance on grammatical tasks.

Research has demonstrated that use of texting slang (textisms) when text messaging does not appear to impact negatively on children's literacy outcomes and may even benefit children's spelling attainment. However, less attention has been paid to the impact of text messaging on the development of children's and young people's understanding of grammar. This study therefore examined the interrelationships between children's and young adults' tendency to make grammatical violations when texting and their performance on formal assessments of spoken and written grammatical understanding, orthographic processing and spelling ability over the course of 1 year. Zero-order correlations showed patterns consistent with previous research on textism use and spelling, and there was no evidence of any negative associations between the development of the children's performance on the grammar tasks and their use of grammatical violations when texting. Adults' tendency to use ungrammatical word forms ('does you') was positively related to performance on the test of written grammar. Grammatical violations were found to be positively associated with growth in spelling for secondary school children. However, not all forms of violation were observed to be consistently used in samples of text messages taken 12 months apart or were characteristic of typical text messages. The need to differentiate between genuine errors and deliberate violation of rules is discussed, as are the educational implications of these findings.

The readability of expert reports for non-scientist report-users: reports of forensic comparison of glass.

Scientific language contains features that may impede understanding for non-scientists. Forensic scientists' written reports are read by police, lawyers, and judges, and thus assessment of readability is warranted. Past studies of readability differed in background theory and approach, but analysed one or more of: content and sequence; language; and format. Using a holistic approach, we assessed the readability of expert reports (n=78) of forensic glass comparison from 7 Australian jurisdictions. Two main audiences for reports were relevant: police and the courts. Reports for police were presented either as a completed form or as a brief legal-style report. Reports for court were less brief and used either legal or scientific styles, with content and formatting features supporting these distinctions. Some jurisdictions prepared a single report to satisfy both the courts and police. In general, item list, analytical techniques, results, notes on interpretation, and conclusions were included in reports of all types. However, some reports omitted analytical techniques, and results and conclusions were sometimes combined. According to Flesch Reading Ease, language was difficult, with a Flesch-Kincaid grade level of university undergraduate. Sentences were long and contained undefined specialist terms. Information content per clause (lexical density), was typically high, as for other scientific texts. Uncertainty was expressed differently by jurisdiction. Reports from most jurisdictions were cluttered in appearance, with single-line spacing, narrow margins, and gridlines in tables. Simple suggestions, based on theory and past research, are provided to assist scientists to enhance the readability of expert reports for non-scientists.

The readability of expert reports for non-scientist report-users: reports of DNA analysis.

DNA evidence can be extremely compelling. With ongoing scientific advances and applications of DNA evidence in the criminal justice system, it is increasingly important that police, lawyers, and judges recognise both the limitations of DNA evidence and the strength of the evidence in particular cases. Because most forensic sciences are formally communicated via expert reports, we analysed the readability of 68 such reports of DNA evidence from 6 of 8 Australian jurisdictions. We conducted content analyses using three categories: content and sequence, language, and format. Categories contained qualitative and quantitative items drawn from theory and past research. Report styles differed by jurisdiction and by main audience - police and the courts. Reports for police were brief and few links were made between sections in these reports. Reports for courts were less brief and used either legal or scientific styles. Common sections in reports for courts included: the scientist's specialised knowledge; laboratory accreditation information; item list; results; and notes on interpretation. Sections were often not in a logical sequence, due to the use of appendices. According to Flesch Reading Ease scores, reports for police had language that was fairly difficult, and reports for courts, difficult. Difficulty was compounded by the use of specialist terms. Reports for police and the appendices of reports for court often used very small font and single line spacing. Many reports for court contained tables that spanned several pages. Suggestions based on theory and past research are provided to assist scientists to enhance the readability of reports for non-scientists.

Forensic scientists' conclusions: how readable are they for non-scientist report-users?

Scientists have an ethical responsibility to assist non-scientists to understand their findings and expert opinions before they are used as decision-aids within the criminal justice system. The communication of scientific expert opinion to non-scientist audiences (e.g., police, lawyers, and judges) through expert reports is an important but under-researched issue. Readability statistics were used to assess 111 conclusions from a proficiency test in forensic glass analysis. The conclusions were written using an average of 23 words per sentence, and approximately half of the conclusions were expressed using the active voice. At an average Flesch-Kincaid Grade level of university undergraduate (Grade 13), and Flesch Reading Ease score of difficult (42), the conclusions were written at a level suitable for people with some tertiary education in science, suggesting that the intended non-scientist readers would find them difficult to read. To further analyse the readability of conclusions, descriptive features of text were used: text structure; sentence structure; vocabulary; elaboration; and coherence and unity. Descriptive analysis supported the finding that texts were written at a level difficult for non-scientists to read. Specific aspects of conclusions that may pose difficulties for non-scientists were located. Suggestions are included to assist scientists to write conclusions with increased readability for non-scientist readers, while retaining scientific integrity. In the next stage of research, the readability of expert reports in their entirety is to be explored.

Do beez buzz? Rule-based and frequency-based knowledge in learning to spell plural -s.

There has been much discussion about whether certain aspects of human learning depend on the abstraction of rules or on the acquisition of frequency-based knowledge. It has usually been agreed, however, that the spelling of morphological patterns in English (e.g., past tense -ed) and other languages is based on the acquisition of morphological rules, and that these rules take a long time to learn. The regular plural -s ending seems to be an exception: Even young children can spell this correctly, even when it is pronounced /z/ (as in bees). Reported here are 3 studies that show that 5- to 9-year-old children and adults do not usually base their spellings of plural real-word and pseudo-word endings on the morphological rule that all regular plurals are spelled with -s. Instead, participants appeared to use their knowledge of complex but untaught spelling patterns, which is based on the frequency with which certain letters co-occur in written English.