Jose F. Arocha

Health literacy and the World Wide Web: Comparing the readability of leading incident cancers on the Internet

Primary objective: to assess the readability level of Web-based information on leading incident cancers. Research design: websites on breast, prostate, and colorectal cancers were selected for analysis by comparing the first 100 hits across 10 popular search engines. A total of 100 websites on breast (n = 33), prostate (n = 34), and colorectal (n = 33) cancers were included in the final analysis. Methods: readability was assessed using SMOG, Flesch-Kincaid (F – K), and Flesch Reading Ease (FRE) measures. SMOG was hand-calculated on 10 – 30 lines of continuous text. Identical text was entered into Microsoft® Word 2002 where F – K and FRE scores were determined automatically by the word processor. Results: the mean readability score of the cancer websites was Grade 12.9 using SMOG and Grade 10.7 according to F – K. The mean FRE score was 45.3, a score considered ‘difficult’. Colorectal cancer websites were most difficult to read compared to breast and prostate cancer websites. All measures indicated that prostate cancer websites were written at the lowest readability. Significantly higher reading levels were required for concluding paragraphs of Web articles compared to introduction paragraphs. Conclusions: findings suggest the need for readable cancer information on the Web. Health promoters, health informaticians, medical journalists, and web page editors must collaborate to ensure the use of plain language to match the literacy skills of consumers.

Identifying reasoning strategies in medical decision making: a methodological guide

Reasoning strategies are a key component in many medical tasks, including decision making, clinical problem solving, and understanding of medical texts. Identification of reasoning strategies used by clinicians may prove critical to the optimal design of decision support systems. This paper presents a formal method of cognitive-semantic analysis for the identification and characterization of reasoning strategies deployed in medical tasks and demonstrates its use through specific examples. Although semantic analysis was originally developed in the investigation of knowledge structures, it can also be applied to identify the reasoning and decision processes used by physicians and medical trainees in clinical tasks. Assumptions underlying the methods, as well as illustrations of their use in diagnostic explanation tasks, are presented. We discuss semantic analysis in the context of the current interests in developing medical ontologies and argue that a frame-based propositional analytic methodology can provide a systematic way of addressing the construction of such ontologies. Although the application of propositional analysis methods has some limitations, we show how such limitations are being addressed and present some examples of information tools that have been developed to ease, and make more systematic, the process of analysis.

Methodological Review: Cognitive and learning sciences in biomedical and health instructional design: A review with lessons for biomedical informatics education

Theoretical and methodological advances in the cognitive and learning sciences can greatly inform curriculum and instruction in biomedicine and also educational programs in biomedical informatics. It does so by addressing issues such as the processes related to comprehension of medical information, clinical problem-solving and decision-making, and the role of technology. This paper reviews these theories and methods from the cognitive and learning sciences and their role in addressing current and future needs in designing curricula, largely using illustrative examples drawn from medical education. The lessons of this past work are also applicable, however, to biomedical and health professional curricula in general, and to biomedical informatics training, in particular. We summarize empirical studies conducted over two decades on the role of memory, knowledge organization and reasoning as well as studies of problem-solving and decision-making in medical areas that inform curricular design. The results of this research contribute to the design of more informed curricula based on empirical findings about how people learn and think, and more specifically, how expertise is developed. Similarly, the study of practice can also help to shape theories of human performance, technology-based learning, and scientific and professional collaboration that extend beyond the domain of medicine. Just as biomedical science has revolutionized health care practice, research in the cognitive and learning sciences provides a scientific foundation for education in biomedicine, the health professions, and biomedical informatics.

Towards effective evaluation and reform in medical education: a cognitive and learning sciences perspective

Health professions education is dealing with major transformations in light of the changing nature of the health care delivery system, including the use of technology for “just in time” delivery of care, evidence-based practice, personalized medical care and learning, as health professionals strive to integrate biomedical advances and clinical practice. This has forced the medical education community to reassess the current teaching and learning practices and more importantly, the evaluation of the medical education process. There have been recent advances in cognitive and learning sciences theories, some of which can inform medical educators about best teaching and learning practices and their impact on the evaluation process. An understanding of these theories provides a sound rationale for choosing specific instructional strategies and choosing evaluation measures that assess the curricular objectives. The review begins with an overview of evaluation and assessment in education, followed by an overview of major theories from the cognitive and learning sciences. Next, the role of cognitive and learning sciences theories in informing the process of medical education evaluation is discussed, including its impact on student learning, performance and professional competence, as well as recommendations for reform of medical curricula based on such theories. The paper continues with the elaboration of current trends in health sciences education, particularly medical education, and available evidence for the impact on student learning and performance as well as areas where more research is needed.

Errors in interpreting quantities as procedures: The case of pharmaceutical labels

The purpose of this study is to investigate and characterize the errors in cognitive processes deployed in the comprehension of procedural texts found on pharmaceutical labels by subjects of different cultural and educational backgrounds. In this study, participants were asked to read and interpret three pharmaceutical labels related to childrens medications of varying complexity: oral rehydration therapy (ORT); over-the-counter cough medicine; and over-the-counter fever medicine. Results indicate that: (1) all groups of participants had considerable difficulty in interpreting the instructions; (2), cultural and educational background appeared to be only weakly related to the accuracy of dosage and administration; and (3) errors of comprehension were related to three features of the texts: situation-representational complexity, inherent quantification complexity, and conformity with intuitive models of therapy based on prior knowledge. The results are discussed in terms of the role of multiple representations (boundary objects) and theories of text comprehension to facilitate the reduction of errors.

What is consumer health informatics? A systematic review of published definitions

Background: Consumer health informatics (CHI) is an emerging field that utilizes technology to provide health information to enhance health-care decision making by the public. There is, however, no widely accepted or uniform definition of CHI. A consensus definition would be important for pedagogical reasons, to build capacity and to reduce confusion about what the discipline consists of. Aim: We undertook a systematic review of published definitions of CHI and evaluated them using five quality assessment criteria and measures of similarity. Methods: Five databases were searched (Embase, Web of Science, MEDLINE, CINAHL and Business Source Complete) resulting in 1101 citations. Twenty-three studies met the inclusion criteria. Definitions were appraised using five criteria (with each scoring out of one): use of published citation, multi-disciplinarity, journal impact, definition comprehensibility, text readability. Results: Most definitions scored low on citation (Mean ± SD: 0.22 ± 0.42), multi-disciplinarity (0.15 ± 0.28) and readability (0.04 ± 0.21) and somewhat higher on IF (0.35 ± 0.45) and definition comprehensibility (idea density) (0.87 ± 0.34) criteria. Overall, the quality of the published definitions was low 1.63 ± 0.80 (out of five). Conclusions: The definitions of CHI were variable in terms of the quality assessment criteria. This suggests the need for continued discussion amongst consumer health informaticians to develop a clear consensus definition about CHI.

A survey of public health and consumer health informatics programmes and courses in Canadian universities and colleges

Introduction As information technology becomes more widely used by people for health-care decisions, training in consumer and public health informatics will be important for health practitioners working directly with the public. Methods Using information from 74 universities and colleges across Canada, we searched websites and online calendars for programmes (undergraduate, graduate) regarding availability and scope of education in programmes, courses and topics geared to public health and/or consumer health informatics. Results Of the 74 institutions searched, 31 provided some content relevant to health informatics (HI) and 8 institutions offered full HI-related programmes. Of these 8 HI programmes, only 1 course was identified with content relevant to public health informatics and 1 with content about consumer health informatics. Some institutions (n  =  22) – which do not offer HI-degree programmes – provide health informatics-related courses, including one on consumer health informatics. We found few programmes, courses or topic areas within courses in Canadian universities and colleges that focus on consumer or public health informatics education. Discussion Given the increasing emphasis on personal responsibility for health and health-care decision-making, skills training for health professionals who help consumers navigate the Internet should be considered in health informatics education.

Experiences and Perceptions of Adults Accessing Publicly Available Nutrition Behavior-Change Mobile Apps for Weight Management

BACKGROUND Nutrition mobile apps have become accessible and popular weight-management tools available to the general public. To date, much of the research has focused on quantitative outcomes with these tools (eg, weight loss); little is known about user experiences and perceptions of these tools when used outside of a research trial environment. OBJECTIVE Our aim was to understand the experiences and perceptions of adult volunteers who have used publicly available mobile apps to support nutrition behavior change for weight management. DESIGN We conducted one-on-one semi-structured interviews with individuals who reported using nutrition mobile apps for weight management outside of a research setting. PARTICIPANTS/SETTING Twenty-four healthy adults (n=19 females, n=5 males) who had used publicly available nutrition mobile apps for weight management for ≥1 week within the past 3 to 4 months were recruited from the community in southern Ontario and Edmonton, Canada, using different methods (eg, social media, posters, and word of mouth). QUALITATIVE DATA ANALYSIS Interviews were audiorecorded, transcribed verbatim, and transcripts were verified against recordings. Data were coded inductively and organized into categories using NVivo, version 10 (QSR International). RESULTS Participants used nutrition apps for various amounts of time (mean=approximately 14 months). Varied nutrition apps were used; however, MyFitnessPal was the most common. In the interviews, the following four categories of experiences with nutrition apps became apparent: food data entry (database, data entry methods, portion size, and complex foods); accountability, feedback, and progress (goal setting, accountability, monitoring, and feedback); technical and app-related factors; and personal factors (self-motivation, privacy, knowledge, and obsession). Most participants used apps without professional or dietitian support. CONCLUSIONS This work reveals that numerous factors affect use and ongoing adherence to use of nutrition mobile apps. These data are relevant to professionals looking to better assist individuals using these tools, as well as developers looking to develop new and improved apps.

Numeracy, Health Numeracy, and Older Immigrants’ Primary Language: An Observation-Oriented Exploration

ABSTRACT Health information is often provided in number formats not equally present in all languages. We explored the relation between immigrants’ primary language and comprehension of context-free and health numeric information presented in English. The study compared speakers of Kikuyu (Kenya) and Mandarin (China), two languages that differ in the quantity of numeric concepts in their structures. Observation-oriented analysis was performed to determine how accurately the observed data conform to language group. We show how such analysis compares to standard statistical analysis. We argue that primary language contributes to some of the differences in numeracy and health numeracy.

Numeracy and Health Numeracy Among Chinese and Kenyan Immigrants to Canada

Mathematics self-efficacy plays an important role in the performance of quantitative tasks. The objective of this study was to examine the role of mathematics self-efficacy in numeracy and health numeracy among immigrants (60 Mandarin-speaking and 60 Kikuyu-speaking immigrants to Canada) for whom English was a second language (ESL). Two French Kit numeracy tasks (the addition, and the addition and subtraction correction tasks) constituted objective measures of numeracy, and the numeracy component of a health literacy instrument (The Short Test of Functional Health Literacy for Adults [S-TOFHLA]) constituted the health numeracy measure. We measured math self-efficacy using the Mathematics Self-Efficacy Scale (MSES) and the Subjective Numeracy Scale (SNS). All measures were presented in English. Kikuyu speakers had lower math self-efficacy (p < .05) compared with Mandarin speakers (p < .05). Mandarin speakers outperformed Kikuyu speakers in numeracy (p < .001) and health numeracy (p < .023) skills. In multiple regression analyses, 32% to 57 % of the variance in objective numeracy was explained by language, residency in Canada, and self-efficacy, adjusting for the other predictor variables; self-efficacy and format of numeric health information (numbers only vs. numbers with detailed text) consistently predicted health numeracy. Mathematics self-efficacy may be an important factor in numeracy, but not as important in health numeracy for Kikuyu- and Mandarin-speaking immigrants for whom English is a second language. Factors contributing to low numeracy may differ from those explaining low health numeracy in ESL immigrants.