Validation of the Short Assessment of Health Literacy in Portuguese-speaking adults in Portugal / Validación del Short Assessment of Health Literacy in Portuguese-speaking adults en Portugal

OBJECTIVE: To validate the Brazilian version of the Short Assessment of Health Literacy in Portuguese-speaking Adults (SAHLPA), a 50-item test proposed as a particularly helpful instrument to assess health literacy in people with limited skills, in the Portuguese population. METHODS: We used the standard procedure for cultural adaptation and administered the instrument to 249 participants. We examined construct validity using groups with expectedly increasing levels of health literacy (laypersons from the general population, engineering researchers, health researchers, and physicians), and through association with age and educational attainment, dichotomizing scores at the median of the layperson's group. RESULTS: Exploratory factor analysis revealed the instrument was one-dimensional and justified reduction to 33 items. SAHLPA-33 displayed adequate reliability (Cronbach's α = 0.73). The frequency of limited health literacy was highest among laypersons and lowest among physicians (p <0.001; p for trend <0.001). The proportion of participants with limited health literacy decreased with increasing education attainment (age- and sex-adjusted p for trend <0.001). Limited health literacy also tended to decrease with age, although the association was non-significant (sex- and education-adjusted p for trend = 0.067). CONCLUSION: We culturally adapted a brief and simple instrument for health literacy assessment, and showed it was valid and fairly reliable. In Portuguese low-literate adults, SAHLPA-33 fills the gap in health literacy assessment instruments, and may be used to guide communication strategies with vulnerable patients and communities

OBJETIVO: Validar la versión brasileña del Short Assessment of Health Literacy inPortuguese-speakingAdults (SAHLPA), una prueba de 50 ítems que ha sido propuesta como una herramienta particularmente útil para evaluar la alfabetización en salud en personas con bajas competencias, en la población portuguesa. MÉTODOS: Se usó el procedimiento habitual para la adaptación cultural. El instrumento fue administrado a 249 participantes. Se evaluó la validez de constructo utilizando grupos con niveles esperados crecientes de alfabetización en salud (personas no cualificadas de la población general, investigadores en el área de la ingeniería, investigadores en salud y médicos) y a través de la asociación con la edad y la escolaridad, dicotomizando las puntuaciones por la mediana de las del grupo de la población general. RESULTADOS: El análisis factorial exploratorio reveló que el instrumento era unidimensional y así ha sido reducido a 33 ítems. El SAHLPA-33 reveló una consistencia interna aceptable (α de Cronbach = 0,73). La frecuencia de alfabetización en salud limitada fue más elevada en la población general y menor en los médicos (p <0,001; p para la tendencia <0,001). La proporción de participantes con alfabetización en salud limitada disminuyó con el aumento de la escolaridad (p para la tendencia ajustada por edad y sexo <0,001). La alfabetización en salud también tendió a disminuir con la edad, aunque la asociación no era significativa (p para la tendencia ajustada por sexo y escolaridad = 0,067). CONCLUSIÓN: Se adaptó un instrumento simple y rápido para evaluar la alfabetización en salud individual y se mostró que era válido y razonablemente fiable. En los adultos portugueses con bajo nivel de alfabetización, SAHLPA-33 llena el vacío en instrumentos de evaluación de alfabetización en salud. Puede utilizarse para guiar estrategias de comunicación con personas y comunidades vulnerables

Comprensión de los consumidores del etiquetado nutricional para la compra de alimentos envasados / Consumer understanding of nutritional labeling for the purchase of packaged food

FUNDAMENTOS: La industria alimentaria ofrece una amplia variedad de alimentos que utilizan declaraciones nutricionales en su etiquetado para captar la atención de los consumidores. Por lo tanto, el presente trabajo tuvo como objetivo analizar la interpretación que realizan los consumidores de las declaraciones de propiedades nutricionales presentes en las etiquetas de los alimentos envasados. MÉTODOS: Se realizó un estudio descriptivo de corte transversal, empleando un cuestionario autoadministrado validado de preguntas cerradas. La población de estudio fueron docentes y alumnos (n=346) de un Instituto de Educación Superior "de la localidad General José de San Martín (Chaco)", quienes brindaron su consentimiento para participar en el estudio. Para el análisis de la información se utilizó como herramienta de estadística descriptiva las medidas de porcentaje y frecuencias. RESULTADOS: El 69% de los consumidores leen los rótulos de los alimentos antes de comprarlos, el 42% (n=82) y 41% (n=80) consideraran declaraciones referidas a contenido de grasa y sodio muy relevantes cuando compran sus alimentos respectivamente, pero no comprenden el significado de las declaraciones de propiedades nutricionales presentes en los alimentos envasados que compran. CONCLUSIONES: Los encuestados sólo compran productos envasados porque ven que tienen declaraciones nutricionales que resaltan es sus etiquetas, pero no realizan un juicio crítico de lo que significan

BACKGROUND: Food industry offers a wide variety of foods that use nutritional statements on their labels to capture the attention of consumers. Therefore, the aim of this work was to analyze the interpretation that consumers make of the declarations of nutritional properties present in the label of packaged foods. METHODS: A descriptive cross-sectional study was conducted, using a validated self-administered questionnaire of closed questions. The study population were teachers and students (n = 346) from a Higher Education Institute "in the town of General José de San Martín (Chaco)" who consented to participate in the study. For the analysis of the information, percentage and frequency measurements were used as a descriptive statistical tool. RESULTS: Consumers (69%) read the food labels before buying them, consider claims related to sodium (41%) and fats (43%) to be very relevant when choosing between the different products, but do not understand the meaning of the declarations of nutritional properties present in food packaged that buy. CONCLUSIONS: Participants only buy packaged products because they see that they have claims that stand out is their labels, but do not make a critical judgment of what they mean

Alfabetización en salud: propiedades psicométricas del cuestionario HLS-EU-Q16 / Health literacy: psychometric behaviour of the HLS-EU-Q16 questionnaire

OBJETIVO: Describir las propiedades psicométricas y el nivel de comprensión del cuestionario de alfabetización en salud HLS-EU-Q16 en español, implementado en la Encuesta de Salud de la Comunitat Valenciana de 2016. MÉTODO: Estudio descriptivo transversal para describir la comprensión, la fiabilidad, la estructura y la consistencia interna del cuestionario sobre la muestra de 5485 sujetos, de 15 o más años de edad, participantes en la encuesta. RESULTADOS: Los porcentajes de comprensión sin mucha dificultad fueron elevados. La fiabilidad fue alta (coeficiente de correlación intraclase: 0,923; kappa: 0,814). El análisis factorial sugirió una estructura unifactorial (79,1% de variabilidad explicada por el factor común), con altas cargas factoriales. La consistencia fue alta (alfa de Cronbach: 0,982). CONCLUSIONES: El HLS-EU-Q16 en español es un instrumento breve, adecuado y válido para medir el nivel de alfabetización en salud de la población

OBJECTIVE: To describe the psychometric properties and the level of understanding of the health literacy questionnaire HLS-EU-Q16 in Spanish, implemented in the Health Survey of the Valencian Region (Spain) of 2016. METHOD: Descriptive cross-sectional study to describe understanding, reliability, structure and internal consistency of the questionnaire on a sample of 5485 subjects, aged 15 or over, who participated in the survey. RESULTS: The percentages of understanding without much difficulty were high. Reliability was high (intraclass correlation coefficient:.923; kappa:.814). The factorial analysis suggested a unifactorial structure (79.1% of variability explained by the common factor), with high factorial loads. The consistency was high (Cronbach's alpha: 0.982). CONCLUSIONS: The HLS-EU-Q16 in Spanish is a short, adequate and valid instrument to measure the level of health literacy in the population

The relationship of counterfactual reasoning and false belief understanding: the role of prediction and explanation tasks

The relation between the prediction and explanation of the false belief task (FBT) with counterfactual reasoning (CFR) was explored. Fifty eight 3-5 year-olds received a prediction or an explanation FBT, a belief attribution task and some counterfactual questions of increasing difficulty. Linguistic comprehension was also controlled. CFR highly predicted FBT in the explanation version but not in the prediction one. Additionally, results in the explanation version indicate that CFR underlies achievements prior to the understanding of the representational mind and stimulates the explicitness of the mental domain. This study identifies the conditions under which CFR becomes a fundamental cognitive tool for social cognition. The results obtained contribute to the dialog between the two major theoretical approaches: theory-theory and simulation theory

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Guessability of U. S. pharmaceutical pictograms in Iranian prospective users

OBJECTIVE: This study examined the gueassability of US pharmaceutical pictograms as well as associated demographic factors and cognitive design features among Iranian adults. METHODS: A total of 400 participants requested to guess the meaning of 53 US pharmaceutical pictograms using the open-ended method. Moreover, the participants were asked to rate the cognitive design features of each pictorial in terms of familiarity, concreteness, simplicity, meaningfulness and semantic closeness on a scale of 0-100. RESULTS: The average guessability score (standard deviation) was 66.30 (SD=24.59). Fifty-five percent of pharmaceutical pictograms understudy met the correctness criteria of 67% specified by ISO3864, while only 30% reached the criterion level of 85% set by ANSIz535.3. Low literate participants with only primary school education had substantial difficulty in the interpretation of pharmaceutical pictograms compared to those completed higher education levels. Younger adults of <30 years significantly performed better in the interpretation of pharmaceutical pictograms as compared to >31 years old participants. 'Home patient care' and 'daily medication use' had no effect on guessability performance. Concerning cognitive design features, meaningfulness better predict geussability score compared to the others. CONCLUSIONS: Several USP pictograms fail to be correctly interpreted by Iranian users and need to be redesigned respecting cognitive design features. Interface designers are recommended to incorporate more familiar and concrete elements into their graphics in order to create more meaningful pictorial symbols and to avoid any misinterpretation by the user. Much effective medication use is expected to be achieved by means of this approach, through the improvement of the communication property of pharmaceutical pictograms

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Percepción del etiquetado nutricional en población con obesidad y sobrepeso / Perception of the nutritional labels by population in risk of being obese or overweight

FUNDAMENTOS: El etiquetado nutricional representa una valiosa herramienta para ayudar a los consumidores a tomar decisiones informadas acerca de su dieta y estilo de vida. Son escasos los estudios realizados en España sobre la percepción de la información alimentaria por el consumidor y ninguno considera la población con obesidad y sobrepeso como objetivo principal. Por ello el objetivo de este trabajo es evaluar la percepción de esta población frente a la información que le proporciona el etiquetado de los alimentos, su comprensión, utilidad y uso. MÉTODOS: Se realiza 133 encuestas en personas de la Comunidad Valenciana con obesidad (27,8%) y sobrepeso (72,2%) sobre la lectura, hábitos de compra, comprensión y uso de la información alimentaria. RESULTADOS: Se observa que a pesar del interés por seguir una dieta saludable (27,8%) y la valoración positiva del etiquetado de los alimentos (91%), se lee poco (35,3%) y resulta difícil de comprender (35,6%). El precio es el condicionante que más influye a la hora de la compra (72,9%). El 72,9% no sigue una dieta especial. El semáforo nutricional es el etiquetado frontal mejor comprendido. CONCLUSIONES: La población con obesidad y sobrepeso tiene dificultad para interpretar y comprender el etiquetado de los alimentos

BACKGROUND: Nutritional food label represents a valuable tool to help consumers to make informed decisions about their diets and lifestyle. There are few studies carried out in Spain about the perception of the consumer and none of them has obese or overweight population as their main target. Consequently the high interest to conduct this research in order to assess the perception of this population to food label, their understanding, utility and use. METHODS: 133 surveys are conducted in Comunidad Valenciana on obese (27.8%) and overweight (72.2%) people regarding their reading, shopping habits, use and understanding of food information. RESULTS: It is observed that despite their interest to follow a healthy diet (27.8%) and the positive assessment of the food label (91.0%) little is read (35.3%) and it is difficult to understand (35.6%). Price is the most determining factor regarding purchase (72.9%). 72.9% of the population don't follow a special diet. Traffic light colours used on the front packaging is the best understood food label. CONCLUSIONS: Obese and overweight population has difficulty in interpreting and understanding food labels

Unipersonal families and literacy: economic partner characterization and nursing care needs

The maintenance of good health levels is strongly related to personal, cognitive and social skills that compose the concept of health literacy (HL) (Soellner, Lenartz & Rudinger, 2017). Since low HL levels are associated with vulnerable groups (Pedro, Amaral & Escoval, 2016), we intend to analyze the social, economic and social characteristics of a group of unipersonal families with an elder person as well as to identify needs in nursing care. An exploratory and descriptive study was conducted in unipersonal families with members over 65 years of age, users of primary care. The sample consisted of clients that had the characteristics of the population who used a health unit in the northern part of Portugal requesting a nursing consultation, between March and April 2017. The data collection was performed based on the structural dimension of the MDAIF (Figueiredo, 2012). Data analysis was done through descriptive sta-tistics. In the sample composed of 15 families, 80% pertained to the lower middle class. All individuals suffer of one or more chronic diseases. The most common nursing interventions were directed to the residential building, safety precaution and water supply. The assessment of the structural dimension of unipersonal households is an essential resource in identifying potentialities or vulnerabilities, in order to guide nursing interventions to improve patients' levels of HL, or proactively preventing complications arising from their limitations

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Análisis de los estilos de aprendizaje en alumnos de Medicina de la Universidad de Chile / Analysis of learning styles in Medical students in the University of Chile

Neuroanatómicamente, con la estimulación temprana, la experiencia vivida y los intereses personales cada individuo desarrolla los procesos y competencias para aprender a modo de estilos de aprendizaje. El test de Kolb evalúa las formas de aprender de cada persona. Su conocimiento facilita la adaptación de estrategias de enseñanza/aprendizaje según los estilos de aprendizaje, como también poner atención en alumnos con estilos de aprendizaje diferentes al de la cohorte. OBJETIVOS: Conocer los estilos de aprendizaje y su distribución en alumnos de Medicina de la Universidad de Chile. MATERIAL Y MÉTODO: El test de Kolb se aplica a estudiantes ingresados a la carrera de Medicina (segundo semestre) con una explicación previa breve. Se consideraron 101 estudiantes. Paralelamente se preguntó por origen geográfico, procedencia escolar preuniversitaria y edad. Los datos fueron tabulados en Excel y analizados con Stata 11.0. RESULTADOS: Se analizaron las respuestas del Test de Estilos de Aprendizaje de 101 estudiantes; la edad promedio fue de 18,9±1,2años. El 62,4% son de sexo masculino, el 64,3% provienen de colegios particulares pagados, 3 de cada 5 estudiantes provienen de la región metropolitana. Respecto a la forma de comprender y la experiencia del aprender, la mayoría lo hace por conceptualización abstracta (84,2%) y de modo de transformar la experiencia. En la mayoría de los casos se realiza por medio de la experiencia activa. En general el estilo de aprendizaje más frecuente es convergente (50,5%). En la forma en cómo perciben o cómo procesan lo aprendido no existe diferencia significativa según género (p≤0,05)

Neuro-anatomically, with early stimulation, lived experience and personal interests, each individual develops the processes and skills to learn according to a mode of learning styles. Kolb's essay evaluates each person's ways of learning. Their knowledge helps in the adaptation of teaching/learning strategies according to the learning styles, as well as taking into account students with learning styles different from the cohort or are special. OBJECTIVES: To determine the learning styles and their distribution in the medical students of the University of Chile. MATERIAL AND METHOD: After giving a brief explanation, the Kolb test was applied to 101 students admitted to the medical school (second semester). At the same time, questions were asked about geographic origin, pre-university background, and age. The data were tabulated in Excel and analysed using Stata 11.0. RESULTS AND CONCLUSION: An analysis was made of the responses of the Learning Styles Test of 101 students with a mean age of 18.9±1.2years, of which 62.4% were male, 64.3% came from fee-paying private schools, and 3 out of 5 students came from the metropolitan region. As regards, the way of understanding and the experience of learning, the majority did by abstract conceptualization (84.2%) and by the transforming of experience method. In most cases it is done through active experience. In general, the most frequent learning style is Convergent (50.5%). There was no significant difference by gender (P<.05) in the way in which they are perceived or how they process what is learned

Self-efficacy matters more than interruptions in a sequential multitasking experiment

Interruptions and multitasking have received a great deal of attention from researchers. The present study is the first to examine task self-efficacy along with interruptions in an experimental multitasking framework. Perceptions of resumption lag times and task rehearsal were also examined. Participants (N= 110) completed a primary task (puzzle) with some being interrupted to pursue a secondary task (a word search) either once or four times. Uninterrupted participants completed the puzzle 26% faster than those interrupted once and 30% faster than those interrupted four times. However, self-efficacy predicted performance much more strongly than did interruptions, and therefore should receive more attention in future studies. Participants generally disagreed that they experienced resumption lags or task rehearsal. Practically, the results indicate that training to the point of high self-efficacy on tasks will do more to enhance performance than would eliminating interruptions. In reality, such training is likely easier to accomplish (AU)

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Modeling local item dependence in cloze and reading comprehension test items using testlet response theory

In this study the magnitudes of local dependence generated by cloze test items and reading comprehension items were compared and their impact on parameter estimates and test precision was investigated. An advanced English as a foreign language reading comprehension test containing three reading passages and a cloze test was analyzed with a two-parameter logistic testlet response model and a two-parameter logistic item response model. Results showed that the cloze test produced substantially higher magnitudes of local dependence than reading items, albeit the levels of local dependency produced by reading items was not ignorable. Further analyses demonstrated that while even substantial magnitudes of testlet effect does not impact parameter estimates it does influence test reliability and information. Implications of the research for foreign language proficiency testing, where testlets are regularly used, are discussed (AU)

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Dificuldade na noção lógica de conservação de quantidade no estágio pré-operatório / Difficulty with the logical notion of conservation of quantity at preoperational stage / Dificultad en la noción lógica de conservación de la cantidad en la etapa pre-operativa

O artigo aborda a dificuldade na noção lógica de conservação de quantidade da criança, no estágio pré-operatório. Retoma essa análise presente na investigação de Piaget e Szeminska (1975). Argumenta que, a partir da abordagem lógica do sentido e da referência em Frege (1892), verificamos uma aproximação entre essa abordagem e a análise de Piaget e Szeminska e pensamos que a criança com acesso à noção lógica de conservação de quantidade se encontra sob o primado da referência. Ademais, argumenta que Lacan (1971), a partir da abordagem de Frege, reivindica que a referência é fálica e, nessa direção, podemos pensar que a referida criança, quando aprende a conservar quantidade, está sob o primado da referência fálica que diz da operacionalidade da função paterna. Propõe, nessa direção, que o argumento apresentado por Lacan contribui para a compreensão dessa dificuldade detectada por Piaget. (AU)

This article discusses the child’s difficulty with the logical notion of conservation of quantity at preoperational stage, with the aid of Piaget and Szeminska’s investigation on the matter. Based on Frege’s approach to sense and reference (1892), we can observe a close relationship between said approach and Piaget and Szeminska’s analysis, and consider that the child with access to the logical notion of conservation is under the rule of the reference. In addition, we argue that Lacan (1971), based on Frege’s approach, claims that the reference is phallic and, in this sense, we can think that when children learn to conserve they are under the rule of the phallic reference, which is closely related to the operability of the paternal role. As a result, we propose that Lacan’s argument contributes to the understanding of this difficulty detected by Piaget. (AU)

El artículo aborda la dificultad de la noción lógica de conservación de la cantidad de niños en la etapa pre-operativa. Recoge este análisis presente en la investigación de Piaget y Szeminska (1975). Argumenta que desde el enfoque de la lógica de sentido y referencia en Frege (1892), se pode ver una conexión entre este enfoque y el análisis de Piaget y Szeminska, y pensar que el niño con el acceso a la noción lógica de conservación de la cantidad se encuentra bajo el primado de la referencia. Además, argumenta que Lacan (1971) desde el enfoque de Frege reivindica que la referencia es fálica, y, por consiguiente, se pode pensar que ese niño cuando aprende a conservar la cantidad está bajo el primado de la referencia fálica diciendo la operatividad del padre simbólico. Propone, en este sentido, que el argumento presentado por Lacan contribuye a la comprensión de esta dificultad, detectada por Piaget.(AU)

Dificuldade na noção lógica de conservação de quantidade no estágio pré-operatório / Difficulty with the logical notion of conservation of quantity at preoperational stage / Dificultad en la noción lógica de conservación de la cantidad en la etapa pre-operativa

O artigo aborda a dificuldade na noção lógica de conservação de quantidade da criança, no estágio pré-operatório. Retoma essa análise presente na investigação de Piaget e Szeminska (1975). Argumenta que, a partir da abordagem lógica do sentido e da referência em Frege (1892), verificamos uma aproximação entre essa abordagem e a análise de Piaget e Szeminska e pensamos que a criança com acesso à noção lógica de conservação de quantidade se encontra sob o primado da referência. Ademais, argumenta que Lacan (1971), a partir da abordagem de Frege, reivindica que a referência é fálica e, nessa direção, podemos pensar que a referida criança, quando aprende a conservar quantidade, está sob o primado da referência fálica que diz da operacionalidade da função paterna. Propõe, nessa direção, que o argumento apresentado por Lacan contribui para a compreensão dessa dificuldade detectada por Piaget.

This article discusses the child’s difficulty with the logical notion of conservation of quantity at preoperational stage, with the aid of Piaget and Szeminska’s investigation on the matter. Based on Frege’s approach to sense and reference (1892), we can observe a close relationship between said approach and Piaget and Szeminska’s analysis, and consider that the child with access to the logical notion of conservation is under the rule of the reference. In addition, we argue that Lacan (1971), based on Frege’s approach, claims that the reference is phallic and, in this sense, we can think that when children learn to conserve they are under the rule of the phallic reference, which is closely related to the operability of the paternal role. As a result, we propose that Lacan’s argument contributes to the understanding of this difficulty detected by Piaget.

El artículo aborda la dificultad de la noción lógica de conservación de la cantidad de niños en la etapa pre-operativa. Recoge este análisis presente en la investigación de Piaget y Szeminska (1975). Argumenta que desde el enfoque de la lógica de sentido y referencia en Frege (1892), se pode ver una conexión entre este enfoque y el análisis de Piaget y Szeminska, y pensar que el niño con el acceso a la noción lógica de conservación de la cantidad se encuentra bajo el primado de la referencia. Además, argumenta que Lacan (1971) desde el enfoque de Frege reivindica que la referencia es fálica, y, por consiguiente, se pode pensar que ese niño cuando aprende a conservar la cantidad está bajo el primado de la referencia fálica diciendo la operatividad del padre simbólico. Propone, en este sentido, que el argumento presentado por Lacan contribuye a la comprensión de esta dificultad, detectada por Piaget.

Strategic decisions in task-oriented reading

Answering questions from texts are assessment and instructional activities that are frequently used in schools. Nevertheless, little is known about the strategic processes that students take while performing these tasks. We explored the amount and frequency that students initially read of a text before they answered questions pertaining to the material. In a procedure similar to the one used in the PISA (Program for International Students Assessment), one-hundred-seventy students between 7th and 9th grade read and answered several questions designed to assess task-oriented reading in three specific texts. We recorded on-line indexes that evaluated student behavior (e.g., the amount of text that students read before answering questions raised within a given text), performance, and comprehension skill. The results revealed that students skilled in comprehension initially read a high proportion of the texts, which in turn improved their overall performance in two of the three texts read (text 1: CI95%: 0.01 to 0.09; text 2: CI95%: -0.01 to 0.05; text 3: CI95%: 0.04 to 0.20). Therefore, we conclude that this strategic behavior should be considered during the assessment and instruction of reading literacy (AU)

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Improving reading comprehension in reading and listening settings: the effect of two training programmes focusing on metacognition and working memory.

BACKGROUND: Metacognition and working memory (WM) have been found associated with success in reading comprehension, but no studies have examined their combined effect on the training of reading comprehension. Another open question concerns the role of listening comprehension: In particular, it is not clear whether training to improve reading comprehension must necessarily be based on processing written material or whether, as suggested in a recent study by Clarke et al. (2010, Psychol. Sci., 21, 1106), a programme based on verbal language could also be effective. AIMS: The study examined the feasibility of improving text comprehension in school children by comparing the efficacy of two training programmes, both involving metacognition and WM, but one based on listening comprehension, the other on reading comprehension. PARTICIPANTS: The study involved a sample of 159 pupils attending eight classes in the fourth and fifth grades (age range 9-11 years). METHOD: The listening and reading programmes focused on the same abilities/processes strictly related to text comprehension, and particularly metacognitive knowledge and control, WM (per se and in terms of integrating information in a text). The training programmes were implemented by school teachers as part of the class's normal school activities, under the supervision of experts. Their efficacy was compared with the results obtained in an active control group that completed standard text comprehension activities. RESULTS: Our results showed that both the training programmes focusing on specific text comprehension skills were effective in improving the children's achievement, but training in reading comprehension generated greater gains than the listening comprehension programme. CONCLUSIONS: Our study suggests that activities focusing specifically on metacognition and WM could foster text comprehension, but the potential benefit is influenced by the training modality, that is, the Reading group obtained greater and longer-lasting improvements than the Active control or Listening groups.

Readability assessment of online ophthalmic patient information.

IMPORTANCE: Patients increasingly use the Internet to access information related to their disease, but poor health literacy is known to impact negatively on medical outcomes. Multiple agencies have recommended that patient-oriented literature be written at a fourth- to sixth-grade (9-12 years of age) reading level to assist understanding. The readability of online patient-oriented materials related to ophthalmic diagnoses is not yet known. OBJECTIVE: To assess the readability of online literature specifically for a range of ophthalmic conditions. DESIGN AND SETTING: Body text of the top 10 patient-oriented websites for 16 different ophthalmic diagnoses, covering the full range of ophthalmic subspecialties, was analyzed for readability, source (United Kingdom vs non-United Kingdom, not for profit vs commercial), and appropriateness for sight-impaired readers. MAIN OUTCOMES AND MEASURES: Four validated readability formulas were used: Flesch Reading Ease Score (FRES), Flesch-Kincaid Grade Level (FKGL), Simple Measure of Gobbledygook (SMOG), and Gunning Fog Index (GFOG). Data were compared with the Mann-Whitney test (for 2 groups) and Kruskal-Wallis test (for more than 2 groups) and correlation was assessed by the Spearman r. RESULTS: None of the 160 webpages had readability scores within published guidelines, with 83% assessed as being of "difficult" readability. Not-for-profit webpages were of significantly greater length than commercial webpages (P = .02) and UK-based webpages had slightly superior readability scores compared with those of non-UK webpages (P = .004 to P < .001, depending on the readability formula used). Of all webpages evaluated, only 34% included facility to adjust text size to assist visually impaired readers. CONCLUSIONS AND RELEVANCE: To our knowledge, this is the first study to assess readability of patient-focused webpages specifically for a range of ophthalmic diagnoses. In keeping with previous studies in other medical conditions, we determined that readability scores were inferior to those recommended, irrespective of the measure used. Although readability is only one aspect of how well a patient-oriented webpage may be comprehended, we recommend the use of readability scoring when producing such resources in the future. Minimum readability policies and inclusion of facilities within webpages to maximize viewing potential for visually impaired readers are important to ensure that online ophthalmic patient information is accessible to the broadest audience possible.

Invariance levels across language versions of the PISA 2009 reading comprehension tests in Spain / Evaluación de la invarianza entre las versiones lingüísticas de las pruebas de comprensión lectora PISA 2009 en España

Background: The PISA project provides the basis for studying curriculum design and for comparing factors associated with school effectiveness. These studies are only valid if the different language versions are equivalent to each other. In Spain, the application of PISA in autonomous regions with their own languages means that equivalency must also be extended to the Spanish, Galician, Catalan and Basque versions of the test. The aim of this work was to analyse the equivalence among the four language versions of the Reading Comprehension Test (PISA 2009). Method: After defining the testlet as the unit of analysis, equivalence among the language versions was analysed using two invariance testing procedures: multiple group mean and covariance structure analyses for ordinal data and ordinal logistic regression. Results: The procedures yielded concordant results supporting metric equivalence across all four language versions: Spanish, Basque, Galician and Catalan. Conclusions: The equivalence supports the estimated reading literacy score comparability among the language versions used in Spain (AU)

Antecedentes: el proyecto PISA es la base de estudios y comparaciones sobre diseño curricular y factores de eficacia educativa, que solo son posibles si se garantiza la equivalencia entre las versiones idiomáticas de las pruebas. La aplicación de PISA en comunidades autónomas con lengua propia extiende el cumplimiento de la equivalencia a las versiones lingüística utilizadas en España: español, gallego, catalán y vasco. El objetivo de este trabajo fue analizar la equivalencia de la Prueba de Comprensión Lectora (PISA 2009) entre las 4 versiones idiomáticas. Método: tras definir el testlet como unidad de análisis se analizó la equivalencia entre versiones utilizando dos procedimientos de estudio de la invarianza: las estructuras de medias y covarianzas multigrupo para datos ordinales y la regresión logística ordinal. Resultados: los procedimientos arrojaron resultados concordantes que permiten avalar la equivalencia métrica entre versiones idiomáticas tanto con referencia al español, como entre los idiomas vasco, gallego y catalán. Conclusiones: la equivalencia respalda la comparabilidad de las estimaciones de competencia lectora entre las versiones lingüísticas utilizadas en España (AU)

Riddle appreciation and reading comprehension in Cantonese-speaking children.

PURPOSE: Inference-making skills are necessary for reading comprehension. Training in riddle appreciation is an effective way to improve reading comprehension among English-speaking children. However, it is not clear whether these methods generalize to other writing systems. The goal of the present study was to investigate the relationship between inference-making skills, as measured by riddle appreciation ability, and reading comprehension performance in typically developing Cantonese-speaking children in the 4th grade. METHOD: Forty Cantonese-speaking children between the ages of 9;1 (years;months) and 11;0 were given tests of riddle appreciation ability and reading comprehension. Chinese character reading and auditory comprehension abilities were also assessed using tests that had been standardized in Hong Kong. RESULTS: Regression analyses revealed that riddle appreciation ability explained a significant amount of variance in reading comprehension after variance due to character reading skills and auditory comprehension skills were first considered. Orthographic, lexical, morphological, and syntactic riddles were also significantly correlated with reading comprehension. CONCLUSION: Riddle appreciation ability predicts reading comprehension in Cantonese-speaking 4th-grade children. Therefore, training Cantonese speakers in riddle appreciation should improve their reading comprehension.

Readability assessment of Internet-based patient education materials related to endoscopic sinus surgery.

OBJECTIVES/HYPOTHESIS: Numerous professional societies, clinical practices, and hospitals provide Internet-based patient education materials (PEMs) to the general public, but not all of this information is written at a reading level appropriate for the average patient. The National Institutes of Health and the US Department of Health and Human Services recommend that PEMs be written at or below the sixth-grade level. Our purpose was to assess the readability of endoscopic sinus surgery (ESS)-related PEMs available on the Internet and compare readability levels of PEMs provided by three sources: professional societies, clinical practices, and hospitals. STUDY DESIGN: A descriptive and correlational design was used for this study. METHODS: The readability of 31 ESS-related PEMs was assessed with four different readability indices: Flesch-Kincaid Grade Level (FKGL), Flesch Reading Ease Score (FRES), Simple Measure of Gobbledygook (SMOG), and Gunning Frequency of Gobbledygook (Gunning FOG). Averages were evaluated against national recommendations and between each source using analysis of variance and t tests. RESULTS: The majority of PEMs (96.8%) were written above the recommended sixth-grade reading level, based on FKGL (P < .001). Only one article (3.2%) had an FKGL at or below the sixth-grade level. The mean readability values were: FRES 47.1 ± 13.4, FKGL 10.7 ± 2.4, SMOG 13.7 ± 1.6, and Gunning FOG 12.4 ± 2.7. CONCLUSIONS: Current Internet-based PEMs related to ESS, regardless of source type, were written well above the recommended sixth-grade level. Materials from the hospitals/university-affiliated websites had lower readability scores, but were still above recommended levels. Web-based PEMs pertaining to ESS should be written with the average patient in mind.

Readability of patient-reported outcome questionnaires for use with persons who stutter.

OBJECTIVE: The purpose of this study was to examine the readability of several published patient-reported outcome (PRO) questionnaires for use with persons who stutter, and to compare the readability results to existing data about average reading levels for English-speaking adults living in the United States. DESIGN: Published PRO questionnaires were identified that are traditionally completed by persons who stutter in a self-administered format. METHOD: Reading grade levels were analyzed using the Flesch Reading Ease, FOG, and FORCAST formulas as computed by a readability calculations software package. Descriptive statistics were computed across the questionnaires. RESULTS: The results of this study demonstrate that many of the PRO questionnaires exceeded the fifth to sixth grade reading levels recommended by health literacy experts. CONCLUSIONS: The clinician should consider the average reading level needed to understand a particular PRO questionnaire when administering it to a patient or their proxy. Likewise, developers of PRO questionnaires should consider reading level of respondents and include information about this when reporting psychometric data. EDUCATIONAL OBJECTIVES: The reader will get an overview over the literature on patient-reported outcome (PRO) questionnaires and their use with persons who stutter and will be able to: (1) define readability, (2) describe how reading levels are determined for a given PRO questionnaire, (3) list the strengths and limitations of readability assessment in the evaluation of persons who stutter and (4) analyze the role of readability assessment in future PRO questionnaire development.