Grade Level Equivalents Research Articles

Spanish Adaptation and Evaluation of Clinical Discussion Guides: Communicating the External Beam Radiotherapy Experience (CEBRE) en Español

Cancer is the leading cause of death for the Hispanic/Latinx U.S. community, which comprises 64% of the U.S. population with limited English proficiency. Despite the common utilization of radiotherapy for cancer treatment, there is a dearth of radiotherapy educational materials-at appropriate reading levels-available in Spanish. To address the gap in patient-centered educational resources for communicating with Spanish-speaking patients about radiotherapy, we sought to linguistically and culturally adapt the Communicating the External Beam Radiotherapy Experience (CEBRE) clinical discussion guide series into Spanish. From January to December 2021, we developed and applied a stepwise methodology for Spanish adaptation of the discussion guides involving (1) professional translation, (2) interprofessional review for linguistic and cultural appropriateness and medical accuracy, (3) design review, and (4) evaluation for readability, understandability, and actionability using validated tools. We applied four indices for readability evaluation: Gilliam-Peña-Mountain, Läsbarhetsindex, Rate Index, and the Spanish Simple Measure of Gobbledygook. Two trained reviewers assessed understandability and actionability using the Patient Education Materials Assessment Tool (PEMAT). After two revision rounds, four CEBRE en español discussion guides were produced through an interprofessional, iterative translation and linguistic/cultural adaptation process. Readability scores across the four guides ranged from 4.3 to 7.3 grade-level equivalents, thereby meeting the American Medical Association's 8th-grade standard. PEMAT analysis yielded near-perfect scores along understandability and actionability domains. The stepwise linguistic/cultural adaptation process yielded a patient-centered guide that is appropriately readable, understandable, and actionable for Spanish-speaking patients receiving radiotherapy in the U.S. Future work should include an external evaluation of CEBRE en español by clinicians and patients. The methodology described can be applied to adapting resources for patient-centered communication in other fields of medicine and into other languages as part of an interprofessional approach to delivering equitable healthcare for all.

Availability and Readability of Non-English Patient Education Materials for Radiotherapy in the United States

Availability and Readability of Non-English Patient Education Materials for Radiotherapy in the United States

Physical performance, demographic, psychological, and physiological predictors of success in the U.S. Army Special Forces Assessment and Selection course

This study assessed predictors of successful selection in the very challenging and stressful United States Army Special Forces Assessment and Selection (SFAS) course among 800 Soldiers. A battery of measures were collected during the course and their ability to predict selection were assessed using logistic regression and chi-square tests. Physical performance measures were most predictive, including road march times, land navigation coordinates found, run times, fitness test score, obstacle course score, and pull-ups (p < .05). Soldiers that were officers or 18× enlisted (fast-tracked to SFAS), had <1 year of active duty, ≥ bachelor degree, no children, were not married, and were Ranger school graduates were more likely to be selected (p < .05). Several psychological measures were predictive, including intelligence quotient, grade level equivalents, resilience score, military aptitude score, and grit (p < .05). Basal serum physiological markers weakly predicted selection and were weakly associated with behavioral assessments. Lower C-reactive protein (< 9.5 nmol/L) and higher cortisol and sex-hormone binding globulin (SHBG) predicted selection (p < .05). Higher C-reactive protein (≥ 9.5 nmol/L) was associated with lower fitness test scores and slower road march time (p < .05). Cortisol was correlated with higher grit and resilience scores (p < .05). SHBG correlated with higher grade level equivalents and better performance on pull-ups, land navigation, obstacle course, and the fitness test (p < .05). Testosterone was correlated with faster run and road march times (p < .05). Dehydroepiandrosterone-sulfate (DHEA-S) correlated with lower resilience scores, and DHEA-S, epinephrine, and norepinephrine correlated with worse performance on several physical events (p < .05). These findings suggest measures that could be targeted in interventions to monitor and enhance performance and resilience.

Readability of Patient Education Materials in Radiation Oncology—Are We Improving?

PurposePrior research suggests that patient education materials on radiation therapy from various professional groups are written at reading levels above national recommendations of sixth to eighth grade. Since publication of these initial findings, many materials from these sources have been updated or newly created. However, the extent to which readability was considered in the design of these new documents remains unknown. Therefore, the goal of this investigation was to evaluate readability of online education materials for radiation therapy, comparing readability of updated materials with those included in the previous study. Methods and MaterialsPatient education materials related to radiation oncology were identified from websites of the 3 professional societies used in the original investigation (the American College of Radiology, the American Cancer Society, and the American Society for Radiation Oncology). The documents included in the first analysis were used as a comparator. To allow for accurate evaluation across groups, materials were matched by content; when necessary, documents were combined from the original cohort to create topically equivalent materials to reflect those currently available on society websites. Identified materials were analyzed using 7 validated readability indices, and results are reported in grade-level equivalents. Original materials were also reanalyzed with the same method. ResultsAmerican Cancer Society materials had the lowest average baseline levels (9.4-11.3 grade level) and showed improved readability in the more recent materials (8.0-10.5 grade level). By contrast, the American Society for Radiation Oncology materials had high average baseline readability levels (11.1-13.9 grade level) that actually worsened in the more recent materials (11.7-16.2 grade level). The number of documents meeting national recommendations did not improve in the updated cohort. ConclusionDespite evidence that readability levels of patient education materials in radiation oncology are unacceptably high, the readability of newly created materials is not consistently improving across professional societies. Although certain groups may incorporate readability in the design of educational documents, more consistent consideration across all organizations is needed.

Assessing Readability: Are Urogynecologic Patient Education Materials at an Appropriate Reading Level?

The National Institutes of Health recommends readability of patient material not exceed sixth-grade level. Our aim was to determine readability of American Urogynecologic Society (AUGS) and International Urogynecological Association (IUGA) patient education documents. Available English- and Spanish-language IUGA patient information leaflets and AUGS patient fact sheets were scored for grade reading level. Readability assessment was performed using Flesch-Kincaid, Simple Measure of Gobbledygook, and Fry graph formulas for English documents. For Spanish documents, Fernandez-Huerta and SOL readability formulas were utilized. Each document was assessed by a health literacy expert using standards of plain language best practices. We assessed 86 documents: 18 AUGS, 34 IUGA, and 34 IUGA Spanish documents. Readability combined scores for English AUGS documents ranged from 8th to 12th grade level equivalents, whereas English IUGA documents ranged from 7th to 13th. Combined average readability score for AUGS sheets was 9.9 ± 1.2 grade level equivalents versus 10.5 ± 1.3 for IUGA leaflets. The AUGS documents had lower grade level equivalents on all 3 readability scales. Spanish-language IUGA leaflets had an average readability score of 5.9 ± 0.6 grade level equivalents, with a range of fifth to seventh. Health literacy expert analysis found only 1 document met all the criteria for plain language best practice. All assessed AUGS and IUGA patient information English documents had readability scores above National Institutes of Health-recommended reading level. Spanish IUGA documents were written at a lower reading level than their English counterparts. To best meet patient education needs, future materials development should emphasize readability and utilization of plain language best practices.

Considering Low Health Literacy: How Do the Pelvic Floor Distress Inventory-Short Form 20 and Pelvic Floor Impact Questionnaire-Short Form 7 Measure Up?

The objective of this study was to evaluate the readability and understandability of 2 commonly used pelvic floor disorder questionnaires, Pelvic Floor Distress Inventory-Short Form 20 (PFDI-20) and Pelvic Floor Impact Questionnaire-Short Form 7 (PFIQ-7), in a low health literacy patient population. Flesh-Kincaid, SMOG, Fry, and FORCAST readability assessment tools were used to assign US grade levels to each questionnaire (PFDI-20, PFIQ-7). Two health literacy experts used PEMAT and ELF-Q tools to determine understandability, organization, content, and quality of each form. A focus group of women with low health literacy used Stop Light Coding and a facilitator-prompted discussion to further evaluate understandability and critique the forms. The PFIQ-7 required higher reading ability compared with PFDI-20 (ninth to 11th vs sixth to eighth mean grade level equivalents). Expert and focus group reviews identified concerns regarding purpose, formatting, and word choice in both forms. Focus group participants recommended assistance with questionnaire completion from clinical staff and gave mean overall ratings of 5.4 (0-10/worst to best) for PFDI-20 and 8.0 for PFIQ-7. Knowledge of potential barriers to understanding and completion may improve utilization of and accuracy of patient responses to PFDI-20 and PFIQ-7 in women with low health literacy.

Enhancing Youth Outcomes and Organizational Practices Through a Camp-Based Reading Program

Many children experience summer learning loss during the summer as measured by grade-level equivalents on standardized tests. Camp-based reading programs are a promising strategy to reduce summer learning loss. Situated within a positive youth development (PYD) theoretical approach, this study explored the efficacy of a U.S. camp-based reading program called Explore 30 and examined promising practices for reading interventions in camps as a mechanism for enhancing youth reading outcomes. Youth and director surveys were used to collect quantitative and qualitative data about program impacts. Approximately 70% of participants read for at least 30 min each day. A paired-samples t test found a significant difference (in the positive direction) in feelings about reading from pretest ( M = 2.09, SD = 1.20) to posttest ( M = 1.89, SD = 1.08), t(590) = 5.96, p &lt; .001. Findings suggest that the program was an appropriate model for enhancing camp organizational capacity for summer reading. Implications for practice and recommendations for research are addressed.

Using the NAART to Estimate WRAT-4 Reading Grade Level in a Predominantly African American Sample

Tests of word-reading ability, such as the North American Adult Reading Test (NAART) and Wide Range Achievement Test (WRAT) Word Reading subtest, are often used by neuropsychologists to estimate premorbid intelligence. However, despite the fundamental basis in reading, little work has been done to calculate or estimate literacy level from NAART performance. Additionally, few prior studies have evaluated the use of word-reading tests in underrepresented populations such as African Americans or individuals with lower socioeconomic status and educational attainment. Finally, while the correlations between the NAART and older editions of the WRAT are known, no study has yet examined the relationship between the NAART and WRAT-Fourth Edition (WRAT-4). The purpose of the current study, then, was to replicate and extend prior research in these areas. NAART and WRAT-4 Word Reading (WRAT4WR) performances were examined in a sample of 173 primarily African American individuals who were HIV-positive and who had an average of fewer than 12 years of education. Analyses revealed a strong correlation between NAART error scores and WRAT4WR raw scores (r = −.866, p < .001). Linear regression was used to establish the predictive equation to estimate WRAT4WR scores from NAART errors. This information allows for determining reading grade-level equivalents based on NAART error scores.

Psychometric Properties of Meta-cognitive Awareness of Reading Strategy Inventory

The construct validity of the Meta-cognitive Awareness of Reading Strategy Inventory (MARSI; Mokhtari &Reichard, 2002) was tested with 189 college students, and its convergent validity with reading comprehensionability was investigated. Reading ability was assessed using self-report and standardized measures. Resultsdemonstrate weak construct validity of the MARSI, suggesting that the current form of the MARSI is notappropriate for use with students who are very proficient in reading (i.e., grade level equivalents beyond 12thgrade). More theoretically-based quantitative and qualitative studies using the MARSI are warranted.

Saccadic tracking skills of poor readers in high school

Background Oculomotor control has been implicated as a factor when reading is poor, but few studies exist for adolescents. Methods The saccadic eye movement efficiency of 684 ninth grade students, identified as poor readers in 5 California high schools, was quantified using the Developmental Eye Movement test. Frequency distributions were produced from scores on vertical and horizontal components, and gender and test-retest factors were considered during analysis. Results Vertical times were within 1 standard deviation of normal for eighth grade. However, horizontal (saccadic) times were typical of grade 3, and the average number of errors on the horizontal test was typical of grade 2. Boys and girls performed similarly. Results of retests showed slightly improved horizontal times and fewer errors, but the grade level equivalents remained dramatically low. Overall, fewer than 10% of students scored above the 50th percentile for eighth grade. Conclusion The results indicate that poor readers in high school may be at high risk for poor saccadic tracking skill.

Curriculum bias and reading achievement test performance

The overlap of words specifically taught in reading textbooks with the contents of standardized reading achievement tests may be a source of bias that is frequently overlooked in psychoeducational assessments. This study compares the standardized achievement test performance of 62 second graders receiving instruction in two different reading curricula (Open Court and Houghton-Mifflin) to determine whether either curriculum generates different quantitative estimates of reading achievement. Reading subtest scores derived from the Kaufman Test of Educational Achievement-Brief Form (K-TEA), the Wide Range Achievement Test-Revised (WRAT-R), and the Reading Recognition and Reading Comprehension subtests from the Peabody Individual Achievement Test (PIAT) were examined. Grade level equivalents and scaled scores from the California Achievement Test (CAT) were also examined. Three Curriculum × Test repeated measures ANOVAs were conducted using grade level scores (2×7), standard scores (2×4), and CAT scaled scores (2 × 5) as dependent measures. A significant Curriculum × Test interaction was identified, suggesting differences among tests in estimates of reading ability as a function of the reading program.

UNINTERPRETABLE SCORES: THEIR IMPLICATIONS FOR TESTING PRACTICE

Chance-level scores have long been problematic in the interpretation of multiple choice tests. Fry (1971) referred to them as Orangoutang Scores, suggesting that many scores on tests could be achieved by a lucky orangoutang. stated his opinion strongly: He who uses or puts into cumulative folders test scores at or below (chance level) should be certified to teach, test, and provide guidance services only to Orangoutangs. Fry also noted that test publishers sometimes report grade-level equivalents for chance-level scores without giving any interpretive assistance to the user. It is in fact rare that users of scores are confronted with a specific reminder that the score which is being reported to them is, in fact, not significantly different from a mean chance score. The possible randomness' of the responses is, for all intents and purposes, not considered.

An Analysis of Teacher Judgments of Reading Level

Eighty-four elementary school techers estimated the grade level equivalents of reading paragraphs to determine whether skill in making such judgments existed, and whether there were significant differences between the level of judgments of teachers in urban and suburban schools. The results indicated that skill in making accurate judgments varies widely, and that teachers in urban schools make significantly higher estimations of grade level equivalents than suburban teachers. This urban-suburban difference was interpreted as indicating that techers in urban schools may have a lower achievement standard than teachers in suburban schools. The results of the study indicate further research is needed to determine whether the levels of judgment reflect teacher expectations, and whether these operate as self-fulfilling prophecies by moderating the level of a teacher’s reading instruction and thereby the achievement of the students.

Sentence Depth Measures as Predictors of Reading Difficulty

TWO SUMMARY MEASURES of sentence complexity-depth of postponement and number of levels in a sector analysis-were evaluated as predictors of reading difficulty. Criteria were cloze scores and listed grade level equivalents for 80 of the McCall-Crabbs Standard Test Lessons in Reading. The Lorge Readability Formula was also recalculated, using both the Test Lessons and the Miller-Coleman Readability Scale. The two sentence complexity measures were found to be highly correlated with sentence length and similar to it as predictors of reading difficulty. The revised Lorge Formula is considerably simplified. It omits the ratio of prepositional phrases, which was shown to be an unreliable contributor to prediction when used in combination with vocabulary load and sentence length.

The English Grade Level Equivalents of High School French Reading Material

An attempt to grade objectively, in terms of thought content, some translated French passages from various texts, with the aid of English control passages of known grade. None of the material used ranked above the sixth year elementary school level. Revaluation of criteria for selecting reading material is implied.

The English Grade Level Equivalents of High School French Reading Material

The English Grade Level Equivalents of High School French Reading Material