Carel Jansen

How to limit clinical errors in interpretation of data

We all assume that we can understand and correctly interpret what we read. However, interpretation is a collection of subtle processes that are easily influenced by poor presentation or wording of information. This article examines how evidence-based principles of information design can be applied to medical records to enhance clinical understanding and accuracy in interpretation of the detailed data that they contain.

The Association of Health Literacy with Physical Activity and Nutritional Behavior in Older Adults, and Its Social Cognitive Mediators

ABSTRACT Inadequate health literacy is a common problem among older adults and is associated with poor health outcomes. Insight into the association between health literacy and health behaviors may support interventions to mitigate the effects of inadequate health literacy. The authors assessed the association of health literacy with physical activity and nutritional behavior in community-dwelling older adults. The authors also assessed whether the associations between health literacy and health behaviors are mediated by social cognitive factors. Data from a study among community-dwelling older adults (55 years and older) in a relatively deprived area in The Netherlands were used (baseline n = 643, response: 43%). The authors obtained data on health literacy, physical activity, fruit and vegetable consumption, and potential social cognitive mediators (attitude, self-efficacy, and risk perception). After adjustment for confounders, inadequate health literacy was marginally significantly associated with poor compliance with guidelines for physical activity (OR = 1.52, p = .053) but not with poor compliance with guidelines for fruit and vegetable consumption (OR = 1.20, p = .46). Self-efficacy explained 32% of the association between health literacy and compliance with physical activity guidelines. Further research may focus on self-efficacy as a target for interventions to mitigate the negative effects of inadequate health literacy.

Health Literacy Is Associated With Health Behaviors and Social Factors Among Older Adults: Results from the LifeLines Cohort Study

This study assesses the associations between health literacy and various health behaviors and social factors among older adults, and whether social factors moderate the other associations. Data from 3,241 participants in the LifeLines Cohort Study were analyzed (mean baseline age = 68.9 years). Data on health literacy, health behaviors (physical activity, fruit and vegetable consumption, smoking, breakfast consumption, alcohol consumption, and body mass index (BMI), and social factors (loneliness, social support, social activities, social contacts, and living situation) were collected in three waves. Logistic regression analyses were used, adjusted for age and gender. Low health literacy was associated with insufficient physical activity, insufficient fruit and vegetable consumption, lack of regular breakfast consumption, obesity (odds ratios (ORs) > 1.31, p-values < .005) and low alcohol use (OR = 0.81, p = .013), but not with smoking. Low health literacy was also associated with greater loneliness, engaging in fewer social activities, and having fewer social contacts (ORs > 1.48, p-values < .005), but not with social support or living situation. Only the association between health literacy and smoking was moderated by social contacts, but this finding needs confirmation in future studies. In conclusion, low health literacy is negatively associated with health behaviors and social factors in older adults, but social factors seldom moderate the associations between health literacy and health behaviors.

The influence of task and format on reading results with an online text

The aim of the study was to map the influence of reading task and text format on reading results with an online text. To this purpose, an experiment performed by S. Gordon et al. (1988) was replicated and enhanced. In four conditions, subjects were given a reading task (summarize or answer specific questions) and an online text (linear or hypertext format). In all conditions, both text and task were administered through the World Wide Web, After the subjects had completed their reading, all were given the same assignment: make a summary and answer specific questions. No significant main effects of the independent variables (format and task) were found on the performance of the subjects. There proved to be a significant interaction effect, however, on the completeness of the summaries. The most thorough summaries were written by subjects who were told before the experiment that they would have to summarize the text, and who were presented with the text in a linear version. As far as reading time was concerned, there was a significant difference between the format conditions: reading the text in linear format took more time than reading the text in hypertext format.

HIV/AIDS messages as a spur for conversation among young South Africans?

HIV/AIDS messages are often deliberately puzzling so as to increase the chance for them to be used as food for conversation. The South African health organisation ‘loveLife,’ for instance, uses messages that include complicated rhetorical expressions in their media campaigns, reasoning that those who find the messages puzzling and wonder about their meaning will be inclined to discuss the messages with their peers. In order to test the assumption that puzzlement about health messages is related to keenness to talk about these messages, structured interviews were held with 30 black learners, ages 15 to 19, from Limpopo Province, South Africa, about the messages of six HIV/ AIDS posters and six HIV/AIDS radio advertisements from ‘loveLife’ or another South African health organisation. No support was found for the assumption that presenting a puzzling health message will contribute to engaging the recipients in discussion. The participants indicated that they were willing to discuss the themes addressed in either a poster or radio advertisement because they appreciated the message and felt that its content was relevant to them, rather than because the message was puzzling or difficult to understand. The participants’ overall actual comprehension of the messages, however, proved to be strikingly low.

Comprehensibility of Health-Related Documents for Older Adults with Different Levels of Health Literacy: A Systematic Review

A systematic review was conducted to assess the available evidence for the effectiveness of interventions aiming to improve the comprehensibility of health-related documents in older adults (≥50) with different levels of health literacy. Seven databases were searched (2005 forward), and references in relevant reviews were checked. The selection procedure was conducted by 2 independent reviewers. Data extraction and assessment of the quality of the resulting studies were conducted by 1 reviewer and checked for accuracy by a 2nd reviewer. A total of 38 intervention studies had a study population of older adults (n = 35) or made an explicit comparison between age groups, including older adults (n = 3). Inconsistent evidence was found for the importance of design features to enhance the comprehensibility of health-related documents. Only for narratives and multiple-feature revisions (e.g., combining revisions in textual and visual characteristics) did the included studies provide evidence that they may be effective for older adults. Using narrative formats and/or multiple-feature revisions of health-related documents seem to be promising strategies for enhancing the comprehensibility of health-related documents for older adults. The lack of consistent evidence for effective interventions stresses the importance of (a) replication and (b) the use of standardized research methodologies.

The Sequential Order of Procedural Instructions: Some Formal Methods for Designers of Flow Charts

Document designers who present procedural instructions can choose several formats: prose, table, logical tree, or flow chart. In all cases, however, it is essential that the instructions are ordered in a way that allows users to reach the outcome in as little time as possible. In this article two formal methods are discussed that help determine which order is most efficient. The first method is based on the selection principle. The second method is based on the principle of the average least effort.

‘No ‘til we know.’ Fela ba a tseba naa? Using African languages to communicate about HIV and AIDS to young South Africans

Abstract An experiment was conducted in order to determine the extent to which the presentation of HIV and AIDS messages in different languages would affect the appreciation and comprehension of these messages among young South Africans. Interviews were carried out with 60 learners in rural and peri-rural schools in Limpopo Province. Four messages (on posters or in radio advertisements), were presented in three languages. The interviews focused on appreciation (to what extent do the participants like the messages?), perceived comprehension (to what extent do the participants think that they understand the message?), and actual comprehension (to what extent do the participants really understand the message?). The language of presentation did not prove to have any influence on appreciation, perceived comprehension or actual comprehension. A considerable gap was found between perceived comprehension and actual comprehension; participants overestimated their level of understanding. Significant correlations were found between perceived comprehension and appreciation, indicating that the better members of this target group think they understand HIV and AIDS messages, the more they like them.

Development of a Communication Intervention for Older Adults With Limited Health Literacy: Photo Stories to Support Doctor–Patient Communication

Successful doctor–patient communication relies on appropriate levels of communicative health literacy, the ability to deal with and communicate about health information. This article aims to describe the development of a narrative- and picture-based health literacy intervention intended to support older patients with limited health literacy when communicating during their primary care consultations. We performed a formative evaluation that included a review of the literature and interviews with stakeholders on relevant health literacy issues, qualitative studies with the target group, intervention planning, and a small-scale evaluation. Cocreation with the target group was a major component. Seven photo stories were developed incorporating principles from narrative and social learning theory and covering communication themes and strategies identified during focus group discussions and role-play exercises. The intervention was developed in 3 different formats: 1-page photo stories, narrated video clips using the original photo story pictures, and interactive video clips covering participation and communication during primary care consultations. In our small-scale evaluation, older adults considered the cocreated intervention appealing and comprehensible. The intervention shows promise for improving the health of older adults but needs further evaluation. This study provides a rigorous template for the participatory development of health literacy interventions.

ALEXIS: computer-assisted feedback on written assignments (1)

ABSTRACT ALEXIS is an educational software package, designed to support teaching staff in a number of time-consuming tasks: organizing and managing courses, administrating student activities and results, and, above all, supplying printed feedback on written assignments. ALEXIS has been used successfully in the curricula of Nijenrode, the Netherlands School of Business, and Twente University of Technology. In this paper we describe the specifications of the software package, and pay special attention to its capability of supplying differentiated commentary on the same textual shortcomings.