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Background Delirium has conventionally been considered a disorder of consciousness. Alertness and arousal are used as surrogates in clinical practice but are insufficient for the purposes of a more dimensional assessment of consciousness. We present a process of development and validation of candidate measures of phenomenal consciousness that could be applied to the diagnosis of delirium. Methods First, a narrative review of available instruments in the fields of phenomenal consciousness, including prereflective consciousness, the phenomenal-sensed experience and reflective thought, was undertaken. Eligibility of tools in the context of applicability to delirium was based upon objectivity in test interpretation and the requirement for tester administration. Second, where there was a gap in suitable cognitive tools, new items were derived using the silent generation technique. A process of face and construct validity using a diverse panel of experts was performed, and readability was evaluated. Results 814 articles were screened from the literature review. Fourteen candidate tools were reported from the three domains of phenomenal consciousness. One of these met the eligibility criteria for a delirium assessment. Fifty-seven new tests of phenomenal consciousness were identified. After a process of item reduction, a total of 26 individual tests were identified. After content validity, 22 of the 26 items were retained. The scale average content validity index was 0.89. The agreement between raters was between 80% and 97%. 100% of responses for face validity were rated as positive. Flesch Reading Ease Score was 91.6 (very easy to read). Conclusions Candidate measures of phenomenal consciousness are described, and early validity studies are promising. [ABSTRACT FROM AUTHOR]

People from culturally and linguistically diverse (CaLD) backgrounds in Australia generally experience poorer health outcomes, explained in part by low levels of health literacy. We conducted a systematic review to examine the development and evaluation of health education resources designed for CaLD populations. Five electronic databases were searched for English language, peer-reviewed studies published between 1980 and 2020. Thirty-four studies met the inclusion criteria. Twenty-four different health education resources were described and broadly categorized into four types: media campaigns (n  = 10), text-based materials (n  = 5), films (n  = 8) and radio (n  = 1). Studies were assessed against domains adapted from a health literacy guideline incorporating: need, collaboration, audience, health literacy, theory, test and process and impact evaluation. All but one study met the majority of the domains. All studies reported positive evaluation outcomes; this may be due to studies involving community early in resource design and including health literacy considerations in their design. Reporting resource design and evaluation against standard practice controls is recommended to build a more robust evidence base for developing effective health education resources for use by audiences from CaLD backgrounds. [ABSTRACT FROM AUTHOR]

Background: Social media is a popular source of information about food and nutrition. There is a high degree of inaccurate and poor-quality nutrition-related information present online. The aim of this study was to evaluate the quality and accuracy of nutrition-related information posted by popular Australian Instagram accounts and examine trends in quality and accuracy based on author, topic, post engagement, account verification and number of followers. Methods: A sample of posts by Australian Instagram accounts with ≥ 100,000 followers who primarily posted about nutrition was collected between September 2020 and September 2021. Posts containing nutrition-related information were evaluated to determine the quality and accuracy of the information. Quality was assessed using the Principles for Health-Related Information on Social Media tool and accuracy was assessed against information contained in the Australian Dietary Guidelines, Practice-based Evidence in Nutrition database, Nutrient Reference Values and Metafact. Results: A total of 676 posts were evaluated for quality and 510 posts for accuracy, originating from 47 Instagram accounts. Overall, 34.8% of posts were classified as being of poor quality, 59.2% mediocre, 6.1% good and no posts were of excellent quality. A total of 44.7% of posts contained inaccuracies. Posts authored by nutritionists or dietitians were associated with higher quality scores (β, 17.8, CI 13.94–21.65; P < 0.001) and higher accuracy scores (OR 4.69, CI 1.81–12.14, P = 0.001) compared to brands and other accounts. Information about supplements was of lower accuracy (OR 0.23, CI 0.10–0.51, P < 0.001) compared to information about weight loss and other nutrition topics. Engagement tended to be higher for posts of lower quality (β -0.59, P = 0.012), as did engagement rate (β -0.57, P = 0.016). There was no relationship between followers or account verification and information quality or accuracy and no relationship between engagement and accuracy. Conclusions: Nutrition-related information published by influential Australian Instagram accounts is often inaccurate and of suboptimal quality. Information about supplements and posts by brand accounts is of the lowest quality and accuracy and information posted by nutritionists and dietitians is of a higher standard. Instagram users are at risk of being misinformed when engaging with Australian Instagram content for information about nutrition. [ABSTRACT FROM AUTHOR]

Transitions of patient care between hospital discharge and primary care are known to be an area of high-risk where communication is imperative for patient safety. Discharge summaries are known to often be incomplete, delayed and unhelpful for community healthcare providers. The aim of this review was to identify and map the literature which discusses Australian general practitioners' (GPs) views on the qualities that make up effective discharge communication. Medline, Scopus and the Cochrane register of controlled drug trails and systematic reviews were searched for publications until October 2021 that discussed Australian GPs' views on discharge communication from hospital to general practice. Of 1696 articles identified, 18 met inclusion and critical appraisal criteria. Five studies identified that GPs view timeliness of discharge summary receipt to be a problem. Communication of medication information in the discharge summary was discussed in six studies, with two reporting that GPs view reasons for medication changes to be essential. Five studies noted GPs would prefer to receive clinical discipline or diagnosis specific information. Four studies identified that GPs viewed the format and readability of discharge summaries to be problematic, with difficulties finding salient information. The findings of this scoping review indicate that GPs view timeliness, completeness, readability, medication related information and diagnosis/clinical discipline specific information to be qualities that make up effective discharge communication from hospital to the community. There are opportunities for further research in perspectives of effective discharge communication, and future studies on interventions to improve discharge communication, patient safety and policy in transfers of care. The aim of this scoping review was to identify and map the literature which discusses specifically Australian general practitioners' (GPs) views on the qualities that make up effective discharge communication from hospital care back to primary care. The findings indicate that GPs view timeliness , completeness , readability , medication related information and diagnosis/clinical discipline specific information to be qualities that make up effective discharge communication from hospital to the community. There are opportunities for further research into perspectives of effective discharge communication, and future studies on interventions to improve discharge communication, patient safety and policy in transfers of care. [ABSTRACT FROM AUTHOR]

Background: People are increasingly using the Internet to retrieve health information about chronic musculoskeletal conditions, yet content can be inaccurate and of variable quality. Objective: To summarise (i) comprehensiveness, (ii) accuracy and clarity, iii) quality of information about treatment choices, (iv) credibility and (v) readability of online information about knee osteoarthritis. Method: Systematic appraisal of website content. Searches for "knee osteoarthritis" and "knee arthritis" were performed using Google and Bing (October 2020). The top 20 URLs of each search were screened for eligibility. Comprehensiveness, accuracy and clarity of content were matched against 14 pre-defined topic descriptors. DISCERN and HONcode were used to measure quality of information about treatment choices and website credibility, respectively. Flesch Reading Ease and Flesch-Kincaid Grade Level tests were used to assess readability. Results: Thirty-five websites were included. Websites were generally comprehensive (median, range = 12, 0–14/14) with descriptors available for 67% (n = 330/490) of topics across all websites, but only 35% (n = 116/330) were accurate and clear. Quality of information about treatment choices was generally low (median DISCERN score, range = 40, 16–56/80). Credibility descriptors were present for 65% (n = 181/280) of items, with 81% (n = 146/181) of descriptors being clear. Median Flesch reading ease was 53 (range = 21–74), and Flesch-Kincaid grade level was 8 (range = 5–11). Conclusion: Few websites provide accurate and clear content aligned to key research evidence. Quality of information about treatment choices was poor, with large variation in comprehensiveness, credibility and readability. Implications: Careful consideration is required by clinicians to identify what online information people with knee osteoarthritis have accessed and to address misinformed beliefs. [ABSTRACT FROM AUTHOR]

Background: Participant information sheets and consent forms (PICFs) used in interventional studies are often criticised for being hard to read and understand. We assessed the readability and its correlates of a broad range of Australian PICFs.Methods: We analysed the participant information sheet portion of 248 PICFs. Readability scores were measured using three formulae: the Flesch Reading Ease, the Flesch-Kincaid Grade Level, and the Simple Measure of Gobbledygook (SMOG). We investigated how various features (including sponsor type and PICF type) correlated with PICF length and readability and examined compliance with other measures known to improve readability.Results: For a sample of 248 PICFs, the mean (standard deviation) Flesch Reading Ease score was 49.3 (5.7) and for the Flesch-Kincaid Grade Level 11.4 (1.1). The mean (SD) SMOG score was 13.2 (0.9). The median document length was 3848 words (8 pages). Commercial PICFs were more than twice as long as non-commercial, but statistically more readable (p = 0.03) when analysed using the SMOG formula. Subgroup analyses indicated that PICFs for self-consenters were statistically more readable than those for proxy consenters. The use of tables, but not the use of illustrations was associated with better readability scores.Conclusions: The PICFs in our sample are long and complex, and only 3 of the 248 achieved the recommended readability score of grade 8 or below. The broader use of best practice principles for writing health information for consumers and the development of more context-sensitive templates could improve their utility. [ABSTRACT FROM AUTHOR]

Poor comprehenders are a significant subgroup of poor readers who, due to their ability to read aloud accurately, are often difficult to identify. This study aimed to determine whether assessment using two oral language tasks, mapped onto the two components of the Simple View of Reading, would provide an efficient approach to identification. Children (N = 218) from School Years 3 to 6 (ages 7; 8–12; 1) attending two schools in Australia were assessed, and 45 identified as potential poor comprehenders, based on a profile of average phonological awareness but poor listening comprehension. Subsequent assessment of decoding and text reading comprehension confirmed 24 of these children to be poor comprehenders, consistent with reported prevalence rates. Five of these children were judged to be weak readers by their classroom teacher. The oral tasks alone overidentified this group; however, the findings suggest that using the tasks as an initial phase, followed up with a reading assessment, could be effective in identifying poor comprehenders, and reduce time spent in testing as this would only involve at-risk children. [ABSTRACT FROM AUTHOR]

Objectives: Consent forms that are difficult to understand may jeopardize informed consent. The aim of this study was to determine whether consent documents for cardiology-related procedures could be easily read and understood by patients with low health literacy.Methods: All 37 cardiology-related consent forms with patient information material were retrieved from a publicly available suite of documents from one state in Australia. Two raters independently assessed documents and resolved discrepancies through discussion. Understandability was assessed using the Patient Education Materials Assessment Tool for Printed materials (PEMAT-P). Readability was assessed using the Gunning Fog Index, SMOG and Flesch Reading Ease formulas. Images were assessed using the 5C Image checklist. Results were analyzed descriptively.Results: Only 1 of 37 forms met the general PEMAT-P threshold (70%) for being 'understandable'. The average readability score was high, requiring a grade 10-12 level of education to understand. Most images lacked useful captions, had low visual clarity, and were not purpose-designed for the material.Conclusions: The current format for cardiology consent forms does not meet recommended standards for understandability and readability.Practice Implications: Development of consent forms would benefit from taking health literacy principles into account with patient input, and purpose-designed images should be included in all forms to reinforce text. [ABSTRACT FROM AUTHOR]

Adult cochlear implant (CI) candidates seeking to make an informed decision about cochlear implantation can find themselves needing to quickly understand large volumes of complex information provided by different professionals in different formats. This study investigates the suitability, within a health literacy context, of one of those sources of information: the CI brochure. A single-observation design. Thirty English passages of approximately 100-words each were sampled from 15 sections of seven CI brochures. All brochures were readily available to the general public on the Australian websites of four CI manufacturers at the time of the analysis (June 2019). Analyses by two examiners using the Suitability Assessment of Materials (SAM) classified all 15 sections from all seven CI brochures as being "not suitable" for general, adult readers. Analyses by the same examiners using four readability formulae (Flesch Reading Ease Scale, Fry Readability Graph, Flesch-Kincaid Readability Formula, and the Fog index) showed sampled passages from the 15 sections were written at a level best suited for persons with 10 to 14 years of schooling. Brochures intended for adult CI candidates should be revised to improve their suitability and readability for adult CI candidates. Specific recommendations are suggested. [ABSTRACT FROM AUTHOR]

Background: This study examined the health literacy demands of My Health Record (MyHR) in the context of preparing for a government-announced opt-out system by repeating two studies of health information and usability conducted in 2016. Objective: To examine whether Australia's MyHR meets the information and usability needs of people at risk of low health literacy and changes since 2016. Method: Content analysis : Informed by the 2016 methods and findings, measures of information quality, themes and target audiences were recorded and reported for each online consumer-facing health information resource. Heuristic evaluation : An evaluation of the MyHR and supporting information website was conducted using a predetermined checklist of usability criteria. A list of usability violations for both websites was identified. Results: Total number of resources grew from 80 in 2016 to 233 in 2018. There was little change since 2016 to average readability levels, target audiences, presentation style, links between resources and usability of MyHR. Compared to 2016, this study demonstrated increases in resources from non-government organisations; video resources; translated resources; and resources with themes of privacy, security and post-registration use. Conclusion: This study identified some improvements in information quality since 2016, but gaps remain in information quality and usability which may negatively impact the ability for people with low health literacy to access and use MyHR. Implications: This study provides a framework for ongoing monitoring and evaluation of the suitability of MyHR for people at risk of low health literacy. [ABSTRACT FROM AUTHOR]

Purpose: Children sometimes wait 12 months or longer to access speech-language pathology services. Information on websites may support families' active waiting for speech-language pathology; however, there are few user-friendly, evidence-based websites specifically designed for children and families for this purpose. The current study aimed to: (1) ascertain appropriate website content, format, features and functions; (2) evaluate the quality of existing speech and language sites and (3) obtain feedback on a prototype website. Method: A three-stage explanatory sequential mixed-methods design was employed. Stage 1 involved 119 participants completing an online questionnaire recommending website content, format, features and functions. Stage 2 involved evaluating the quality of 25 online sites about children's speech and language. Stage 3 involved focus groups with 16 participants to explore aspirations and feedback on a website to support active waiting. Result: Participants wanted information about typical development and services to access while waiting; strategies to stimulate children's speech and language development; simple web architecture; and high readability. High scoring sites contained evidence-based information from trustworthy sources. Strategies from the theory of preparative waiting arose in the focus groups. Conclusion: Participants considered easily identifiable, trustworthy sources of information, and user-friendly strategies and resources to be important on a website to support active waiting for speech-language pathology. The theory of preparative waiting may be a viable framework informing waiting for speech-language pathology for children with speech and language difficulties. [ABSTRACT FROM AUTHOR]

Deliberate practice is essential for acquiring a wide range of skills that have been central to humans' adaptive success, yet little is known about when and how children develop this capability. The current study examined 4- to 7-year-olds' (N = 120) ability to selectively practice a skill that would be useful in the near future, as well as their broader understanding of the role of deliberate practice in skill acquisition. Six- and 7-year-olds demonstrated both an explicit understanding of deliberate practice and the capacity to practice without being prompted. Five-year-olds showed an understanding of deliberate practice and some capacity to practice, whereas 4-year-olds showed neither of these capabilities. Findings reveal important developments in children's future-directed behavior beyond the preschool years. [ABSTRACT FROM AUTHOR]

This study investigated the accuracy and readability of Wikipedia on the subject of hearing loss. A total of 39 articles were evaluated using a modified version of the DISCERN quality rating tool and the Flesch-Kincaid Grade Level tool. Twenty percent of articles were rated as 'Good' in accuracy, 60% as 'Moderate', with the remaining 20% rated as 'Poor'. All articles, with the exception of one, scored 10 or above in readability, indicating a level of reading which is difficult to understand. A focus on improving the readability of Wikipedia for the general public is recommended to improve its effectiveness as an online health resource. [ABSTRACT FROM AUTHOR]

Background: Low health literacy, low levels of positive belief and privacy and security concerns have been identified as a significant barrier to personal electronic health record uptake and use. An important tool for overcoming these barriers is the consumer-facing information which accompanies the system. My Health Record (MyHR) is the Australian national e-health record system, for which a large suite of online resources exists to facilitate consumer registration and use. This study uses a number of different measures of health resource quality to assess the MyHR online consumer-facing information and identify any gaps or areas for improvement. Objective: To analyse the quality and content of the online consumer-facing resources which support the uptake and use of MyHR. Method: Australian information resources aimed at healthcare consumers about the MyHR were included in this study. A comprehensive search using Internet search engines was conducted to locate all online consumer-facing resources about MyHR from both government and non-government sources. Readability (measured by Flesch–Kincaid grade level), year of publication/review, publishing organisation type, presentation style, linked websites, target audience, and themes were identified as important measures of health information quality, and these were recorded and reported on for each resource. Results: Eighty resources met the inclusion criteria. The mean Flesch–Kincaid grade level was 11.8. Most resources were created by Australian government sources (n = 55), and the most common target audience was the general public (n = 65). Registration (n = 51), privacy/security (n = 49), and benefits of use (n = 46) were the most common resource themes. Conclusion: The authors identified a number of gaps and areas for improvement in the provision of consumer-facing information about MyHR. Readability is too high for the general Australian population, and there are few translated resources, which means that the information provided does not cater to people with low literacy levels, communication disability, and/or difficulties in understanding written English. The target audiences for resources do not reflect priority groups that were identified during the MyHR development processes. There are also gaps in information provision about how consumers can use MyHR as a tool to meaningfully engage with health professionals and services to support their own person-centred care. [ABSTRACT FROM AUTHOR]

Producing health information that people can easily understand is challenging and time-consuming. Existing guidance is often subjective and lacks specificity. This study outlines the development and user-testing of the Health Literacy Editor. This new automated tool helps users write health information that is easy to understand and that adheres to health literacy guidelines. Existing health literacy and plain language guidelines were collated. Items amenable to programmable automated assessment were incorporated into the Editor. The prototype was iteratively refined across four rounds of user-testing with health services staff (N=20). After each round, Yardley's (2021) optimisation criteria were applied to collate user feedback. These criteria guided which changes would be implemented. The Editor comprises six assessments: readability, complex language, passive voice, text structure, lexical density/diversity, and person-centred language. These are presented as global scores, with additional, more specific feedback flagged in the text itself. Feedback is provided in real-time such that users can iteratively revise and improve the text. Key changes from user-testing included: making the interface more intuitive, reducing the amount of information presented to first-time users, and creating varying 'levels' of support (e.g. 1-2 sentences, in-depth videos). Evaluations using the System Usability Scale and Technology Acceptance Model, showed high usability (Mean=84.25/100; SD=13.9) and perceived usefulness by health staff (M=8.62/10; SD=1.35). The Health Literacy Editor is an innovative new tool to improve the quality and safety of written health information. It provides objective, immediate feedback on a range of factors, complementing readability with other, less widely used but important objective assessments such as complex and person-centred language. User-testing with health services staff has made the Editor more intuitive and engaging. This is a scalable intervention to support the uptake of health literacy guidelines by health services and providers of health information. [ABSTRACT FROM AUTHOR]

We introduce a novel model and associated data collection method to examine how a distributed organisation of military staff who feed a Common Operating Picture (COP) generates Situation Awareness (SA), a critical component in organisational performance. The proposed empirically derived Situation Awareness Weighted Network (SAWN) model draws on two scientific models of SA, by Endsley involving perception, comprehension and projection, and by Stanton et al. positing that SA exists across a social and semantic network of people and information objects in activities connected across a set of tasks. The output of SAWN is a representation as a weighted semi-bipartite network of the interaction between people ('human nodes') and information artefacts such as documents and system displays ('product nodes'); link weights represent the Endsley levels of SA that individuals acquire from or provide to information objects and other individuals. The SAWN method is illustrated with aggregated empirical data from a case study of Australian military staff undertaking their work during two very different scenarios, during steady-state operations and in a crisis threat context. A key outcome of analysis of the weighted networks is that we are able to quantify flow of SA through an organisation as staff seek to "value-add" in the conduct of their work. [ABSTRACT FROM AUTHOR]

Objective: To assess the content and readability of online patient information resources against the current understanding of gout.Methods: An online survey was undertaken using Google UK, USA, Australia, and Canada. Information was assessed for content and accuracy on 19 key points regarding core content for gout patient information resources. Readability was assessed using the Flesch-Kincaid Reading Ease score. Fifteen randomly selected websites were reviewed by a blinded second observer.Results: A total of 85 websites were selected. More than 50% of the websites provided no information or had inaccuracies regarding the pathogenesis of gout. Most websites contained information on dietary and lifestyle modifications for treating gout and did not emphasize urate-lowering therapy (ULT) and its potential for cure. Over 75% of the websites had no/inaccurate information on the role of ULT or prophylaxis for preventing gout attacks on starting ULT. The majority of websites were difficult to read, with information in 68% of the websites rated at least fairly difficult.Conclusion: Only a few web-based patient information resources provide accurate and easy-to-read information on gout. This study will help physicians direct patients to currently reliable resources, but there is a need to improve many web-based patient information resources, which at present act as barriers to care. [ABSTRACT FROM AUTHOR]

Objective: As uptake of cervical screening continues to decline, this systematic review synthesises the qualitative literature on women's perceptions and experiences of cervical screening in the context of an organised call-recall programme, in order to understand the barriers to informed uptake.Methods: We searched nine databases for English language peer-reviewed publications reporting on qualitative data from screening-eligible women, exploring barriers to cervical screening in countries that offer a nationally organised call-recall programme. Evidence was integrated using thematic synthesis.Results: Thirty-nine papers from the UK, Australia, Sweden and Korea were included. The majority of participants had attended screening at least once. Two broad themes were identified: (a) should I go for screening? and (b) screening is a big deal. In considering whether to attend, women discussed the personal relevance and value of screening. Women who had previously attended described how it was a big deal, physically and emotionally, and the varied threats that screening presents. Practical barriers affected whether women translated screening intentions into action.Conclusions: The variation in women's understanding and perceptions of cervical screening suggests that interventions tailored to decisional stage may be of value in increasing engagement with the invitation and uptake of screening in those who wish to take part. There is also a need for further research with women who have never attended screening, especially those who remain unaware or unengaged, as their perspectives are lacking in the existing literature. © 2016 The Authors. Psycho-Oncology Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

Purpose: This study developed standardized vignettes that depict a mild traumatic brain injury (TBI) from one of several causes and subjected them to formal expert review. Method: A base vignette was developed using the World Health Organization operational criteria for mild TBI. Eight specific causes (e.g. sport vs assault) were examined. A convenience sample of mild TBI experts with a discipline background of Neuropsychology from North America, Australasia and Europe (n= 21) used an online survey to evaluate the vignettes and rated the role of cause on outcome. Results: The vignette suite was rated as fitting the mild TBI WHO operational diagnostic criteria at least moderately well. When compared to other factors, cause was not rated as significantly contributing to outcome. When evaluated in isolation, approximately half of the sample rated cause as important or very important and at least two of three clinical outcomes were associated with a different cause. Discussion: The vignettes may be useful in experimental mild TBI research. They enable the injury parameters to be controlled so that the effects of cause can be isolated and examined empirically. Such studies should advance understanding of the role of this factor in mild TBI outcome. [ABSTRACT FROM PUBLISHER]

There is limited evidence for cognitive-communication reading comprehension (CCRC) interventions for adults following acquired brain injury (ABI), particularly during sub-acute rehabilitation. The purpose of this study was to investigate the clinical practice of speech-language pathologists (SLPs) with CCRC deficits during sub-acute ABI rehabilitation and compare it to the best available evidence. An electronic survey was used to gather information from clinicians across Australia regarding clinical practice in the areas of assessment, intervention, treatment hierarchies and service delivery; survey questions were developed from an extensive review of the literature and expert clinician opinion. Survey findings were then compared with the literature in the form of a systematic review. Surveyed clinicians provided multiple interventions for CCRC rehabilitation, including impairment based (94.7%), activity based (94.7%) and reading strategy interventions (100.0%). Five strategies were used by >94% of SLPs (highlighting, identifying main points/wh- questioning, re-reading, summarising, reducing visual load). When compared with the literature, strong similarities were found for strategy-based interventions and individual service delivery, with broad similarities for functional and impairment-based interventions, and impairment based treatment hierarchies. Strong differences in assessment were identified. Strategy use reported in clinical practice (100.0% SLPs) was higher than in the literature. Further investigation into the effectiveness of specific reading strategies for people with ABI is warranted. [ABSTRACT FROM AUTHOR]

Introduction: Sharing of health data for secondary uses such as research and public policy development is common. There are many potential benefits, but also risks if information about an individual's health record can be inferred. Studies show cautious willingness amongst the public to share health data for beneficial purposes, as long as they are confident in their data privacy and security. There has been relatively little research into whether the technical guarantees of privacy-preserving technologies are well understood by people asked to consent to sharing their data.Objectives: We sought to assess how accurately people understood the effectiveness of techniques for protecting the privacy of shared health data.Methods: We designed an online survey describing a data-sharing scenario motivated by medical research where data could be shared: raw (including identifiers), de-identified (using k-anonymity), aggregated, and differential privacy applied to aggregated data. Respondents were asked about willingness to share their data, and how likely it was that they could be identified. They were also asked for the meaning of 'de-identified' and whether they would agree to sharing information for 'not solely commercial' purposes, thus mirroring the consent language used by Australia's My Health Record system.Results: Our findings revealed substantial tolerance for researcher use of health data with consistent preference to share data when better privacy-preserving techniques were employed. This was not entirely consistent as slight preference was shown for aggregated data over differential privacy, despite differential privacy being objectively more secure. We conjecture this was because differential privacy and its benefits were not well understood. Similarly, respondents showed no consistent understanding of the term 'de-identified', indicating that this needs to be carefully defined in contexts that seek consent. Finally, many respondents who indicated a willingness to share for purposes that were 'not solely commercial' nevertheless rejected at least some specific scenarios that mixed research and commercial objectives, again indicating a possible gap in their understanding of the terms.Conclusions: We found overall preference for better privacy protection of data as a precondition for secondary use, but limitations in respondents' understanding of key terminology and the differing privacy guarantees of available techniques. Further effort is needed to word secondary data use consent policies to ensure public understanding of commonly used terms and methods, if genuinely informed consent for data sharing is to be gained. [ABSTRACT FROM AUTHOR]

Background: As of 2021, 89% of the Australian population are active internet users. Although the internet is widely used, there are concerns about the quality, accuracy, and credibility of health-related websites. A 2015 systematic assessment of infant feeding websites and apps available in Australia found that 61% of websites were of poor quality and readability, with minimal coverage of infant feeding topics and lack of author credibility.Objective: We aimed to systematically assess the quality, interactivity, readability, and comprehensibility of information targeting infant health behaviors on websites globally and provide an update of the 2015 systematic assessment.Methods: Keywords related to infant milk feeding behaviors, solid feeding behaviors, active play, screen time, and sleep were used to identify websites targeting infant health behaviors on the Google search engine on Safari. The websites were assessed by a subset of the authors using predetermined criteria between July 2021 and February 2022 and assessed for information content based on the Australian Infant Feeding Guidelines and National Physical Activity Recommendations. The Suitability Assessment of Materials, Quality Component Scoring System, the Health-Related Website Evaluation Form, and the adherence to the Health on the Net code were used to evaluate the suitability and quality of information. Readability was assessed using 3 web-based readability tools.Results: Of the 450 websites screened, 66 were included based on the selection criteria and evaluated. Overall, the quality of websites was mostly adequate. Media-related sources, nongovernmental organizations, hospitals, and privately owned websites had the highest median quality scores, whereas university websites received the lowest median score (35%). The information covered within the websites was predominantly poor: 91% (60/66) of the websites received an overall score of ≤74% (mean 53%, SD 18%). The suitability of health information was mostly rated adequate for literacy demand, layout, and learning and motivation of readers. The median readability score for the websites was grade 8.5, which is higher than the government recommendations (Conclusions: Quality, content, readability, and interactivity of websites promoting health behaviors during infancy ranged between poor and adequate. Since the 2015 systematic assessment, there was a slight improvement in the quality of websites but no difference in the Suitability Assessment of Materials rating and readability of information. There is a need for researchers and health care providers to leverage innovative web-based platforms to provide culturally competent evidence-based information based on government guidelines that are accessible to those with limited English proficiency. [ABSTRACT FROM AUTHOR]

In this study, we assessed the quality of publicly available cancer-related physical activity ( PA) information appearing on reputable sites from Canada and other English-speaking countries. A cross-sectional Internet search was conducted on select countries (Canada, USA, Australia, New Zealand, UK) using Google to generate top 50 results per country for the keywords ''physical activity' AND 'cancer''. Top results were assessed for quality of PA information based on a coding frame. Additional searches were performed for Canadian-based sites to produce an exhaustive list. Results found that many sites offered cancer-related PA information (94.5%), but rarely defined PA (25.2%). Top 50 results from each country did not differ on any indicator examined. The exhaustive list of Canadian sites found that many sites gave information about PA for survivorship (78.3%) and prevention (70.0%), but rarely defined (6.7%) or referenced PA guidelines (28.3%). Cancer-related PA information is plentiful on the Internet but the quality needs improvement. Sites should do more than mention PA; they should provide definitions, examples and guidelines. With improvements, these websites would enable healthcare providers to effectively educate their patients about PA, and serve as a valuable resource to the general public who may be seeking cancer-related PA information. [ABSTRACT FROM AUTHOR]

This study sought to investigate the level of knowledge of language constructs in a cohort of Australian teachers and to examine their self-rated ability and confidence in that knowledge. Seventy-eight teachers from schools across the Australian state of Victoria completed a questionnaire which included items from existing measures, as well as newly developed items. Consistent with a number of earlier Australian and international studies, teachers' explicit and implicit knowledge of basic linguistic constructs was limited and highly variable. A statistically significant correlation was found between (1) total self-rated ability and (2) years since qualification and experience teaching the early years of primary school; however, no relationship was found between self-rated ability and overall performance on knowledge items. Self-rated ability to teach phonemic awareness and phonics had no relationship with demonstrated knowledge in these areas. Teachers were most likely to rate their ability to teach skills including spelling, phonics, comprehension or vocabulary as either moderate or very good. This was despite most respondents demonstrating limited knowledge and stating that they did not feel confident answering questions about their knowledge in these areas. The findings from this study confirm that in the field of language and literacy instruction, there is a gap between the knowledge that is theoretically requisite, and therefore expected, and the actual knowledge of many teachers. This finding challenges current pre-service teacher education and in-service professional learning. [ABSTRACT FROM AUTHOR]

Background: The effectiveness of print-based health promotion materials is dependent on their readability. This study aimed to assess the characteristics of print-based oral health information literature publically available in Tasmania, Australia. Methods: Oral health education brochures were collected from 11 dental clinics across Tasmania and assessed for structure and format, content and readability. Reading level was calculated using three widely-used measures: Flesch-Kincaid Grade Level (FKGL), Flesch Reading Ease, and Simple Measure of Gobbledygook (SMOG) reading grade level. Results: The FKGL of the 67 brochures sampled ranged from grade 3 to 13. The grade level for government health department brochures (n = 14) ranged from grade 4 to 11 (5.6 ± 1.8). Reading levels for materials produced by commercial sources (n = 22) ranged from 3 to 13 (8.3 ± 2.1), those from professional associations (n = 22) ranged from grade 7 to 11 (8.9 ± 0.9) and brochures produced by other sources (n = 9) ranged from 5 to 10 (7.6 ± 1.5). The SMOG test was positively correlated with the FKGL (rs = 0.92, p < 0.001) though consistently rated materials 2-3 grades higher. The reading level required to comprehend brochures published by government sources were, on average, lower than those from commercial, professional and other sources. Government materials were also more likely to contain fewer words and professional jargon terms than brochures from the other sources. Conclusion: A range of oral health information brochures were publically available for patients in both public and private dental clinics. However, their readability characteristics differed. Many brochures required a reading skill level higher than that suited to a large proportion of the Tasmanian population. Readability and other characteristics of oral health education materials should be assessed to ensure their suitability for use with patients, especially those suspected of having low literacy skills. [ABSTRACT FROM AUTHOR]

Background: Child maltreatment has severe short-and long-term consequences for children's health, development, and wellbeing. Despite the provision of child protection education programs in many countries, few have been rigorously evaluated to determine their effectiveness. We describe the design of a multi-site gold standard evaluation of an Australian school-based child protection education program. The intervention has been developed by a not-for-profit agency and comprises 5 1-h sessions delivered to first grade students (aged 5-6 years) in their regular classrooms. It incorporates common attributes of effective programs identified in the literature, and aligns with the Australian education curriculum.Methods/design: A three-site cluster randomised controlled trial (RCT) of Learn to be safe with Emmy and friends™ will be conducted with children in approximately 72 first grade classrooms in 24 Queensland primary (elementary) schools from three state regions, over a period of 2 years. Entire schools will be randomised, using a computer generated list of random numbers, to intervention and wait-list control conditions, to prevent contamination effects across students and classes. Data will be collected at baseline (pre-assessment), immediately after the intervention (post-assessment), and at 6-, 12-, and 18-months (follow-up assessments). Outcome assessors will be blinded to group membership. Primary outcomes assessed are children's knowledge of program concepts; intentions to use program knowledge, skills, and help-seeking strategies; actual use of program material in a simulated situation; and anxiety arising from program participation. Secondary outcomes include a parent discussion monitor, parent observations of their children's use of program materials, satisfaction with the program, and parental stress. A process evaluation will be conducted concurrently to assess program performance.Discussion: This RCT addresses shortcomings in previous studies and methodologically extends research in this area by randomising at school-level to prevent cross-learning between conditions; providing longer-term outcome assessment than any previous study; examining the degree to which parents/guardians discuss intervention content with children at home; assessing potential moderating/mediating effects of family and child demographic variables; testing an in-vivo measure to assess children's ability to discriminate safe/unsafe situations and disclose to trusted adults; and testing enhancements to existing measures to establish greater internal consistency.Trial Registration: Australian and New Zealand Clinical Trials Register (ACTRN12615000917538). Registered (02/09/2015). [ABSTRACT FROM AUTHOR]

Background: The No Germs on Me (NGoM) Social Marketing Campaign to promote handwashing with soap to reduce high rates of infection among children living in remote Australian Aboriginal communities has been ongoing since 2007. Recently three new television commercials were developed as an extension of the NGoM program. This paper reports on the mass media component of this program, trialling an evaluation design informed by the Theory of Planned Behaviour (TPB).Methods: A survey questionnaire taking an ecological approach and based on the principals and constructs of the TPB was developed. Surveys were completed in six discrete Aboriginal communities immediately before and on completion of four weeks intensive televising of the three new commercials.Results: Across the six communities access in the home to a television that worked ranged from 49 to 83 % (n = 415). Seventy-seven per cent (n = 319) of participants reported having seen one or more of the new commercials. Levels of acceptability and comprehension of the content of the commercials was high (97 % n = 308). Seventy-five per cent (n = 651) of participants reported they would buy more soap, toilet paper and facial tissues if these were not so expensive in their communities. For TPB constructs demonstrated to have good internal reliability the findings were mixed and these need to be interpreted with caution due to limitations in the study design.Conclusions: Cultural, social-economic and physical barriers in remote communities make it challenging to promote adults and children wash their hands with soap and maintain clean faces such that these behaviours become habit. Low levels of access to a television in the home illustrate the extreme level of disadvantage experienced in these communities. Highlighting that social marketing programs have the potential to increase disadvantage if expensive items such as television sets are needed to gain access to information. This trial of a theory informed evaluation design allowed for new and rich information to be obtained about community members' beliefs, attitudes and intentions towards teaching and assisting children so safe hygiene behaviours become habit. Findings will support an evidence-based approach is taken to plan future NGoM program activities. [ABSTRACT FROM AUTHOR]

Commercial dog health programs in Australian Indigenous communities are a relatively recent occurrence. Health promotion for these programs is an even more recent development, and lacks data on effective practices. This paper analyses 38 resources created by veterinary-community partnerships in Indigenous communities, to 71 resources available through local veterinary service providers. On average, community-produced resources used significantly more of the resource area as image, more imagery as communicative rather than decorative images, larger fonts and smaller segments of text and used images of people with a range of skin tones. As well as informal registers of Standard Australian English, community-produced resources used Aboriginal English and/or Creole languages in their text, while extra-community (EC)-produced resources did not. The text of EC resources had Flesh–Kincaid reading grade levels that excluded a large proportion of community recipients. Also, they did not cover some topics of importance in communities, used academic, formal and technical language, and did not depict people of a representative range of skin tones. As such, community-produced resources were more relevant to the unique situations in remote communities, while EC resources were often inappropriate and in some cases could even distance recipients by using inappropriate language, formats and imagery. [ABSTRACT FROM AUTHOR]

The article evaluates the readability criterion and the use of jargon in enterprise agreements made in the domain of higher education and fast food sectors between 1993 and 2011. It informs that very small progress has been made during this period in improving readability or abating the use of jargon in agreements.

Theory suggests that children's developing conceptions and views of relationship are important outcomes of social experiences, which can affect later relationships and mental health. However, research has been limited because no measure is currently available that captures children's pessimistic and optimistic expectations of relationships. Two studies were conducted with children (aged 9 to 12 years) with the purpose of developing such a measure (Study 1 n = 226; Study 2 n = 200). Exploratory and confirmatory analyses resulted in a final measure that included eight items measuring optimistic relationship expectations and eight items measuring pessimistic expectations. The two subscales formed distinct factors were moderately correlated, and were reliable and valid when tested against measures of rejection sensitivity, social competence, relationships with peers and parents, personality, and self-presentation. The new Children's Optimistic and Pessimistic Expectations of Relationships Scale (COPER) will be useful in future studies testing children's relationship expectations. [ABSTRACT FROM AUTHOR]

Abstract: Background: Support and education for parents faced with managing a child with atopic dermatitis is crucial to the success of current treatments. Interventions aiming to improve parent management of this condition are promising. Unfortunately, evaluation is hampered by lack of precise research tools to measure change. Objectives: To develop a suite of valid and reliable research instruments to appraise parents’ self-efficacy for performing atopic dermatitis management tasks; outcome expectations of performing management tasks; and self-reported task performance in a community sample of parents of children with atopic dermatitis. Methods: The Parents’ Eczema Management Scale (PEMS) and the Parents’ Outcome Expectations of Eczema Management Scale (POEEMS) were developed from an existing self-efficacy scale, the Parental Self-Efficacy with Eczema Care Index (PASECI). Each scale was presented in a single self-administered questionnaire, to measure self-efficacy, outcome expectations, and self-reported task performance related to managing child atopic dermatitis. Each was tested with a community sample of parents of children with atopic dermatitis, and psychometric evaluation of the scales’ reliability and validity was conducted. Setting and participants: A community-based convenience sample of 120 parents of children with atopic dermatitis completed the self-administered questionnaire. Participants were recruited through schools across Australia. Results: Satisfactory internal consistency and test–retest reliability was demonstrated for all three scales. Construct validity was satisfactory, with positive relationships between self-efficacy for managing atopic dermatitis and general perceived self-efficacy; self-efficacy for managing atopic dermatitis and self-reported task performance; and self-efficacy for managing atopic dermatitis and outcome expectations. Factor analyses revealed two-factor structures for PEMS and PASECI alike, with both scales containing factors related to performing routine management tasks, and managing the child''s symptoms and behaviour. Factor analysis was also applied to POEEMS resulting in a three-factor structure. Factors relating to independent management of atopic dermatitis by the parent, involving healthcare professionals in management, and involving the child in the management of atopic dermatitis were found. Parents’ self-efficacy and outcome expectations had a significant influence on self-reported task performance. Conclusions: Findings suggest that PEMS and POEEMS are valid and reliable instruments worthy of further psychometric evaluation. Likewise, validity and reliability of PASECI was confirmed. [Copyright &y& Elsevier]

The ‘cloze’ test is one possible investigative instrument for predicting text comprehensibility. Conceptual coding of student replacement of deleted words has been considered to be more valid than exact coding, partly because conceptual coding seemed fairer to poorer readers. This paper reports a quantitative study of 447 Australian secondary school student responses to three differing cloze tests covering identical content. The study sought to better understand the impact of cloze coding decisions on estimation of text difficulty and/or reader competence. Findings reveal the following: (a) conceptual coding increases reader cloze score differentially; (b) the increase in score from conceptual coding is greater for more able readers; (c) conceptual coding differentially advantages more able readers of less difficult text. This study is significant because instructors, researchers and developers often make decisions based on interpretation of mean scores from grouped cloze test results and such summaries of result distributions can obscure differential advantages such as those made clearer by this study. Estimates of text comprehensibility based on mean scores of conceptually coded cloze tests may overestimate group competence and underestimate text difficulty for some groups of readers. This contradicts an apparent consensus in the literature dealing with deletion-based tests. [ABSTRACT FROM AUTHOR]

The aims of this study were to measure the readability of Australian based informed consent documents and determine whether informed consent readability guidelines have been established by Australian human research ethics committees (HRECs). A total of 20 informed consent documents, 10 HIV/AIDS and 10 type 2 diabetes, were measured for readability using the Simple Measure of Gobbledygook (SMOG) and Gunning Fog Index (Fog). Published guidelines and policy statements of the two local HREC who approved the 20 clinical trials under study where examined to identify whether they had any formal policies/guidelines on the readability of informed consent documents. The two HRECs were contacted via e-mail to also determine whether they utilised any informal readability standards or “rules of thumb” that may not have been mentioned in the published documents. The HIV/AIDS and type 2 diabetes informed consent documents were, on average, written at a grade 13 reading level. Formal readability standards had not been established by the two local HRECs, however, they did verify the use of informal rules for assessing readability of informed consent documents. Based on Australian literacy data, the majority of informed consent documents were written well beyond the reading ability of many Australians. Unreadable informed consent documents may result in patients rejecting trial participation altogether or conversely may result in their participating in a trial with inadequate consent. Therefore, a step toward reducing the complexity of informed consent documents may be to implement objective readability assessments into the human research ethics application and review process. [ABSTRACT FROM AUTHOR]

In this article we report on reading ability of twin children in kindergarten to Grade 2 as a function of whether members of the pairs are assigned to the same or different classrooms. All analyses were run using mixed model regressions to account for the interdependence between twin pairs. The samples, total N = 1505, are from Australia and the United States. We found a close-to-significant difference in favor of same-class children in kindergarten and Grade 1. However, when results were adjusted to take account of pre-existing differences in disruptive behavior and in preliteracy ability, the class assignment effects disappeared. We suggest that these pre-existing differences, particularly disruptive behavior, are influencing decisions about whether to separate twins or not and also affecting early reading performance, a conclusion supported by significant correlations between the behavioral measures, preliteracy, and school-based reading. We conclude that, on average, early literacy in twins is not directly affected by their assignment to the same or different classrooms. [ABSTRACT FROM AUTHOR]

Background: Three main changes were implemented in the Australian National Cervical Screening Program (NCSP) in December 2017: an increase in the recommended age to start screening, extended screening intervals, and change from the Papanicolaou (Pap) test to primary human papillomavirus screening (cervical screening test). The internet is a readily accessible source of information to explain the reasons for these changes to the public. It is important that web-based health information about changes to national screening programs is accessible and understandable for the general population.Objective: This study aimed to evaluate Australian web-based resources that provide information about the changes to the cervical screening program.Methods: The term cervical screening was searched in 3 search engines. The first 10 relevant results across the first 3 pages of each search engine were selected. Overall, 2 authors independently evaluated each website for readability (Flesch Reading Ease [FRE], Flesch-Kincaid Grade Level, and Simple Measure of Gobbledygook [SMOG] index), quality of information (Patient Education Materials Assessment Tool [PEMAT] for printable materials), credibility (Journal of the American Medical Association [JAMA] benchmark criteria and presence of Health on the Net Foundation code of conduct [HONcode] certification), website design, and usability with 5 simulation questions to assess the relevance of information. A descriptive analysis was conducted for the readability measures, PEMAT, and the JAMA benchmark criteria.Results: Of the 49 websites identified in the search, 15 were eligible for inclusion. The consumer-focused websites were classed as fairly difficult to read (mean FRE score 51.8, SD 13.3). The highest FRE score (easiest to read) was 70.4 (Cancer Council Australia Cervical Screening Consumer Site), and the lowest FRE score (most difficult to read) was 33.0 (NCSP Clinical Guidelines). A total of 9 consumer-focused websites and 4 health care provider-focused websites met the recommended threshold (sixth to eighth grade; SMOG index) for readability. The mean PEMAT understandability scores were 87.7% (SD 6.0%) for consumer-focused websites and 64.9% (SD 13.8%) for health care provider-focused websites. The mean actionability scores were 58.1% (SD 19.1%) for consumer-focused websites and 36.7% (SD 11.0%) for health care provider-focused websites. Moreover, 9 consumer-focused and 3 health care provider-focused websites scored above 70% for understandability, and 2 consumer-focused websites had an actionability score above 70%. A total of 3 websites met all 4 of the JAMA benchmark criteria, and 2 websites displayed the HONcode.Conclusions: It is important for women to have access to information that is at an appropriate reading level to better understand the implications of the changes to the cervical screening program. These findings can help health care providers direct their patients toward websites that provide information on cervical screening that is written at accessible reading levels and has high understandability. [ABSTRACT FROM AUTHOR]