Low Readability Research Articles

Online information on chronic pain in 3 countries: an assessment of readability, credibility, and accuracy.

To assess the readability, credibility, and accuracy of online information on chronic pain in Australia, Mexico, and Nepal. We assessed Google-based websites and government health websites about chronic pain for readability (using the Flesch Kincaid Readability Ease tool), credibility (using the Journal of American Medical Association [JAMA] benchmark criteria and Health on the Net Code [HONcode]), and accuracy (using 3 core concepts of pain science education: (1) pain does not mean my body is damaged; (2) thoughts, emotions, and experiences affect pain; and (3) I can retrain my overactive pain system). We assessed 71 Google-based websites and 15 government websites. There were no significant between-country differences in chronic pain information retrieved through Google for readability, credibility, or accuracy. Based on readability scores, the websites were "fairly difficult to read," suitable for ages 15 to 17 years or grades 10 to 12 years. For credibility, less than 30% of all websites met the full JAMA criteria, and more than 60% were not HONcode certified. For accuracy, all 3 core concepts were present in less than 30% of websites. Moreover, we found that the Australian government websites have low readability but are credible, and the majority provided all 3 core concepts in pain science education. A single Mexican government website had low readability without any core concepts but was credible. The readability, credibility, and accuracy of online information on chronic pain should be improved internationally to support facilitating better management of chronic pain.

A Corpus-based Analysis of the Linguistic Complexity Levels of the Reading Passages in Three Asian EFL Countries’ College Entrance English Exams

This study investigates the linguistic complexity levels of the reading passages of the foreign language (English) domain of the College Scholastic Aptitude Test (CSAT) in Korea and compares them with those in two other Asian EFL countries. For the study, the reading passages of the Korean, Chinese, and Japanese college entrance English exams from the 2018 to 2020 academic year were collected and analyzed based on the length, propositional content and organizational characteristics by using a variety of corpus linguistic tools. The Kruskal-Wallis test was administered in order to see if there was a statistically significant difference among the tests. Also, when between-group differences were detected, the Mann-Whitney U post hoc test was conducted to further look into significant differences between the CSAT and the other tests. Overall findings suggest that the reading passages of the CSAT English exam maintained the highest difficulty level among the three Asian EFL countries’ college entrance English exams, with cognitively demanding academically-oriented items, highly advanced vocabulary, complex syntactic structure and low readability. Based on the findings, this research is expected to shed light on the intention of incorporating criterion-referenced English assessment into the CSAT as well as provide pedagogical implications for test developers and education policy makers in Korea.

Navigating the haze: Environmental performance feedback and CSR report readability

Despite the prevalence of comprehensive discussions on coping strategies for financial performance feedback, firms’ responses to environmental performance feedback, which possess distinct frames compared to financial performance feedback, remain insufficiently explored. To address this gap, our study explores how firms employ less readable reports in response to environmental performance feedback. We argue that firms receiving negative or positive feedback tend to produce reports with low readability, bewildering stakeholders, while those with environmental performance close to their aspirations are more likely to present clear, highly readable reports. Our findings indicate an inverted-U-shaped relationship between environmental performance feedback and corporate social responsibility report readability. Furthermore, we found that ascribed and achieved political connections have negative and positive moderating effects on this nonlinear relationship, respectively. Our arguments are supported by a sample of Chinese small and medium-sized enterprises from 2010 to 2017.

Validation testing of a language translation device for suitability in assisting Australian radiation therapists to communicate with Mandarin-speaking patients

Clear, timely communication between practitioners and patients is key in ensuring equitable access to health services and optimal care. Australia's linguistically diverse population adds complexity to healthcare provision. This paper describes a validation study to assess clinical suitability of a language translation device, intended for use with Mandarin speaking patients undergoing radiotherapy (RT). After a comprehensive device selection process, common phrases used in RT practice were curated within one clinical center and translated by interpreters. Phrases were categorized by conversation type and readability (according to Flesch-Kincaid and FORCAST scores). Validation of device performance was undertaken by purposely selected radiation therapists (RTTs) who tested and evaluated the device using a survey with 5-point Likert scale responses. Statistical analysis was undertaken on Excel using Pearson's chi-square, z-test, interrater reliability/agreement and linear regression analyses. Six RTTs and two interpreters volunteered to participate in this study. 188 common phrases were spoken verbatim into the device and scored on a 5-point Likert scale, yielding an overall output accuracy of 66%. A z-test confirmed significance against prior comparative research and Linear regression analysis observed improved output between consecutive participants. 62.7% of interpreter scores were identical; a further 29.1% constituted a single point scoring variation. Poorer outcomes were observed with colloquial English and lower readability. This study found the device produced suitable translation accuracy and identified language styles that should be avoided with use. Further research could consider clinical application, expanded languages and/or health disciplines, and development of a national RTT phrase list.

Analysis of online materials regarding DIEP and TRAM flap autologous breast reconstruction

Online resources have become a mainstay for health information, and it is vital that such resources maintain accessible literacy levels to empower informed decision making. Previous studies have shown that the online resources regarding post-mastectomy breast reconstruction are of low readability; however, none have evaluated specific online resources regarding the most common procedures within autologous breast reconstruction, limiting analysis to the results of generic searches. This study sought to discover the readability of online, patient-directed resources regarding the Deep Inferior Epigastric Perforator (DIEP) and Transverse Rectus Abdominis Muscle (TRAM) flaps, the most utilized autologous flaps in breast reconstruction, using health literacy analysis. We hypothesized that the online materials regarding DIEP and TRAM flaps would yield literacy scores above the 6th-grade reading level, as recommended by the American Medical Association, despite previous literature and readability recommendations. Google searches for "DIEP breast reconstruction" and "TRAM breast reconstruction" were conducted. All patient-directed, non-sponsored websites found within the first three pages of the search underwent analysis using a variety of readability formulae. Both DIEP and TRAM resources were well above the 6th-grade reading level according to every metric used, and there was no significant difference in the reading level between the two procedures. Based on these results, significant work was needed to simplify the online resources to be more understandable for patients; these authors propose one method for such. In addition, the low readability of online resources suggests added emphasis on the need for surgeons to ensure that patients understand the medical information discussed during the presurgical consultations.

Assessing the readability and quality of online information on anosmia.

Anosmia can have a significant impact on well-being and quality of life. Due to an ageing population and the coronavirus disease 2019, increasing numbers of patients are seeking online information on anosmia. This report systematically assesses the readability and quality of online information on anosmia. The terms 'anosmia' and 'loss of smell' were entered into Google. The first 50 websites generated for each search term were screened. Readability was assessed using the Flesch-Kincaid Reading Ease Score (FRES), Flesch-Kincaid Grade Level (FKGL), Simple Measure of Gobbledygook (SMOG) Index and Gunning Fog Index (GFI). Quality was assessed using the DISCERN instrument. Spearman's correlation between quality and readability was calculated. A total of 79 websites met the inclusion criteria. The mean and 95% confidence interval for the FRES, FKGL, SMOG, GFI and DISCERN scores were 46.31 (42.94-49.68), 12.00 (11.27-12.73), 10.70 (10.16-11.23), 14.62 (13.85-15.39) and 2.90 (2.69-3.11), respectively. Significant negative correlation was noted between the DISCERN and FRES (rs=-0.500; p<0.05). Online information on anosmia is written above the recommended reading age guidance in the UK, and has moderate deficiencies in quality. As a result, the information may be used inappropriately and could result in worse health outcomes. We recommend that patients are directed to websites produced by health providers or nonprofit organisations that develop material for patient health education. Online information on anosmia is of low readability and moderate quality. Healthcare professionals should direct patients towards high-quality resources written for the layperson.

Linguistic analysis of plain language summaries and corresponding scientific summaries of Cochrane systematic reviews about oncology interventions.

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

Words and numbers: A disagreement story from post-earnings announcement return and volume patterns

We examine whether disclosure readability affects investor disagreement following earnings announcements. Analyzing annual announcements by U.S.-listed firms between 2007 and 2018, we find that firms with lower disclosure readability experience higher unexplained trade volume and abnormal volatility after the announcement, consistent with low readability generating investor disagreement. We also show that financial analysts help alleviate the disagreement induced by low readability. Moreover, we document that low readability is unassociated with post-announcement returns, indicating that readability-driven disagreement spurs unexplained trade volume and volatility without affecting the aggregate market valuation. Overall, the results suggest that low disclosure readability increases stock-market investor disagreement.

Evaluation of accuracy, reliability, quality, and readability of online patient information materials on coccyx injury.

The aim of this research is to evaluate the websites containing "coccydynia, coccyx trauma or fracture" in terms of readability, reliability, accuracy, and quality. Searches for "coccydynia, coccyx trauma, coccyx fracture" were carried out in the 3 most used search engines in the USA: Google, Yahoo, and Bing in February 2022. A total of 141 websites were rated by 2 different neurosurgeons for the "Global Quality Score" and "Alexa Popularity Rank." 97.2% of the sites examined include the definition of the disease, 66% include the importance of the disease, 92.9% include the symptoms of the disease, 88.7% include the treatment of the disease, 78% include the signs of the disease, 77.3% include the mechanism of the disease It has been determined that the websites examined within the scope of the research have high global quality score (GQS) and APR and are enriched with images to a large extent.

ANÁLISE DA CAPACIDADE DE COMPREENSÃO PELO PACIENTE DO TERMO DE CONSENTIMENTO CIRÚRGICO INFORMADO

Introduction: Medical Assistance, Assistance and research, the principles initiated by the Nuremberg Code, were materialized through written documents called Consent Forms. The present study aims to assess the understanding of the consent form in hospitals in the state of São Paulo. Method: Terms that meet the inclusion criteria were retrieved in the analysis with textual readability analysis, and the specific online assessment instrument of the textual readability program was used: Flesch Readability Test; Gulpease Index; Flesch-Kincaid graduation level; Adapted Gunning cloudiness index ; Automated readability index; Coleman-Liau index. Results: The present study presents data between texts of terms with: two at level 11 (high readability); eight are from level 13 to16 (medium readability) and three are from level 17 to18 (low readability). Therefore, the results of the present study indicated that in order to understand the analyzed terms the reader had to be at a univerisity level course ou have graduated from the university. Conclusion: It is recommended that sample be expanded and that they hospitals adopt measures that readability of terms. Keywords: Free and Informed Consent, Understanding, Operative Surgical Procedures

Is the Authoritative Online COVID-19 Consumer Health Information Intelligible to Adults of the General Public?: A COVID-19 Information Analysis

Objective To investigate whether the authoritative COVID-19 consumer health information provided by the Centers for Disease Control and Prevention (CDC) in the United States (U.S.) and the World Health Organization (WHO) is at low readability levels (i.e., at or below a sixth-grade reading level). Major public health organizations, such as these have quickly distributed authoritative COVID-19 health information on the Internet during the pandemic. However, scant research has assessed whether the information disseminated by these two major public health organizations enables access by adults from the general public. This study examines the Flesch-Kincaid grade levels of the COVID-19 health information in English distributed by the CDC and the WHO. Design The study is guided by communication and information science frameworks. It examines the reading level of the resources to see if they are compatible with the guidelines of the American Medical Association for patient education materials. Methods/setting The methodology used centered on content and document analyses. The samples analyzed were identified through accessing the COVID-19 health information shared on the websites of the public library systems of the twenty largest cities in the U.S. Key results The results show that the documents reviewed in the study are not compatible with the sixth-grade reading level recommended by the American Medical Association for patient education materials.

How do overconfident CEOs respond to regulation fair disclosure? Evidence from financial report readability

This paper examines how overconfident CEOs adjust financial report readability (FRR) in response to Regulation Fair Disclosure (RegFD). Our difference-in-differences analysis shows that while being associated with lower readability ex ante, overconfident CEOs increase their firms' FRR relatively to non-overconfident peers after the importance of public disclosure grows due to RegFD adoption. We also find that the relative increase in readability is dependent on the extent of firms' financial constraints and financing through the equity market. Overall, our results suggest that overconfident CEOs fine-tune FRR to reduce the external equity financing cost, especially when selective disclosure and communication are restricted.

The impact of business strategy and annual report readability on financial reporting quality

Purpose This study aims to mainly explore the impact of business strategy and annual reports readability on financial reporting quality in Tehran Stock Exchange (TSE). Design/methodology/approach The sample comprised 160 companies listed in TSE from 2014 to 2020. Five proxies (including two accounting-based attributes and two market-based attributes) were used to measure financial reporting quality. In this study, cost leadership and differentiation strategies were considered and Fog index was used to measure the annual report readability. Findings The results showed that in all methods of calculating financial reporting quality, cost leadership strategy, differentiation strategy and annual report readability had a positive and significant impact on financial reporting quality. Also, only at the high level of the differentiation strategy, the annual reports readability influenced financial reporting quality. In addition, at all levels of high and low annual report readability, cost leadership strategy affected financial reporting quality, but only in companies with a high annual report readability, the differentiation strategy affected financial reporting quality. Only for companies with a low readability, the annual report readability affected financial reporting quality. Originality/value To the best of the authors’ knowledge, no study had examined the impact of business strategy and annual report readability on financial reporting quality at the core of the present study. Furthermore, little was known about the strategic choices made in Iran. So, the research filled this gap in TSE. This study provided insights for policymakers to enhance the readability and reduce the complexity of annual reports.

Online patient literature related to oesophageal surgery: the need for greater readability, accreditation and higher quality.

Oesophageal cancer is the sixth most common cause of death worldwide but is treatable through surgery. As part of the consenting process, surgeons may guide patients towards online information leaflets to understand more about their condition and treatment. This review aimed to systematically analyse some of the current resources that can be accessed via the internet. A stringent search criteria was used to select online patient information leaflets for oesophageal cancer surgery. Leaflets were scored based on the Flesch-Kincaid Reading Ease score, DISCERN score, Health on the Net Code of Conduct (HONcode) certification/Information Standard Certification and International Patient Decision Aid Standards (IPDAS) score. Only five sites had achieved HONcode certification. Only three sources were deemed readable using the Flesch-Kincaid scoring system and no sources reached the recommended readability using IPDAS. No source reached a maximum score with DISCERN, with the mean overall quality being 2.98. There was no significant difference between accredited and unaccredited sources. From our sample, patient information sources on oesophageal cancer surgery have a low readability. More research is required to ascertain patient behaviour with regards to accessing the literature. Patients and healthcare professionals should liaise with each other to produce more readable, high-quality patient information on oesophageal cancer surgery.

Design of Chained Document HTML Generation Technique Based on Blockchain for Trusted Document Communication

Digital document communication between an enterprise and a customer is becoming a primary form of communication rather than the traditional physical document communication. A PDF document, the most popular document format, provides an identical document layout regardless of OS or device and has a content integrity verification feature with a digital signature. However, it has a bad user experience, such as low readability on a mobile device. On the other hand, an HTML document has a weakness in verifying the content integrity even though it is the primary document format and provides a good user experience on mobile devices. There are certified document services using blockchain technology, but it is still vulnerable to verifying content integrity. Furthermore, research on the document HTML has proposed the trusted document generation technique by HTML conformance and digital signature; however, this research does not provide content delivery verification, and there is a file size overhead. In this paper, we have developed the chained document HTML by defining HTML conformance, digital signature, and blockchain technology. First, the chained document HTML has to embed all resources and does not allow loading content on-demand. Second, the file is signed by a digital signature, and the signature value is added in the file header. Lastly, the metadata to verify the content integrity is inserted in a blockchain node. We have created the chained document HTML generation and verification experiment environment by Ethereum and Python. We have confirmed that the chained document HTML provides content and delivery integrity verification in the research. We expect the chained document HTML will be widely used in document communication between an enterprise and a customer, especially if the document has sensitive personal information that might have a legal dispute.

Health Information on COVID-19 Vaccination: Readability of Online Sources and Newspapers in Singapore, Hong Kong, and the Philippines

To address the COVID-19 pandemic, as with other infectious diseases, a key intervention is vaccination. Health communications are thus of vital importance for informing the public on the benefits and risks of vaccines. This in turn makes the readability of media content fundamental. Previous studies of COVID-19-related information have found the readability of online information considerably more difficult than recommended. However, studies on the readability of information related to COVID-19 vaccination in Asian contexts have yet to be carried out. Furthermore, especially in the case of the current pandemic, health information is communicated by a variety of information channels, including the internet and mass media. This paper investigates the readability of textual information on COVID-19 vaccination found online and in newspaper articles in parts of Asia where English is one of the main languages, namely Singapore, Hong Kong, and the Philippines. Readability was assessed using a set of readability tests (Flesch–Kincaid Reading Ease, Flesch–Kincaid Grade Level, Gunning Fog Index, Coleman–Liau Index, and Simple Measure of Gobbledygook Grade level). It was found that a low proportion of URLs scored within recommended readability thresholds, and did so consistently across locations and types of sources. Furthermore, a relatively low proportion of web searches returned information from local sources; most URLs linked to sources outside of Singapore, Hong Kong, or the Philippines. Further, local online and newspaper sources scored similarly poorly on readability on average compared to non-local sources. Understanding of fast-evolving health communications concerning COVID-19 vaccination encompasses information about vaccine development and deployment from other locations, as well as locally. Nevertheless, these findings indicated a fairly low proportion of local sources among the top search results, and relatively low (i.e., difficult-to-read) readability scores for top search results and for local newspapers. An important issue for health communications strategies addressing COVID-19 vaccination will therefore be to consider different types of media sources in order to achieve the right mix of local and non-local sources while also ensuring appropriate readability.

COVID‐19 Disclosures and Market Uncertainty: Evidence from 10‐Q Filings

We examine whether the quarterly filing COVID‐19 disclosures reduce uncertainty for investors and analysts. We find a negative relationship between COVID‐19 disclosure and return volatility, suggesting COVID‐19 disclosure reduces investor uncertainty. This reduction effect concentrates mainly during the short window following 10‐Q releases and phases out over time. We then detect that industry‐wide COVID‐19 disclosure dispersion is positively associated with return volatility, suggesting high variation of industry‐wide COVID‐19 disclosures reduces information comparability across firms, resulting in increased investor uncertainty. Moreover, we find that COVID‐19 disclosures are positively associated with analysts’ downward earnings forecast revisions and negatively associated with analyst forecast dispersion after 10‐Q releases, suggesting the disclosures reduce information risk even for sophisticated market participants. Further analyses show that COVID‐19 disclosures are negatively associated with future financial and operational performances (i.e., sales, operating cash flow, operating income and ROA). Lastly, we find that the low readability of COVID‐19 disclosure attenuates the negative relation between COVID‐19 disclosure and market volatility. Collectively, our findings suggest that 10‐Q COVID‐19 disclosures contain value‐relevant information that temporarily assists market participants in evaluating the changes in firms’ values in the time of a crisis.

Improvisation and Communicative Agency: Contribution of an Improvisational Model to the Analysis of Communicative Agency

Introduction: Persons with congenital deafblindness mainly communicate using the bodily tactile modality. Their expressive communication is often formulated by an authentic language that gives the persons with congenital deafblindness low readability towards the rest of the world. This can be an obstacle for the development of their communicative agency. In the present study it is investigated whether a theoretical approach to improvisation can contribute to the development of communicative agency in a person with congenital deafblindness with low readability and authentic language in a dialogical perspective. Method: The study employs a qualitative design conducted as a dialogical single case study. Even though this research is based only on one recording of a communicative encounter between a person with deafblindness and her communication partner, it is assumed that the study can be used as a representative case study for people with low readability and authentic language. A video of communication between a person with CDB and a sighted/hearing communication partner is transcribed and the transcription is analysed in three stages through 1) Conversational analysis (CA), 2) Improvisation analysis and 3) Subjectivity/intersubjectivity analysis. Results: The Conversation analysis proved useful to identify complex turn-taking patterns in the communication. Through the improvisation model it was possible to define the degree of subjectivity/intersubjectivity in every utterance by each participant, as well as how each act was met by the other. With the improvisation model discriminations could be made between the different modalities, as vocal speech and bodily tactile acts. Regarding communicative agency, the model was useful to analyze degrees of self-expression as well as the balance of subjectivity and intersubjectivity between the participants. Conclusion and discussion: The model of improvisation contributed to specify subjectivity/intersubjectivity and multimodality in communication, though it did not contribute to the analysis of turn-taking. The model contributed to the development of communicative agency by pointing to the open-ended outcome for each utterance as the most important factor for developing and sustaining communicative agency. Limitations: The main limitation of this study was that the analyses were performed on only one video-clip with one dyad. Due to time constraints, a consensus check could not be carried out. Recommendations for future research is that, since this is a very innovative method in the deafblind field, replications of the study should be performed on more dyads, different dialogues and more video clips. Recommendation for practice: The combination of conversation analysis and improvisation analyses can very well be used with focus groups of care professionals in clinical practice under supervision of a trained expert in this method of communication analyses.

Financial statement readability and credit rating conservatism

AbstractThe paper examines the relation between the financial statement readability and credit rating conservatism. The Fog Index of the financial statements of the United States publicly listed companies and the text length of their financial statements are employed as the readability indicators. I find that: (1) firms with annual reports that are harder to read (i.e., they have a higher Fog index and longer length) have more conservatism; (2) rating agencies have become more conservative in assigning credit ratings during dot.com bubble and financial crisis; (3) rating agencies have faced increased regulatory pressure result in becoming more conservative after Sarbanes‐Oxley Act; and (4) as firms have lower readability, it will influence the rating agencies becoming more conservative during crises or after SOX act.

The Translation Quality of Facebook Translation

This study aims to assess the quality level of the Facebook translation From English to Indonesian, what techniques are used and to determine the causes of the low quality of the automatic translation tool. This study compares the results of the Facebook translation with the results of the respondents presented with a qualitative descriptive method. The researcher conducted a test on 40 Facebook translation data involving 8 students of the English language education study program to assess whether the Facebook translation results were acceptable or still require re-translation from them. From 48 techniques used by Facebook, found 48 data (100%) categorized as not accurate, not acceptable and low readability translations consisting of 37 data using literal translation (77,1 %), borrowing namely 9 data (18,7 %), calque namely 1 data (2,1%), and reduction namely 1 data (2,1%). Meanwhile, the translation techniques used by the respondents were more diverse. From 54 techniques used by Respondents, found 54 data (100%) categorized as accurate, acceptable and high readability translations consisting of 21 data using literal translation (38,8 %), adaptation namely 14 data (25,9 %), transposition namely 9 data (16,6%), borrowing namely 4 data (7,4%), description namely 2 data (3,7%), amplification namely 1 data (1,9%), calque namely 1 data (1,9%), modulation namely 1 data (1,9%) and reduction namely 1 data (1,9%). Facebook's tendency to often use Literal translation is believed to be the cause of the low level of quality because this technique is used as an early stage of translation and is called the lowest technique.