Corine S. Meppelink

The Effectiveness of Health Animations in Audiences With Different Health Literacy Levels: An Experimental Study

Background Processing Web-based health information can be difficult, especially for people with low health literacy. Presenting health information in an audiovisual format, such as animation, is expected to improve understanding among low health literate audiences. Objective The aim of this paper is to investigate what features of spoken health animations improve information recall and attitudes and whether there are differences between health literacy groups. Methods We conducted an online experiment among 231 participants aged 55 years or older with either low or high health literacy. A 2 (spoken vs written text) x 2 (illustration vs animation) design was used. Participants were randomly exposed to one of the four experimental messages, all providing the same information on colorectal cancer screening. Results The results showed that, among people with low health literacy, spoken messages about colorectal cancer screening improved recall (P=.03) and attitudes (P=.02) compared to written messages. Animations alone did not improve recall, but when combined with spoken text, they significantly improved recall in this group (P=.02). When exposed to spoken animations, people with low health literacy recalled the same amount of information as their high health literate counterparts (P=.12), whereas in all other conditions people with high health literacy recalled more information compared to low health literate individuals. For people with low health literacy, positive attitudes mediated the relationship between spoken text and the intention to have a colorectal cancer screening (b=.12; 95% CI 0.02-0.25). Conclusions We conclude that spoken animation is the best way to communicate complex health information to people with low health literacy. This format can even bridge the information processing gap between audiences with low and high health literacy as the recall differences between the two groups are eliminated. As animations do not negatively influence high health literate audiences, it is concluded that information adapted to audiences with low health literacy suits people with high health literacy as well.

Exploring the role of health literacy in the evaluation of online health information: Insights from a mixed-methods study

OBJECTIVE To gain new insights into the relationship between health literacy and evaluation of online health information. METHODS Using a mixed-methods approach, forty-four semi-structured interviews were conducted followed by a short questionnaire on health literacy and eHealth literacy. Qualitative and quantitative data were merged to explore differences and similarities among respondents with different health literacy levels. RESULTS Thematic analysis showed that most respondents did not question the quality of online health information and relied on evaluation criteria not recognized by existing web quality guidelines. Individuals with low health literacy, despite presenting higher eHealth literacy scores, appeared to use less established criteria and to rely more heavily on non-established ones compared to those with high health literacy. CONCLUSION Disparities in evaluation ability among people with different health literacy might be related to differences in awareness of the issue and to the use of different evaluation criteria. Future research should quantitatively investigate the interplay between health literacy, use of established and non-established criteria, and ability to evaluate online health information. PRACTICE IMPLICATIONS Communication and patient education efforts should aim to raise awareness on online health information quality and to promote use of established evaluation criteria, especially among low health literate citizens.

Inter-party Agenda-Setting in the Belgian Parliament: The Role of Party Characteristics and Competition

In this article we explore the inter-party agenda-setting dynamics in the Belgian parliament during the period 1993–2000 and investigate whether and when parties respond to the attention paid to issues by other parties in parliament. We rely on an elaborate coding of parliamentary questions and interpellations, as well as media coverage and government meetings. Pooled time series analyses demonstrate considerable agenda-setting effects from one party agenda to another. The results indicate that in particular parties from the same language community, parties that participate in government and extreme-right and environmental ‘niche parties’ have agenda-setting power.

Should We Be Afraid of Simple Messages? The Effects of Text Difficulty and Illustrations in People With Low or High Health Literacy

It is often recommended that health information should be simplified for people with low health literacy. However, little is known about whether messages adapted to low health literacy audiences are also effective for people with high health literacy, or whether simple messages are counterproductive in this group. Using a two (illustrated vs. text-only) by two (nondifficult vs. difficult text) between-subjects design, we test whether older adults with low (n = 279) versus high health literacy (n = 280) respond differently to colorectal cancer screening messages. Results showed that both health literacy groups recalled information best when the text was nondifficult. Reduced text difficulty did not lead to negative attitudes or less intention to have screening among people with high health literacy. Benefits of illustrations, in terms of improved recall and attitudes, were only found in people with low health literacy who were exposed to difficult texts. This was not found for people with high health literacy. In terms of informed decisions, nondifficult and illustrated messages resulted in the best informed decisions in the low health literacy group, whereas the high health literacy group benefited from nondifficult text in general, regardless of illustrations. Our findings imply that materials adapted to lower health literacy groups can also be used for a more general audience, as they do not deter people with high health literacy.

Exploring the role of health literacy on attention to and recall of text-illustrated health information

We use eye tracking to examine attention to online health information.Health literacy influences the attention-recall relationship.Attention to illustrations increases recall in limited health literacy groups.Attention to text increases recall in adequate health literacy groups. Although the use of illustrations is often recommended for audiences with limited health literacy, it is unclear how health literacy impacts the use of different online formats. The aim of this paper is therefore to investigate how health literacy influences attention to text and illustrations in online health information, and whether such attention is related to recall of information. Sixty-one participants were exposed to either text-only or text-illustrated information. Using eye tracking, we recorded attention patterns on a health webpage after which recall of information was assessed. Results showed that health literacy influenced the attention-recall relationship. For people with limited health literacy, attention to the illustrations was positively related to recall, whereas attention to the text improved recall of information in the adequate health literate group. As attention to different parts of online health information leads to different information processing routes for people with different levels of health literacy, effective health communication should consider both text and illustrations that attract attention and improve understanding of the health message.

Health Literacy and Online Health Information Processing: Unraveling the Underlying Mechanisms

The usefulness of the Internet as a health information source largely depends on the receiver’s health literacy. This study investigates the mechanisms through which health literacy affects information recall and website attitudes. Using 2 independent surveys addressing different Dutch health websites (N = 423 and N = 395), we tested the mediating role of cognitive load, imagination ease, and website involvement. The results showed that the influence of health literacy on information recall and website attitudes was mediated by cognitive load and imagination ease but only marginally by website involvement. Thus, to improve recall and attitudes among people with lower health literacy, online health communication should consist of information that is not cognitively demanding and that is easy to imagine.

Dutch health websites and their ability to inform people with low health literacy

OBJECTIVE To evaluate whether Dutch online health information (OHI) generally reflects message elements that support information processing and understanding among people with low health literacy. METHODS We content-analyzed one hundred Dutch webpages about Ebola, fibromyalgia, ALS, losing weight, borderline personality disorder, hemorrhoids, ADD, bladder infection, shingles, and chicken pox. The codebook covered the following domains: images and videos, readability level, Suitability Assessment of Materials (SAM), advertising, interactive features, and reliability cues. RESULTS Thirty-seven webpages contained informative images that visualized the text. Twelve webpages incorporated videos, six of which were animations. Readability varied widely, but 79.2% of the texts exceeded the recommended B1 level. Half of the webpages had inadequate SAM scores; five were classified as superior. Interactive features were infrequently used. Many webpages included only a few elements that help users evaluate the reliability of OHI. Four presented a quality label. CONCLUSION Over a wide range of health-related topics, Dutch OHI does not generally contain message elements that improve information processing among people with low health literacy. PRACTICE IMPLICATIONS Communication professionals should make better use of digital message features. Videos, narration, and interactivity are scarcely used but can be valuable for people with low health literacy.