Written products and writing processes in Swedish deaf and hard of hearing children: an explorative study on the impact of linguistic background.

The small body of research on writing and writing processes in the group of deaf and hard of hearing (DHH) children has shown that this group struggles more with writing than their hearing peers. This article aims to explore in what ways the DHH group differs from their peers regarding the written product and the writing processes. Participants are all in the age span 10-12 years old and include: (a) 12 DHH children with knowledge of Swedish sign language (Svenskt teckenspråk, STS) as well as spoken Swedish, (b) 10 age-matched hearing children of deaf adults (CODA) who know STS, (c) 14 age-matched hearing peers with no STS knowledge. More specifically we investigate how text length and lexical properties relate to writing processes such as planning (measured through pauses) and revision, and how the background factors of age, gender, hearing and knowledge of STS predict the outcome in product and process. The data consists of picture-elicited narratives collected with keystroke logging. The overall results show that age is a strong predictor for writing fluency, longer texts and more sophisticated lexicon for all the children. This confirms theories on writing development which stress that when children have automatized basic low-level processes such as transcription and spelling, this will free up cognitive space for engaging in high-level processes, such as planning and revision-which in turn will result in more mature texts. What characterizes the DHH group is slower writing fluency, higher lexical density, due to omitted function words, and extensive revisions (both deletions and insertions) on word level and below. One explanation for the last finding is that limitations in the auditory input lead to more uncertainty regarding correct and appropriate lexical choices, as well as spelling. The article contributes with more specific knowledge on what is challenging during writing for DHH children with knowledge of STS and spoken Swedish in middle school, in the developmental stage when basic writing skills are established.

Are patients willing to take a more active role? Questionnaires to measure patients' willingness to be empowered.

OBJECTIVE: One crucial prerequisite for increased patient empowerment is the willingness among patients to take a more active role. The aim of this study was to develop questionnaires for measuring a patient's willingness to be empowered in general and by using e-health. METHODS: The study was based on a random sample from an online panel. The 800 responders were Swedish citizens and reflected the internet-using population in Sweden regarding age, gender, income, and education. The measurement properties were evaluated according to the Rasch Measurement Theory. RESULTS: The analyses showed two questionnaires with adequate fit to the basic measurement model and with high reliability (PSI 0.84 and 0.89, respectively). CONCLUSION: We conclude that this study generated two questionnaires with an intuitive order of items illustrating an understandable progression of willingness to be empowered in general as well as for e-health. PRACTICE IMPLICATIONS: The suggested questionnaires are valuable tools supporting the effort to tailor empowerment strategies to meet the patient's willingness. Questionnaires will also be valuable for evaluating strategies for supporting willingness, studying factors related to willingness and potential inequalities due to e.g. varying digital literacy, and for enabling identification of patient stereotypes using cluster analyses.

Predictors of narrative text quality in students with hearing loss.

AIM: Students with hearing loss (HL) often fall behind hearing peers in complex language tasks such as narrative writing. This study explored the effects of school grade, gender, cognitive and linguistic predisposition and audiological factors on narrative text quality in this target group. METHOD: Eleven students with HL in Grades 5-6 and 7-8 (age 12-15) who took part in a writing intervention wrote four narrative texts over six months. A trained panel rated text quality. The effects of the students' working memory capacity, language comprehension, reading comprehension, school grade and gender and the intervention were analyzed as a mixed-effects regression model. Audiological factors were considered separately. RESULTS: The analysis showed that throughout the period, texts written by female students in Grade 7-8 received the highest text quality ratings, while those written by male students in Grade 7-8 received the lowest ratings. There was no effect of the intervention, or of the linguistic and cognitive measures. The students with the lowest text quality ratings received amplification later than those with high ratings, but HL severity was not associated with text quality. CONCLUSION: Hearing loss severity was not a decisive factor in narrative text quality. The intervention which the students took part in is potentially effective, with some adaptation to the special needs of students with HL. The strong gender effects are discussed.

Online Communities as a Driver for Patient Empowerment: Systematic Review.

BACKGROUND: The use of online resources has changed how people manage health care processes. Patients seek information about health conditions, guidance in treatment, and support from peers online, complementary to traditional health care trajectories. Online communities have the potential to contribute to the quality of care by increasing patient empowerment; however, there is a gap in research regarding in what way online communities contribute to patient empowerment. OBJECTIVE: We synthesized research regarding how online communities contribute to patient empowerment to address the research question "In what ways can participation in online communities support patient empowerment?" by studying how patient empowerment is operationalized in different studies. The definition of patient empowerment used in this paper is enablement for people to develop mastery over actions and control over decisions that influence their lives. The mastery is both through processes and outcomes of the development. METHODS: A systematic review was conducted by searching in the following databases: Scopus, ACM Digital Library, EBSCO (CINAHL and MEDLINE), PubMed, and Web of Science. In total, there were 1187 papers after excluding duplicates, and through selection processes using an analytical framework with definitions of patient empowerment and related concepts, 33 peer-reviewed papers were included. RESULTS: Findings indicated that online communities support patient empowerment both as a process and as outcomes of these processes. Additionally, it was seen as a complement to traditional health care and encouragement for health care professionals to have a more positive attitude toward patients' usage. There was a mix between deductive (19/33, 58%), inductive (11/33, 33%), and a mixed approach (3/33, 9%) of studying patient empowerment in various forms. The online communities in most papers (21/33, 64%) were well-established and represented patients' initiatives. CONCLUSIONS: There is a need to include professionals' perspectives regarding how health care can embrace patient empowerment through online communities. This systematic review's main contribution is the proposal of a new framework and conceptualization of how patient empowerment in online communities can be understood from different hierarchical levels.

Effects of intervention on self-efficacy and text quality in elementary school students' narrative writing.

AIM: Self-efficacy for writing is an important motivational factor and considered to predict writing performance. Self-efficacy for narrative writing has been sparsely studied, and few studies focus on the effects of writing intervention on self-efficacy. Additionally, there is a lack of validated measures of self-efficacy for elementary school students. In a previous study, we found that a trained panel rated personal narrative text quality higher for girls than for boys, which led to our aim: to investigate boys' and girls' self-efficacy for narrative writing before and after an intervention, and to explore associations between self-efficacy and text quality. METHODS: An 18-item self-efficacy scale was developed. Fifty-five fifth-grade students (M 11:2 years, SD 3.7 months) filled out the scale before and after a five-lesson observational learning intervention. Self-efficacy was then related to writing performance as measured by holistic text quality ratings. RESULTS: The students demonstrated strong self-efficacy, which increased significantly post-intervention. Girls and boys demonstrated similar self-efficacy, despite girls' higher text quality. There were moderate correlations between self-efficacy and writing performance pre- and post-intervention. CONCLUSIONS: The results support previous findings of strong self-efficacy at this age. The interaction between writing self-efficacy and performance is complex. Young students may not be able to differentiate between self-efficacy, general writing skills, task performance, and self-regulation. Self-efficacy scales should thus be carefully constructed with respect to age, genre, instruction, and to students' general educational context.

Individualized blended care for patients with colorectal cancer: the patient's view on informational support.

PURPOSE: The number of colorectal cancer patient survivors is increasing. Information and support during and after treatment are requested by patients, but questions remain on what to provide. The aim of this study was to understand what informational needs colorectal cancer patients and survivors have, with a focus on the potential support given by patient peers and the use of blended care. METHODS: A qualitative study using focus groups was conducted with patients diagnosed at the same hospital at least one year prior to the initiation of the study. The focus group interviews were transcribed verbatim and analyzed using deductive content analysis. RESULTS: The need for informational support varied over time and depended on individual patient characteristics. Timing was crucial and patients requested options of blended care and informational support after treatment cessation. The patients felt alone after treatment and requested assistance in communication with their next-of-kin. They also identified the value of peer support, especially to contextualize knowledge provided by healthcare. CONCLUSION: This study showed a need for focus on individualized informational support. Blended care through integrating communication with peers online could be one way to support patients, both to enable shared decision-making as well as to provide person-centered care.

Spelling in Deaf, Hard of Hearing and Hearing Children With Sign Language Knowledge.

What do spelling errors look like in children with sign language knowledge but with variation in hearing background, and what strategies do these children rely on when they learn how to spell in written language? Earlier research suggests that the spelling of children with hearing loss is different, because of their lack of hearing, which requires them to rely on other strategies. In this study, we examine whether, and how, different variables such as hearing degree, sign language knowledge and bilingualism may affect the spelling strategies of children with Swedish sign language, Svenskt teckenspråk, (STS) knowledge, and whether these variables can be mirrored in these children's spelling. The spelling process of nineteen children with STS knowledge (mean age: 10.9) with different hearing degrees, born into deaf families, is described and compared with a group of fourteen hearing children without STS knowledge (mean age: 10.9). Keystroke logging was used to investigate the participants' writing process. The spelling behavior of the children was further analyzed and categorized into different spelling error categories. The results indicate that many children showed exceptionally few spelling errors compared to earlier studies, that may derive from their early exposure of STS, enabling them to use the fingerspelling strategy. All of the children also demonstrated similar typing skills. The deaf children showed a tendency to rely on a visual strategy during spelling, which may result in incorrect, but visually similar, words, i.e., a type of spelling errors not found in texts by hearing children with STS knowledge. The deaf children also showed direct transfer from STS in their spelling. It was found that hard-of-hearing children together with hearing children of deaf adults (CODAs), both with STS knowledge, used a sounding strategy, rather than a visual strategy. Overall, this study suggests that the ability to hear and to use sign language, together and respectively, play a significant role for the spelling patterns and spelling strategies used by the children with and without hearing loss.

Writing intervention in university students with normal hearing and in those with hearing impairment: can observational learning improve argumentative text writing?

Observational learning has shown to be a successful intervention for writing. Until now, however, studies have only been performed with normal-hearing participants, usually high school or university students. Additionally, there have been conflicting results in whether subjective text quality correlates with one or more objectively measured text characteristics. In this study, we measured the effect of observational learning in a group of four university students with hearing impairment, and compared the results with those of a group of 10 students with normal hearing who did the same intervention, and those of a control group consisting of 10 students with normal hearing who did not do the intervention. Subjective text quality ratings and nine objectively measured text characteristics were collected for three argumentative texts written by each of the participants. In between writing these three texts, the participants in the experimental groups watched a video of a model writer who read out loud and corrected a similar kind of text. The statistical analysis showed significant correlations between the subjective ratings and four out of the nine objective measures, but no significant intervention effect. These findings suggest that observation-learning intervention is most effective when the model writer is a peer learner, and when the intervention is stretched out over time. Additionally, the method may be better suited for learners younger than the ones who were included in the present study.

Reading during the composition of multi-sentence texts: an eye-movement study.

Writers composing multi-sentence texts have immediate access to a visual representation of what they have written. Little is known about the detail of writers' eye movements within this text during production. We describe two experiments in which competent adult writers' eye movements were tracked while performing short expository writing tasks. These are contrasted with conditions in which participants read and evaluated researcher-provided texts. Writers spent a mean of around 13 % of their time looking back into their text. Initiation of these look-back sequences was strongly predicted by linguistically important boundaries in their ongoing production (e.g., writers were much more likely to look back immediately prior to starting a new sentence). 36 % of look-back sequences were associated with sustained reading and the remainder with less patterned forward and backward saccades between words ("hopping"). Fixation and gaze durations and the presence of word-length effects suggested lexical processing of fixated words in both reading and hopping sequences. Word frequency effects were not present when writers read their own text. Findings demonstrate the technical possibility and potential value of examining writers' fixations within their just-written text. We suggest that these fixations do not serve solely, or even primarily, in monitoring for error, but play an important role in planning ongoing production.

Combined eyetracking and keystroke-logging methods for studying cognitive processes in text production.

Writers typically spend a certain proportion of time looking back over the text that they have written. This is likely to serve a number of different functions, which are currently poorly understood. In this article, we present two systems, ScriptLog+ TimeLine and EyeWrite, that adopt different and complementary approaches to exploring this activity by collecting and analyzing combined eye movement and keystroke data from writers composing extended texts. ScriptLog+ TimeLine is a system that is based on an existing keystroke-logging program and uses heuristic, pattern-matching methods to identify reading episodes within eye movement data. EyeWrite is an integrated editor and analysis system that permits identification of the words that the writer fixates and their location within the developing text. We demonstrate how the methods instantiated within these systems can be used to make sense of the large amount of data generated by eyetracking and keystroke logging in order to inform understanding of the cognitive processes that underlie written text production.