An effort to improve the collection of patient-generated data: readability and understandability of patient-reported outcomes measures in a survivorship cohort.

PURPOSE: In this study, we evaluated readability and understandability of nine French-language Patient-Reported Outcome Measures (PROMs) that are currently used in a contemporary longitudinal cohort of breast cancer survivors as part of an effort to improve equity in cancer care and research. METHODS: Readability of PROMs was assessed using the Flesh Reading Ease Score (FRES), the Gunning's Fog Index (FOG), and the FRY graphics. Readability was considered ideal if mean score ≤ 6th-grade level and acceptable if between 6th and 8th grade. Understandability was evaluated using the Patient Education Materials Assessment Tool and defined as ideal if PEMAT ≥ 80%. The Evaluative Linguistic Framework for Questionnaires (ELF-Q) provided additional qualitative elements to assess understandability. Plain-language best practice was met if both readability and understandability were ideal. RESULTS: None of the 9 PROMs evaluated had ideal readability scores and only 1 had an acceptable score. Understandability ranged from 55% to 91%, and only 3 PROMs had ideal scores. ELF-Q identified points for improvement in several understandability dimensions of the PROMs. None of the instruments met the definition of plain-language best practice. CONCLUSION: None of the studied PROMs met the standards of readability and understandability. Future development and translation of PROMs should follow comprehensive linguistic and cultural frameworks to ensure plain-language standards and enhance equitable patient-centered care and research.

Investigation of the quality and health literacy demand of online information on pelvic floor exercises to reduce stress urinary incontinence.

BACKGROUND: Many women are embarrassed to discuss pelvic floor exercises with health professionals during pregnancy; instead they search the internet for information on pelvic floor exercises. AIMS: This project investigated the quality and health literacy demand in terms of readability, understandability and actionability of information available on the internet relating to pelvic floor exercises. MATERIALS AND METHODS: An analysis was conducted on 150 websites and 43 videos obtained from three consecutive Google searches relating to pelvic floor exercises. Websites were assessed for Health on the Net certification. Readability was assessed using a readability calculator, and understandability/actionability of website and video information was assessed using the Patient Education Materials Assessment Tool (PEMAT) for Print or Audiovisual Materials. RESULTS: Less than one-third (24%) of the websites were certified for quality. The median readability score for the websites was grade 9 and the websites and videos both rated highly for understandability and actionability. The median understandability score for the website information was 87%, and the median actionability score was 71%. The median understandability score of the video information was 95.5% and the median actionability score was 100%. The understandability and actionability of video information was also significantly greater than that for website information (P < 0.01). CONCLUSION: Clinicians could consider directing patients to video-based resources when advising online pelvic floor exercise resources for women during pregnancy, especially those with lower health literacy.

Reshaping Smart Cities through NGSI-LD Enrichment.

The vast amount of information stemming from the deployment of the Internet of Things and open data portals is poised to provide significant benefits for both the private and public sectors, such as the development of value-added services or an increase in the efficiency of public services. This is further enhanced due to the potential of semantic information models such as NGSI-LD, which enable the enrichment and linkage of semantic data, strengthened by the contextual information present by definition. In this scenario, advanced data processing techniques need to be defined and developed for the processing of harmonised datasets and data streams. Our work is based on a structured approach that leverages the principles of linked-data modelling and semantics, as well as a data enrichment toolchain framework developed around NGSI-LD. Within this framework, we reveal the potential for enrichment and linkage techniques to reshape how data are exploited in smart cities, with a particular focus on citizen-centred initiatives. Moreover, we showcase the effectiveness of these data processing techniques through specific examples of entity transformations. The findings, which focus on improving data comprehension and bolstering smart city advancements, set the stage for the future exploration and refinement of the symbiosis between semantic data and smart city ecosystems.

Evaluation of the usefulness and understandability of information leaflets on fall prevention from the perspective of hospital patients and their relatives.

BACKGROUND: Falls are a major problem among adults over 60 years. Multiple preventive measures must be taken. Written information leaflets can support the knowledge transfer and positively influence recall of the information provided. OBJECTIVE: The aim was to ensure usefulness and understandability of the information leaflets on home fall prevention from the target groups' perspective. METHODS: A cross-sectional survey study with a feedback questionnaire for patients and relatives was conducted at a university hospital in Austria. Quantitative data analysis and qualitative content analysis according to Schreier were performed. RESULTS: The majority (63.9%) of patients rated the overall impression as "very good". 44.2% of the relatives rated it as "very good" and 23% as "good". The question "appealing design" was the only one with a statistically significant difference between patients and relatives. Subgroup analysis has shown a statistically significant difference between educational groups regarding the questions "easy to read" and "easy to understand". CONCLUSION: It could be shown that the information leaflets were already well tailored to the target group. The few comments regarding understandability were considered to improve the content of the information leaflets. A further evaluation regarding the benefit of the fall prevention leaflets in discharge management should be performed.

Designing Dietary Education Materials for People With Chronic Kidney Disease: Recommendations for Improving the Quality of Resources.

OBJECTIVE: The aim of this study is to quantify the readability, actionability, understandability, and overall quality of dietary education resources designed for patients and published in the Journal of Renal Nutrition. DESIGN AND METHODS: All patient education materials published in the "Patient Education" section of the journal from 2011 to 2021 were included. The readability, health literacy demand, and quality were evaluated using the Hemingway editor, Patient Education Materials Assessment Tool, and the Centers for Disease Control and Prevention Clear Communication Index (CDC CCI) respectively. Good quality materials were those with a reading grade level of ≤8; a Patient Education Materials Assessment Tool score of >70% (indicating materials were understandable and actionable), and a CDC CCI score >90%. RESULTS: A total of 42 resources were evaluated. Most materials (92%) were written at an appropriate level of readability (median grade 5, interquartile range [IQR: 5-7). The median understandability score was 71% (IQR: 60-81); however, only half (52%) of the materials met the 70% benchmark. Materials published performed poorly for actionability with the median actionability score of 37% (IQR: 20-83), and only 29% met the benchmark score. Overall quality was scored as low, with a median CDC CCI score of 65%, and only 10% of materials met the benchmark score. Areas for improvement were identified including providing a clear purpose, and summary of important points, explaining numbers and how to perform calculations, and including at least one action to take. Future efforts to improve actionability need to use the active voice, directly address readers, explain how to act, and describe the steps required. CONCLUSION: Patient education materials that are attentive to health literacy principles beyond readability may enhance patient engagement, confidence, and empowerment, and improve adherence to the kidney diet.

Using Animated Videos to Promote the Accessibility and Understandability of Package Leaflets: Retrospective Observational Study Evaluating the First Year of Implementation.

BACKGROUND: The medication package leaflet is the most used and trusted source of information in the home situation but is often incomprehensible for individuals, especially for those with limited health literacy. The platform "Watchyourmeds" comprises a web-based library with over 10,000 animated videos that explain the most essential information from the package leaflet in an unambiguous and simple manner to increase the accessibility and understandability of package leaflets. OBJECTIVE: This study aimed to investigate Watchyourmeds in the Netherlands from a user perspective during the first year of implementation by investigating (1) usage data, (2) self-reported user experiences, and (3) the preliminary and potential impact on medication knowledge. METHODS: This was a retrospective observational study. The first aim was investigated by examining objective user data from 1815 pharmacies from the first year of implementation of Watchyourmeds. User experiences (second aim) were investigated by examining individuals' completed self-report questionnaires (n=4926) that they received after completing a video. The preliminary and potential impact on medication knowledge (third aim) was investigated by examining users' self-report questionnaire data (n=67) that assessed their medication knowledge about their prescribed medication. RESULTS: Nearly 1.8 million videos have been distributed to users by over 1400 pharmacies, with monthly numbers increasing to 280,000 in the last month of the implementation year. Most users (4444/4805, 92.5%) indicated to have fully understood the information presented in the videos. Female users reported more often to have fully understood the information than male users (χ24=11.5, P=.02). Most users (3662/4805, 76.2%) said that they did not think any information was missing in the video. Users with a lower educational level stated more often (1104/1290, 85.6%) than those with a middle (984/1230, 80%) or higher (964/1229, 78.4%) educational level that they did not seem to be missing any information in the videos (χ212=70.6, P<.001). A total of 84% (4142/4926) of the users stated that they would like to use Watchyourmeds more often and for all their medication, or would like to use it most of the time. Male users and older users stated more often that they would use Watchyourmeds again for other medication than the female (χ23=25.0, P<.001) and younger users (χ23=38.1, P<.001), respectively. Almost 88% (4318/4926) of the users would recommend the web-based library to friends, family, or acquaintances. Regarding the third aim, results showed that 73.8% (293/397) of the questions assessing users' medication knowledge were answered correctly. CONCLUSIONS: The results of this study suggest that a web-based library with animated videos is a valuable and acceptable addition to stand-alone package leaflets to increase the understanding and accessibility of medication information.

Assessment of Online Patient Education Material About Dysphagia.

To examine quality, readability, understandability, and actionability of English-language online educational materials about dysphagia. A Google search of "dysphagia" and related terms was conducted. Web page quality and accountability were measured using HON and URAC certification seals, the DISCERN instrument, and JAMA benchmark criteria. Understandability and actionability were assessed with the Patient Education Materials Assessment Tool for Printed Material (PEMAT-P). Readability was assessed using the Flesch Reading Ease (FRE), Flesch-Kincaid Grade Level (F-KGL), Gunning Fog (FOG), and the Simple Measure of Gobbledygook (SMOG) scores using dedicated readability software. Fifty web pages were analyzed. Seventeen web pages displayed a HON or URAC seal. DISCERN scores ranged from 17 to 50 (Mdn = 25.00; IQR = 32.25-21.00). Of the JAMA benchmark criteria, 88% of web pages met the disclosure criterion, while only 22% met the authorship, 20% met the attribution, and 16% met the currency criteria. PEMAT-P understandability and actionability scores were 69.38% ± 11.14% and 28.58% ± 22.19%, respectively. Readability scores, on average, exceeded the recommended grade reading levels for health information (FRE 46.34 ± 13.59, F-KGL 10.26 ± 2.29, FOG 12.11 ± 2.08, and SMOG 12.38 ± 1.70). Online materials about dysphagia can be improved by obtaining quality certificates and by including content that is more readable and easier to understand and act upon.

A Brief Report: Comparative Evaluation of Online Spanish and English Content on Pancreatic Cancer Treatment.

The Internet is a major source of patient information on medical subjects. Several studies have evaluated the content of English medical material for patient use. However, few have focused on evaluating other languages, an important gap in a growing Spanish-speaking population. The aim of this study is to evaluate and compare English and Spanish online content related to pancreatic cancer treatment. We conducted a Google web search in English and Spanish using the following terms "pancreatic cancer treatment" and "tratamiento cancer de pancreas." The first 15 educational patient-directed websites for each language were included. Two independent reviewers assessed materials for quality and understandability using the DISCERN and the Patient Education Materials Assessment Tool (PEMAT)-validated tools. Readability was measured using two standardized tests. Wilcoxon rank sum test and unpaired Student's T-test were used for comparisons. Overall, websites in Spanish and English were understandable and had moderate to high quality. There were no significant differences in quality (p = 0.712) and understandability (p = 0.069) between languages. Readability level was significantly higher in English (p < 0.001) with content being at the university level, while Spanish was at the 12th grade level. Patient-directed online content on pancreatic cancer treatments exceeds the recommended reading level in both languages. Material is understandable with reasonable quality. Health content creators should acknowledge readability for information to be easily comprehended by those with lower health literacy.

How Good Is Online Information for Patients on the Treatment for Luminal Gastrointestinal Cancers? A Comprehensive Evaluation in English and Spanish.

The internet has become a necessary communication platform for health information. The quality of online material for patients varies significantly, and this is not different for material on gastrointestinal cancers. We aimed to assess English and Spanish online patient information addressing esophageal, gastric, and colorectal cancer treatment. Six independent Google searches were conducted using the terms: esophageal cancer treatment, gastric cancer treatment, colorectal cancer treatment, and their translations in Spanish. Websites were included in the top 50 results for each search. Readability was assessed using two validated tests for each language. Understandability/actionability, quality, and cultural sensitivity were assessed using Patient Education Materials Assessment Tool (PEMAT), DISCERN, and Cultural Sensitivity Assessment Tool (CSAT), respectively. Pearson's chi-squared was used for categorical variables and Wilcoxon rank-sum (2 groups) or Kruskal-Wallis (> 2 groups) for continuous. One hundred twelve websites were analyzed. Readability levels were high in both languages (between 11th grade and university level) and significantly higher in English. Mean quality scores for English and Spanish were consistent with good quality. CSAT scores met the cultural acceptability with lower CSAT scores for gastric cancer treatment in English. Higher actionability scores were found in English for colorectal cancer. Also, there was a clear trend for higher cultural sensitivity and quality of Spanish material for gastric cancer treatment. Online patient information on esophageal, gastric, and colorectal cancer treatment, in English and Spanish, were at a readability level above the average literacy level and even significantly higher in English. Initiatives to improve online information on gastrointestinal cancer treatments are warranted.

Enhancing students' online collaborative PBL learning performance in the context of coauthoring-based technologies: A case of wiki technologies.

Understandability and completeness are essential in modern collaborative digital platforms and their learning systems. These platforms have shaken up the traditional education setting, particularly in leveraging the coauthoring approach in problem-solving and streamlining the learning behavior of cowriting or corevising. Such a learning context has attracted considerable interest from various stakeholders; however, it needs to be explored further as an independent topic. Based on social capital and social identity theories, we explore how online collaborative problem-based learning (PBL) effectiveness, relational quality, and social identity influence students' perceived PBL performance during learning activities. Based on the core elements of online coauthoring processes (i.e., platform, cocreation, and problem-solving), this study employs a holistic view of the coauthor to discuss the effects of understandability and completeness. This study also highlights the mediating impact of trust on students' social identity. Based on the responses of 240 students, the results support the proposed hypotheses using partial least squares analysis. The study's implications suggest guidelines to educators on how to enhance students' perceived PBL performance by using wiki technologies.

Assessment of patient education materials for age-related macular degeneration.

PURPOSE: Age-related macular degeneration (AMD) is a leading cause of vision loss. It is helpful for patients living with AMD to understand the prognosis, risk factors and management of their condition. Online education materials are a popular and promising channel for conveying this knowledge to patients with AMD. However, the quality of these materials-particularly with respect to qualities such as 'understandability' and 'actionability'-is not yet known. This study assessed a collection of online materials about AMD based on these qualities of 'understandability' and 'actionability'. METHODS: Online education materials about AMD were sourced through Google from six English-speaking nations: Australia, New Zealand, USA, UK, Ireland and Canada. Three Australian/New Zealand trained and registered optometrists participated in the grading of the 'understandability' and 'actionability' of online education materials using the Patient Education Materials Assessment Tool (PEMAT). RESULTS: This study analysed a total of 75 online materials. The mean 'understandability' score was 74% (range: 38%-94%). The 'understandability' PEMAT criterion U11 (calling for a summary of the key points) scored most poorly across all materials. The mean 'actionability' score was 49% (range: 0%-83%). The 'actionability' PEMAT criterion A26 (using 'visual aids' to make instructions easier to act on) scored most poorly across all materials. CONCLUSION: Most education materials about AMD are easy to understand, but difficult to act on, because of a lack of meaningful visual aids. We propose future enhancements to AMD education materials-including the use of summaries, visual aids and a habit tracker-to help patients with AMD improve their understanding of disease prognosis, risk factors and eye assessment schedule requirements.

Assessment of Clinical Information Quality in Digital Health Technologies: International eDelphi Study.

BACKGROUND: Digital health technologies (DHTs), such as electronic health records and prescribing systems, are transforming health care delivery around the world. The quality of information in DHTs is key to the quality and safety of care. We developed a novel clinical information quality (CLIQ) framework to assess the quality of clinical information in DHTs. OBJECTIVE: This study explored clinicians' perspectives on the relevance, definition, and assessment of information quality dimensions in the CLIQ framework. METHODS: We used a systematic and iterative eDelphi approach to engage clinicians who had information governance roles or personal interest in information governance; the clinicians were recruited through purposive and snowball sampling techniques. Data were collected using semistructured online questionnaires until consensus was reached on the information quality dimensions in the CLIQ framework. Responses on the relevance of the dimensions were summarized to inform decisions on retention of the dimensions according to prespecified rules. Thematic analysis of the free-text responses was used to revise definitions and the assessment of dimensions. RESULTS: Thirty-five clinicians from 10 countries participated in the study, which was concluded after the second round. Consensus was reached on all dimensions and categories in the CLIQ framework: informativeness (accuracy, completeness, interpretability, plausibility, provenance, and relevance), availability (accessibility, portability, security, and timeliness), and usability (conformance, consistency, and maintainability). A new dimension, searchability, was introduced in the availability category to account for the ease of finding needed information in the DHTs. Certain dimensions were renamed, and some definitions were rephrased to improve clarity. CONCLUSIONS: The CLIQ framework reached a high expert consensus and clarity of language relating to the information quality dimensions. The framework can be used by health care managers and institutions as a pragmatic tool for identifying and forestalling information quality problems that could compromise patient safety and quality of care. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1136/bmjopen-2021-057430.

Zenker's Diverticulum: Readability and Quality of Online Written Education Materials.

To assess the readability and quality of online materials for Zenker's diverticulum. A Google search of "Zenker's diverticulum" was performed and the first 50 websites were reviewed. Readability was measured by Flesch Reading Ease (FRES), Flesch-Kincaid Grade Level (FKGL) and the Simple Measure of Gobbledygook (SMOG) scores using an online calculator. Understandability and actionability were assessed with the Patient Education Materials Assessment Tool for Printed Materials (PEMAT-P). Websites were categorized as either patient-targeted or physician-targeted and unpaired t tests were used to compare scores between these two groups. A total of 31 websites (23 patient-oriented sites and 8 physician-oriented sites) were analyzed. The average FRES, FKGL, and SMOG scores were 29.96 ± 14.72, 13.75 ± 2.78, and 12.19 ± 2.02, respectively, for the entire cohort. Readability scores for the patient-oriented sites were better than the physician-oriented sites for each measure (FRES 36.21 ± 8.86 vs 11.96 ± 13.54, FKGL 12.68 ± 1.58 vs 16.85 ± 3.25, and SMOG 11.37 ± 1.26 vs 14.53 ± 1.98; p < 0.001 for all comparisons). PEMAT-P understandability and actionability scores for the entire cohort were 68.20% ± 10.19% and 10.75% ± 16.52% respectively, and did not differ between patient-oriented and physician oriented sites. Though patient-oriented sites had better readability than physician-oriented sites for Zenker's Diverticulum, both categories had readability levels more advanced than what is recommended for medical education materials.

What's in Between the Lines: Assessing the Readability, Understandability, and Actionability in Breast Cancer Survivorship Print Materials.

Educational print materials for young women breast cancer survivors (YBCS) are supplemental tools used in patient teaching. However, the readability of the text coupled with how well YBCS understand or act upon the material are rarely explored. The purpose of this study was to assess the readability, understandability, and actionability of commonly distributed breast cancer survivorship print materials. We used an environmental scan approach to obtain a sample of breast cancer survivorship print materials available in outpatient oncology clinics in the central region of a largely rural Southern state. The readability analyses were completed using the Flesch-Kincaid (F-K), Fry Graph Readability Formula (Fry), and Simple Measure of Gobbledygook (SMOG). Understandability and actionability were analyzed using Patient Education Materials Assessment Tool for Printable Materials (PEMAT-P). The environmental scan resulted in a final sample of 14 materials. The mean readability of the majority of survivorship materials was "difficult," but the majority scored above the recommended 70% in both understandability and actionability. The importance of understandability and actionability may outweigh readability results in cancer education survivorship material. While reading grade level cannot be dismissed all together, we surmise that patient behavior may hinge more on other factors such as understandability and actionability. Personalized teaching accompanying print material may help YBCS comprehend key messages and promote acting upon specific tasks.

Understanding Dilated Mathematical Relationship between Image Features and the Convolutional Neural Network's Learnt Parameters.

Deep learning, in general, was built on input data transformation and presentation, model training with parameter tuning, and recognition of new observations using the trained model. However, this came with a high computation cost due to the extensive input database and the length of time required in training. Despite the model learning its parameters from the transformed input data, no direct research has been conducted to investigate the mathematical relationship between the transformed information (i.e., features, excitation) and the model's learnt parameters (i.e., weights). This research aims to explore a mathematical relationship between the input excitations and the weights of a trained convolutional neural network. The objective is to investigate three aspects of this assumed feature-weight relationship: (1) the mathematical relationship between the training input images' features and the model's learnt parameters, (2) the mathematical relationship between the images' features of a separate test dataset and a trained model's learnt parameters, and (3) the mathematical relationship between the difference of training and testing images' features and the model's learnt parameters with a separate test dataset. The paper empirically demonstrated the existence of this mathematical relationship between the test image features and the model's learnt weights by the ANOVA analysis.

Review of the quality of printed patient education materials on asthma available in primary care in Singapore.

Objective: Patient education materials (PEMs) are commonly used for patient education. This study assessed readability, format quality, accuracy, understandability and actionability of printed asthma PEMs available in primary care in Singapore.Methods: Primary care in Singapore is provided by island-wide polyclinics and private general practices. We invited the three polyclinic healthcare groups and private general practices via the Primary Care Research Network to submit asthma-related PEMs. Readability was assessed using Simple Measure of Gobbledegook (SMOG) and Flesch-Kincaid (FK) score. Format quality was assessed using "Clear-print and large-print golden rules" from UK Association for Accessible Formats (UKAAF). Understandability and actionability were evaluated using Patient Education Materials Assessment Tool - Printed. Three pulmonologists assessed content accuracy.Results: Thirty leaflets were assessed. SMOG and FK estimated 93% (mean 9.3, range 5-14, SD 1.8) and 47% (mean 6.8, range 2.4-9.9, SD 2.0) exceeded the recommended sixth-grade reading level, respectively. About a third (37%) were fully concordant with UKAAF guidelines, with poor format quality contributed by small font size, poor text emphasis methods, and not using left-aligned text. Leaflets generally scored well in both understandability (mean 84%) and actionability (mean 72%). Thirteen leaflets were inaccurate, 92% of which contained at least one inaccuracy judged to have potentially harmful consequences to patients, including wrong emergency advice.Conclusion: While understandability and actionability are adequate, current asthma PEMs are limited by inappropriately high reading levels, poor format quality and inaccuracies. Healthcare professionals need to assess patients' reading abilities and ensure PEMs are accurate and suitable for their patients.

Computer-Based Readability Testing of Information Booklets for German Cancer Patients.

Understandable health information is essential for treatment adherence and improved health outcomes. For readability testing, several instruments analyze the complexity of sentence structures, e.g., Flesch-Reading Ease (FRE) or Vienna-Formula (WSTF). Moreover, the vocabulary is of high relevance for readers. The aim of this study is to investigate the agreement of sentence structure and vocabulary-based (SVM) instruments. A total of 52 freely available German patient information booklets on cancer were collected from the Internet. The mean understandability level L was computed for 51 booklets. The resulting values of FRE, WSTF, and SVM were assessed pairwise for agreement with Bland-Altman plots and two-sided, paired t tests. For the pairwise comparison, the mean L values are LFRE = 6.81, LWSTF = 7.39, LSVM = 5.09. The sentence structure-based metrics gave significantly different scores (P < 0.001) for all assessed booklets, confirmed by the Bland-Altman analysis. The study findings suggest that vocabulary-based instruments cannot be interchanged with FRE/WSTF. However, both analytical aspects should be considered and checked by authors to linguistically refine texts with respect to the individual target group. Authors of health information can be supported by automated readability analysis. Health professionals can benefit by direct booklet comparisons allowing for time-effective selection of suitable booklets for patients.

A systematic evaluation of advance care planning patient educational resources.

BACKGROUND: Advance care planning (ACP) conversations help individuals exercise autonomy and make informed decisions about their care. There are many ACP resources available to support the process of advance care planning, yet available resources not universally accepted and under-utilized in clinical practice. OBJECTIVE: This study aims to systematically evaluate commonly available general ACP patient educational resources using a comprehensive approach to assess elements ranging from resource inclusion to health literacy. DESIGN: Systematic evaluation of general ACP educational resources METHODS: ACP educational resources were systematically identified and evaluated for: Patient Education Materials Assessment Tool (PEMAT) score, Flesch-Kincaid reading ease and grade level, cost, languages available, and categories of content including Advance directive/Healthcare proxy, Physician Order for Life-Sustaining Treatment (POLST), Living will, values, preferences, and goals. RESULTS: Educational resources (n = 20) were identified. These resources were classified as information resources, workbooks, interactive websites, or and activities/conversation guides. The average PEMAT understandability score was 86 (range 58-100) and the average actionability was 90 (range 40-100). Two resources met Flesch-Kincaid reading ease and grade level. Eight were available in English only, nine in two languages, and three in more than two languages. Three explicitly discussed completion of POLST forms. The majority of the resources adequately addressed the content of advanced directives and health care proxy, values, goals, and preferences for future care. The level of time commitment required to use each resource also varied considerably. CONCLUSION: We present a comprehensive evaluation of resources to support ACP. Using the Transtheoretical Model, we provide a guide for the use of these educational resources based on patient readiness. This review allows clinicians to identify aspects of each resource that may be helpful in preparing older adults for future healthcare decsions. Our analysis has identified the need to continue to refine these educational resources so that they can reach a broad population with varying needs. Advance care planning (ACP) conversations help individuals exercise autonomy and make informed decisions about their care. There are many ACP educational resources available to support the process of advance care planning, yet available resources are not universally accepted and under-utilized in clinical practice. We present a comprehensive evaluation of 20 educational resources to support ACP. Educational resources were identified and evaluated for: Patient Education Materials Assessment Tool (PEMAT) score, Flesch-Kincaid reading ease and grade level, cost, languages available, and categories of content. Using the Transtheoretical Model, we provide a guide for the use of these educational resources based on patient readiness. This review allows clinicians to identify aspects of each resource that may be helpful in preparing older adults for future healthcare decisions. Our analysis has identified the need to continue to refine these educational resources so that they can reach a broad population with varying needs.

Modeling compliance specifications in linear temporal logic, event processing language and property specification patterns: a controlled experiment on understandability.

Mature verification and monitoring approaches, such as complex event processing and model checking, can be applied for checking compliance specifications at design time and runtime. Little is known about the understandability of the different formal and technical languages associated with these approaches. This uncertainty regarding understandability might be a major obstacle for the broad practical adoption of those techniques. This article reports a controlled experiment with 215 participants on the understandability of modeling compliance specifications in representative modeling languages, namely linear temporal logic (LTL), the complex event processing-based event processing language (EPL) and property specification patterns (PSP). The formalizations in PSP were overall more correct. That is, the pattern-based approach provides a higher level of understandability than EPL and LTL. More advanced users, however, seemingly are able to cope equally well with PSP and EPL in modeling compliance specifications.

Understandability of Patient Information Booklets for Patients with Cancer.

The improvement of health literacy in general and the information of individual patient is a major concern of the German national cancer plan and similar initiatives in other western countries. The aim of our study was to assess the readability and understandability of information booklets for cancer patients available at German Web sites. A support vector machine (SVM) was used to discriminate between laymen- and expert-centric patient information booklets about nine most common tumor types. All booklets had to be available for free at the Internet. A total of 52 different patient booklets were downloaded and assessed. Overall, the assessment of all booklets showed that an understandability level L of 4.6 and therefore increased medical background knowledge is required to understand a random text selected from the sample. The assessed information booklets on cancer show very limited suitability for laymen. We were able to demonstrate that a medical background is necessary to understand the examined booklets. The current study highlights the need to create information material adjusted to the needs of laymen. Assessing understandability before publication, especially for laymen with low health literacy, could ensure the suitability and thus quality of the information material.