Grade Reading Research Articles

(131) EFFECTIVENESS OF AN INTERACTIVE PATIENT LEARNING MODULE: INTIMACY IN PREGNANCY

Abstract Introduction Two-thirds of women experience negative sexual symptoms during their pregnancy. Women suffer with dyspareunia, arousal issues, decreased libido, and anorgasmia frequently throughout pregnancy, with a significant worsening of symptoms during the third trimester. Also, many women restrict their sexual activity due to fear and misconceptions of inducing preterm labor or harming the fetus and social parameters of sexual conduct during pregnancy. Due to the lack of readily available medical education regarding sexual function in pregnancy, many women of various religious backgrounds may feel lack of trusting asking family members or medical professionals regarding sexual wellness. Objective Patient education given during pregnancy will increase patient knowledge of intimacy during pregnancy as well as improve sexual satisfaction and relationship quality and mental health in pregnancy. Moreover, this module will address gaps in common misconceptions by introducing supportive literature findings regarding benefits of intercourse during pregnancy dispensing the social stigma. Methods This prospective study is a single group before and after pilot study. This study recruited 25 patients beyond 12 weeks’ gestation. We approached 34 of patients and 25 agreed to participate in review an educational module titled “Sexual Intimacy and Pregnancy” build from ACOG guidelines. This module was created at an 8th grade reading level. Patients completed a presurvey, used the module on an electronic device and then completed a post-module assessment. Results 68% of women currently experience sexual dysfunction as either one of more of the following: pain with sex, decreased libido, anorgasmia, or vaginal dryness. Compared to their pre-module response, more women correctly answered the items “What percentage of pregnant women experience sexual dysfunction?” (28.0% versus 76.0%; p = .001) and “Having sex will cause labor” (28.0% versus 4.0%; p = .03). Additionally, women were more comfortable asking their doctor about sex while pregnant following the module (OR = 2.26, 95% CI: 1.06 – 4.83; p = .04). Through the recruitment process, we noticed that patients more likely to participate based on age, level of education received and most significant gravidity. The key for this recruitment was to create an environment in the exam room where both parents were able to see and engage with the module. During the module, partners spoke about current sexual dysfunction initially followed by confirmation by the pregnant patient. Prior to viewing this module, most participants predicted a much smaller percentage of women would be afflicted by sexual dysfunction in pregnancy which illustrating the broad deficits in sexual health education. Conclusions All participants would recommend this educational module to fellow pregnant women and all participants rated the completion and content of this module at easy or very easy to follow. This education module demonstrates baseline improvement in knowledge of sexual function in pregnancy and increases comfort level of discussing sexual function during prenatal care. Future direction of this study aims to target education in various socioeconomic cultures where intimacy education is not discussed in the clinical setting. Disclosure No.

Comprehension of Physical Activity Promotion Material: A Retrospective and Comparative Analysis

Readability research suggests most physical activity promotion (PAP) materials in circulation are not ready for dissemination. However, these studies are largely based on indirect measures of end-user ability to understand material (i.e., reading grade level, RGL). We advanced knowledge in this area by replicating the cloze procedure study by Cardinal and Seidler (1995), which directly showed lay adults, with a wide range in educational attainment (i.e., ≥ high school diploma; N = 56), could only partially understand a PAP brochure marked for wide dissemination. Limitations of their study included not statistically comparing subgroup scores to interpretive cut-points and using nonrepresentative PAP test material (i.e., RGL equaled 18.52). Our retrospective and comparative analysis of their results (January-April 2023, N = 25) partially confirmed their findings, and we confirmed writing PAP material above the max-recommended RGL (i.e., 8th grade) would likely result in lay adults having inadequate comprehension of these materials.

Indigenously Promoting Acquisition of Basic Reading Skills in Preprimary Grades in Zambezi Region, Namibia

Objective. Through the lens of Lev Vygotsky’s sociocultural theory of how children develop literacy skills, this paper explores how indigenous knowledge (IK) promotes the acquisition of basic reading skills in preprimary grades in Zambezi Region, Namibia. We consider this to be critical as children’s background knowledge plays a pivotal role in the acquisition of new skills, and children’s basic reading skill is not an exception. Therefore, learning contents and children’s potential learning abilities are based on and are informed by their (children’s) environmental knowledge herein understood as societal and environmental motivating learning factors. Materials and Methods. The data were generated by interviewing three preprimary teachers face-to-face, observing their lessons to see how they incorporated elements of IK in their reading lessons, as well as analyzing the preprimary syllabus for segments of IK as an illustration of its (IK) significance in promoting acquisition of reading among learners in preprimary grades in Zambezi region of Namibia. Results. The key question was: How does indigenous knowledge promote the acquisition of reading in preprimary grades in Zambezi region in Namibia? This key question was explored and answered through the following subquestions: How does IK help to promote the basic reading skills of preprimary learners in Zambezi Region of Namibia? What is the importance of IK inclusion in the preprimary literacy curriculum? Conclusions. The study found that teachers understood the concept of IK and how it promotes the acquisition of preprimary learners’ reading skills though this could not be figured out in their lessons, resulting in a huge inconsistency between interview data, lesson observation data and data from preprimary syllabus analysis.

On English Reading Teaching in Junior High School Based on ARCS Learning Motivation Model

In the cultivation of the four basic skills of listening, speaking, reading, and writing in language learning, reading is a more comprehensive reflection of the language application process. However, there are still many problems in the current stage of English reading teaching, which affects the effectiveness of English reading teaching and the improvement of students’ reading ability. Strong reading motivation is a key factor in promoting students to actively learn reading. Professor Keller, a renowned American psychologist, proposed the “ARCS Learning Motivation Model” in 1983, which starts with four elements: Attention, Relevance, Confidence, and Satisfaction, and designs corresponding motivational strategies based on the characteristics of students’ learning motivation and teaching content. This study aims to stimulate students’ reading motivation as a breakthrough point, apply the ARCS learning motivation model to English reading teaching in junior high school, and explore whether English reading teaching based on this model can improve students’ reading motivation and thus improve their reading ability and grades. This research selected two classes in the first grade of a middle school as experimental subjects. The experimental class adopted a reading teaching method based on the ARCS learning motivation model, while the control class adopted traditional reading teaching methods. Through a one-month teaching experiment, the researchers collected and analyzed data from students, including questionnaires, tests, and interviews. Based on the analysis of the research results, this research confirms the effectiveness of middle school English reading teaching based on the ARCS learning motivation model in enhancing students’ reading motivation, improving reading ability, and improving reading performance. This provides useful insights for English reading teaching in junior high school and also serves as a reference for future research in related fields.

Assessing the missions and visions of NCI-designated cancer centers and their affiliated hospitals.

e23118 Background: Mission and vision statements (MVS) help convey an institution's identity and priorities. Missions describe objectives and responsibilities, while visions describe overarching directions for the future. Effectively communicating MVS is particularly important for cancer centers and hospitals seeking to inspire and reach patients and employees. We sought to assess the composition, readability, and topics addressed for MVS provided by NCI-designated cancer centers and their affiliated hospitals. Methods: We extracted MVS data from institutional websites for 65 NCI-designated cancer centers and 59 affiliated hospitals in 2023 (6 cancer centers did not have an affiliated hospital). We determined the composition of statements using word counts and time to read. We assessed the readability of statements using Flesch-Kincaid (FK) reading ease and grade level scores. We reviewed the MVS to determine the presence of four topics: equity, quality care, training, and research. We used descriptive statistics to compare these issues in MVS for cancer center versus the hospital. Results: Among the 65 cancer centers, we found mission statements for 93.9% (61/65) and vision statements for 63.1% (41/65). All affiliated hospitals provided a mission statement and 86.4% (51/59) had a vision statement. Data for composition, readability, and topics addressed for MVS are provided in the table. Overall, readability of MVS was difficult based on FK reading ease scores, with relatively high reading grade levels. Mission statements for cancer centers had a significantly lower reading ease and higher grade level compared with hospitals. In general, mission statements were slightly longer than vision statements, more frequently addressing the topics of quality care, training, and research. Compared with hospitals, cancer centers had a significantly lower frequency of mentioning the topic "training" in their MVS. Conclusions: We found that the majority of NCI-designated cancer centers report mission statements, but fewer provide vision statements. We demonstrated difficult readability for the MVS provided, highlighting a need to consider simpler diction and structure of language. Additionally, our work provides an overview of topics addressed for these statements including equity, quality care, training, and research. These topics underscore the values and priorities of an institution, and this review of MVS provides insights into the messaging that cancer centers communicate. [Table: see text]

Optimizing patient (pt) care through pt-focused resources to prevent and manage hand-foot skin reaction (HFSR).

e24144 Background: Research has shown that pts and caregivers (non-HCPs) seek medical and disease-related information more than once a month, and this has accelerated due to the COVID-19 pandemic. However, they find it difficult to understand the information they receive and thus, can be misinformed. By understanding the use of fair-balanced medical information (MI) resources by non-HCPs, pharmaceutical companies can develop scientifically accurate yet pt-friendly resources to meet their needs (Goettner, 2022; Rai, 2022). Upon reviewing the unsolicited oncology inquiries received by our MI department, approximately 25% of inquiries were from non-HCPs seeking information. Over the past 3 years, non-HCPs have submitted almost 10,000 inquiries regarding our oncology products, in which 191 inquiries were specifically regarding HFSR and regorafenib and sorafenib. Historically, our MI department responded to non-HCP inquiries by sharing the product label information. However, we identified an unmet need for trustworthy, comprehensive, and accurate pt resources in plain language. Methods: A full literature review was performed, and the relevant data were summarized in plain language for pts. Both HCPs and pts participated in developing the global pt resource on the prevention and management of HFSR for regorafenib and sorafenib. The seven-page interactive brochure was written in 4th to 6th grade reading level which included images and graphics to enhance the understanding of data, easy navigation to the content of interest, and glossary to define key terms. Furthermore, these materials were translated for pts who participated in the regorafenib and sorafenib Patient Support Program in Brazil to further educate and support pts who have started therapy. Results: As of June 2023, the global pt medical resource has been deployed 28 times in Brazil, delivering key information to non-HCPs on their disease and treatment while emphasizing its practical utility and addressing health literacy challenges. We collected feedback from pts who utilized the translated material, and they described it to be “informative” and “helpful” since it empowered them to effectively navigate and address HFSR-associated discomforts during their treatment journey. The feedback has also been utilized to further enhance the resource’s feasibility. Conclusions: The pt feedback on the brochures showcases the value of pt-focused approach in oncology and the positive impact of collective efforts across all stakeholders including pts, pharmaceutical MI departments and pt programs. Furthermore, it demonstrates how MI can bridge the gap between pt insights and clinical knowledge by addressing their needs and providing practical and trustworthy tools. Not only does this initiative enhance pt understanding but also empowers pts to take a more active role in their treatment and fosters shared-decision making.

Acceptance and usability testing of a visual care-navigation tool for patients, survivors, caregivers, nurses, and oncologists.

e13064 Background: Breast cancer patients (BCP) and family caregivers (CG) describe their experience as a difficult hike, without access to a map, relevant gear, or a guide. The shrinking oncologist workforce has ~24 minutes per patient to communicate the condition, treatment plan and answer questions. Many use hand-drawn visuals – analogous to a map or process flow diagrams. 97% of BCP use Dr. Google™, which results in “Cancer Information Overload” and non-evidence-based activities. A team of survivors, cartographers, and oncologists developed an interactive cancer map and self-management platform to coach BCP to navigate treatment. Using equitable design, features include: (a) 7th grade reading level; (b) written content and audio/video assets; (c) supporting the user from diagnosis through survivorship to make the platform accessible to a diverse population. After acceptance testing showed high willingness to use & recommend (ASCO Quality 2023;552), we tested the platform’s usability through observed use and task-analysis. Methods: A convenience sample of BCP, CG and oncology HCP [including advanced practice providers (APP)] underwent a usability test in two waves. We defined a set of tasks the users should be able to accomplish. We observed the users during a 30-minute virtual session and recorded the session, noted the task accomplishments, and any issues. Issues from wave 1 were addressed and incorporated into the test for wave 2. Results: We tested two waves of users between November 30, 2023 and February 1, 2024. The results are shown in the table. After wave 1, we modified the platform and tested the maps with wave 2 users. Two core usability features were added between waves: (a) user drill down to access a more detailed level of the map; (b) a product tour guiding the user through the tool, which addressed qualitative user observations that showed initial confusion as to how to begin navigation. Conclusions: Cartographically represented maps of the cancer journey and the self-management tools are acceptable to BCP, survivors, and CG and are usable. Per the ASCO Quality 2023;552 poster, the platform is acceptable to HCPs and not perceived to increase work, and APPs found value in the platform to enable education. Features have been added to ensure a diverse population can easily use the platform including guided walk through and welcome videos. [Table: see text]

A Decision Aid for Patients Considering Surgery for Sciatica: Codesign and User-Testing With Patients and Clinicians.

Surgery can help patients with leg pain caused by sciatica recover faster, but by 12 months outcomes are similar to nonsurgical management. For many the decision to have surgery may require reflection, and patient decision aids are an evidence-based clinical tool that can help guide patients through this decision. The aim of this study was to develop and refine a decision aid for patients with sciatica who are deciding whether to have surgery or 'wait and see' (i.e., try nonsurgical management first). Semistructured interviews with think-aloud user-testing protocol. Twenty clinicians and 20 patients with lived experience of low back pain or sciatica. Items from Technology Acceptance Model, Preparation for Decision Making Scale and Decision Quality Instrument for Herniated Disc 2.0 (knowledge instrument). The prototype integrated relevant research with working group perspectives, decision aid standards and health literacy guidelines. The research team refined the prototype through seven rounds of user-testing, which involved discussing user-testing feedback and implementing changes before progressing to the next round. As a result of working group feedback, the decision aid was divided into sections: before, during and after a visit to the surgeon. Across all rounds of user-testing, clinicians rated the resource 5.9/7 (SD = 1.0) for perceived usefulness, and 6.0/7 for perceived ease of use (SD = 0.8). Patients reported the decision aid was easy to understand, on average correctly answering 3.4/5 knowledge questions (SD = 1.2) about surgery for sciatica. The grade reading score for the website was 9.0. Patients scored highly on preparation for decision-making (4.4/5, SD = 0.7), suggesting strong potential to empower patients. Interview feedback showed that patients and clinicians felt the decision aid would encourage question-asking and help patients reflect on personal values. Clinicians found the decision aid acceptable, patients found it was easy to understand and both groups felt it would empower patients to actively engage in their care and come to an informed decision that aligned with personal values. Input from the working group and user-testing was crucial for ensuring that the decision aid met patient and clinician needs. Patients and clinicians contributed to prototype development via the working group.

A cross-sectional quantitative analysis of the readability and quality of online resources regarding thumb carpometacarpal joint replacement surgery

BackgroundThumb carpometacarpal (CMC) joint osteoarthritis is a common degenerative condition that affects up to 15 ​% of the population older than 30 years. Poor readability of online health resources has been associated with misinformation, inappropriate care, incorrect self-treatment, worse health outcomes, and increased healthcare resource waste. This study aims to assess the readability and quality of online information regarding thumb carpometacarpal (CMC) joint replacement surgery. MethodsThe terms “thumb joint replacement surgery”, “thumb carpometacarpal joint replacement surgery”, “thumb cmc joint replacement surgery”, “thumb arthroplasty”, “thumb carpometacarpal arthroplasty”, and “thumb cmc arthroplasty” were searched in Google and Bing. Readability was determined using the Flesch Reading Ease Score (FRES) and the Flesch-Kincaid Reading Grade Level (FKGL). FRES >65 or a grade level score of sixth grade and under was considered acceptable. Quality was assessed using the Patient Education Materials Assessment Tool (PEMAT) and a modified DISCERN tool. PEMAT scores below 70 were considered poorly understandable and poorly actionable. ResultsA total of 34 websites underwent qualitative analysis. The average FRES was 54.60 ​± ​7.91 (range 30.30–67.80). Only 3 (8.82 ​%) websites had a FRES score >65. The average FKGL score was 8.19 ​± ​1.80 (range 5.60–12.90). Only 3 (8.82 ​%) websites were written at or below a sixth-grade level. The average PEMAT percentage score for understandability and actionability was 76.82 ​± ​9.43 (range 61.54–93.75) and 36.18 ​± ​24.12 (range 0.00–60.00) respectively. Although 22 (64.71 ​%) of websites met the acceptable standard of 70 ​% for understandability, none of the websites met the acceptable standard of 70 ​% for actionability. The average total DISCERN score was 32.00 ​± ​4.29 (range 24.00–42.00). ConclusionsMost websites reviewed were written above recommended reading levels. Most showed acceptable understandability but none showed acceptable actionability. To avoid the negative outcomes of poor patient understanding of online resources, providers of these resources should optimise accessibility to the average reader by using simple words, avoiding jargon, and analysing texts with readability software before publishing the materials online. Websites should also utilise visual aids and provide clearer pre-operative and post-operative instructions.

English Teachers’ Perceptions of the Importance of Essential Components and Early Grade Reading Instruction

This study examines English teachers’ perceptions of the importance of essential components and early grade reading instruction: Ethiopian context. To this end, the researchers chose a descriptive research design of quantitative-qualitative approaches. Twenty (20) randomly selected primary schools were the sources of data; 125 primary school English teachers of Hawassa City Administration filled in a questionnaire. Among the twenty schools, two were selected randomly and interviews were conducted with six English teachers of grades one to three (1-3). The quantitative data analysis was done by using software for data analysis (SPSS Version 25.0), descriptive statistics. The data gathered through semi-structured interview were analyzed descriptively in words. The results have shown that participant teachers were not practicing the strategies appropriate for literacy instruction although they have positive perceptions of importance of the critical components of early grade reading instruction. Therefore, it is strongly recommended that teacher preparation programs should reconsider the level of emphasis placed on early grade reading instruction, and practice focused trainings should be given to Ethiopian lower grades English teachers on early grade reading instruction and assessment.

Reliability and readability analysis of ChatGPT-4 and Google Bard as a patient information source for the most commonly applied radionuclide treatments in cancer patients

PurposeSearching for online health information is a popular approach employed by patients to enhance their knowledge for their diseases. Recently developed AI chatbots are probably the easiest way in this regard. The purpose of the study is to analyze the reliability and readability of AI chatbot responses in terms of the most commonly applied radionuclide treatments in cancer patients. MethodsBasic patient questions, thirty about RAI, PRRT and TARE treatments and twenty-nine about PSMA-TRT, were asked one by one to GPT-4 and Bard on January 2024. The reliability and readability of the responses were assessed by using DISCERN scale, Flesch Reading Ease(FRE) and Flesch-Kincaid Reading Grade Level(FKRGL). ResultsThe mean (SD) FKRGL scores for the responses of GPT-4 and Google Bard about RAI, PSMA-TRT, PRRT and TARE treatmens were 14.57 (1.19), 14.65 (1.38), 14.25 (1.10), 14.38 (1.2) and 11.49 (1.59), 12.42 (1.71), 11.35 (1.80), 13.01 (1.97), respectively. In terms of readability the FRKGL scores of the responses of GPT-4 and Google Bard about RAI, PSMA-TRT, PRRT and TARE treatments were above the general public reading grade level. The mean (SD) DISCERN scores assesses by nuclear medicine phsician for the responses of GPT-4 and Bard about RAI, PSMA-TRT, PRRT and TARE treatments were 47.86 (5.09), 48.48 (4.22), 46.76 (4.09), 48.33 (5.15) and 51.50 (5.64), 53.44 (5.42), 53 (6.36), 49.43 (5.32), respectively. Based on mean DISCERN scores, the reliability of the responses of GPT-4 and Google Bard about RAI, PSMA-TRT, PRRT, and TARE treatments ranged from fair to good. The inter-rater reliability correlation coefficient of DISCERN scores assessed by GPT-4, Bard and nuclear medicine physician for the responses of GPT-4 about RAI, PSMA-TRT, PRRT and TARE treatments were 0.512(95% CI 0.296: 0.704), 0.695(95% CI 0.518: 0.829), 0.687(95% CI 0.511: 0.823) and 0.649 (95% CI 0.462: 0.798), respectively (p < 0.01). The inter-rater reliability correlation coefficient of DISCERN scores assessed by GPT-4, Bard and nuclear medicine physician for the responses of Bard about RAI, PSMA-TRT, PRRT and TARE treatments were 0.753(95% CI 0.602: 0.863), 0.812(95% CI 0.686: 0.899), 0.804(95% CI 0.677: 0.894) and 0.671 (95% CI 0.489: 0.812), respectively (p < 0.01). The inter-rater reliability for the responses of Bard and GPT-4 about RAİ, PSMA-TRT, PRRT and TARE treatments were moderate to good. Further, consulting to the nuclear medicine physician was rarely emphasized both in GPT-4 and Google Bard and references were included in some responses of Google Bard, but there were no references in GPT-4. ConclusionAlthough the information provided by AI chatbots may be acceptable in medical terms, it can not be easy to read for the general public, which may prevent it from being understandable. Effective prompts using 'prompt engineering' may refine the responses in a more comprehensible manner. Since radionuclide treatments are specific to nuclear medicine expertise, nuclear medicine physician need to be stated as a consultant in responses in order to guide patients and caregivers to obtain accurate medical advice. Referencing is significant in terms of confidence and satisfaction of patients and caregivers seeking information.

Evaluating ChatGPT-3.5 and ChatGPT-4.0 Responses on Hyperlipidemia for Patient Education.

Introduction Hyperlipidemia is prevalent worldwide and affects a significant number of USadults. It significantly contributes to ischemic heart disease and millions of deaths annually. With the increasing use of the internet for health information, tools like ChatGPT (OpenAI, San Francisco, CA, USA) have gained traction. ChatGPT version 4.0, launched in March 2023, offers enhanced features over its predecessor but requires a monthly fee. This study compares the accuracy, comprehensibility, and response length of the free and paid versions of ChatGPT for patient education on hyperlipidemia. Materials and methods ChatGPT versions 3.5 and 4.0 were prompted in three different ways and 25 questions from the Cleveland Clinic's frequently asked questions (FAQs) on hyperlipidemia. Prompts includedno prompting (Form 1), patient-friendly prompting (Form 2), and physician-level prompting (Form 3). Responses were categorized as incorrect, partially correct, or correct. Additionally, the grade level and word count from each response were recorded for analysis. Results Overall, scoring frequencies for ChatGPT version 3.5 were: five (6.67%) incorrect, 18 partially correct (24%), and 52 (69.33%) correct. Scoring frequencies for ChatGPT version 4.0 were: one (1.33%) incorrect, 18 (24.00%) partially correct, and 56 (74.67%) correct. Correct answers did not significantly differ between ChatGPT version 3.5 and ChatGPT version 4.0 (p = 0.586). ChatGPT version 3.5 had a significantly higher grade reading level than version 4.0 (p = 0.0002). ChatGPT version 3.5 had a significantly higher word count than version 4.0 (p = 0.0073). Discussion There was no significant difference in accuracy between the free and paid versions of hyperlipidemia FAQs. Both versions provided accurate but sometimes partially complete responses. Version 4.0 offered more concise and readable information, aligning with the readability of most online medical resources despite exceeding the National Institutes of Health's (NIH's) recommended eighth-grade reading level. The paid version demonstrated superior adaptability in tailoring responses based on the input. Conclusion Both versions of ChatGPT provide reliable medical information, with the paid version offering more adaptable and readable responses. Healthcare providers can recommend ChatGPT as a source of patient education, regardless of the version used. Future research should explore diverse question formulations and ChatGPT's handling of incorrect information.

Are plain language summaries more readable than scientific abstracts? Evidence from six biomedical and life sciences journals.

In recent decades, members of the general public have become increasingly reliant on findings of scientific studies for decision-making. However, scientific writing usually features a heavy use of technical language, which may pose challenges for people outside of the scientific community. To alleviate this issue, plain language summaries were introduced to provide a brief summary of scientific papers in clear and accessible language. Despite increasing attention paid to the research of plain language summaries, little is known about whether these summaries are readable for the intended audiences. Based on a large corpus sampled from six biomedical and life sciences journals, the present study examined the readability and jargon use of plain language summaries and scientific abstracts on a technical level. It was found that (1) plain language summaries were more readable than scientific abstracts, (2) the reading grade levels of plain language summaries were moderately correlated with that of scientific abstracts, (3) researchers used less jargon in plain language summaries than in scientific abstracts, and (4) the readability of and the jargon use in both plain language summaries and scientific abstracts exceeded the recommended threshold for the general public. The findings were discussed with possible explanations. Implications for academic writing and scientific communication were offered.

Performance of an online chat-based artificial intelligence interface for patient education on atrial fibrillation ablation

Abstract Background Chat-based artificial intelligence (AI) web interfaces that aim to mimic human conversation have increasing utilization in healthcare to help with simple tasks such as scheduling appointments, and even more complex tasks such as providing patient educational responses to COVID-19 questions as done by the World Health Organization.1 Chat-based AI has also been shown to provide accurate responses to cardiovascular disease prevention questions.2 Its ability to provide patient education for more complex treatments like atrial fibrillation (AF) ablation has not been explored. Purpose To evaluate the quality of a popular chat-based AI program’s answers to patient questions about AF ablation. Methods Twenty commonly asked questions ("prompts") regarding AF ablation were entered into ChatGPT (Chat Generative Pre-trained Transformer), a large language model-based AI program (Fig. 1). Prompts were written in plain language; technical terms were avoided except for "radiofrequency", "cryoablation" and "pulsed field ablation" (PFA). SMOG readability calculator was used to assess responses for difficulty and grade-level, as healthcare organizations recommend ≤ 8th-grade level complexity for patient information. Response content was graded by 3 experienced cardiac electrophysiologists as "reasonable", "missing important elements/some inaccuracies" or "misleading/inappropriate". Responses are presented in mean +/- standard deviation and percentages. Results Responses averaged 118±67 words (Fig. 1). Of 20 responses, 17 (85%) were deemed reasonable, 3 (15%) missing important elements/some inaccuracies and none inappropriate or misleading; 16 (80%) emphasized discussion of issues with the healthcare team (Fig. 2). Responses missing important elements/some inaccuracies were those about risks/complications of ablation [missing phrenic nerve palsy, atrioesophageal fistula (AEF), potential need for emergent cardiac surgery or pacemaker, death], concerning symptoms post-procedure (missing symptoms of hematoma, AEF, stroke), and that PFA is not yet approved for use in all regions. Average reading grade level of responses was 13.8 (college level or "professional"): 17 (85%) responses were 12th grade level, 11 (55%) were college-level or higher, and 6 (30%) were college-graduate level ("extremely difficult"). None were ≤ 8th grade level (Fig. 2). Conclusions A majority of ChatGPT responses to common patient questions about AF ablation had reasonable content quality that frequently emphasized the importance of discussion with the healthcare team. However, responses to more difficult questions regarding risks, symptoms of potential complications, or newer technology missed important details; more than half of responses required college-level reading skills. While use of Chat-AI for patient education on EP topics appears promising, patients should be advised to use caution. Further AI training to improve content and readability should be explored.

A quality and readability comparison of artificial intelligence and popular health website education materials for common hand surgery procedures

IntroductionChatGPT and its application in producing patient education materials for orthopedic hand disorders has not been extensively studied. This study evaluated the quality and readability of educational information pertaining to common hand surgeries from patient education websites and information produced by ChatGPT. MethodsPatient education information for four hand surgeries (carpal tunnel release, trigger finger release, Dupuytren’s contracture, and ganglion cyst surgery) was extracted from ChatGPT (at a scientific and fourth-grade reading level), WebMD, and Mayo Clinic. In a blinded and randomized fashion, five fellowship-trained orthopaedic hand surgeons evaluated the quality of information using a modified DISCERN criteria. Readability and reading grade level were assessed using Flesch Reading Ease (FRE) and Flesch-Kincaid Grade Level (FKGL) equations. ResultsThe Mayo Clinic website scored higher in terms of quality for carpal tunnel release information (p = 0.004). WebMD scored higher for Dupuytren’s contracture release (p < 0.001), ganglion cyst surgery (p = 0.003), and overall quality (p < 0.001). ChatGPT - 4th Grade Reading Level, ChatGPT - Scientific Reading Level, WebMD, and Mayo Clinic written materials on average exceeded recommended reading grade levels (4th–6th grade) by at least four grade levels (10th, 14th, 13th, and 11th grade, respectively). ConclusionsChatGPT provides inferior education materials compared to patient-friendly websites. When prompted to provide more easily read materials, ChatGPT generates less robust information compared to patient-friendly websites and does not adequately simplify the educational information. ChatGPT has potential to improve the quality and readability of patient education materials but currently, patient-friendly websites provide superior quality at similar reading comprehension levels.

A Cross-Sectional Analysis of the Readability of Online Information Regarding Hip Osteoarthritis.

Introduction Osteoarthritis (OA) is an age-related degenerative joint disease. There is a 25% risk of symptomatic hip OA in patients who live up to 85 years of age. It can impair a person's daily activities and increase their reliance on healthcare services. It is primarily managed with education, weight loss and exercise, supplemented with pharmacological interventions. Poor health literacy is associated with negative treatment outcomes and patient dissatisfaction. A literature search found there are no previously published studies examining the readability of online information about hip OA. Objectives To assess the readability of healthcare websites regarding hip OA. Methods The terms "hip pain", "hip osteoarthritis", "hip arthritis", and "hip OA" were searched on Google and Bing. Of 240 websites initially considered, 74 unique websites underwent evaluation using the WebFX online readability software (WebFX®, Harrisburg, USA). Readability was determined using the Flesch Reading Ease Score (FRES), Flesch-Kincaid Reading Grade Level (FKGL), Gunning Fog Index (GFI), Simple Measure of Gobbledygook (SMOG), Coleman-Liau Index (CLI), and Automated Readability Index (ARI). In line with recommended guidelines and previous studies, FRES >65 or a grade level score of sixth grade and under was considered acceptable. Results The average FRES was 56.74±8.18 (range 29.5-79.4). Only nine (12.16%) websites had a FRES score >65. The average FKGL score was 7.62±1.69 (range 4.2-12.9). Only seven (9.46%) websites were written at or below a sixth-grade level according to the FKGL score. The average GFI score was 9.20±2.09 (range 5.6-16.5). Only one (1.35%) website was written at or below a sixth-grade level according to the GFI score.The average SMOG score was 7.29±1.41 (range 5.4-12.0). Only eight (10.81%) websites were written at or below a sixth-grade level according to the SMOG score. The average CLI score was 13.86±1.75 (range 9.6-19.7). All 36 websites were written above a sixth-grade level according to the CLI score. The average ARI score was 6.91±2.06 (range 3.1-14.0). Twenty-eight(37.84%) websites were written at or below a sixth-grade level according to the ARI score. One-sample t-tests showed that FRES (p<0.001, CI -10.2 to -6.37), FKGL (p<0.001, CI 1.23 to 2.01), GFI (p<0.001, CI 2.72 to 3.69), SMOG (p<0.001, CI 0.97 to 1.62), CLI (p<0.001, CI 7.46 to 8.27), and ARI (p<0.001, CI 0.43 to 1.39) scores were significantly different from the accepted standard. One-way analysis of variance (ANOVA) testing of FRES scores (p=0.009) and CLI scores (p=0.009) showed a significant difference between categories. Post hoc testing showed a significant difference between academic and non-profit categories for FRES scores (p=0.010, CI -15.17 to -1.47) and CLI scores (p=0.008, CI 0.35 to 3.29). Conclusions Most websites regarding hip OA are written above recommended reading levels, hence exceeding the comprehension levels of the average patient. Readability of these resources must be improved to improve patient access to online healthcare information which can lead to improved patient understanding of their own condition and treatment outcomes.

Evaluation of the Current Status of Artificial Intelligence for Endourology Patient Education: A Blind Comparison of ChatGPT and Google Bard Against Traditional Information Resources.

Introduction: Artificial intelligence (AI) platforms such as ChatGPT and Bard are increasingly utilized to answer patient health care questions. We present the first study to blindly evaluate AI-generated responses to common endourology patient questions against official patient education materials. Methods: Thirty-two questions and answers spanning kidney stones, ureteral stents, benign prostatic hyperplasia (BPH), and upper tract urothelial carcinoma were extracted from official Urology Care Foundation (UCF) patient education documents. The same questions were input into ChatGPT 4.0 and Bard, limiting responses to within ±10% of the word count of the corresponding UCF response to ensure fair comparison. Six endourologists blindly evaluated responses from each platform using Likert scales for accuracy, clarity, comprehensiveness, and patient utility. Reviewers identified which response they believed was not AI generated. Finally, Flesch-Kincaid Reading Grade Level formulas assessed the readability of each platform response. Ratings were compared using analysis of variance (ANOVA) and chi-square tests. Results: ChatGPT responses were rated the highest across all categories, including accuracy, comprehensiveness, clarity, and patient utility, while UCF answers were consistently scored the lowest, all p < 0.01. A subanalysis revealed that this trend was consistent across question categories (i.e., kidney stones, BPH, etc.). However, AI-generated responses were more likely to be classified at an advanced reading level, while UCF responses showed improved readability (college or higher reading level: ChatGPT = 100%, Bard = 66%, and UCF = 19%), p < 0.001. When asked to identify which answer was not AI generated, 54.2% of responses indicated ChatGPT, 26.6% indicated Bard, and only 19.3% correctly identified it as the UCF response. Conclusions: In a blind evaluation, AI-generated responses from ChatGPT and Bard surpassed the quality of official patient education materials in endourology, suggesting that current AI platforms are already a reliable resource for basic urologic care information. AI-generated responses do, however, tend to require a higher reading level, which may limit their applicability to a broader audience.

Challenges of teaching isiZulu reading in the early grades

The present study was conducted at a time when South African educational researchers and practitioners have become increasingly concerned about the state of the reading competence of the country’s primary school learners. Another concern that also drove this study was the teaching practices of foundation phase teachers, specifically regarding the current ‘science of reading’ (SoR). In a cross-sectional study of Grades 1–3 learners and their teachers in a primary school in Soweto, Johannesburg, the aim was to capture not only the reading competence of the learners, but also the teachers’ pedagogy and their reflections about their work. To this end, 263 learners were randomly selected from a population of 2 001, along with 24 teachers. Classroom practice was observed and recorded, and interviews with teachers were conducted over a period of six weeks during the third school term in 2019, while the selected learners completed the Early Grade Reading Assessment (EGRA). The outcome of the qualitative data from the classroom observations and the interviews with teachers captured their struggle with instructional methods. The assessment results show young learners’ worryingly low scores, leaving teachers with the urgent pedagogical challenge of teaching reading that could lead to learners’ improved performance.

Predictors of reading comprehension and profiling of poor readers in Croatian: educational and clinical perspectives.

Reading is an important academic skill. Children who exhibit reading difficulties are more likely to experience various negative professional and personal consequences. To successfully identify children with reading problems as early as possible, one must first understand how reading skills can be mastered, as well as the course of reading development in children with typical reading skills from the beginning of their formal reading instruction. Thus, the purpose of this study was to determine the influence of decoding and language comprehension on reading comprehension ability. In addition, this study aimed to determine types of profiles among poor readers and estimate their frequency in the study sample. Based on the Simple View of Reading model, we developed decoding, language comprehension, and reading comprehension tasks. Participants included 100 typical readers (TR) and 95 poor readers (PR) in the second grade in Croatian schools. Phonemic awareness, phonological working memory, and rapid automatized naming tasks were used to test underlying abilities of decoding skills in both groups of participants. As expected, PRs showed significantly lower performance on all variables than TRs. The correlations between decoding, language comprehension and reading comprehension are significant in the PR group. The linear regression analysis showed that language comprehension was a significant predictor of reading comprehension for TRs, while decoding and language comprehension were significant predictors of reading comprehension for PRs. The profiling of reading difficulties revealed five different profiles, the most common of which was a mixed reading difficulty, i.e., difficulties in both decoding and language comprehension. In line with theoretical expectations, success in reading comprehension in TRs at the end of the second grade depends mainly on language comprehension. To achieve this complex cognitive skill, PRs' language comprehension alone is not sufficient, so they still rely on their decoding skills. Among the poor readers, there was a high prevalence of children with decoding problems (i.e., three out of five profiles). Teachers should be able to identify and monitor decoding difficulties in children, since these difficulties are associated with noticeable manifestations, unlike those associated with comprehension difficulties.

Burn Model System educational outputs: Domestic and global dissemination

Knowledge translation and consumer testing aims to move research findings from scientists, professional journals, and conferences to the hands of end-users and organizations who use the information regularly. The purpose of this report is to outline the process by which the Burn Model System (BMS) has worked with the Model System Knowledge Translation Center (MSKTC) to develop and disseminate patient education materials to consumers. The National Institute on Disability, Independent Living, and Rehabilitation Research-funded BMS in collaboration with the MSKTC uses a multi-step process for developing and consumer-testing evidence-based/consensus-derived educational information prioritized by consumers. The final written products are made available in both English and Spanish at/below an 8th grade reading level. Products are disseminated through websites, clinical encounters, social media, and national/international engagement with clinicians and burn-related organizations. Written products are reviewed every five years to ensure they remain current and relevant. Number of online views for each product is a key measure of dissemination. Since 2011, the collaboration between the BMS and the MSKTC has produced or updated 22 educational factsheets, three videos, three infocomics, and one infographic. Collectively, these products have been viewed over two million times by people in 216 countries. Online views of all products have generally increased year-to-year. This process makes relevant health information accessible and understandable for consumers. As a result, Burn Model System informational products have been increasingly viewed by US and international consumers.