Rosemary Clerehan

Up to a quarter of the Australian population may have suboptimal health literacy depending upon the measurement tool: results from a population-based survey

The objective of this paper is to measure health literacy in a representative sample of the Australian general population using three health literacy tools; to consider the congruency of results; and to determine whether these assessments were associated with socio-demographic characteristics. Face-to-face interviews were conducted in a stratified random sample of the adult Victorian population identified from the 2004 Australian Government Electoral Roll. Participants were invited to participate by mail and follow-up telephone call. Health literacy was measured using the Rapid Estimate of Adult Literacy in Medicine (REALM), Test of Functional Health Literacy in Adults (TOFHLA) and Newest Vital Sign (NVS). Of 1680 people invited to participate, 89 (5.3%) were ineligible, 750 (44.6%) were not contactable by phone, 531 (32%) refused and 310 (response rate 310/1591, 19.5%) agreed to participate. Compared with the general population, participants were slightly older, better educated and had a higher annual income. The proportion of participants with less than adequate health literacy levels varied: 26.0% (80/308) for the NVS, 10.6% (51 33/310) for the REALM and 6.8% (21/309) for the TOFHLA. A varying but significant proportion of the general population was found to have limited health literacy. The health literacy measures we used, while moderately correlated, appear to measure different but related constructs and use different cut offs to indicate poor health literacy.

Transition to Tertiary Education in the Arts and Humanities Some Academic Initiatives from Australia

The ‘successful’ Arts student of the new millennium in Australia is likely to be female and studying full-time, having justcompleted her final year of schooling. Increasing numbers of students, however, are mature-age, are working long hours in paid employment, ormay be the first in their family to attend university. A significant proportion of this heterogeneous population may appear on campus only rarely. In order toengage the hearts and minds of thesestudents in their arts and humanities studies, it is necessary to acknowledge such realities. Last century’s solutions to the ‘academic adjustment’ question will not hold. The new transition to study initiatives rely to an extent on differentiating between student groups to establish starting points, but must also find broad and stable ways of supporting the student cohort to make the transition successfully, particularly to the kinds of writingand thinking that characterize the individual disciplines.

Patient assessment of medication information leaflets and validation of the Evaluative Linguistic Framework (ELF)

OBJECTIVE To obtain patient feedback about the structure and quality of medication information leaflets and validate the usefulness of the Evaluative Linguistic Framework (ELF) for improving written communication with patients. METHODS Triangulated feedback about a set of rheumatoid arthritis (RA) medication leaflets, some developed with knowledge of the ELF, was obtained from 27 people with RA from interviews, focus group discussion and self-administered questionnaires. The principal elements of the framework were investigated: overall generic structure and functions of each stage, interpersonal relationship between writer and reader, technicality of language and density of information. RESULTS Participant assessments of the leaflets aligned with the framework in terms of what constituted a good leaflet. While the main purpose of the leaflets was identified as being information provision, participants also wanted clear instructions, benefits to be highlighted and side effects to be comprehensively listed. For comprehensiveness and user-friendliness, leaflets developed with guidance of the ELF were consistently preferred. CONCLUSION According to people with RA, leaflets generated from a linguistic framework are clearer and more effective in communicating information about medications. PRACTICE IMPLICATIONS The ELF is a user-friendly, structured analytic system that can assist with the development of effective high quality patient information materials.

Transforming learning support: an online resource centre for a diverse student population

The diverse student population at large multi-campus universities requires English language and academic skills support which is targeted to their needs and easily accessible. The Online Student Resource Centre website, developed at Monash University, provides opportunities for students, no matter where they are, to make contact with staff and to access information, but more significantly offers a suite of stand-alone tutorials and downloadable resources, using NetObjects Fusion as the platform. These derive from some 100 print booklets covering academic writing, reading, listening, speaking, grammar and study skills/exam strategies. This paper outlines the process and philosophy of development of these tutorials, based on a constructivist framework, with guided and self-directed learning paths designed to accommodate a range of learning styles. Two tutorials are analysed to highlight some of the pedagogical challenges in translating print resources for the online environment. The paper concludes by reporting on a pilot evaluation of the two tutorials. Transformation d’un support d’enseignement: un centre de ressources en ligne pour une population variée d’étudiants. Les populations trés variées d’étudiants dans les grand campus multiples de certaines universités exigent une langue anglaise et des compétences académiques adaptés À leurs besoins et facilement accessible. Le centre de ressources en ligne pour les étudiants grÂce au site web, mis au point À Monash University fournit aux étudiants, où qu’ils soient, des occasions de contacts avec les enseignants et d’accès À l’information, mais de facon plus significative, offre une série d’actions de tuteurs alors que les étudiants sont seuls et de ressources que l’on peut télécharger utilisant la fusion d’objet du Net comme platforme. Ceux ci sont extraits d’une centaine de livrets imprimés concernant l’écriture, la lecture, l’écoute, la parole, la grammaire et les compétences pour les études et les stratégies des examens. L’article donne les grandes lignes et la philosophie du développement de ces exercices de tutorat, basés sur un cadre constructiviste comportant des cheminements d’apprentissage guidés et dirigés par les étudiants pour faire face À toute une série de styles d’apprentissages. On analyse 2 exercices de tutorat pour mettre en valeur certaines challenges pédagogiques en traduisant des ressources imprimés pour un environnement on ligne. L’article se termine par le rapport d’une évaluation pilote de ces 2 exercices. Veränderte Lernhilfen: Ein Online Resource Centre für unterschiedliche Studentengruppen. Unterschiedliche Studentengruppen an grossen Campus Universitäten benötigen Unterstützung in der englischen Sprache und bei der Verbesserung der akademischen Fähigkeiten, die auf ihre Bedürfnisse zugeschnitten und einfach zugänglich ist. Das Online Student Resource Centre, das auf der Webseite von der Monash Universität entwickelt wurde, bietet den Studenten Gelegenheit, unabhängig von ihrem Wohnort, sich mit den Lehrern in Verbindung zu setzen und Informationen abzurufen, aber darüber hinaus bietet es ein Forum für Tutorials and kopierfähiges Informationsmaterial unter Anwendung von NetObjects Fusion als Plattform. Dieses Unterstützungsmaterial stammt von 100 gedruckten Büchern über die Disziplinen, wissenschaftliches Schreiben, Lesen, Hören, Sprechen, Grammatik und Lernfähigkeiten /Prüfungsstrategien. Dieser Artikel beschreibt den Prozess und die Philosophie, die der Entwicklung dieser Tutorials zugrunde liegen und auf einem ausbaufähigen System basieren und mit vorgegebenen und selbst bestimmten Lernpfaden so angelegt sind, dass sie mehrere Lernstile berücksichtigen. Zwei Tutorials werden analysiert um an ihnen einige der pädagogischen Herausforderungen zu verdeutlichen, die bei der übertragung von gedrucktem Material in das online Lernfeld entstehen. Der Artikel endet mit einem Bericht über die Pilot Evaluierung dieser beiden Tutorials.

Providing culturally congruent care for Saudi patients and their families

Abstract This article aims to increase an awareness of caring for Saudi families by non-Saudi nurses to improve their understanding of culturally competent care from a Saudi perspective. Healthcare providers have a duty of a care to deliver holistic and culturally specific health care to their patients. As a consequence of ‘duty of care’ obligations, healthcare providers must facilitate culturally congruent care for patients of diverse cultural backgrounds. For the Saudi family considerable cultural clashes may arise when Saudi patients are hospitalized and receive care from healthcare professionals who do not understand Islamic principles and Saudi cultural beliefs and values. The healthcare workforce in Saudi Arabia is a unique multicultural workforce that is mix of Saudi and significant other nationalities. Saudi nurses for example represent only 36.3% of the workforce in the different health sectors. Whilst the different ethnic and cultural background expatriate nurses represent 63.7% (Ministry of Health, 2010). This article also could increase the awareness of healthcare professionals caring for Arab and Muslims patients in another context in the world.

Assessing Health Literacy: A New Domain for Collaboration Between Language Testers and Health Professionals

Health literacy, defined as an individuals capacity to process health information in order to make appropriate health decisions, is the focus of increasing attention in medical fields due to growing awareness that suboptimal health literacy is associated with poorer health outcomes. To explore this issue, a number of instruments, reported to have high internal consistency and strong correlations with general literacy tests, have been developed. However, their validity as measures of the target construct is seldom explored using multiple sources of evidence. The current study, involving collaboration between health professionals and language specialists, set out to assess the validity of the Rapid Estimate of Adult Literacy in Medicine (REALM), which describes itself as a “reading recognition” test that measures ability to pronounce common medical and lay terms. Drawing on a sample of 310 respondents, including both native and non-native speakers of English, investigations were undertaken to probe the REALMs validity as a measure of understanding the selected terms and to consider associations between scores on this widely used test and those derived from other recognized health literacy tests. Results suggest that the REALM is underrepresenting the health literacy construct and that the test may also be biased against non-native speakers of English. The study points to an expanded role for language testers, working in collaboration with experts from medical disciplines, in developing and evaluating health literacy tools.

Toward Ensuring Health Equity: Readability and Cultural Equivalence of OMERACT Patient-reported Outcome Measures

Objective. The goal of the Outcome Measures in Rheumatology (OMERACT) 12 (2014) equity working group was to determine whether and how comprehensibility of patient-reported outcome measures (PROM) should be assessed, to ensure suitability for people with low literacy and differing cultures. Methods. The English, Dutch, French, and Turkish Health Assessment Questionnaires and English and French Osteoarthritis Knee and Hip Quality of Life questionnaires were evaluated by applying 3 readability formulas: Flesch Reading Ease, Flesch-Kincaid grade level, and Simple Measure of Gobbledygook; and a new tool, the Evaluative Linguistic Framework for Questionnaires, developed to assess text quality of questionnaires. We also considered a study assessing cross-cultural adaptation with/without back-translation and/or expert committee. The results of this preconference work were presented to the equity working group participants to gain their perspectives on the importance of comprehensibility and cross-cultural adaptation for PROM. Results. Thirty-one OMERACT delegates attended the equity session. Twenty-six participants agreed that PROM should be assessed for comprehensibility and for use of suitable methods (4 abstained, 1 no). Twenty-two participants agreed that cultural equivalency of PROM should be assessed and suitable methods used (7 abstained, 2 no). Special interest group participants identified challenges with cross-cultural adaptation including resources required, and suggested patient involvement for improving translation and adaptation. Conclusion. Future work will include consensus exercises on what methods are required to ensure PROM are appropriate for people with low literacy and different cultures.

A Testing Issue: Key skills assessment in Australia

Maintenance of academic standards, assessment and monitoring are key tasks for tertiary education, as the system attempts to meet government targets for universal participation. Tertiary education therefore demands more attention to the measurement of outcomes. However, the use of a graduate skills assessment test, we contend--particularly in the form this currently takes in Australia--implies a limited sense of the value added by a university education. We question the validity of national testing both on grounds of its suitability to assess the skills cultivated by university study and on grounds of equity and cultural inclusiveness.

FRAMING WRITING SUPPORT ONLINE FOR AN INTERNATIONAL STUDENT POPULATION

The provision of stand-alone, web-based materials is one way of making language and academic skills support for first-year students accessible, flexible, and more or less permanently available. “Writing in Subject Areas” is a web-based resource developed at Monash University in Australia to facilitate students’ transition to the kinds of thinking and writing valued in higher education. The research and pedagogy underpinning the site is based on the significance for first-year students of understanding: (1) textual structures; (2) discursive processes; and (3) institutional practices in the academy. Using a common template, the site provides materials for ten subjects in four faculties. The current paper discusses the student evaluation of the resource, elicited via questionnaire from almost 1,000 respondents over two years. In 2005, 29% of students at the University were international and so the learning needs of this group are of particular interest. The paper compares the international to the local student response on a series of key issues. The results suggest significant differences between the two student cohorts. While the resource’s usefulness was commended by both groups, the international student cohort was more likely to use all elements and to be more motivated, even while finding it more difficult than local students. The difficulty was found to be more pronounced for a subgroup of offshore students. The study concludes by reinforcing the benefit of theoretically grounded and specially targeted assistance. Further, it underscores the need for ethnographically inspired investigations by staff providing online teaching and academic support for diverse cultural groups.