Using Gaze Tracking as a Research Tool in the Deaf Health Literacy and Access to Health Information Project: Protocol for a Multisite Mixed Methods Study and Preliminary Results.

BACKGROUND: Previous studies have identified the internet as a major source of health information. Reliable and accessible sources of web-based health information are critical for cultivating patient-centered care. However, the accessibility and use of web-based health information remains largely unknown for deaf individuals. We used gaze-tracking technology to understand the navigation and use of web-based health information by deaf adults who communicate with sign language and by hearing adults. OBJECTIVE: This paper discusses our protocol for implementing gaze-tracking technology in a study that included both deaf and hearing participants. We report the preliminary results and lessons learned from the implementation of the protocol. METHODS: We conducted gaze-tracking sessions with 450 deaf signers and 450 hearing participants as a part of a larger, multisite mixed methods research study. Then, we conducted qualitative elicitation interviews with a subsample of 21 deaf and 13 hearing participants, who engaged in a search task and reviewed their gaze recordings. To our knowledge, no study has implemented a similar research protocol to better understand the experiences of deaf adults. As such, we also examined research staff notes and observations from team meetings regarding the conduct of gaze-tracking data to delineate lessons learned and best practices for research protocols in this area. RESULTS: Findings from the implementation of this study protocol highlight the use of gaze technology with deaf participants. We developed additional protocol steps to minimize gaze disruption from either lipreading or communicating in sign language. For example, research assistants were often unable to maintain eye contact with participants while signing because of the need to simultaneously point at the computer monitor to provide instructions related to gaze study components, such as the calibration process. In addition to developing ways to effectively provide instructions in American Sign Language, a practice exercise was included in the gaze tracker session to familiarize participants with the computer and technology. The use of the playback feature permitted a deeper dialogue between researchers and participants, which we found vital for understanding the experiences of deaf participants. CONCLUSIONS: On the basis of our experience using the study protocol through a large research project, incorporating gaze-tracking technology offers beneficial avenues for better understanding how individuals interact with health information. Gaze tracking can determine the type and placement of visual content that attracts attention from the viewers of diverse backgrounds, including deaf individuals. The lessons learned through this study will help future researchers in determining ideal study designs, such as suitable protocols and participant characteristics (eg, deaf signers), while including gaze trackers in their projects. This approach explored how different ways of presenting health information can affect or enable visual learners to engage and use health information effectively. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR1-10.2196/26708.

The Deaf Community's Experiences Navigating COVID-19 Pandemic Information.

BACKGROUND: Users of American Sign Language (ASL) who are deaf often face barriers receiving health information, contributing to significant gaps in health knowledge and health literacy. To reduce the spread of coronavirus disease 2019 (COVID-19) and its risk to the public, the government and health care providers have encouraged social distancing, use of face masks, hand hygiene, and quarantines. Unfortunately, COVID-19 information has rarely been available in ASL, which puts the deaf community at a disadvantage for accessing reliable COVID-19 information. OBJECTIVE: This study's primary objective was to compare COVID-19-related information access between participants who are deaf and participants who are hearing. METHODS: The study included 104 adults who are deaf and 74 adults who are hearing who had participated in a prior health literacy study. Surveys were conducted between April and July 2020 via video conference, smartphone apps, or phone calls. COVID-19 data were linked with preexisting data on demographic and health literacy data as measured by the Newest Vital Sign (NVS) and the ASL-NVS. KEY RESULTS: Neither group of participants differed in their ability to identify COVID-19 symptoms. Adults who are deaf were 4.7 times more likely to report difficulty accessing COVID-19 information (p = .011), yet reported using more preventive strategies overall. Simultaneously, adults who are deaf had 60% lower odds of staying home and calling their doctor versus seeking health care immediately or doing something else compared with participants who are hearing if they suspected that they had COVID-19 (p = .020). CONCLUSIONS: Additional education on recommended COVID-19 management and guidance on accessible health care navigation strategies are needed for the deaf community and health care providers. Public health officials should ensure that public service announcements are accessible to all audiences and should connect with trusted agents within the deaf community to help disseminate health information online in ASL through their social media channels. [HLRP: Health Literacy Research and Practice. 2021;5(2):e162-e170.] Plain Language Summary: Compared to participants who are hearing, a higher portion of participants who are deaf reported challenges with accessing, understanding, and trusting COVID-19 information. Although respondents who are deaf had similar knowledge of symptoms compared to participants who are hearing, they used more prevention strategies and were more likely to plan immediate care for suspected symptoms. Improved guidance on COVID-19 management and health care navigation accessible to the deaf community is needed.

Beliefs, Attitudes, and Practices of Latinas Related to Gestational Weight Gain: A Qualitative Meta-Synthesis.

INTRODUCTION: Excessive and inadequate gestational weight gain (GWG) are associated with a number of negative health outcomes for mother and infant. Approximately two-thirds or more of Latinas gain outside of GWG guidelines. Acculturation plays a role in GWG-related factors, however the views of Latinas are often aggregated in overall study samples, thus trivializing the specific needs of this demographic group. The purpose of the present meta-ethnography was to better understand GWG beliefs, attitudes, and practice among Latinas by synthesizing extant qualitative findings on this topic. METHODS: Qualitative studies offer an important window into Latinas' views and practices related to GWG. A qualitative meta-ethnography (a form of meta-synthesis) was implemented to synthesize qualitative studies about Latinas' views of GWG-related factors. An initial sample of articles was distilled based on meta-ethnography guidelines from Noblit and Hare (1988) to a final sample of six qualitative articles that included perspectives from Latinas. RESULTS: Six concepts emerged across the studies, they included: shifts in feeling control, inconsistent/lacking information, self vs. other, applied wisdom, isolation vs. support, and everyday practicality. Studies met most quality assessment criteria (Atkins et al., BMC Medical Research Methodology 8:21, 2008). DISCUSSION: The views of Latinas about GWG-related factors are often buried in with perspectives of other women, which hides important details that are valuable for health program interventions designed to support these women. Future research should further explore the cultural differences in experience among Latinas to produce information and resources that are culturally relevant and relatable.

Health Literacy in Adult Education Centers: Exploring Educator and Staff Needs.

Objective. Incorporating health content into adult education courses is promising for increasing health literacy skills among "hard-to-reach" populations. The purpose of this study was to gain previously untapped knowledge of adult education personnel (i.e., educators, staff) about the strategies and programs that would be beneficial for helping students learn about health. Method. Personnel (N = 53) from three literacy coalitions completed an online survey that assessed interest and preferences for developing a health literacy curriculum. Results. Personnel indicated general concepts such as health services and insurance as those of greatest priority. Additionally, tools designed for general use (completion of forms) were favored. Personnel preferred programs that focused on general skills over those designed to address specific health topics, χ2(1) = 11.52, p = .001. Conclusions. Adult education personnel find greatest value in health literacy programs aimed at increasing general skills rather than disease-/topic-specific content. There were several mismatches in topics noted as a "priority" and those for which personnel felt comfortable teaching. A focus on fostering general health skills will help all students-not just those with specific health concerns such as diabetes and asthma. Teaching health literacy through general skill development could make health programs exciting, engaging, and accessible for students.

Family Health in Adult Education: A Missing Piece of the Health Literacy Puzzle.

Previous research and interventions define health literacy as an individual-level concept. Although it is necessary to design programs aimed at individual people, not all health decisions are made by patients themselves, and calls have been made to expand health literacy work beyond the individual. This brief report stems from a larger study in which personnel working for adult literacy coalitions identified family health as a priority topic for health-focused lessons, yet often felt ill-equipped to teach students in this area. This brief report examines adult educators' perspectives on the types of content needed for a family health module designed for the adult education curriculum. Personnel from adult literacy coalitions offered qualitative insights on their desires for health literacy content in the context of family care. Adult literacy coalition educators and staff can provide important insights regarding the health literacy needs of adults in vulnerable populations. Three key themes emerged: American Family Health, Nutritious Eating, and Identify and Act. Rather than using a personal approach, a program that frames health literacy as family health and offers a holistic view on caring for others may serve to provide important context for health decisions and communication for adults at literacy centers. [HLRP: Health Literacy Research and Practice. 2019;3(Suppl.):S75-S78.].

Health Literacy and Perceptions of Stigma.

Calls for progress in health literacy argue that efforts across society are promising for increasing capacities at a broader level. However, it is unknown how the general public perceives people who struggle with health information. While it may be ideal to establish interventions beyond the individual, stigma held by others could limit this work. This study explores whether one's personal health literacy skills are associated with stigma enacted toward others who struggle with health literacy. Adults (N = 5,151) responded to a survey consisting of health literacy assessments and a vignette in which a patient made a health-related mistake. Differences were observed regarding the number of participants who self-reported (n = 251) versus objectively scored as having low health literacy (n = 794). Participants who self-reported (MlowHL = 5.67, MhighHL = 5.99, p < .01) or had low objective health literacy (MlowHL = 5.75, MhighHL = 6.01, p < .001) exhibited less pity for the person in the vignette than health literate participants. Participants were more demanding of a young person featured in the vignette (33-year old), indicating greater personal responsibility (M72 = 5.12, M33 = 5.67), anger (M72 = 4.54, M33 = 5.57), and less pity (M72 = 6.18, M33 = 5.75) compared to an older person (72-year old). Results from the present study suggest contradictory perceptions among patients who are likely to feel stigma themselves.

Deaf Adults' Health Literacy and Access to Health Information: Protocol for a Multicenter Mixed Methods Study.

BACKGROUND: Deaf American Sign Language (ASL) users often struggle with limited health literacy compared with their hearing peers. However, the mechanisms driving limited health literacy and how this may impact access to and understanding of health information for Deaf individuals have not been determined. Deaf individuals are more likely than hearing individuals to use the internet, yet they continue to report significant barriers to health information. This study presents an opportunity to identify key targets that impact information access for a largely marginalized population. OBJECTIVE: This study aims to elucidate the role of information marginalization on health literacy in Deaf ASL users and to better understand the mechanisms of health literacy in this population for the purpose of identifying viable targets for future health literacy interventions. METHODS: This is an exploratory mixed methods study to identify predictors and moderators of health literacy in the Deaf population. These predictors of health literacy will be used to inform the second step that qualitatively explains the findings, including how Deaf individuals access and understand Web-based health information. Multiple interviewer- and computer-based instruments underwent translation and adaptation, from English to ASL, to make them accessible for the Deaf participants in our study. A planned sample of 450 Deaf ASL users and 450 hearing native English speakers, aged 18 to 70 years, will be recruited from 3 partnering sites: Rochester, NY; Flint, MI; and Chicago, IL. These individuals will participate in a single data collection visit. A subset of participants (approximately 30) with key characteristics of interest will be invited for a second data collection visit to observe and inquire more about their ability to directly access, navigate, and comprehend Web-based health information. The study will help assess how the ways health literacy and information are visualized may differ between Deaf individuals and hearing individuals. The study will also survey participants' ownership and use of computer and mobile devices and their level of Web-based information use, including health information. RESULTS: Adaptation and translation of protocols and instruments have been completed and are now in use for the study. Recruitment is underway and will continue until late 2020. Results from this study will be used to provide a guide on how to structure Web-based health information in a way that maximizes accessibility and improves health literacy for Deaf individuals. CONCLUSIONS: The results from this mixed methods proposal will advance what is known about health literacy and health information accessibility for Deaf individuals. This innovative study will generate rich data on how to formulate health information and health literacy interventions more accurately to take advantage of visual learning skills. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/14889.

Assessment of Safe Listening Intentional Behavior Toward Personal Listening Devices in Young Adults.

Recreational noise-induced hearing loss (RNIHL) is a highly preventable disorder that is commonly seen in teenagers and young adults. Despite the documented negative effects of RNIHL, it is still challenging to persuade people to adopt safe listening behaviors. More research is needed to understand the underlying factors guiding listeners' intentions to engage in safe listening habits. We used the Theory of Planned Behavior (TPB) to identify attitudes, social norms, and behavioral control in 92 young adults toward two intentional behaviors related to safe listening habits while listening to their personal listening devices: (1) lowering the intensity of loud music, and (2) shortening the listening duration of loud music. Using a Qualtrics survey, the major factors of the TPB model as they relate to the participants' intention to engage in risk-controlling behavior were assessed. Behavioral intentions to turn the music down and listen for shorter durations were thought to be predicted by the TPB factors (attitudes, social norms, and perceived behavioral control). Linear regression findings indicated that the overall TPB models were significant. Positive attitudes toward turning the music down and shortening the durations were significantly associated with intentions to engage in non-risky behavior, more so for the former behavior.

Promoting Mental Health Resource Use on Campus by "Trying Something New".

PURPOSE: To design and test a persuasive health promotion campaign that aligns with the qualities of trying something new for the first time. Given that a majority of students have not previously sought/considered professional mental health assistance before, the hypothesis tested in this study asked whether a campaign that takes this into account is effective with this audience. DESIGN: Participants viewed an online informational message (n = 84), information message plus first-time experience banner (n = 99), or 1 of 4 full campaigns, each depicting a student story and photo about a first-time experience (moving from home [n = 48], skydiving [n = 52], acting in a play [n = 48], and exercising with personal trainer [n = 48]). MEASURES: Visual poster items: appeal (visually pleasing, 7 items, α = .92), support (value of poster, 5 items, α = .86) and behavioral intention items: engagement (participant seek help/pay attention, 3 items, α = .86), relevance (content as relevant, 3 items, α = .84), and judgment (judgment of others for not seeking help, 2 items, α = .87). PARTICIPANTS: College students (N = 380). RESULTS: In comparison to information-only messages, framing mental health help seeking as a first-time experience was linked with increased appeal, support, and engagement (Minformationonly = 2.79 [standard deviation, SD = 1.34], Minformationplusbanner = 3.25 [SD = 1.23], Mfullcampaign = 4.07 [SD = 1.28], P < .001, Minformationonly = 4.38 [SD = 1.47], Minformationplusbanner = 4.92 [SD = 1.21], Mfullcampaign = 4.57 [SD = 1.26], P = .014, and Minformationonly = 3.13 [SD = 1.76], Minformationplusbanner = 3.56 [SD = 1.48], Mfullcampaign = 4.02 [SD = 1.42], P < .001, respectively). As anticipated, the full campaign garnered the highest affect and engagement scores. When comparing the 4 first-time experiences, there were main effects on support and engagement (Mtrain = 5.06 [SD = 1.17], Mplane = 4.27 [SD = 1.28], Mhome = 4.59 [SD = 1.19], Mplay = 4.38 [SD = 1.29], P = .009 and Mtrain = 4.50 [SD = 1.27], Mplane = 3.75 [SD = 1.43], Mhome = 4.01 [SD = 1.49], Mplay = 3.84 [SD = 1.39], P = .042, respectively), with the novel experience of "working with a personal trainer" rated highest. CONCLUSION: Findings from this study have implications for the design of health promotion materials on college campuses. Specifically, campaigns that frame seeking help for mental health as a new experience potentially increase student engagement in this behavior. A key finding from the present study is that a campaign in which this behavior is linked to a familiar form of interpersonal help seeking (personal training) can create receptivity to the stigmatized issue of mental health help seeking.

Breaking Health Insurance Knowledge Barriers Through Games: Pilot Test of Health Care America.

BACKGROUND: Having health insurance is associated with a number of beneficial health outcomes. However, previous research suggests that patients tend to avoid health insurance information and often misunderstand or lack knowledge about many health insurance terms. Health insurance knowledge is particularly low among young adults. OBJECTIVE: The purpose of this study was to design and test an interactive newsgame (newsgames are games that apply journalistic principles in their creation, for example, gathering stories to immerse the player in narratives) about health insurance. This game included entry-level information through scenarios and was designed through the collation of national news stories, local personal accounts, and health insurance company information. METHODS: A total of 72 (N=72) participants completed in-person, individual gaming sessions. Participants completed a survey before and after game play. RESULTS: Participants indicated a greater self-reported understanding of how to use health insurance from pre- (mean=3.38, SD=0.98) to postgame play (mean=3.76, SD=0.76); t71=-3.56, P=.001. For all health insurance terms, participants self-reported a greater understanding following game play. Finally, participants provided a greater number of correct definitions for terms after playing the game, (mean=3.91, SD=2.15) than they did before game play (mean=2.59, SD=1.68); t31=-3.61, P=.001. Significant differences from pre- to postgame play differed by health insurance term. CONCLUSIONS: A game is a practical solution to a difficult health issue-the game can be played anywhere, including on a mobile device, is interactive and will thus engage an apathetic audience, and is cost-efficient in its execution.

Toward a Better Understanding of Patient Health Literacy: A Focus on the Skills Patients Need to Find Health Information.

While many health literacy assessments exist, this area of research lacks an instrument that isolates and reflects the four components driving this concept (abilities to find, understand, use, and communicate about health information). The purpose of this study was to determine what abilities comprise the first component, how a patient finds health information. Low ( n = 13) and adequate ( n = 14) health literacy patients, and health professionals ( n = 10) described their experiences when looking for health information and the skills they employed to complete these tasks. Major skills/themes elicited included knowing when to search, credibility assessments, finding text and numerical information, interpersonal seeking, technology and online search, and spatial navigation. Findings from this study suggest that each of the dimensions included in the definition of health literacy warrants specific attention and assessment. Given identification of the skills comprising each dimension, interventions targeting deficits across health literacy dimensions could be developed to improve patient health.

Health Literacy and Health Information Technology Adoption: The Potential for a New Digital Divide.

BACKGROUND: Approximately one-half of American adults exhibit low health literacy and thus struggle to find and use health information. Low health literacy is associated with negative outcomes including overall poorer health. Health information technology (HIT) makes health information available directly to patients through electronic tools including patient portals, wearable technology, and mobile apps. The direct availability of this information to patients, however, may be complicated by misunderstanding of HIT privacy and information sharing. OBJECTIVE: The purpose of this study was to determine whether health literacy is associated with patients' use of four types of HIT tools: fitness and nutrition apps, activity trackers, and patient portals. Additionally, we sought to explore whether health literacy is associated with patients' perceived ease of use and usefulness of these HIT tools, as well as patients' perceptions of privacy offered by HIT tools and trust in government, media, technology companies, and health care. This study is the first wide-scale investigation of these interrelated concepts. METHODS: Participants were 4974 American adults (n=2102, 42.26% male, n=3146, 63.25% white, average age 43.5, SD 16.7 years). Participants completed the Newest Vital Sign measure of health literacy and indicated their actual use of HIT tools, as well as the perceived ease of use and usefulness of these applications. Participants also answered questions regarding information privacy and institutional trust, as well as demographic items. RESULTS: Cross-tabulation analysis indicated that adequate versus less than adequate health literacy was significantly associated with use of fitness apps (P=.02), nutrition apps (P<.001), activity trackers (P<.001), and patient portals (P<.001). Additionally, greater health literacy was significantly associated with greater perceived ease of use and perceived usefulness across all HIT tools after controlling for demographics. Regarding privacy perceptions of HIT and institutional trust, patients with greater health literacy often demonstrated decreased privacy perceptions for HIT tools including fitness apps (P<.001) and nutrition apps (P<.001). Health literacy was negatively associated with trust in government (P<.001), media (P<.001), and technology companies (P<.001). Interestingly, health literacy score was positively associated with trust in health care (P=.03). CONCLUSIONS: Patients with low health literacy were less likely to use HIT tools or perceive them as easy or useful, but they perceived information on HIT as private. Given the fast-paced evolution of technology, there is a pressing need to further the understanding of how health literacy is related to HIT app adoption and usage. This will ensure that all users receive the full health benefits from these technological advances, in a manner that protects health information privacy, and that users engage with organizations and providers they trust.

Creating a Screening Measure of Health Literacy for the Health Information National Trends Survey.

PURPOSE: Create a screening measure of health literacy for use with the Health Information National Trends Survey (HINTS). DESIGN: Participants completed a paper-based survey. Items from the survey were used to construct a health literacy screening measure. SETTING: A population-based survey conducted in geographic areas of high and low minority frequency and in Central Appalachia. SUBJECTS: Two thousand nine hundred four English-speaking participants were included in this study: 66% white, 93% completed high school, mean age = 52.53 years (SD = 16.24). MEASURES: A health literacy screening measure was created using four items included in the HINTS survey. Scores could range from 0 (no questions affirmative/correct) to 4 (all questions answered affirmatively/correctly). ANALYSIS: Multiple regression analysis was used to determine whether demographic variables known to predict health literacy were indeed associated with the constructed health literacy screening measure. RESULTS: The weighted average health literacy score was 2.63 (SD = 1.00). Those who were nonwhite (p = .0005), were older (p < .0005), or had not completed high school (p < .0001) tended to have lower health literacy screening measure scores. CONCLUSION: This study highlights the need to assess health literacy in national surveys, but also serves as evidence that screening measures can be created within existing datasets to give researchers the ability to consider the impact of health literacy.

Is the Consumption of Energy Drinks Associated With Academic Achievement Among College Students?

Despite widely reported side effects, use of energy drinks has increased among college students, who report that they consume energy drinks to help them complete schoolwork. However, little is known about the association between energy drink use and academic performance. We explored the relationship between energy drink consumption and current academic grade point average (GPA) among first-year undergraduate students. Participants included 844 first-year undergraduates (58.1 % female; 50.7 % White). Students reported their health behaviors via an online survey. We measured energy drink consumption with two measures: past month consumption by number of drinks usually consumed in 1 month and number consumed during the last occasion of consumption. We used multiple linear regression modeling with energy drink consumption and current GPA, controlling for gender, race, weekend and weekday sleep duration, perceived stress, perceived stress management, media use, and past month alcohol use. We found that past month energy drink consumption quantity by frequency (p < 0.001), and energy drinks consumed during the last occasion (p < 0.001), were associated with a lower GPA. Energy drinks consumed during the last occasion of consumption (p = 0.01) remained significantly associated with a lower GPA when controlling for alcohol use. While students report using energy drinks for school-related reasons, our findings suggest that greater energy drink consumption is associated with a lower GPA, even after controlling for potential confounding variables. Longitudinal research is needed that addresses whether GPA declines after continued use of energy drinks or if students struggling academically turn to energy drinks to manage their schoolwork.

Gestational Weight Gain Through a Health Literacy Lens: A Scoping Review.

Few women gain the recommended amount of weight during pregnancy, which has health implications for mothers and their newborns. Work in this area focuses on factors that are difficult to change. The purpose of this project was to review literature on a more patient-centered concept-health literacy. A scoping review was conducted to determine whether aspects of health literacy are included in gestational weight gain (GWG) research. Thirty articles were selected for review. Although these studies included health literacy aspects indirectly, only 2 directly measured health literacy using existing measures. Work that incorporates health literacy in a GWG context is needed. Health literacy may be a critical, yet understudied, factor in understanding why GWG falls outside of the recommendations.

Advancing Health Marketing Research and Policy Recommendations by Incorporating Source Perspectives.

Communication researchers, recognizing the message sent is not necessarily the same as the message received, have incorporated the perspective of advertising professionals into the study of advertising effects. Health marketing research could similarly benefit from incorporating this largely absent perspective into the academic and policy debate surrounding the impact of advertising on health issues ranging from obesity to alcohol use. This commentary serves as a call to action to stakeholders in this academic and policy debate: focus on the perspective of advertising professionals to enrich health marketing and public health research in which advertising is the delivery vehicle for health messages.

The Many Health Literacies: Advancing Research or Fragmentation?

Health literacy is the degree to which individuals can obtain, process, understand, and communicate about health-related information needed to make informed health decisions and is an important factor in patient health outcomes and resulting health care costs. Because of its importance across many areas of health, specific attention has been given to studying and measuring health literacy in recent years; however, the field lacks consensus on how health literacy should be defined and measured. As a result, numerous definitions and measures of health literacy exist. This fragmentation and inconsistency creates a barrier to conceptualizing, measuring, and understanding health literacy across health domains and fields. A directed literature search reveals a substantial body of work on health literacy; however, findings from studies often emphasize health literacy within specific health domains, populations, contexts, and languages, which makes the comparison of findings across studies difficult. While there is recognition that the measurement of health literacy should be improved, it is important to take into consideration what can be gained from a general health literacy focus and how this could be applied across domains.

Saving time and resources: observational research to support adoption of a hand hygiene promotion campaign.

Hand hygiene is the most effective way to prevent the spread of health care-associated infections, but many facilities may not have the resources or expertise to develop their own hand hygiene promotion campaign. This observational study demonstrated that a campaign developed for 1 facility could successfully contribute to behavior change at another, unrelated facility. It serves as a model and evidence that health care facilities can successfully adopt hand hygiene promotion campaigns developed and validated at other facilities.

"Take time. Save lives. Clean hands protect." A comparison of two hand hygiene health promotion posters.

Two posters were designed to encourage hospital staff hand hygiene. One focused on broad benefits of hand hygiene to patients and staff, and the other highlighted hand hygiene as a long-known measure to infection control. The former was better received in terms of attention, likability, and potential to promote hand hygiene. A third-person effect, the perception of stronger impact of communication messages on others, was observed. Implications on health promotion message design were discussed.

Readability, suitability, and health content assessment of web-based patient education materials on colorectal cancer screening.

BACKGROUND: Colorectal cancer (CRC) screening rates in the Unites States are still below target level. Web-based patient education materials are used by patients and providers to provide supplemental information on CRC screening. Low literacy levels and patient perceptions are significant barriers to screening. There are little data on the quality of these online materials from a health literacy standpoint or whether they address patients' perceptions. OBJECTIVE: To evaluate the readability, suitability, and health content of web-based patient education materials on colon cancer screening. DESIGN: Descriptive study. SETTING: Web-based patient materials. INTERVENTIONS: Twelve reputable and popular online patient education materials were evaluated. Readability was measured by using the Flesch-Kincaid Reading Grade Level, and suitability was determined by the Suitability Assessment of Materials, a scale that considers characteristics such as content, graphics, layout/typography, and learning stimulation. Health content was evaluated within the framework of the Health Belief Model, a behavioral model that relates patients' perceptions of susceptibility to disease, severity, and benefits and barriers to their medical decisions. Each material was scored independently by 3 reviewers. MAIN OUTCOME MEASUREMENTS: Flesch-Kincaid Reading Grade Level score, Suitability Assessment of Materials score, health content score. RESULTS: Readability for 10 of 12 materials surpassed the maximum recommended sixth-grade reading level. Five were 10th grade level and above. Only 1 of 12 materials received a superior suitability score; 3 materials received inadequate scores. Health content analysis revealed that only 50% of the resources discussed CRC risk in the general population and <25% specifically addressed patients at high risk, such as African Americans, smokers, patients with diabetes, and obese patients. For perceived barriers to screening, only 8.3% of resources discussed embarrassment, 25% discussed pain with colonoscopy, 25% addressed cost of colonoscopy, and none specifically mentioned the need to get colonoscopy when no symptoms are present. No material discussed the social benefits of screening. LIMITATIONS: Descriptive design. CONCLUSION: Most online patient education materials for CRC screening are written beyond the recommended sixth-grade reading level, with suboptimal suitability. Health content is lacking in addressing key perceived risks, barriers, and benefits to CRC screening. Developing more appropriate and targeted patient education resources on CRC may improve patient understanding and promote screening.