Henk Pander Maat

Improving the usability of patient information leaflets

OBJECTIVE This study assesses the usability of three patient information leaflets and attempts to improve them while complying with the current EU regulations. METHODS Three original leaflets were tested among 154 potential users. Every participant answered 15 scenario questions for one of the leaflets. The leaflets were subsequently redesigned based on the test results and evidence-based Document Design principles. The revised texts were tested among 164 participants. RESULTS All three original leaflets suffered from usability problems, especially problems related to finding relevant information. On average, only 75% of the topics could be located. Comprehension of the information, once found, was around 90%. The revisions led to better performance. Information was found faster and more successful. Comprehension scores were higher as well. A follow-up study shows that these findings can be generalized over paper formats. CONCLUSION Although the current EU regulations for patient information leaflets do not guarantee leaflet usability, the leaflets can be improved somewhat within the regulations. However, further research should evaluate the text structure currently imposed on leaflets. PRACTICAL IMPLICATIONS Information leaflets must be written, or rewritten, according to Document Design principles. Furthermore, they must be user tested in a rigorous way.

HOW PROMOTIONAL LANGUAGE IN PRESS RELEASES IS DEALT WITH BY JOURNALISTS Genre Mixing or Genre Conflict

This study investigates how promotional language in corporate press releases is dealt with when the release is reused in different journalistic genres. Using a new coding system, it analyzes 89 press releases and their journalistic transformations. Promotional language is shown to be a regular feature of corporate press releases, especially those presenting new products or services. The first press release corpus consisted of releases issued by companies in the airline industry, and the second corpus contained press releases of various large companies operating in the Netherlands. The press releases in the first corpus were generally used in special interest media such as magazines on air travel; these media largely preserved the promotional tone of the press releases, thus exemplifying the tendency of “promotionalization.” The press releases in the second corpus were used in economics sections of daily papers; these news reports conformed to a more “hard news” register because they did not include most of the promotional elements from press release material.

Classifying negative coherence relations on the basis of linguistic evidence

Abstract This article proposes to revise the Sanders et al. (1992, 1993) classification of negative coherence relations on the basis of a comparative, corpus-based analysis of seven Dutch connectives. First, some conceptual problems in the Sanders et al. classification are discussed, with special attention for the ‘polarity’ parameter that distinguishes between ‘positive’ and ‘negative’ relations. Subsequently, a methodological section reviews different kinds of evidence for relation classifications. It is argued that the behavior of linguistic devices for the expression of coherence relations constitutes a crucial source of evidence and it is proposed to use a Discriminating Connective Principle when assessing this linguistic evidence. By means of a corpus study, it is shown that several refinements of the Sanders et al. classification are conceivable. In the revised framework, comparative relations take the place of additive relations, direct and indirect comparisons are distinguished and epistemic negative relations are further differentiated on the basis of the configuration of perspectives in the successive discourse segments. The linguistic support for the revised classification, as provided by the distribution of seven Dutch negative connectives over the relational classes, is shown to be satisfactory.

International application of health literacy measures: adaptation and validation of the newest vital sign in The Netherlands

OBJECTIVE The newest vital sign assesses individual reading and numeracy skills. The aim of this study was to create a Dutch version (NVS-D) and to assess its feasibility, reliability, and validity in The Netherlands. METHODS We performed a qualitative study among experts (n=27) and patients (n=30) to develop the NVS-D and to assess its feasibility. For validation, we conducted a quantitative survey (n=329). Reliability was assessed by Cronbachs alpha. Construct validity was examined by analyzing association patterns. Receiver operating characteristic (ROC) curves determined optimal cut-off scores. RESULTS Cronbachs alpha was 0.76. In accordance with a priori hypotheses we found strong associations between NVS-D, general vocabulary, prose literacy and objective health literacy, and weaker associations between NVS-D and subjective health literacy. A score of ≥4 out of 6 best distinguished individuals with adequate versus inadequate health literacy. CONCLUSION The results suggest that the NVS-D is a reliable and valid tool that allows international comparable health literacy research in The Netherlands. PRACTICE IMPLICATIONS The NVS-D can be applied in research on the role of health literacy in health and health care, and the development of interventions. The methods can be applied in cross-cultural adaptation of health literacy measures in other countries.

A short assessment of health literacy (SAHL) in the Netherlands

BackgroundAn earlier attempt to adapt the REALM (Rapid Estimate of Adult Literacy in Medicine) word recognition test to Dutch was not entirely successful due to ceiling effects. In contrast to REALM, the Short Assessment of Health Literacy (SAHL) assesses both word recognition and comprehension in the health domain. The aim of this study was to design, test and validate a SAHL for Dutch patients (SAHL-D).MethodsWe pretested 95 health-related terms (n = 127) and selected 33 best performing items for validation in a quantitative survey (n = 329). For each item, a correct recognition (1 point) and comprehension (1 point) contributed to the total score (scale 0–66). Internal consistency was assessed using Cronbach’s alpha. Construct validity was examined by analyzing association patterns of SAHL-D with educational level, objective and subjective health literacy, prose literacy, and vocabulary. Receiver operating characteristic (ROC) curves, with prose literacy as the reference standard, determined optimal cut-off scores.ResultsCronbach’s alpha was 0.77 for recognition, 0.79 for comprehension, and 0.86 for the total score. Scores significantly differed substantially by educational level. Association patterns mostly confirmed a priori expectations in direction and strength, thereby supporting the construct validity of the SAHL-D. The optimal cut-off scores for differentiating between adequate and low literacy lie between 52.5 and 55.5. A shorter SAHL-D version presenting 22 terms offers a comparable prediction performance.ConclusionThe results provide positive evidence for the reliability and validity of the SAHL-D. The SAHL-D can be applied to analyze the role of health literacy in health and healthcare, and for the development and evaluation of targeted interventions.

How newspaper journalists reframe product press release information

Newspaper journalism is said to increasingly depend on PR sources and news agencies. However, news production evolves in several phases. There may be considerable source dependency in the news discovery phase, but sources may be less prominent in the later phases of news gathering and news writing. This study concentrates on the last two phases and analyzes how Dutch journalists rework product launch press releases into newspaper reports. Forty-nine pairs of releases and news reports were analyzed sentence by sentence. Compared to press releases, news reports provide less product or company information and more contextual information, provide less positive and more negative evaluations, and more often attribute information to sources. Overall, less than half of the information in the reports originates from the releases. A framing analysis learns that while releases adopt an advertising frame focused on selling the product, reports offer two kinds of reframing: they regularly recontextualize the release information by adding consumer information and occasionally reconceptualize the launch as a business move. Both the distancing operations and the reframings enhance the report’s usability to news consumers. However, radical transformations are rare: most reframings occur later on in the report and the primary frame of the source text is often left in place.

How grammatical and discourse factors may predict the forward prominence of referents: two corpus studies

Abstract One of the ways in which discourse coheres is by means of repeated reference to entities. Theoretical accounts of referential coherence propose heuristics for the interpretation of referential expressions, which are especially important when there is more than one potential antecedent. One of the most explicit accounts is provided by Centering Theory (Grosz et al., Computational Linguistics 21: 203–225, 1995). Using features such as grammatical status, expression type, and the referential relation with sentences still further back in the discourse, it produces a ranking of discourse referents in terms of forward prominence. We present two corpus studies of how these features, in combination with discourse topichood, help to predict referential continuations in actual discourse. In Study 1, we analyzed newspaper fragments in which he is preceded by a sentence presenting two male singular participants. The factors Grammatical Role (being a Subject), Backward Center Status and Discourse Topichood appear to increase the chance that a referent is the intended one for a potentially ambiguous pronoun, while Expression Type (noun or pronoun) makes no difference. In Study 2, the continuations for sentences with two referents differing on the same four factors were compared, assuming that the most prominent referent will reappear in the next sentence. The study reveals that Grammatical Role only affects the form of continuation: subject referents do not reappear more often, but when reappearing they are more often realized as pronouns. Backward Center Status increases the chance of subsequent references to a referent, and also decreases the chances for its competitor of being referred to again. Discourse Topichood has the same double effect. In conclusion, both global and local factors affect referential prominence, but in different ways.

Investigating the Processes of Reading-to-Assess among Dutch Legislators.

This study investigated the reading of policy documents by Dutch legislators. Its first aim was to investigate reading-to-assess processes using methods that address the limitations of previous studies. Its second aim was to analyze the reading-to-assess processes of the legislators to extend existing models and theories of reading in professional contexts. Data were gathered from 8 Dutch legislators who thought aloud while reading a policy document. Three methods of data analysis were employed: analyses of information-seeking behaviors, cognitive processes, and reading goals. Results indicated that the legislators read efficiently, focusing on relatively small portions of the policy documents in a nonlinear fashion, and that their processing of the text was devoted to elaborating and evaluating in relation to their goals for reading. Findings are discussed in relation to existing models of reading texts in professional life.

How to Test Mandatory Text Templates: The European Patient Information Leaflet

The structure of patient information leaflets (PILs) supplied with medicines in the European Union is largely determined by a regulatory template, requiring a fixed sequence of pre-formulated headings and sub-headings. The template has been criticized on various occasions, but it has never been tested with users. This paper proposes an alternative template, informed by templates used in the USA and Australia, and by previous user testing.The main research question is whether the revision better enables users to find relevant information. Besides, the paper proposes a methodology for testing templates. Testing document templates is complex, as they are “empty”. For both the current and the alternative template, we produced a document with bogus text and real headings (reflecting the empty template) and a real-life document with readable text (reflecting the “filled” template). The documents were tested both in Dutch and in English, with 64 British and 64 Dutch users. The test used a set of scenario questions that covers the full range of template (sub)topics; users needed to indicate the text locations where they expected each question to be answered. The revised template improved findability of information; this effect was strongest for the “filled” template with readable text. When participants were shown both filled templates, there was a clear preference for the revised template. A closer analysis of the findability data revealed question-specific effects of topic grouping, topic ordering, subtopic granularity and wording of headings. Most of these favoured the revised template, but our revision led to adverse effects as well, for instance in the new heading Check with your doctor. Language-specific effects showed that the wording of the headings is a delicate task. Generally, we conclude that document template designs can be analyzed in terms of the four parameters grouping, ordering, granularity and wording. Furthermore, they need to be tested on their effects on information findability, with template translations requiring separate testing. The methodology used in this study seems an appropriate one for such tests. More specifically, we find that the new patient information leaflet template proposed here provides better information findability.

How Text Presentation and Financial Literacy Affect Pension Communication Success

This study examined the effects of (a) text presentation and (b) prior knowledge and language skill on finding information in financial documents. First, the participants filled out tests that measured their levels of vocabulary, reading skill, domain knowledge, and topic knowledge. Subsequently, they read an on-screen text on pension information in either a linear structure (“nonlayered”) or a hypertext structure (“layered”). Readers’ performance was measured by verbal scenario questions. No difference was found for text presentation. Language skill and domain knowledge were both important predictors for finding, whereas topic knowledge was not associated with readers’ performance at all. When differentiating between text presentation conditions, we found that domain knowledge only plays a role in the nonlayered condition, not in the layered condition. These results indicate that the set of skills needed to successfully read a document varies with both type of task and type of reading, confirming prior research.