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Easy-to-Read Health Materials (NLM Boost Box)


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Slides were given as part of a presentation hosted by the National Library of Medicine's Boost Box program. The description of the session:
Miraida Morales will discuss the challenges of using easy-to-read health materials, such as their high reading level, lack of control or standardization of readability, and problems with readability formulas. In this session she will offer practical solutions for what librarians and other professionals can do to minimize these issues for our communities. Miraida will also share her research findings on how adult beginning and developing readers evaluate health information materials.

Published in: Healthcare
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Easy-to-Read Health Materials (NLM Boost Box)

  1. 1. EASY-TO-READ HEALTH MATERIALS: Are they really? Slides created by Miraida Morales for the National Library of Medicine Copyright 2016 Use only with permission
  2. 2. Introduction Miraida Morales Ph.D. Candidate, Rutgers University Health Literacy | Adult New Readers | Community Health Practices
  3. 3. Agenda Readability formulas What are they? How do they work? Limitations Should we be using these formulas on health materials? Case Studies How do different people evaluate health information?
  4. 4. Readability a quality that determines how easy are texts to read for a particular individual, but... identifying just what makes texts easy to read remains a problem... especially for health materials
  5. 5. WHY? Readability is usually determined through the application of formulas to text
  6. 6. Flesch Kincaid Grade Level = (0.39 x ASL) + (11.8 x ASW) - 15.59 Dale Chall = (Raw Score = 0.1579 * (PDW) + 0.0496 * ASL) SMOG Formula = SO MANY FORMULAS ! The formulas do not take into account meaning.
  7. 7. How do these formulas work? They count the average length of words (syllables) They count the average number of words in a sentence They match these counts to grade levels
  8. 8. Assumptions longer words are more rare than shorter words in English & longer sentences have more complex structure
  9. 9. Limitation #1 Health materials include lots of “rare” or long words.
  10. 10. Limitation #2 Shorter texts are not always better.
  11. 11. Limitation #3 Readability formulas were developed using educational texts, often for educational purposes.
  12. 12. Limitation #4 Readability formulas precede advances in computation.
  13. 13. Limitation #5 Readability formulas can only assess complete sentences.
  14. 14. The big picture.
  15. 15. Let’s look at an example Although gestational diabetes is a serious condition, you can learn how to take care of it and prevent problems for you and your baby. Because the placenta leaves your body when the baby is delivered, gestational diabetes usually goes away when the baby is born. (American Diabetes Association)
  16. 16. Flesch-Kincaid Grade Level: 12.7 Average syllable length: 1.88 Average words per sentence: 16
  17. 17. Easy-to-Read Collection
  18. 18. Problem #1 Who is responsible for determining the readability of health materials?
  19. 19. Problem #2 Is everyone using the same method to determine readability of health materials?
  20. 20. Problem #3 Health information tends to be rather difficult to read. How do we simplify it?
  21. 21. There’s some good news...
  22. 22. Going beyond Easy-to- Read materials Don’t need to only rely on docs in the Easy-to-Read collection Readability of these documents doesn’t vary that much from documents not included in this collection. This means we have a bigger selection of topics available. Readability formulas are not necessarily applicable to health materials. Vocabulary and sentence length assumptions built into readability formulas don’t hold for health materials. Health materials tend to over-index on long words. Health materials don’t always include full sentences (e.g. bulleted lists, phases, etc.).
  23. 23. “Besides word and sentence length, what features of text and reader might better determine the readability of health materials for adult new readers?
  24. 24. We don’t know enough about how different people read.
  25. 25. [ Topic Knowledge ] [ Reading Expertise ] = X What’s the relationship between these factors?
  26. 26. CASE STUDIES WITH ADULT READERS 2. Adult women, some high school ed 3. Evaluate Diabetes Brochures 1. Diaspora Community Services
  27. 27. DESIGN FEATURES Document Length Preferred shorter document to longer one. One woman had trouble recalling information in the longer document. This is consistent with perceived ease or difficulty. Charts and Lists Though preferred, these proved difficult for participants to interpret accurately. Information presented in these formats was not necessarily easier to recall. Images Provide visual markers to anchor the text. Allow for scanning. Serve similar purpose to section headings.
  28. 28. “That’s true.” AND “I know…” Prior Knowledge All participants viewed favorably portions of brochures that resonated with their prior knowledge. Future Use Usefulness of information in the brochures was an important evaluation criteria for participants.
  29. 29. Sources of difficulty when reading Statistics Percentages and other numerical figures were difficulty for participants to interpret. Word Use Lack of definitions for complicated health terms, such as gestational diabetes or prediabetes created uncertainty or confusion. Bulleted Lists Because they often lack function words or phrases, information presented in lists can be difficult to interpret. Participants often expected list to follow a narrative structure, with each item linking to the previous one.
  30. 30. MANY READERS, MANY TEXTS A. Types of Readers B. Types of Knowledge C. Types of Texts D. Types of Uses
  31. 31. FUTURE DIRECTIONS Research into cohesion, narrativity, simplification User & usability studies What do members of our communities want?
  32. 32. ONGOING RESEARCH Recruiting participants Focusing on adult new & developing readers Conducting usability tests Collaborating with libraries
  33. 33. THANKS! Any questions? You can find me at: @Miraidam
  34. 34. References & More Reading ○ DuBay, W. H. (2004). The Principles of Readability. Costa Mesa: Impact Information, 76. Retrieved from ○ Feng, L., Elhadad, N., & Huenerfauth, M. (2009, March). Cognitively motivated features for readability assessment. In Proceedings of the 12th Conference of the European Chapter of the Association for Computational Linguistics (pp. 229-237). Association for Computational Linguistics. ○ McNamara, D. S., Graesser, A. C., McCarthy, P. M., & Cai, Z. (2014). Automated evaluation of text and discourse with Coh-Metrix. Cambridge University Press. ○ Schriver, K. (2000). Readability Formulas in the New Millennium: What’s the Use? ACM Journal of Computer Documentation, 24(3), 138–140. ○