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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]

The study aim was to cross-culturally adapt the Identification of Functional Ankle Instability (IdFAI) into a Spanish-language version (IdFAI-Sp), which would then be validated and its psychometric properties evaluated for use in possible cases of ankle instability. The cross-cultural adaptation was performed following the guidelines of the International Society for Pharmacoeconomics and Outcomes Research. Pearson correlations were calculated to assess the convergent validity between IdFAI and the Cumberland Ankle Instability Tool. Cronbach's alpha and test re-test reliability values were calculated and floor/ceiling effects analysed. Construct validity was assessed by confirmatory factor analysis (CFA). The study population was composed of 110 participants, with a mean age of 40.49 years (10.43) and of whom 62 (56.36%) were female. Good test-retest results were obtained, with an intraclass correlation coefficient of 0.85 (ICC2,1: 95% CI: 0.82 − 0.88). The structure matrix was examined by CFA, which revealed a three-factor solution that accounted for 79.89% of the variance. The IdFAI-Sp obtained an excellent fit (RMSEA 0.068, GFI 0.94, CFI 0.98 and NFI 0.97). This study validates the IdFAI-Sp questionnaire, corroborating its value to researchers and medical professionals as a self-reported outcomes measure for use with a Spanish-speaking population. The Spanish-language version of the Identification of Functional Ankle Instability questionnaire (IdFAI-Sp) is a valid and reliable tool. The IdFAI-Sp enables researchers and healthcare professionals to identify and classify chronic ankle instability among Spanish-speaking patients. Accordingly, it can be considered a useful clinical instrument. Aapplication of the questionnaire before and after treatment can reveal the patient's degree of recovery over time. [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]

Aims and objectives: To obtain feedback regarding the comprehension and acceptability of an information leaflet on breast cancer screening among women. Background: Women usually receive a leaflet inviting them to participate in breast cancer screening programmes for early detection of breast cancer. These leaflets include relevant information about mammograms to aid with decision‐making. It is important to know how the target population perceives these leaflets, as this may influence the attitude towards breast cancer screening. Design: A mixed‐methods study (concurrent triangulation design). Methods: Participants were 41 women aged between 40–60 years in the north of Spain. The leaflet included information about breast cancer, mammograms, benefits/risks of screening, and the breast cancer mortality and survival rates in relation to screening. Three written methods were used to assess the leaflet: a readability assessment (Flesch Index) and two comprehension assessments (Cloze and multiple‐choice questions). In addition, 26 semi‐structured interviews were conducted to explore the women's opinions regarding comprehension, acceptability and the contribution of the leaflet as a decision aid. The COREQ checklist was used to guarantee the quality and rigour of the qualitative study. Results: Overall, women found the leaflet fairly easy to read and most understood the content. Some women found the information on mortality alarming, difficult to understand and a cause for rejection. The leaflet was viewed as a decision aid, although further information was requested on mammograms, the need for complementary tests and the risks and symptoms of breast cancer. Conclusion: The leaflet was accepted by women and, overall, easy to understand. The participation of the target population enabled the content and format of the leaflet to be adjusted to their needs. Relevance for clinical practice: Nurses can contribute towards improving the breast cancer screening leaflets, considering women's perceptions surrounding screening. [ABSTRACT FROM AUTHOR]

This article analyses the readability of the communication in Spanish language from the board of directors based on the study of narrative texts at Sustainability Reports of IBEX35 companies, which includes the 35 largest listed companies in Spain given their market capitalization. It undertakes an empirical study with two purposes: first, to describe the readability scale of these texts, and second, to ascertain whether or not compliance on sustainability influences the readability of disclosure. The study was carried out on the narrative texts of six GRI data standards related to compliance with laws and regulations, included in 116 Sustainability Reports of IBEX35 Spanish-listed companies in the period 2015-2018. Readability was measured using two indices for Spanish language readability: the Fernandez-Huerta and the Inflesz indices. These indices are based on the Flesch Reading Ease Formula for English narrative texts. Findings suggest that communication from the board concerning Sustainability Reports needs improvement since, in general, these reports are difficult to read. Finding also suggest that compliance with GRI standards could be related to low readability difficulty of reports and non-compliance to high readability difficulty. [ABSTRACT FROM AUTHOR]

Objective: To determine whether the implementation and use of the electronic health records (EHR) modifies the quality, readability and/or the length of the discharge summaries (DS) and the average number of coded diagnosis and procedures per hospitalization episode.Design: A pre-post-intervention descriptive study conducted between 2010 and 2014.Setting: The 'Hospital Universitario 12 de Octubre' (H12O) of Madrid (Spain). A tertiary University Hospital of up to 1200 beds.Intervention: Implementation and systematic use of the EHR.Main Outcome Measures: The quality, length and readability of the DS and the number of diagnosis and procedures codes by raw and risk-adjusted data.Results: A total of 200 DS were included in the present work. After the implementation of the EHR the DS had better quality per formal requirements, although were longer and harder to read (P < 0.001). The average number of coded diagnoses and procedures was increased, 9.48 in the PRE-INT and 10.77 in the POST-INT, and the difference was statistically significant (P < 0.001) in both raw and risk-adjusted data.Conclusions: The implementation of EHR improves the formal quality of DS, although poor use of EHR functionalities might reduce its understandability. Having more clinical information immediately available due to EHR increases the number of diagnosis and procedure codes enhancing their utility for secondary uses. [ABSTRACT FROM AUTHOR]

We report an eye-tracking experiment that examined argument linking and the role of prominence in Spanish sentence comprehension by testing the interplay between word order and verb type. Previous evidence from a self-paced reading study (Gattei, Dickey, Wainselboim, & París, 2015). showed that comprehenders use morphosyntactic information to form predictions about the thematic structure of the upcoming verb. In this study we focussed on the time course of this process. Results showed an interaction between verb type and word order for late eye movement measures but not for early eye movement measures. Participants regressed more and for longer time when word order did not match the canonical order for each verb class. This interaction is observed from the verb region onwards, independently of word order. We interpret that these effects take place due to the misinterpretation of the prominence status of the preverbal argument, leading to differential reading strategies. [ABSTRACT FROM AUTHOR]

Members of racial/ethnic minorities, in contrast to majority groups, experience disparities in stroke risk factors, recognition, evaluation, and treatment. This article describes the use of qualitative methods to examine the cultural and lifestyle appropriateness, clarity of item-wording, comprehension of item intent, and conceptual equivalence of the developed Spanish and the revised English Stroke Action Test (which includes three additional atypical stroke symptoms more common in women). Thirty in-depth cognitive interviews were conducted (10 in Spanish) using concurrent structured probes. The desired ultimate outcome was to obtain conceptually equivalent measures in both languages. Four sources of variability in comprehension were identified: unfamiliar and/or idiosyncratic Spanish words used in translation; phrases in the original (English) and in the literal (Spanish) translation that were not understood; and unclear intended meaning of the original (English) items. Cognitive interviews helped identify problematic items, highlighted potential response errors, and provided insight regarding putative causes for inconsistent interpretation. [ABSTRACT FROM AUTHOR]

Research has shown that semantic processing of sentences engages more activity in the bilingual compared to the monolingual brain and, more specifically, in the inferior frontal gyrus. The present study aims to extend those results and examines whether semantic and also grammatical sentence processing involve different cerebral structures when testing in the native language. In this regard, highly proficient Spanish/Catalan bilinguals and Spanish monolinguals made grammatical and semantic judgments in Spanish while being scanned. Results showed that both types of judgments recruited more cerebral activity for bilinguals in language-related areas including the superior and middle temporal gyri. Such neural differences co-occurred with similar performance at the behavioral level. Taken together, these data suggest that early bilingualism shapes the brain and cognitive processes in sentence comprehension even in their native language; on the other hand, they indicate that brain over activation in bilinguals is not constrained to a specific area. [ABSTRACT FROM AUTHOR]

Prominence is the hierarchical relation among arguments that allows us to understand 'Who did what to whom' in a sentence. The present study aimed to provide evidence about the role of prominence information for the incremental interpretation of arguments in Spanish. We investigated the time course of neural correlates associated to the comprehension of sentences that require a reversal of argument prominence hierarchization. We also studied how the amount of available prominence information may affect the incremental build-up of verbal expectations. Results of the ERP data revealed that at the disambiguating verb region, object-initial sentences (only one argument available) elicited a centro-parietal negativity with a peak at 400 ms post-onset. Subject-initial sentences (two arguments available) yielded a broadly distributed positivity at around 650 ms. This dissociation suggests that argument interpretation may depend on their morphosyntactic features, and also on the amount of prominence information available before the verb is encountered. [ABSTRACT FROM AUTHOR]

Aims and objectives To develop a questionnaire to address barriers and self-care behaviour among persons with type 2 diabetes mellitus. Background Several instruments are available in the literature to measure barriers to self-care in this population, but many of them present limitations in its psychometric validation process, and lack of theoretical background. Design Content validation study using multiple qualitative methods. Methods A systematic review was conducted, and two focus groups with fifteen participants ( n = 15) were analysed to identify key topics and categories concerning barriers and self-care behaviour. These categories were used to generate items that were subjected to expert scrutiny, using the Delphi technique. The resulting list of items was tested for readability and comprehension by nine diabetic patients ( n = 9), through cognitive interviews. The whole process was conducted in accordance with the Theory of Planned Behaviour. Results The mean age (standard deviation) of participants in the focus groups and cognitive interviews was 66·05 (8·47) and 63·11 (6·13) years, respectively. 46·7% of the members of the focus groups and 44·4% of those interviewed were female, and the mean duration (standard deviation) of their diabetes was 6·53 (3·17) and 4·89 (3·84) years, respectively. After the qualitative analysis, 27 codes were obtained. Thereafter, items were generated in accordance with the dimensions of this theory: attitudes towards the behaviour ( n = 23), social norms ( n = 13), perceived behavioural control ( n = 17) and behavioural intention ( n = 15). Conclusions A rigorous process of content validation with multiple methods was implemented to obtain an instrument aimed at addressing barriers and self-care behaviour of patients with type 2 Diabetes Mellitus. Relevance to clinical practice An instrument theoretically rooted and supported on professional and patients' views is available to assess self-care behaviours in patients with type 2 Diabetes Mellitus. The evaluation of its reliability and construct validity will determine the instrument's value and practical application in the clinical context. [ABSTRACT FROM AUTHOR]

Readability refers to the ease of reading and understanding a text. The need to ensure the readability of Web pages is related to universal access to products and services in the information society, which aims to provide an Internet for all. This article describes a study conducted to assess the readability of textual contents of Web portals of 40 universities at the top positions in international university rankings to determine whether the best universities have readable web pages. Mathematical formulas that evaluate syntactic difficulty of text oriented to texts written in English or in Spanish were applied. [ABSTRACT FROM AUTHOR]

Adult literacy skills studies indicate that large percentage of adults in most industrialized nations have difficulty using print material to accomplish everyday tasks with accuracy and consistency. Words in signs, postings, and forms within health care settings establish a physical literacy environment and reflect the demands and expectations of the institutions. We report on an assessment of the literacy environment of 10 hospitals in Catalonia, Spain, to indentify factors that hinder or support the ability of people to make their way to and within, a hospital. The authors used standardized rating tools for the evaluation of navigation, specific readability tools for the assessment of written communication, and a patient survey for the evaluation of patients' perception of written and oral communication. Thematic analysis of results indicates insecurity and confusion in finding one's way throughout health care facilities. Readability assessment of selected health education materials and informed consent documents shows extensive use of scientific language that is inappropriate for the general public. Patients' assessment of oral communication was rated high although statistically significant differences exist between hospitals. This assessment offers insight into the literacy demands placed on patients and visitors. [ABSTRACT FROM AUTHOR]

A key issue in understanding artefacts from the past is the loss of readability of the signs they may have borne. The two 16th-century musical instruments studied here—rare Italian violins made by Andrea Amati (c.1505-1577) in Cremona—bear remains of painted heraldic emblems, which are barely legible and thus remained undeciphered until today. They are exemplary representatives of this research question, indeed combining various types of losses, which are widely encountered on archaeological artefacts: they are now incomplete (parts are missing, surfaces are abraded) and the paint matter itself, of which the signs are made, has altered. In this study, the complete original outlines and geometrical subdivisions of the shields are deduced from calculations based on the conventional heraldic construction practices of the times. Also, in situ elemental imaging of the shield areas—here using scanning X-ray fluorescence (XRF) spectroscopy— brings two types of information: (i) the nature of pigments, allowing to deduce the initial colours of the paints not discernable to the eye, whether abraded or discoloured; (ii) the spatial distribution of these pigments and colours inside the shield. This multi-approach method leads to the unprecedented revelation of a combination of symbols (tinctures of fields, emblematic ornaments, and their relative spatial distribution), all having meanings in heraldic language. The reconstructed coats of arms appear to be pointing to a very specific nine-year period (1559–1568) of the life of the queen Elisabeth (Isabel) of Valois, spouse of Philip II of Spain. We suggest that this approach, combining an imaging spectroscopic technique and a geometrical study of remaining decors, here providing new insights into the musical history at the Court of Spain, may be used to enhance the readability of a wide range of writings, signs and symbols on artefacts from the past. [ABSTRACT FROM AUTHOR]