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Background: Behavioural intention (BI) has been predicted using other variables by adopting the technology acceptance model (TAM). However, few studies have examined whether BI can predict learning performance. Objectives: The present study used an extended TAM to investigate whether students' BI is a predictor of their listening learning performance (LLP) through vocabulary learning performance (VLP) in the context of mobile vocabulary‐assisted listening learning by using two mobile learning tools. Methods: A total of 129 college students with a pre‐intermediate level of English were recruited as participants, and a 10‐week mobile vocabulary‐assisted, listening‐learning course was conducted in 2022. In each task of this course, the students had to learn target words from a listening passage on Quizlet and then engage in listening activities on Randall's ESL Cyber Listening Lab. Quantitative responses obtained through an online questionnaire were analysed through partial‐least‐squares structural equation modelling. Results: The analysis results indicated that BI significantly predicted LLP through VLP. Perceived ease of use (PEU) and perceived usefulness (PU) were significant antecedents of BI. However, PEU did not significantly predict PU because of the difficulty of navigating between the two technological tools used in this study. The extended model demonstrated its effectiveness in explaining listening learning performance, as evidenced by an explained variance (R2) of 69%. Conclusion: The extended model validates the influence of BI on learning performance and it can also draw teachers' focus toward the significance of enhancing students' BI to improve their listening learning performance. Pedagogical implications based on the results are provided in this paper. Lay Description: What is already known about this topic?: TAM was used to study learners' acceptance of mobile‐assisted language learning.TAM incorporates latent variables to explore mobile‐assisted language learning.Investigating factors influencing BI is a primary research focus in extended TAM literature.Mobile tools could improve listening learning and vocabulary retention. What this paper adds to that: Learning performance was considered as a dependent variable in an extended TAM.BI might predict students' learning performance in vocabulary and listening in an extended TAM.Teachers used two mobile tools to design mobile vocabulary‐assisted listening tasks.Pre‐learning the target words facilitate students' listening learning performance. Implications for practice and/or policy: We show the importance of BI on predicting listening learning performance.The impact of BI on other factors became another focus of TAM research.Results highlight pre‐learning target words' importance for better listening performance.Existing mobile tools improve listening performance, avoiding new system development. [ABSTRACT FROM AUTHOR]

Objective: Safe home tracheostomy care requires engagement and troubleshooting by patients, who may turn to online, AI‐generated information sources. This study assessed the quality of ChatGPT responses to such queries. Methods: In this cross‐sectional study, ChatGPT was prompted with 10 hypothetical tracheostomy care questions in three domains (complication management, self‐care advice, and lifestyle adjustment). Responses were graded by four otolaryngologists for appropriateness, accuracy, and overall score. The readability of responses was evaluated using the Flesch Reading Ease (FRE) and Flesch–Kincaid Reading Grade Level (FKRGL). Descriptive statistics and ANOVA testing were performed with statistical significance set to p <.05. Results: On a scale of 1–5, with 5 representing the greatest appropriateness or overall score and a 4‐point scale with 4 representing the highest accuracy, the responses exhibited moderately high appropriateness (mean = 4.10, SD = 0.90), high accuracy (mean = 3.55, SD = 0.50), and moderately high overall scores (mean = 4.02, SD = 0.86). Scoring between response categories (self‐care recommendations, complication recommendations, lifestyle adjustments, and special device considerations) revealed no significant scoring differences. Suboptimal responses lacked nuance and contained incorrect information and recommendations. Readability indicated college and advanced levels for FRE (Mean = 39.5, SD = 7.17) and FKRGL (Mean = 13.1, SD = 1.47), higher than the sixth‐grade level recommended for patient‐targeted resources by the NIH. Conclusion: While ChatGPT‐generated tracheostomy care responses may exhibit acceptable appropriateness, incomplete or misleading information may have dire clinical consequences. Further, inappropriately high reading levels may limit patient comprehension and accessibility. At this point in its technological infancy, AI‐generated information should not be solely relied upon as a direct patient care resource. [ABSTRACT FROM AUTHOR]

Background Objectives Methods Results Conclusion Temporomandibular disorders (TMD) are a prevalent ailment with a global impact, affecting a substantial number of individuals. While some individuals are receiving treatment from orthodontists for TMD, a significant proportion of individuals obtain knowledge through websites.Our purpose had been to evaluate, from a patient‐oriented perspective, the readability of home pages of websites scored in the 10 most prominent devoted to TMD. We also determined what level of education would have been needed to get an overview of the information on the websites under scrutiny. This approach ensures that our findings are centred on the patient experience, providing insights into how accessible and understandable websites about TMD.We determined the top 10 patient‐focused English language websites by searching for ‘temporomandibular disorders’ in the ‘no country redirect’ plugin of the Google Chrome browser (www.google.com/ncr). The readability of the texts was assessed using the Gunning fog index (GFI), Coleman Liau index (CLI), Automated readability index (ARI) Simple Measure of Gobbledygook (SMOG), Flesch Kincald grade level (FKGL), Flesh reasing ease (FRE) (https://readabilityformulas.com).The mean Flesch reading ease index score was determined to be 48.67, accompanied by a standard deviation of 15.04 and these websites require an average of 13.49 years of formal education (GFI), with a standard deviation of 2.62, for ease of understanding.Our research indicates that a significant proportion of websites related to TMD can be defined as a level of complexity that exceeds the ability to read comprehension of the general population. [ABSTRACT FROM AUTHOR]

Objectives: Following a user‐centred redesign and refinement process of an electronic delirium screening tool (eDIS‐MED), further accuracy assessment was performed prior to anticipated testing in the clinical setting. Methods: Content validity of each of the existing questions was evaluated by an expert group in the domains of clarity, relevance and importance. Questions with a Content Validity Index (CVI) <0.80 were reviewed by the development group for potential revision. Items with CVI <0.70 were discarded. Next, face validity of the entirety of the tests was conducted and readability measured. Results: A panel of five clinical experts evaluated the test battery comprising eDIS‐MED. The content validity process endorsed 61 items. The overall scale CVI was 0.92. Eighty‐eight per cent of the responses with regard to question relevancy, usefulness and appropriateness were positive. The questions were deemed fifth grade level and very easy to read. Conclusions: A revised electronic screening tool was shown to be accurate according to an expert group. A clinical validation study is planned. [ABSTRACT FROM AUTHOR]

Background: Gynaecological cancer symptoms are often vague and non‐specific. Quality health information is central to timely cancer diagnosis and treatment. The aim of this study was to identify and evaluate the quality of online text‐based patient information resources regarding gynaecological cancer symptoms. Methods: A targeted website search and Google search were conducted to identify health information resources published by the Australian government and non‐government health organisations. Resources were classified by topic (gynaecological health, gynaecological cancers, cancer, general health); assessed for reading level (Simple Measure of Gobbledygook, SMOG) and difficulty (Flesch Reading Ease, FRE); understandability and actionability (Patient Education Materials Assessment Tool, PEMAT, 0–100), whereby higher scores indicate better understandability/actionability. Seven criteria were used to assess cultural inclusivity specific for Aboriginal and Torres Strait Islander people; resources which met 3–5 items were deemed to be moderately inclusive and 6+ items as inclusive. Results: A total of 109 resources were identified and 76% provided information on symptoms in the context of gynaecological cancers. The average readability was equivalent to a grade 10 reading level on the SMOG and classified as 'difficult to read' on the FRE. The mean PEMAT scores were 95% (range 58–100) for understandability and 13% (range 0–80) for actionability. Five resources were evaluated as being moderately culturally inclusive. No resource met all the benchmarks. Conclusions: This study highlights the inadequate quality of online resources available on pre‐diagnosis gynaecological cancer symptom information. Resources should be revised in line with the recommended standards for readability, understandability and actionability and to meet the needs of a culturally diverse population. [ABSTRACT FROM AUTHOR]

Background: Stroke profoundly affects quality of life (QOL), including loss of employment, reduced social activity, shrinking social networks and low mood. Dysgraphia (impaired writing) is a common symptom of aphasia yet is rarely targeted in rehabilitation. Recent technological advances might challenge this, since much communication is now conducted digitally through writing. The rehabilitation of writing may therefore help to address the wider consequences of stroke and aphasia. Aims: Can assistive technology (AT) training for people with dysgraphia: (1) improve written output, and are gains achieved only with AT? (2) improve reading comprehension scores, and are gains achieved only with AT? and (3) affect social participation, mood or QOL Methods and Procedures: Design A mixed‐methods, repeated measures, small group study design was adopted (qualitative outcomes will be reported elsewhere). Participants: Recruited from community settings, for example, Stroke Association communication support groups. Inclusion criteria: over 18 years old, aphasia due to stroke, acquired dysgraphia, writing more impaired than speech, fluent English prior to stroke, access to computer and Internet. Exclusion criteria: currently receiving speech and language therapy, significant cognitive impairment, neuromuscular/motor‐speech impairments/structural abnormalities, developmental dyslexia, uncorrected visual/auditory impairments. Procedures: Screening and diagnostic assessments at time T1 (first baseline). Outcome measures at T1; repeated at T2 (second baseline), T3 (end of intervention), T4 (3‐month follow up). Social participation assessment and cognitive monitoring at T2, T3, T4. Intervention: Seven–ten hours individual therapy weekly and additional email support. Participants were trained to operate Dragon NaturallySpeaking (speech to text package) and ClaroRead (read writing aloud). Outcome measures were administered on pen and paper (control) and on computer, with AT enabled only at T3, T4. Outcomes and Results: Computer narrative writing was significantly improved by AT training (Friedman's χ2 (3) = 8.27, p = 0.041), indicating a compensatory effect of AT. Though reading comprehension significantly improved in the computer condition (Friedman's χ2 (3) = 21.07, p = 0.001), gains could not be attributed to the AT. Gains were achieved only when measures were administered on the keyboard, with AT enabled. Thus, a compensatory rather than remediatory effect was suggested. Social network size significantly increased; there were no significant changes in mood/QOL. Individual success rates varied. Conclusion and Implications: The customisable AT training was acceptable to participants and resulted in significantly improved narrative writing. Compensatory AT interventions are a useful adjunct to remediatory writing interventions and may particularly support functional writing. WHAT THIS PAPER ADDS: What is already known on this subject: Writing is rarely spared in aphasia and may present as the most impaired communication modality. Yet, people with aphasia report that writing is seldom included in their rehabilitation. Many communication activities are now conducted digitally through writing, therefore rehabilitation of this is more important than ever before. This study sought to address whether an assistive technology (AT) software package can improve writing and whether any changes were compensatory or remediatory. What this study adds to existing knowledge: This group study found that AT training led to gains in written discourse and social network in people with aphasia and dysgraphia. Gains were not replicated in handwritten tasks, suggesting this was a compensatory therapeutic approach. What are the clinical implications of this work?: AT programs such as this may present speech and language therapists with a practical, pragmatic adjunct to writing or typing therapy, particularly for clients with chronic, intractable impairments for whom remediatory therapy may have a low chance of success. [ABSTRACT FROM AUTHOR]

Objective: To assess the readability and the comprehensiveness of patient‐reported outcome measures (PROMs) utilized in primary headache disorders literature. Background: As the health‐care landscape has evolved toward a patient‐centric model, numerous PROMs have been developed to capture treatment outcomes in patients with headache disorders. For these PROMs to advance our understanding of headache disorders and their treatment impact, they must be easy to understand (i.e., reading grade level 6 or less) and comprehensively capture what matters to patients with headache. The aim of this study was to (a) assess the readability of PROMs utilized in headache disorders literature, and (b) assess the comprehensiveness of PROMs by mapping their content to a health‐related quality of life framework. Methods: In this scoping review, recently published systematic reviews were used to identify PROMs used in primary headache disorders literature. Readability analysis was performed at the level of individual items and full PROM using established readability metrics. The content of the PROMs was mapped against a health‐related quality‐of‐life framework by two independent reviewers. Results: In total, 22 PROMs (15 headache disorders related, 7 generic) were included. The median reading grade level varied between 7.1 (interquartile range [IQR] 6.3–7.8) and 12.7 (IQR 11.8–13.2). None of the PROMs were below the recommended reading grade level for patient‐facing material (grade 6). Three PROMs, the Migraine‐Treatment Assessment Questionnaire, the Eurolight, and the European Quality of Life 5 Dimensions 3 Level Version, were between reading grade levels 7 and 8; the remaining 19 PROMs were above reading grade level 8. In total, the PROMs included 425 items. Most items (n = 134, 32%) assessed physical function (e.g., work, activities of daily living). The remaining items assessed physical symptoms (n = 127, 30%; e.g., pain, nausea), treatment effects on symptoms (n = 65, 15%; e.g., accompanying symptoms relief, headache relief), treatment impact (n = 56, 13%; e.g., function, side effects), psychological well‐being (n = 41, 10%; e.g., anger, frustration), social well‐being (n = 29, 7%; e.g., missing out on social activities, relationships), psychological impact (n = 14, 3%; e.g., feeling [not] in control, feeling like a burden), and sexual well‐being (n = 3, 1%; e.g., sexual activity, sexual interest). Some of the items pertained to treatment (n = 27, 6%), of which most were about treatment type and use (n = 12, 3%; e.g., medication, botulinum toxin), treatment access (n = 10, 2%; e.g., health‐care utilization, cost of medication), and treatment experience (n = 9, 2%; e.g., treatment satisfaction, confidence in treatment). Conclusion: The PROMs used in studies of headache disorders may be challenging for some patients to understand, leading to inaccurate or missing data. Furthermore, no available PROM comprehensively measures the health‐related quality‐of‐life impact of headache disorders or their treatment, resulting in a limited understanding of patient‐reported outcomes. The development of an easy‐to‐understand, comprehensive, and validated headache disorders–specific PROM is warranted. Plain Language Summary: Patient‐reported outcome measures (PROMs) are used so we can better understand headache disorders (HDs) and how well treatments work; to be most effective, they should be specific to HDs and easy for patients to understand. This study looked at the reading grade level of 22 PROMs used in HD studies and what quality of life topics they covered; the reading grade level ranged from 7.1 to 12.7, higher than the recommended grade level of 6. Most items in the PROMs focused on physical function, symptoms, and treatment effects, but none did a good job of learning about HDs' impacts on quality of life, revealing a need for the development of an improved, easy‐to‐understand HD‐specific PROM. [ABSTRACT FROM AUTHOR]

Background/Aim: Childhood dental trauma poses a prevalent concern, and the limited knowledge of lay caregivers toward the needed immediate actions can adversely affect a child's well‐being. This study aimed to create and validate an educational comic book for lay individuals, designed to guide immediate actions in dental trauma cases, and assess its effects toward enhancing reader knowledge. Methodology: The four‐stage study involved: (1) Literature review and script development; (2) Version 1 of the comic book creation (including illustrations, layout, and design) and Flesch Readability Index (FI) calculation; (3) Version 1 validation by expert judges, assessed by the Content Validity Index (CVI); (4) Version 1 refinement based on the judges' feedback, recalculation of FI, and a pilot test (CVI) involving lay individuals who validated the final material (Version 2). The validation process involved 67 participants, including 13 specialist judges and 54 elementary school teachers. Results: The CVI for Version 1 was calculated at 0.89 (89%), indicating a favorable level of agreement on the evaluated criteria. The FI was determined as 91.1%, indicating a high level of readability. The FI for Version 2 was 92.1% (indicating a very easy level of comprehension). The CVI calculated for the target audience after the pilot test was 0.99 (99%), denoting a substantial agreement among the participants. In assessing the level of knowledge, a significant increase was observed in the rate of correct answers after the comic book was read by lay individuals (p < 0.05), inasmuch as the percentage rose from 50.5% before to 81.2% after reading it. Conclusion: The educational comic book proved valid in terms of readability, appearance, and content. Furthermore, it had a positive impact on gaining the knowledge needed to take the appropriate actions, thus making it a valuable tool for guiding the lay population in cases of dental trauma. [ABSTRACT FROM AUTHOR]

Aim: ChatGPT's role in medical writing is a topic of discussion. I experimented whether ChatGPT almost automatically generates Correspondence or Letter addressed to a "translated" article, and thereby wish to arouse discussion regarding ChatGPT use in medical writing. Methods: I input an English article of mine into ChatGPT, tasking it with generating an English Disagreement Letter (Letter 1). Next, I tasked ChatGPT with translating the manuscript addressed to from English‐French‐Spanish‐German. Then, I once again tasked ChatGPT with generating an English Disagreement Letter addressed to a German manuscript (triplicate translated manuscript) (Letter 2). Results: Letters 1 and 2 are readable and reasonable, shooting the point that the author (myself) felt as the weakness of the article. Letters addressed to French (single translation) and to Spanish (double translation) and longer Letters (corresponding to Letters 1 and 2) are also readable, and thus stand. Conclusions: Solely based on this experiment, one may be able to write a letter even without understanding the meaning of the paper being addressed, let alone the language of the paper. Although this humble experiment does not conclude anything, I plea for a comprehensive discussion on the implications of these findings. [ABSTRACT FROM AUTHOR]

Purpose: While the National Institutes of Health and American Medical Association recommend patient education materials (PEMs) should be written at the sixth‐grade reading level or below, many patient education materials related to traumatic orthopaedic injuries do not meet these recommendations. The purpose of this study is to create a standardised method for enhancing the readability of trauma‐related orthopaedic PEMs by reducing the use of ≥ three syllable words and reducing the use of sentences >15 words in length. We hypothesise that applying this standardized method will significantly improve the objective readability of orthopaedic trauma PEMs. Methods: A patient education website was queried for PEMs relevant to traumatic orthopaedic injuries. Orthopaedic trauma PEMs included (N = 40) were unique, written in a prose format, and <3500 words. PEM statistics, including scores for seven independent readability formulae, were determined for each PEM before and after applying this standard method. Results: All PEMs had significantly different readability scores when comparing original and edited PEMs (p < 0.01). The mean Flesch Kincaid Grade Level of the original PEMs (10.0 ± 1.0) was significantly higher than that of edited PEMs (5.8 ± 1.1) (p < 0.01). None of the original PEMs met recommendations of a sixth‐grade reading level compared with 31 (77.5%) of edited PEMs. Conclusions: This standard method that reduces the use of ≥ three syllable words and <15 word sentences has been shown to significantly reduce the reading‐grade level of PEMs for traumatic orthopaedic injuries. Improving the readability of PEMs may lead to enhanced health literacy and improved health outcomes. [ABSTRACT FROM AUTHOR]

Purpose: Orthopaedic Patient Education Materials (PEMs) related to total hip and total knee arthroplasty (TKA) have repeatedly been shown to not meet American Medical Association and National Institutes of Health recommendations for readability. PEMs that are written with too much complexity limit the ability of some readers to comprehend the material. These complex PEMs also limit the health literacy of patients, a key determinant of health status and outcomes. The purpose of this study was to improve the readability of total hip and TKA‐related PEMs by limiting the use of sentences with ≥15 words and limiting the use of words with ≥ three syllables. Methods: The readability of all 26 PEMs in this study was assessed before and after editing. Editing of articles included limiting the use of sentences with ≥15 words and limiting the use of words with ≥three syllables while preserving PEM content. Results: A total of 26 PEMs were available for use in this study after the application of inclusion and exclusion criteria. The percentage of original PEMs at or below the recommended sixth‐grade reading level was 0% (0 out of 26), while the percentage of edited PEMs at or below the sixth‐grade reading level was 50% (13 out of 26). Conclusions: Using this standardised method for reducing sentence length to <15 words and limiting the use of words with >2 syllables, while preserving key content, significantly improved the readability of PEMs related to total hip and TKA. [ABSTRACT FROM AUTHOR]

Background: Telerehabilitation is an easy and creative approach to rehabilitation treatments for osteoarthritis. In telerehabilitation, there are various modes through which exercises can be explained to the patients. Videos and brochures are commonly used to send patients exercise plans. Videos are easy to understand and can mimic live demonstrations and brochures are easy to create and customise for every patient's need. The present study aimed to evaluate the effectiveness of brochure and video methods of exercise prescription through telerehabilitation in terms of exercise acquisition and retention. Methods: The study design was a randomised clinical trial. A total of 110 knee osteoarthritis patients who agreed to participate in the telerehabilitation programme were recruited for the study. The patients were randomly assigned to a video and brochure group. After the initial consultation through videoconferencing, the prescribed exercises were sent on their phone in the form of video or electronic brochure. The participants were again contacted through video conferencing after 2 days and retention and acquisition tests were recorded. Results: The comparison of both groups through 't' test showed no significant difference in exercise retention and acquisition. The mean and SD of exercise acquisition in the brochure group was 26.3455, ±5.7998 and in the video group was 27.2, ±5.47181 and mean and SD of exercise retention in the brochure group was 7.8727, ±2.31784 and in the video group was 7.6, ±1.256. Further analysis revealed that the hamstring stretching exercise was retained better in the video group than in the brochure group (p = 0.031*). Conclusion: The study found no significant difference in exercise acquisition and retention between the video and brochure groups. Hence, an exercise brochure can be equally effective as a video for exercise prescription if the brochure is developed by keeping in mind the principles of readability and the use of proper instructions. [ABSTRACT FROM AUTHOR]

Objective: The objective of the current study was to assess the quality of large language model (LLM) chatbot versus physician‐generated responses to patient‐generated rheumatology questions. Methods: We conducted a single‐center cross‐sectional survey of rheumatology patients (n = 17) in Edmonton, Alberta, Canada. Patients evaluated LLM chatbot versus physician‐generated responses for comprehensiveness and readability, with four rheumatologists also evaluating accuracy by using a Likert scale from 1 to 10 (1 being poor, 10 being excellent). Results: Patients rated no significant difference between artificial intelligence (AI) and physician‐generated responses in comprehensiveness (mean 7.12 ± SD 0.99 vs 7.52 ± 1.16; P = 0.1962) or readability (7.90 ± 0.90 vs 7.80 ± 0.75; P = 0.5905). Rheumatologists rated AI responses significantly poorer than physician responses on comprehensiveness (AI 5.52 ± 2.13 vs physician 8.76 ± 1.07; P < 0.0001), readability (AI 7.85 ± 0.92 vs physician 8.75 ± 0.57; P = 0.0003), and accuracy (AI 6.48 ± 2.07 vs physician 9.08 ± 0.64; P < 0.0001). The proportion of preference to AI‐ versus physician‐generated responses by patients and physicians was 0.45 ± 0.18 and 0.15 ± 0.08, respectively (P = 0.0106). After learning that one answer for each question was AI generated, patients were able to correctly identify AI‐generated answers at a lower proportion compared to physicians (0.49 ± 0.26 vs 0.97 ± 0.04; P = 0.0183). The average word count of AI answers was 69.10 ± 25.35 words, as compared to 98.83 ± 34.58 words for physician‐generated responses (P = 0.0008). Conclusion: Rheumatology patients rated AI‐generated responses to patient questions similarly to physician‐generated responses in terms of comprehensiveness, readability, and overall preference. However, rheumatologists rated AI responses significantly poorer than physician‐generated responses, suggesting that LLM chatbot responses are inferior to physician responses, a difference that patients may not be aware of. [ABSTRACT FROM AUTHOR]

Identifying factors that associate with more cited or higher quality research may be useful to improve science or to support research evaluation. This article reviews evidence for the existence of such factors in article text and metadata. It also reviews studies attempting to estimate article quality or predict long‐term citation counts using statistical regression or machine learning for journal articles or conference papers. Although the primary focus is on document‐level evidence, the related task of estimating the average quality scores of entire departments from bibliometric information is also considered. The review lists a huge range of factors that associate with higher quality or more cited research in some contexts (fields, years, journals) but the strength and direction of association often depends on the set of papers examined, with little systematic pattern and rarely any cause‐and‐effect evidence. The strongest patterns found include the near universal usefulness of journal citation rates, author numbers, reference properties, and international collaboration in predicting (or associating with) higher citation counts, and the greater usefulness of citation‐related information for predicting article quality in the medical, health and physical sciences than in engineering, social sciences, arts, and humanities. [ABSTRACT FROM AUTHOR]

This article highlights how Wolfgang Herrndorf's bestselling novel Tschick (2010) is particularly well suited for advanced courses focused on cultural and linguistic enrichment. Herrndorf's Tschick, I argue, facilitates interaction, engagement, and individual interpretation; is linguistically accessible because of its use of high‐frequency vocabulary and conceptual orality; and can motivate students to be more active and engaged class participants. The article introduces the novel and describes the advanced college course in which it is taught. It then outlines readability factors and discusses their implication for the teaching of Tschick, providing sample teaching ideas that consider the linguistic ability of the advanced language learner as well as broader professional objectives. [ABSTRACT FROM AUTHOR]

There is concern that accounting standards are difficult to understand by those who use them. We investigate factors that enhance and inhibit the ability of the standards' users to comprehend their meaning and requirements. Readability statistics reveal that Australian accounting standards are difficult or very difficult to read. Interviews with experienced financial statement preparers and auditors from the for‐profit, not‐for‐profit private, and public sectors reveal that 'understandability' is a function of many inter‐related factors, only some of which relate to how standards are written and presented. We offer recommendations to standards‐setters about how the understandability of standards could be improved. [ABSTRACT FROM AUTHOR]

Background: The Manual of dietetic practice ('Manual') is the core textbook for qualified and student dietitians. A survey was conducted to explore views on the scope, content and presentation of the Manual to inform the forthcoming edition. Methods: The survey comprised of questions on demographics, structure, content, access (print/digital), missing topics, strengths and weaknesses. It was distributed to members of the British Dietetic Association (BDA) and other relevant groups in August 2022. Responses are presented as frequencies and free text as themes. Results: Of 1179 responses, 91% were from professionals, of whom 72% were registered dietitians with a mean of 12.7 years (range: 1–44) in practice: 60% worked in the United Kingdom with 52% based in a clinical setting. The printed version was preferred: 59% professionals, 60% students, 94% professionals and 88% students were satisfied with the structure; however, 26% professionals and 22% students identified content that was lacking or outdated, including mental health and sustainability. The strengths were its comprehensive coverage and respected contributing authors. Weaknesses included the cost, size, lack of visual aids and currency. Professionals indicated the seventh edition should focus on more practical information required for clinical practice, whereas students wanted more emphasis on summarised information and visual formats. Conclusions: The survey proved a valuable method to engage with the readership to ensure the next edition reflected their requirements. Although nearly all respondents were satisfied with the scope and content, the results highlighted those topics lacking and/or outdated. Results also showed that the next edition should focus on practical information required for clinical practice, with more summarised and visual formats. Key points: This article presents the results of an online survey to explore views on the scope, content and presentation of the UK Dietetic profession's core text, Manual of dietetic practice.The survey was initiated by the editorial team who felt it important to explore ways in which the new edition of the Manual could be updated to meet the emerging needs of readers, namely qualified dietitians and students of dietetics.Over 1100 respondents completed the survey comprising 91% professionals, 72% of whom were registered dietitians who had been practicing in the UK healthcare system for an average 12 years.Thematic analysis revealed readers felt the Manual to be a highly respected text, regarded as the 'go‐to' source for guidance on the practice of clinical dietetics with comprehensive coverage and extremely knowledgeable contributing authors.However, despite its positive qualities, the Manual suffered from cumbersome updating processes meaning that its content lagged behind real‐life clinical practice.The survey proved a valuable method to engage with the readership to ensure the next edition reflected readers' requirements for updated Manual content, style and format.The editors will ensure the forthcoming seventh edition focuses on practical information required for clinical practice, with more summarised form and visual formats.Further, moving forward it is hoped that there will be more aggressive promotion of the online version of the Manual as it is a format which facilitates content update and is likely to become more widely accessed in the future. [ABSTRACT FROM AUTHOR]

Background: The COVID‐19 pandemic has significantly disrupted clinical experience and exposure of medical students and junior doctors. Artificial Intelligence (AI) integration in medical education has the potential to enhance learning and improve patient care. This study aimed to evaluate the effectiveness of three popular large language models (LLMs) in serving as clinical decision‐making support tools for junior doctors. Methods: A series of increasingly complex clinical scenarios were presented to ChatGPT, Google's Bard and Bing's AI. Their responses were evaluated against standard guidelines, and for reliability by the Flesch Reading Ease Score, Flesch–Kincaid Grade Level, the Coleman‐Liau Index, and the modified DISCERN score for assessing suitability. Lastly, the LLMs outputs were assessed by using the Likert scale for accuracy, informativeness, and accessibility by three experienced specialists. Results: In terms of readability and reliability, ChatGPT stood out among the three LLMs, recording the highest scores in Flesch Reading Ease (31.2 ± 3.5), Flesch–Kincaid Grade Level (13.5 ± 0.7), Coleman–Lau Index (13) and DISCERN (62 ± 4.4). These results suggest statistically significant superior comprehensibility and alignment with clinical guidelines in the medical advice given by ChatGPT. Bard followed closely behind, with BingAI trailing in all categories. The only non‐significant statistical differences (P > 0.05) were found between ChatGPT and Bard's readability indices, and between the Flesch Reading Ease scores of ChatGPT/Bard and BingAI. Conclusion: This study demonstrates the potential utility of LLMs in fostering self‐directed and personalized learning, as well as bolstering clinical decision‐making support for junior doctors. However further development is needed for its integration into education. [ABSTRACT FROM AUTHOR]

Background/Objectives: Sinonasal inverted papilloma (IP) is a rare but serious diagnosis, with a paucity of patient‐centred information regarding this condition. As more patients are seeking healthcare information online, the quality and comprehensibility of this information becomes ever more important. The aim of the study was to investigate the readability and quality of websites on inverted papilloma. Methods: The term IP and seven of its synonyms were inputted into the three of the most commonly used search engines in the English‐speaking world (Google, Yahoo and Bing). The first 20 results returned for each search term were then screened with our exclusion criteria. The remaining websites were assessed for their readability using the using the Flesch Reading Ease Score (FRES) and average grade level (AGL). Quality was assessed using the DISCERN questionnaire. Results: Of the 480 websites returned using our search strategy, 410 were excluded using our screening criteria. Removal of duplicates from the remaining 70 websites left 14 for inclusion in the final analysis. The mean FRES score of the remaining websites was 30.5 ± 10 and the mean AGL was 15.2 ± 1.1, corresponding to a reading age of a 21‐year‐old. The median DISCERN score was 33.5 (30.5–36.5), a score which falls within the 'poor quality' range. Conclusion: The readability and quality of online patient information on IP is far below the expected standard. Healthcare providers have a responsibility to direct patients to appropriate sources of information or consider producing new material should a lack of appropriate sources exist. [ABSTRACT FROM AUTHOR]

Background: The detection and description of language impairments in neurodegenerative diseases like Alzheimer's Disease (AD) play an important role in research, clinical diagnosis and intervention. Various methodological protocols have been implemented for the assessment of morphosyntactic abilities in AD; narrative discourse elicitation tasks and structured experimental tasks for production, offline and online structured experimental tasks for comprehension. Very few studies implement and compare different methodological protocols; thus, little is known about the advantages and disadvantages of each methodology. Aims: To discuss and compare the main behavioral methodological approaches and tasks that have been used in psycholinguistic research to assess different aspects of morphosyntactic production and comprehension in individuals with AD at the word and sentence levels. Methods: A narrative review was conducted through searches in the scientific databases Google Scholar, Scopus, Science Direct, MITCogNet, PubMed. Only studies written in English, that reported quantitative data and were published in peer‐reviewed journals were considered with respect to their methodological protocol. Moreover, we considered studies that reported research on all stages of the disease and we included only studies that also reported results of a healthy control group. Studies that implemented standardized assessment tools were not considered in this review. Outcomes & Results: The main narrative discourse elicitation tasks implemented for the assessment of morphosyntactic production include interviews, picture‐description and story narration, whereas the main structured experimental tasks include sentence completion, constrained sentence production, sentence repetition and naming. Morphosyntactic comprehension in AD has been assessed with the use of structured experimental tasks, both offline (sentence‐picture matching, grammaticality judgment) and online (cross‐modal naming,speeded sentence acceptability judgment, auditory moving window, word detection, reading). For each task we considered studies that reported results from different morphosyntactic structures and phenomena in as many different languages as possible. Conclusions & Implications: Our review revealed strengths and weaknesses of these methods but also directions for future research. Narrative discourse elicitation tasks as well as structured experimental tasks have been used in a variety of languages, and have uncovered preserved morphosyntactic production but also deficits in people with AD. A combination of narrative discourse elicitation and structured production tasks for the assessment of the same morphosyntactic structure has been rarely used. Regarding comprehension, offline tasks have been implemented in various languages, whereas online tasks have been mainly used in English. Offline and online experimental paradigms have often produced contradictory results even within the same study. The discrepancy between the two paradigms has been attributed to the different working memory demands they impose to the comprehender or to the different parsing processes they tap. Strengths and shortcomings of each methodology are summarized in the paper, and comparisons between different tasks are attempted when this is possible. Thus, the paper may serve as a methodological guide for the study of morphosyntax in AD and possibly in other neurodegenerative diseases. WHAT THIS PAPER ADDS: What is already known on this subject: For the assessment of morphosyntactic abilities in AD, various methodological paradigms have been implemented: narrative discourse elicitation tasks and structured experimental tasks for production, and offline and online structured experimental tasks for comprehension. Very few studies implement and compare different methodological protocols; thus, little is known about the advantages and disadvantages of each methodology. What this paper adds to existing knowledge: The paper presents an overview of methodologies that have been used to assess morphosyntactic production and comprehension of people with AD at the word and sentence levels. The paper summarizes the strengths and shortcomings of each methodology, providing both the researcher and the clinician with some directions in their endeavour of investigating language in AD. Also, the paper highlights the need for further research that will implement carefully scrutinized tasks from various experimental paradigms and will explore distinct aspects of the AD patients' morphosyntactic abilities in typologically different languages. What are the potential or actual clinical implications of this work?: The paper may serve as a reference point for (psycho‐)linguists who wish to study morphosyntactic abilities in AD, and for speech and language therapists who might need to apply morphosyntactic protocols to their patients in order to assess them or design appropriate therapeutic interventions for production and comprehension deficits. [ABSTRACT FROM AUTHOR]

Background: Adherence to self‐management greatly impacts patients with chronic obstructive pulmonary disease (COPD) patients. However, most patients with COPD have a limitation in understanding text‐based self‐management plans owing to low health literacy. Thus, strategies to improve self‐management in patients with COPD should be developed. Objectives: This study aimed to develop pictogram‐based content comprising self‐management health information for patients with COPD. Methods: Items for COPD self‐management health information were selected based on in‐depth interviews with patients and text network analysis conducted in our previous study and a systematic literature review to develop preliminary pictogram‐based content. Then, 30 patients with COPD and 10 healthcare professionals (HCPs) were recruited to evaluate the preliminary content using a client satisfaction questionnaire with a maximum score of 32. Results: Content was developed with one item related to disease knowledge while the other 20 concerned self‐management. Patients (28.70 ± 2.94) and HCPs (27.40 ± 2.84) evaluated the content as high quality with adjustments made to increase the size of the letters and shorten the number of items for readability. Twenty‐one items were collated in the final booklet, while 14 of the 21 items were incorporated into a poster. Conclusions: This study indicates that the pictogram‐based content was sufficiently well designed and received good evaluations from both patients with COPD and HCPs. Therefore, it may have prospects for enhancing self‐management in patients with COPD. However, the effect of the content on the outcomes of older patients with COPD and low health literacy will need to be validated in future research. [ABSTRACT FROM AUTHOR]

Objective: Epilepsy surgery is an effective albeit underused treatment for refractory epilepsy, and online materials are vital to patient understanding of the complex process. Our goal is to analyze the readability and content inclusion of online patient health education materials designed for epilepsy surgery. Methods: A private browser setting was used on Google and Bing to identify the top 100 search results for the terms "epilepsy+surgery". Scientific papers, insurance pages, pay‐wall access sites, and non‐text content were excluded. The website text was reformatted to exclude graphics, contact information, links, and headers. Readability metrics were calculated using an online tool. Text content was analyzed for inclusion of important concepts (pre‐surgical evaluation, complications, risks of continued seizures, types of surgery, complimentary diagrams/audiovisual material). Comparison of readability and content inclusion was performed as a function of organization types (epilepsy center, community health organization, pediatric‐specific) and location (region, country). Results: Browser search yielded 82 distinct websites with information regarding epilepsy surgery, with 98.7% of websites exceeding the recommended 6th‐grade reading level for health information. Epilepsy centers had significantly worse readability (Flesch–Kincaid Grade Level (FKGL) P < 0.01 and Flesch Reading Ease (FRE) P < 0.05). Content analysis showed that only 37% of websites discuss surgical side effects and only 23% mention the risks of continued seizures. Epilepsy centers were less likely to report information on surgical side effects (P < 0.001). UK‐based websites had better readability (FKGL P < 0.01 and FRE P < 0.01) and were more likely to discuss side effects (P = 0.01) compared to US‐based websites. Significance: The majority of online health content is overly complex and relatively incomplete in multiple key areas important to health literacy and understanding of surgical candidacy. Our findings suggest academic organizations, including level 4 epilepsy centers, need to simplify and broaden online education resources. More comprehensive, publicly accessible, and readable information may lead to better‐shared decision‐making. [ABSTRACT FROM AUTHOR]

Background: Owner comprehension is vital to recruitment and study success, but limited information exists regarding the readability of public‐facing veterinary clinical trial descriptions. Objectives: The current study sought to evaluate the readability of public‐facing online veterinary clinical trial descriptions from academic institutions and private referral practices. Animals: None. Methods: This prospective study assessed readability in a convenience sample of veterinary clinical trial study descriptions using 3 common methods: the Flesch‐Kincaid Grade Level (F‐K), Flesch Reading Ease Score (FRES), and online Automatic Readability Checker (ARC). Results were compared across specialties and between academic and private institutions. Results: Grade level and readability consensus scores (RCSs) were obtained for 61 online clinical trial descriptions at universities (n = 49) and private practices (n = 12). Average grade‐level RCS for study descriptions was 14.13 (range, 9‐21). Using Microsoft Word, the FRES score was higher in descriptions from universities compared to private practices (P =.03), and F‐K scores were lower in university compared to private practice descriptions (P =.03). FRES (P =.07), F‐K (P =.12), and readability consensus (P =.17) scores obtained from ARC were not different between institution types. Forty‐eight studies (79%) had RCSs over 12, equivalent to reading material at college or graduate school levels. Conclusions and Clinical Importance: Similar to other areas in veterinary communication, the evaluated veterinary clinical trial descriptions used for advertising and recruitment far exceeded the recommended 6th‐grade reading level for medical information. Readability assessments are straightforward to conduct, and ensuring health literacy should be a customary best practice in veterinary medicine and clinical research. [ABSTRACT FROM AUTHOR]

Background: Bruxism patients often access the web to search for information. Unfortunately, the low text readability of online material and the limited medical literacy in the general population may prevent patients' understanding of health information. Objective(s): We aimed to assess the home page's readability of the top 10 patients‐oriented bruxism‐related websites and the educational level required to approach them. Methods: Using the word bruxism in the "no country redirect" extension of Google Chrome browser (www.google.com/ncr), we identified the first 10 patient‐oriented English language websites. The readability of the material was determined using six commonly recommended readability tests (1): Gunning Fog Index (GFI), Coleman Liau Index (CLI), Automated Readability Index (ARI) Simple Measure of Gobbledygook (SMOG), Flesch Kincald Grade Level (FKGL), Flesh Reasing Ease (FRE). Results: The USA National Institutes of Health requirements, which call for websites to be readable at a 6th to 7th‐grade level, were not followed by any of the most popular websites. Conclusion: The average consumer frequently finds the health information on the Internet to be too complex to understand, which can lead to misinterpretation, a delay in diagnosis, and poorer health consequences. [ABSTRACT FROM AUTHOR]

This article, published in Equine Veterinary Education, examines changes in equine insurance premiums and policies in the UK over the past five years. The study replicated a previous study from 2018 and evaluated the cost of insurance, accessibility, and readability of insurance policies. The results showed that the monthly premiums for insurance cover had increased for all five insurance companies, with a maximum increase of 189%. The study also found that the insurance documents remained difficult to read for most horse owners, which can make decisions about colic treatment more stressful. The authors suggest that insurance companies should make their policies clearer and simpler for owners to understand. [Extracted from the article]

KEY POINTS: Patients are increasingly turning to online education materials to aid with disease management.Patient education materials on aspirin‐exacerbated respiratory disease are of poor readability with significant room for improvement. [ABSTRACT FROM AUTHOR]

Background: As patients seek online health information to supplement their medical decision‐making, the aim of this study is to assess the quality and readability of internet information on the left ventricular assist device (LVAD). Methods: Three online search engines (Google, Bing, and Yahoo) were searched for "LVAD" and "Left ventricular assist device." Included websites were classified as academic, foundation/advocacy, hospital‐affiliated, commercial, or unspecified. The quality of information was assessed using the JAMA benchmark criteria (0–4), DISCERN tool (16–80), and the presence of Health On the Net code (HONcode) accreditation. Readability was assessed using the Flesch Reading Ease score. Results: A total of 38 unique websites were included. The average JAMA and DISCERN scores of all websites were 0.82 ± 1.11 and 52.45 ± 13.51, respectively. Academic sites had a significantly lower JAMA mean score than commercial (p < 0.001) and unspecified (p < 0.001) websites, as well as a significantly lower DISCERN, mean score than commercial sites (p = 0.002). HONcode certification was present in 6 (15%) websites analyzed, which had significantly higher JAMA (p < 0.001) and DISCERN (p < 0.016) mean scores than sites without HONcode certification. Readability was fairly difficult and at the level of high school students. Conclusions: The quality of online information on the LVAD is variable, and overall readability exceeds the recommended level for the public. Patients accessing online information on the LVAD should be referred to sites with HONcode accreditation. Academic institutions must provide higher quality online patient literature on LVADs. [ABSTRACT FROM AUTHOR]

Background: Readability metrics provide us with an objective and efficient way to assess the quality of educational texts. We can use the readability measures for finding assessment items that are difficult to read for a given grade level. Hard‐to‐read math word problems can put some students at a disadvantage if they are behind in their literacy learning. Despite their math abilities, these students can perform poorly on difficult‐to‐read word problems because of their poor reading skills. Less readable math tests can create equity issues for students who are relatively new to the language of assessment. Less readable test items can also affect the assessment's construct validity by partially measuring reading comprehension. Objectives: This study shows how large language models help us improve the readability of math assessment items. Methods: We analysed 250 test items from grades 3 to 5 of EngageNY, an open‐source curriculum. We used the GPT‐3 AI system to simplify the text of these math word problems. We used text prompts and the few‐shot learning method for the simplification task. Results and Conclusions: On average, GPT‐3 AI produced output passages that showed improvements in readability metrics, but the outputs had a large amount of noise and were often unrelated to the input. We used thresholds over text similarity metrics and changes in readability measures to filter out the noise. We found meaningful simplifications that can be given to item authors as suggestions for improvement. Takeaways: GPT‐3 AI is capable of simplifying hard‐to‐read math word problems. The model generates noisy simplifications using text prompts or few‐shot learning methods. The noise can be filtered using text similarity and readability measures. The meaningful simplifications AI produces are sound but not ready to be used as a direct replacement for the original items. To improve test quality, simplifications can be suggested to item authors at the time of digital question authoring. Lay Description: What is Known About the Subject: Difficult to read math assessment items cause measurement and equity issuesReadability of math word problems negatively correlated with outcomes What Our Paper Adds: GPT‐3 AI system is capable to simplify math word problemsPrompt‐based and few‐shot learning‐based approaches are able to create meaningful simplifications, but with a very low accuracy rateText similarity and readability measures can be used to filter out noisy outputs and discover interesting simplifications What are the Implications for Practitioners: GPT‐3 AI is capable of generating relevant math world problem simplificationsSimplified text can be used as suggestions to question authors during the digital item authoring process [ABSTRACT FROM AUTHOR]

Background: Cochrane plain language summaries (PLSs) are an important format to present high‐quality healthcare evidence to patients with cancer and their families. They should be written in a way everyone can understand, since they serve as a tool in decision‐making and present a bridge to overcome the gap between the healthcare users and professionals. Objective: The aim of the study was to assess the language characteristics of PLSs of Cochrane systematic reviews of oncology interventions in comparison with corresponding Cochrane scientific abstracts (SAs). Methods: In this cross‐sectional study, we included all Cochrane PLSs and SAs of systematic reviews of oncology interventions available in the Cochrane Database of Systematic Reviews. We assessed text readability, measured using the Simple Measure of Gobbledygook (SMOG) index, and the prevalence of words related to different language tones (clout, authenticity, emotions and analytical tones). Two independent assessors categorized the conclusiveness of the efficacy of interventions into nine categories. Results: The overall median SMOG index for 275 PLSs was 13.0 (95% confidence interval [CI] 12.8–13.3). Readability scores did not differ across Cochrane Review Groups. SAs had a higher readability index than the corresponding PLSs (median = 16.6, 95% CI = 16.4–16.8). Regarding linguistic characteristics, PLSs were shorter than SAs, with less use of analytical tone, but more use of a positive emotional tone and authenticity. Overall, the 'Unclear' category of conclusiveness was the most common among all PLSs. Also, PLSs with 'No evidence' conclusions were the shortest and had the lowest SMOG index. Conclusion: PLSs of Cochrane systematic reviews of oncological interventions have low readability and most give unclear conclusions about the efficacy of interventions. PLSs should be simplified so that patients and their families can benefit from appropriate health information on evidence synthesis. Further research is needed into reasons for unclear language to describe evidence from oncology trials. [ABSTRACT FROM AUTHOR]

Nail findings are common in psoriasis patients with a significant impact on quality of life. For nail psoriasis and psoriasis, 28/100 and 39/100 websites were analyzed, respectively, after excluding duplicates, irrelevant content, and subscription-based sites. Readability scores for both searches were on average below the acceptable middle school reading level, and the top five scoring nail psoriasis websites scored at 9-12th-grade reading levels. [Extracted from the article]

Aim: To develop a Head Nurse Research Leadership Scale and evaluate its reliability and validity. Design: A psychometric instrument validation study was conducted in two phases. Methods: The item tool was generated based on a literature review, semi‐structured interview and brainstorming. Twenty experts validated the content of the initial version for two rounds. Thirty‐nine clinical nurses conducted the HNRLS‐v3 to test the readability of the items in pilot study I. Items were screened based on the critical ratio, correlation coefficient analysis, Cronbach's α coefficient and factor analysis using the data collected from 265 nurses in pilot study II. A cross‐sectional survey was conducted in six hospitals to evaluate the reliability and validity between 4 January 2022 and 15 January 2022. Three hundred and sixteen nurses participated in this survey, and 60 completed the questionnaire to validate the test–retest reliability between 1 February and 6 February. Results: A 15‐item Head Nurse Research Leadership Scale based on 5 dimensions was developed, and the content validity was satisfied. The 15 items accounted for 77.9% of the variance. Confirmatory factor analysis showed acceptable convergent validity and discriminant validity. The Cronbach's α coefficient, split‐half reliability and test–retest reliability of the scale were 0.966, 0.9633 and 0.927, respectively. [ABSTRACT FROM AUTHOR]

Issue addressed: This study evaluated the readability of web pages from two public‐facing Victorian government websites that were responsible for communicating key health messages relating to the COVID‐19 pandemic in 2020. Methods: Webpages were downloaded and filtered to identify relevant materials (English language materials containing HTML files that referred to COVID‐19). The files were converted to text files and two Python packages, SpaCy and TextStat were used to obtain the data presented here. In addition to running two well‐established readability tests, SMOG Index (Simple Measure of Gobbledygook) and Flesch Reading Ease formula, we also calculated the figures for sentence length and word length, which drive the readability measures and allow a disaggregated view of the data. Type token ratio measures were conducted as a reflection of the breadth of vocabulary used in the web pages. Results: Derived measures of text complexity were higher than recommended levels of text complexity for health promotion materials, which are generally set at senior primary school levels. This did not vary depending on the intended audience (public or professional). A senior secondary reading level was required for effective engagement with the text published on both sites. Conclusions: Improving the readability of materials on key government websites where information about COVID‐19 is being communicated to the public, represents a low cost and potentially effective means of improving public understanding of the pandemic and the steps individuals need to take to protect themselves and the community. So what?: Given the challenges widely identified in ensuring compliance with protective behaviours, confidence in seeking vaccination and increasing distrust of government, it would be strategic to improve public communication to ensure health messages are simple and readily understood. Summary: The complexity and readability of text contained in web pages during 2020 from two Victorian government departments were evaluated. Communication regarding the restrictions and the management of risks associated with COVID‐19 was the main focus of these 367 individual web pages from the Department of Health and Human Services (DHHS) and the Department of Education and Training (DET). Results indicated that across both sites and on both readability measures used, an education level equivalent to senior secondary school would be required to readily understand the contents. [ABSTRACT FROM AUTHOR]

Nursing and nurses rely upon qualitative research to understand the intricacies of the human condition. Acknowledging the subjective nature of reality and commonly founded in a constructivist epistemology, qualitative approaches offer opportunities for uncovering insights from the perspective of the individual participants, the insider's view, and the construction of representations that maintain an intimacy with the subject's realities. Debate continues, however, about what is needed for a qualitative construction to be considered an authentic understanding of a subject's realities. Authenticity in the context of qualitative research has been described as entailing consideration of a number of well‐trodden dimensions: fairness, ontological, educative, catalytic and tactical. Taking these dimensional requirements as key, this paper argues that authenticity may not always be as well‐developed through some of the standard practices in qualitative research as perhaps expected. In particular, qualitative understandings of authenticity stress that participants should not be merely reported on but instead should be dynamically involved in and changed by the constructions and interpretations of data developed throughout the research process. As this paper illustrates, such engagements appear problematic for qualitative research approaches that are beholden to designative commitments in the context of language and meaning‐making and which tend to prioritise commonality and generality at the expense of individual authenticity. An alternative qualitative approach, Hermeneutic Constructivism, is proposed as better able to achieve the requirements of the dimensions of authenticity. As outlined, this approach is well‐placed to present an understanding of human experience through a genuinely expressivist approach and transcends the stress upon the common or the general that can be pervasive and problematic. [ABSTRACT FROM AUTHOR]

Background: Patient education information material (PEIM) is an essential component of patient education programs in increasing patients' ability to cope with their diseases. Therefore, it is essential to consider the criteria that will be used to prepare and evaluate these resources. Objective: This paper aims to identify these criteria and recognize the tools or methods used to evaluate them. Methods: National and international databases and indexing banks, including PubMed, Scopus, Web of Science, ProQuest, the Cochrane Library, Magiran, SID and ISC, were searched for this review. Original or review articles, theses, short surveys, and conference papers published between January 1990 and June 2022 were included. Results: Overall, 4688 documents were retrieved, of which 298 documents met the inclusion criteria. The criteria were grouped into 24 overarching criteria. The most frequently used criteria were readability, quality, suitability, comprehensibility and understandability. Conclusion: This review has provided empirical evidence to identify criteria, tools, techniques or methods for developing or evaluating a PEIM. The authors suggest that developing a comprehensive tool based on these findings is critical for evaluating the overall efficiency of PEIM using effective criteria. [ABSTRACT FROM AUTHOR]

Introduction: The informed consent process is key to safeguarding the autonomy of the participant in medical research. For this process to be valid, the information presented to the potential participant should meet their needs and be understood by them. The i‐CONSENT project has developed 'Guidelines for adapting the informed consent process in clinical trials' which aim to improve informed consent so that they are easier to understand and better adapted to the needs and preferences of the target population. The best way to tailor information to the characteristics and preferences of the target population is to involve the community itself. Methods: Following guidelines developed by i‐CONSENT, assent materials were co‐created for a mock clinical trial of the human papillomavirus vaccine in adolescents. During the process, two design thinking sessions were conducted involving a total of 10 children and 5 parents. The objectives of the sessions were to find out the children's opinion of the informed consent (assent in their case) process in clinical trials, identify the parts that were most difficult to understand and alternatives for their presentation and wording, identify the preferred formats for receiving the information and the main characteristics of these formats, design a video explaining the clinical trial and evaluate a tool for assessing comprehension. Results: Assent materials were co‐created in three formats: a web‐based material following a layered approach; a video in story format; a pdf document with an innovative way of presenting information compared to traditional assent documents. In addition, the Comprehension of Assent Questionnaire was co‐designed, based on the Quality of Informed Consent questionnaire. Conclusion: The design thinking methodology has proven to be an easy and useful tool for involving children in designing information tailored to their needs and preferences. Patient or Public Contribution: A sample of the target population participated in the design and piloting of the materials created using design thinking methodology. In addition, patient representatives participated in the design and evaluation of the guidelines developed by the i‐CONSENT project that were followed for the development of the materials in this study. [ABSTRACT FROM AUTHOR]

Knowing what information a user wants is a paramount challenge to information science and technology. Implicit feedback is key to solving this challenge, as it allows information systems to learn about a user's needs and preferences. The available feedback, however, tends to be limited and its interpretation shows to be difficult. To tackle this challenge, we present a user study that explores whether tracking the eyes can unpack part of the complexity inherent to relevance and relevance decisions. The eye behavior of 30 participants reading 18 news articles was compared with their subjectively appraised comprehensibility and interest at a discourse level. Using linear regression models, the eye‐tracking signal explained 49.93% (comprehensibility) and 30.41% (interest) of variance (p <.001). We conclude that eye behavior provides implicit feedback beyond accuracy that enables new forms of adaptation and interaction support for personalized information systems. [ABSTRACT FROM AUTHOR]

Aim: The aim of the paper is to compare the quality of nursing documentation in the Children's Hospital before and after the NANDA‐I nursing diagnoses training. Methods: Research employed the interventional study design, and pre–post study design. Before and after the NANDA‐I nursing diagnoses training, 50 nursing records were analyzed in the interventional pre–post study, using D‐Catch instrument. Results: The most often documented problem‐centered nursing diagnosis before training was anxiety and after the training, hyperthermia. The most common risk diagnoses before and after the training was risk of infection. Before the training, one health promotion diagnosis was determined in the nursing records, and after the training the number increased to four. The highest value was given to readability of the nursing documentation both before and after the training. The lowest score before the training was given to the quality determiners of the accurate nursing diagnoses and after the training given to the determiners of the results' quantity. The sum score of documenting the nursing interventions was the most inconsistent before the training and after the training. The most consistent was the readability of the nursing records before and after the training. Statistically significant differences in the improvement of quality were revealed in all areas except for the readability of the nursing documentation and the quantity of nursing assessment. Conclusions: The results of the study revealed that following the training, the quality of nursing documentation improved, the wording of the nursing diagnoses improved, and the number of accurate nursing diagnoses had increased. Implications for Nursing Practice: Results of the research provide an overview of the importance of the training in improving the quality of nursing documentation and aid the educators in planning the trainings, focusing more on the challenges in the documentation. [ABSTRACT FROM AUTHOR]

Patients are becoming increasingly reliant on online platforms for obtaining health information. Previous research has shown that the quality of information available on the internet regarding novel medical therapies is generally poor and frequently misleading. Shock wave therapy represents a novel restorative therapy for erectile dysfunction (ED) that has recently gained attention. We hypothesised that online sources regarding shock wave therapy for ED would be fraught with misleading claims and unreliable health information. Our objective was to evaluate the quality and readability of online medical information on shock wave therapy as a treatment for ED. Websites were generated using a Google search of 'shock wave therapy for erectile dysfunction' with location filters disabled. Readability was analysed using the Readable software (Readable.com, Horsham, United Kingdom). Quality was assessed independently by three reviewers using the DISCERN tool. Articles were subdivided into those from private clinic websites and those from universities or news media websites. Statistical analysis was conducted using the Student's t test. Nine articles that resulted from the Google search had mean readability scores as follows: Flesch–Kincaid grade level (10.8), Gunning–Fog Index (13.67), Coleman–Liau Index (12.74), Simple Measure of Gobbledygook (SMOG) Index (13.33), FORCAST Grade Level (11.33), and Automated Readability Index (11.08). The mean Flesch Reading Ease score was 46.4. The articles had a mean DISCERN score of 3.1, suggesting 'moderate quality' content. Articles from universities (n = 2) or news sources (n = 3) had significantly higher DISCERN scores than articles from private medical practices (n = 4). There was no difference in readability scores between the groups. Articles from private clinics are just as readable as those from universities or news media, but they are significantly more biased and misleading. The current online material relating to shock wave therapy for ED may not adequately inform patients in their medical decisions making, thereby necessitating closer collaboration between the sources disseminating information and urologists. [ABSTRACT FROM AUTHOR]

There is vigorous debate as to whether influential social media platforms like Twitter and Facebook should censor objectionable posts by prominent individuals in the United States and elsewhere. A tentative middle ground is employing content moderation to signal to social media audiences that certain posts may contain objectionable information through the mechanism of flagging. Existing studies have mainly examined the effect of flagging regular users' content. To add to this emerging literature stream, we examine the effect of flagging when the underlying content is produced by a prominent individual. Leveraging Twitter's moderation activities on former U.S. President Donald Trump's tweets as our empirical setting, we employ three machine learning algorithms to estimate the effect of flagging Trump's tweets. We explore preliminary evidence as to whether these posts were retweeted less or more than expected. Our results indicate that the flagged tweets were retweeted at higher rates than expected. Our findings suggest that flagging content of prominent individuals on social media might be ineffective or even counterproductive in curbing the spread of content deemed objectionable by social media companies. [ABSTRACT FROM AUTHOR]

Background: Developmental language disorder (DLD) has clear functional ramifications in the areas of social competency, emotion recognition, emotional well‐being and literacy skill, which have been found to persist from childhood to adolescence. These domains are important factors during the transition from primary to secondary school in typical development (TD). Nevertheless, there is a paucity of research on the transition from primary to secondary school for adolescents with DLD and low language (LL) ability. Aims: To investigate the association between psychosocial domains, literacy skill and concerns about school during the transition to secondary school for adolescents with DLD, LL and their TD peers. The first research question examined whether levels of social competency, emotion recognition, emotional well‐being and literacy skill predicted school concern for the three groups. The second research question explored the longitudinal relationship between school concern and psychosocial and literacy indicators over the transition. Methods & Procedures: Participants (aged 10–11 years) with DLD (n = 30), LL ((n = 29) and TD (n = 42) were recruited for this longitudinal study from eight UK primary schools. Standardized language and psychosocial assessments were administered in the spring and summer terms of the final year of primary school, and the autumn and summer terms of the first year in secondary school. Outcomes & Results: Regression analyses showed pre‐transition school concern to be predicted by emotion recognition for the DLD group, by social competence and emotional well‐being for the LL group, and by social competence for the TD group. Post‐transition concern was predicted by emotional well‐being for the LL group; with no significant predictors for the DLD/TD groups. Path analyses revealed an association between literacy skill and emotion recognition for the DLD group. A developmental cascade illustrated a relationship between social competence and emotional well‐being for the TD group. Conclusions & Implications: This study concludes that transition interventions must be differentiated according to language ability; support for DLD adolescents should focus on emotion recognition skill, provision for LL adolescents should centre on emotional well‐being, and TD participants should be particularly supported in the domain of social competence in advance of the move to secondary school. Additionally, this study emphasizes the importance of the inclusion of a LL group, as their outcomes cannot be predicted using DLD/TD research. WHAT THIS PAPER ADDS: What is already known on the subject: There is limited research exploring the transition from primary school to secondary for adolescents with DLD or LL ability. Research on TD has highlighted vulnerable domains at this time. As these key areas are evidenced spheres of difficulty in DLD and LL, there was a strong impetus for this study. What this paper adds to existing knowledge: This study reveals differences between language ability groups in the predictors of school concern both pre‐ and post‐transition. Concerns of adolescents with DLD were predicted by emotion recognition, those of adolescents with LL were predicted by emotional well‐being, and a longitudinal link between social competence and emotional well‐being was evidenced for TD adolescents. What are the potential or actual clinical implications of this work?: This study has implications for researchers and clinicians, as a need has been identified for a new clinical group. It also has practical implications for transition support planning for educational practitioners, families and adolescents. [ABSTRACT FROM AUTHOR]

Background: Data regarding the quality of online information regarding alveolar osteitis (AO) are lacking. Objective: To assess the quality of online information regarding AO. Materials and Methods: Two search terms ("alveolar osteitis" and "dry socket") were entered separately into three search engines. A qualitative assessment of the websites that satisfied inclusion/exclusion criteria was carried out using the QUality Evaluation Scoring Tool (QUEST), the Journal of the American Medical Association (JAMA) benchmarks, and via the presence of the Health on the Net (HON)code seal. Website readability was evaluated using the Simple Measure of Gobbledygook (SMOG) and Flesch Reading Ease Score tools. Statistical analyses were performed by GraphPad Software® (GraphPad Software Inc., La Jolla, CA, U.S.). Results: Most of the 31 assessed websites were from the United States (41.93%). The mean QUEST score was 14.10 out of a maximum 28 (SD = 4.63; 95% CI: 11.80–16.39). Eight (25.8%) websites scored three or all four JAMA benchmarks and four (12.9%) scored zero. Five (16.12%) displayed the HONcode seal. Higher QUEST scores were recorded for websites that satisfied at least three out of JAMA criteria (p < 0.01; 95% CI: −13.13 to −5.215) and for websites that contained the HONcode seal (p < 0.01; 95% CI: −15.000 to −5.00) compared to those that did not. The mean SMOG readability score was 8.95 (SD: 8.68; 95% CI: 8.46–9.43). Conclusions: The online information regarding AO varies considerably. The readability scores exceed the recommended levels for written health information. The dental profession should consider the development of online resources that address the highlighted shortcomings. [ABSTRACT FROM AUTHOR]

Background: The role of patient educational materials for paediatric patients is increasing. A reading grade level of eighth‐grade (USA) or year nine (Australia and New Zealand) is recommended as acceptable. The aim of this paper was to assess the reading grade levels of paediatric online patient educational materials, within Australasia. Methods: The online Google® search engine was used with a variety of keyword combinations, filtered to the location of Australia and New Zealand. Suitable websites were explored for webpages related to slipped upper femoral epiphysis, septic arthritis, osteomyelitis, talipes equinovarus and developmental dysplasia of the hip. Readability was assessed using the online readability software WEB FX®. Results: Seventy‐six patient educational webpages were analysed: 66 from Australia and 10 from New Zealand. Only eight of the 76 webpages (10.5%) had reading grade levels below the recommended eighth‐grade (US)/year nine (AUS/NZ) level. Webpages from private healthcare providers and pages related to septic arthritis had the significantly highest reading grades. Conclusions: Australasian families have limited online patient educational materials available to them, which are mostly set at reading grade levels above recommended standards. Healthcare providers should be incentivized to improve the readability of their patient educational materials to reduce health disparities and improve health literacy moving forward. [ABSTRACT FROM AUTHOR]

Background: The Internet provides individuals with intellectual disability with access to information and participation in a broader society, but it also presents risks when content is difficult to comprehend. This study aimed to test whether students with intellectual disability enhanced their comprehension of online blogs as a function of the format (text vs. video) and linguistic simplification. Method: Young students with intellectual disability read or watched text and video‐blog posts about environment, health, society, and technology in their original version or a linguistically simplified/easy‐to‐read version. Then, they completed tests that assessed their reading processing (e.g., calibration) and comprehension of blog content. Results: Participants predicted that they would correctly answer 80% of the comprehension questions, but their average comprehension of the blog posts was 55%, regardless of the condition. Previous levels of students' reading comprehension skills predicted their blog comprehension scores and interacted with format and simplification. Those participants with higher reading comprehension skills learned more from non‐simplified than from simplified blog posts while those with lower levels of reading comprehension skills did not benefit from linguistic simplification nor video‐blog format although the difference with regard to higher comprehenders was lower in the video and simplified conditions. Conclusions: Improving reading comprehension abilities of students with intellectual disability is essential to prevent the digital divide while linguistic simplification is not a useful accommodation and even counterproductive for higher reading comprehenders. [ABSTRACT FROM AUTHOR]

Objective: The Patient Information Leaflet (PIL) is an authoritative document that all people with epilepsy in the EU receive when prescribed antiseizure medication (ASM). We undertook the first independent, comprehensive assessment to determine how understandable they are. Regulators state that when patients are asked comprehension questions about them, ≥80% should answer correctly. Also, recommended is that PILs have a maximum reading requirement of US grade 8. Methods: Study 1: We obtained 140 current ASM PILs written in English. "Readability" was assessed using four tests, with and without adjustment for influence of familiar, polysyllabic words. A total of 179 online materials on epilepsy were also assessed. Study 2: Two PILs from Study 1 were randomly selected (Pregabalin Focus; Inovelon) and shown to 35 people from the UK epilepsy population. Their comprehension was assessed. Study 3: To understand whether the student population provides an accessible alternative population for future examination of ASM PILs, Study 3 was completed, using the same methods as Study 2, except that participants were 262 UK university students. Results: Study 1: No PIL had a reading level of grade 8. Median was grade 11. Adjusting for context, the PILs were still at grade 10.5. PILs for branded ASMs were most readable. PILs were no more readable than (unregulated) online materials. Study 2: Users struggled to comprehend the PILs' key messages. The eight questions asked about pregabalin were typically answered correctly by 54%. For Inovelon, it was 62%. Study 3: Most student participants comprehended the PILs' key messages. The questions about Inovelon were answered correctly by 90%; for pregabalin it was 86%. Significance: This is the first independent and comprehensive examination of ASM PILs. It found that PILs being used fail to meet recommendations and regulatory requirements and risk not being understandable to a substantial proportion of users. In finding that people from the epilepsy population differ markedly in comprehension of PILs compared to students, this study highlights the importance of completing user testing with the target population. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was (1) to evaluate the adequacy of informed consent documentation in the trauma setting for distal radius fracture surgery compared with the elective setting for total knee arthroplasty (TKA) at a large public hospital and (2) to explore the relevant guidelines in New Zealand relating to consent documentation. Methods: Consecutive adult patients (≥16 years) undergoing operations for distal radius fractures and elective TKA over a 12‐month period in a single‐centre were retrospectively identified. All medical records were reviewed for the risks and complications recorded. The consent form was analysed using the Flesch Reading Ease Score (FRES) and the Simple Measure of Gobbledygook (SMOG) index readability scores. Results: A total of 133 patients undergoing 134 operations for 135 distal radius fractures and 239 patients undergoing 247 TKA were included. Specific risks of surgery were recorded significantly less frequently for distal radius fractures than TKA (43.3% versus 78.5%, P < 0.001). Significantly fewer risks were recorded in the trauma setting compared to the elective (2.35 ± 2.98 versus 4.95 ± 3.33, P < 0.001). The readability of the consent form was 40.5 using the FRES and 10.9 using the SMOG index, indicating a university undergraduate level of reading. Conclusions: This study has shown poor compliance in documenting risks of surgery during the informed consent process in an acute trauma setting compared to elective arthroplasty. Institutions must prioritize improving documentation of informed consent for orthopaedic trauma patients to ensure a patient‐centred approach to healthcare. [ABSTRACT FROM AUTHOR]

Fiction reading is a popular leisure activity associated with a variety of pleasurable experiences, including suspense, narrative transportation, and—as indicated by recent empirical studies—also flow. In the context of fiction reading, flow—generally defined as a pleasurable state of mind experienced during an optimally stimulating activity—is specifically related to an optimal balance between text‐driven challenges and the reader's capabilities in constructing a mental story model. The experimental study reported here focused on the psychophysiological underpinnings of flow in the reading context. Cardiovascular data were collected from 84 participants both during a relaxation baseline prior to reading and during reading. Participants were randomly assigned to read one of three versions of a chapter from Homer's Odyssey. According to statistical readability indices, these versions were low, intermediate, or high in readability, and hence in cognitive challenge. Flow was measured immediately after reading with a self‐report scale that was tailored to assess reading‐specific flow experiences. Regression analyses revealed that cardiovascular activation patterns measured before reading that are reflective of parasympathetic dominance—that is, an inner state associated with relaxation and cognitive fluency—moderated flow experiences during reading. In line with the stipulations of flow theory in regard to matching challenge levels being the key determinant for flow, this pattern supported subsequent flow experiences only in response to text versions of high or intermediate, but not of low cognitive challenge. Differences in cardiac vagal tone during reading were, however, not sensitive to our experimental modifications and not predictive of flow experiences. [ABSTRACT FROM AUTHOR]

Mental health services need reliable and valid instruments to measure mental health recovery outcomes, and the only available one in Spanish is arduous. Adapting an instrument is more efficient than creating a new one as it enables international comparison research. The aim of this study was to conduct a cross‐cultural adaptation of the 15‐item Questionnaire about the Process of Recovery. Fifty‐four participants engaged in a five‐stage systematic and standardized process carried out from November 2019 to November 2020. Professional translators (n = 4) from the Translation Service Center for Foreign Languages of the Universidad de Alcalá participated in the direct translation, synthesis and back translation stages, and mental health professionals (n = 33) and service users (n = 17) from the Hospital Regional Universitario de Málaga and the Hospital Universitario Virgen de la Victoria in Andalucía (Spain), with an average of 19.2 (SD 12.86) years of experience in mental health, participated in the committee of experts and pilot debriefing stages. Additionally, legibility was assessed. Out of the 15‐items of the questionnaire, three (20%) were equal amongst translations, three items (20%) of the back translations matched the original questionnaire and discrepancies identified were adapted accordingly. Seven items (46.7%) were approved online by experts and consensus of alternative translations was reached for the rest. The average time spent completing the questionnaire by service users during the face‐to‐face pilot was 4.12 min (SD 2.25). Internal consistency obtained was ω = 0.95 and α = 0.91. Debriefing findings reported the questionnaire as comprehensible (97.1%), adequate in wording (91.2%), formal in language (55.9%) and adequate in terms of length (100%). The questionnaire scored 65.53, 'normal' readability, on the Inflesz scale. The adapted instrument has conceptual, linguistic, cultural and metric equivalence to the original instrument. [ABSTRACT FROM AUTHOR]

Although core in the teaching of academic language skills, little research to date has investigated what makes video‐recorded lectures difficult for language learners. As part of a larger program to develop automated videotext complexity measures, this study reports on selected dimensions of linguistic complexity to understand how they contribute to overall videotext difficulty. Based on the ratings of English language learners of 320 video lectures, we built regression models to predict subjective estimates of video lecture difficulty. The results of our analysis demonstrate that a 4‐component partial least square regression model explains 52% of the variance in video difficulty and significantly outperformed a baseline model in predicting the difficulty of videos in an out‐of‐sample testing set. The results of our study point to the use of linguistic complexity features for predicting overall videotext difficulty and raise the possibility of developing automated systems for measuring video difficulty, akin to those already available for estimating the readability of written materials. [ABSTRACT FROM AUTHOR]

This study examined how mode of input affects the learning of pronunciation and form–meaning connection of second language (L2) words. Seventy‐five Japanese learners of English were randomly assigned to 1 of 3 conditions (reading while listening, reading only, listening only), studied 40 low‐frequency words while viewing their corresponding pictures, and completed a picture‐naming test 3 times (before, immediately, and about 6 days after treatment). The elicited speech samples were assessed for form–meaning connection (spoken form recall) and pronunciation accuracy (accentedness, comprehensibility). Results showed that the reading‐while‐listening group recalled a significantly greater number of spoken word forms than did the listening‐only group. Learners in the reading‐while‐listening and listening‐only modes were judged to be less accented and more comprehensible compared to learners in the reading‐only mode. However, only learners receiving spoken input without orthographic support retained more target‐like (less accented) pronunciation compared to learners receiving only written input. Furthermore, sound–spelling consistency of words significantly moderated the degree to which different learning modes impacted pronunciation learning. Taken together, the findings suggest that simultaneous presentation of written and spoken forms is optimal for the development of form–meaning connection and comprehensibility of novel words but that provision of only spoken input may be beneficial for the attainment of target‐like accent. [ABSTRACT FROM AUTHOR]