Seventh-grade Level Research Articles

Can Patients Comprehend the Educational Materials that Hospitals Provide about Common IR Procedures?

PurposeTo assess the readability of online education materials offered by hospitals describing commonly performed interventional radiology (IR) procedures. Materials and MethodsOnline patient education materials from 402 hospitals selected from the Medicare Hospital Compare database were assessed. The presence of an IR service was determined by representation in the Society of Interventional Radiology physician finder directory. Patient online education materials about (i) uterine artery embolization for fibroid tumors, (ii) liver cancer embolization, (iii) varicose vein treatment, (iv) central venous access, (v) inferior vena cava (IVC) filter placement, (vi) nephrostomy tube insertion, (vii) gastrostomy tube placement, and (viii) vertebral augmentation were targeted and assessed by using six validated readability scoring systems. ResultsOf 402 hospitals sampled, 156 (39%) were presumed to offer IR services. Of these, 119 (76%) offered online patient education material for one or more of the eight service lines. The average readability scores corresponding to grade varied between the ninth- and 12th-grade levels. All were higher than the recommended seventh-grade level (P < .05) except for nephrostomy and gastrostomy tube placement. Average Flesch-Kincaid Reading Ease scores ranged from 42 to 69, corresponding with fairly difficult to difficult readability for all service lines except IVC filter and gastrostomy tube placement, which corresponded with standard readability. ConclusionsA majority of hospitals offering IR services provide at least some online patient education material. Most, however, are written significantly above the reading comprehension level of most Americans. More attention to health literacy by hospitals and IR physicians is warranted.

Health literacy and online educational resources: an opportunity to educate patients.

Given the increasing accessibility of material on the Internet and the use of these materials by patients as a source of health care information, the purpose of this study was to quantitatively evaluate the level of readability of resources made available on the European Society of Radiology website to determine whether these materials meet the health literacy needs of the general public as set forth by guidelines of the U.S. National Institutes of Health (NIH) and the American Medical Association (AMA). All 41 patient education articles created by the European Society of Radiology (ESR) were downloaded and analyzed with the following 10 quantitative readability scales: the Coleman-Liau Index, Flesch-Kincaid Grade Level, Flesch Reading Ease, FORCAST Formula, Fry Graph, Gunning Fog Index, New Dale-Chall, New Fog Count, Raygor Reading Estimate, and the Simple Measure of Gobbledygook. The 41 articles were written collectively at a mean grade level of 13.0 ± 1.6 with a range from 10.8 to 17.2. For full understanding of the material, 73.2% of the articles required the reading comprehension level of, at minimum, a high school graduate (12th grade). The patient education resources on the ESR website are written at a comprehension level well above that of the average Internet viewer. The resources fail to meet the NIH and AMA guidelines that patient education material be written between the third and seventh grade levels. Recasting these resources in a simpler format would probably lead to greater comprehension by ESR website viewers.

Academic skills of chronically unemployed drug-addicted adults.

The strong association between unemployment and drug addiction suggests that employment interventions are an important and needed focus of drug-addiction treatment. The increasing necessity of possessing basic academic skills to function in the workplace may require that some individuals receive educational training along with vocational training. This study investigated the academic skills of drug-addicted and chronically-unemployed adults (N = 559) who were enrolled in one of six studies conducted at the Center for Learning and Health in Baltimore, MD. Upon study enrollment, academic skills in math, spelling, and reading were examined using the Wide Range Achievement Test (WRAT-3 or WRAT-4) and educational history was examined using the Addiction Severity Index-Lite. Although participants completed an average of 11 years of education, actual academic skill level was at or below the seventh grade level for 81% of participants in math, 61% in spelling, and 43% in reading, and most participants were classified as Low Average or below based on age group norms. Despite the fact that participants in this analysis were studied across several years and were from diverse populations, rates of high school completion and academic skill levels were remarkably similar. Programs designed to improve the long-term employment status of drug-addicted individuals may benefit from the inclusion of basic adult education; future research on the topic is needed. Although establishing basic skills does not directly address chronic unemployment, it may help individuals obtain the jobs they desire and function effectively in those jobs.

Quality assessment of online patient education resources for peripheral neuropathy

Given its practicality, the internet is a primary resource for patients afflicted with diseases like peripheral neuropathy. Therefore, it is important that the readily available online resources on peripheral neuropathy are tailored to the general public, particularly concerning readability. Patient education resources were downloaded from the US National Library of Medicine, Mayo Clinic, National Institute of Neurological Disorders and Stroke, Neuropathy.org, GBS/CIDP Foundation International, Hereditary Neuropathy Foundation, Charcot-Marie-Tooth Association, Foundation for Peripheral Neuropathy, and Neuropathy Action Foundation websites. All patient education material related to peripheral neuropathy was evaluated for its level of readability using the Flesch Reading Ease (FRE) and Flesch-Kincaid Grade Level. The FRE scores averaged 43.4 with only the US National Library of Medicine scoring above 60 (76.5). The Flesch-Kincaid Grade Level scores averaged 11.0. All scores were above a seventh-grade level except the US National Library of Medicine, which had a score of a fifth-grade reading level. Most Americans may not fully benefit from patient education resources concerning peripheral neuropathy education on many of the websites. Only the US National Library of Medicine, which is written at a fifth-grade level, is likely to benefit the average American.

Development and Preliminary Validation of a Simplified-Wording Form of the Multidimensional Personality Questionnaire

The Multidimensional Personality Questionnaire (MPQ) assesses a range of personality characteristics pertaining to affective and interpersonal style, behavioral restraint versus disinhibition, and capacity for sensory and imaginal engagement. Its 11 lower order trait scales map onto 3 higher order factors that reflect temperament dimensions. Its content and measurement properties have made the MPQ useful for elucidating constructs relevant to normal and abnormal behavior and investigating their neurobiological underpinnings. However, a barrier to its use in certain populations is the reading difficulty of some MPQ items. We describe efforts to develop a simplified-wording form, the MPQ-SF, composed of items readable at or below the seventh grade level (with most below sixth grade). Simplified-wording items demonstrated high convergence with original-wording items, and resulting trait scales showed adequate internal consistencies and appropriate higher order structure. The availability of a simplified version expands the potential utility of the MPQ to a wider range of samples.

Cognitive Testing and Readability of an Item Bank for Measuring the Impact of Headache on Health-Related Quality of Life

Patient-reported outcomes (PRO) measures should be valid and accessible to a wide audience. Cognitive item testing and readability studies were conducted to evaluate how adult headache sufferers (N = 9) understood and responded to the Headache Impact Test (HIT™) item bank, a PRO measure for headache that serves as the source of item content for the HIT-6™ (a widely used six-item short-form measure of headache impact with more than 30 language translations), and the Dynamic Health Assessment Headache Impact Test (DYNHA® HIT™) [a computerized adaptive test (CAT) of headache impact]. During cognitive interviews, participants were asked to 'think aloud' as they read survey instructions, completed items, and formulated responses. Data analyses evaluated item comprehension, memory recall of relevant information, and decision and response processes; compared various item attributes; and tested shortened item versions. Survey readability was at the seventh-grade level. Respondents understood most revised items as intended, and found shorter items comparable to longer items with some exceptions. When recall period was included in instructions but not within the items themselves, respondents often expanded the recall period to answer the item. Some response scales (e.g. "Never" to "Always") were more readily understood than others (e.g. "Definitely true" to "Definitely false"). Qualitative research can improve the validity and accessibility of PRO measures that are used to monitor health conditions and aid patient-provider communication.

Students’ Science Process Skills within a Cognitive Domain Framework

The purpose of this study was to investigate Turkish primary students’ scientific process skills under the theoretical framework of cognitive domain. The sample set consisted of 306 sixth and seventh grade students from public, private, and bussed schools. The Turkish Integrated Process Skill Test was used to measure scientific process skills, and the findings showed generally low scores. However, results indicated significant differences between sixth and seventh grade students at private and public schools. In addition, significant differences emerged among sixth grade students at each school type. Private school students had higher scores compared to public and bussed school students. Similarly, a significant difference was determined between sixth grade students at public and bussed schools. At the seventh grade level, private school students scored significantly higher than students at public and bussed schools. These differences are explained and discussed under the framework of cognitive domain and possible reasons for science achievement are identified.

Cues to Starting CPAP in Obstructive Sleep Apnea: Development and Validation of the Cues to CPAP Use Questionnaire

The reasons that a patient has to start treatment, their "Cues to Action", are important for determining subsequent health behaviors. Cues to action are an explicit component of the Health Belief Model of continuous positive airway pressure (CPAP) acceptance. At present, there is no scale available to measure this construct for individuals with obstructive sleep apnea (OSA). This paper aims to develop, validate, and describe responding patterns within a sample of patients with OSA to the Cues to CPAP Use Questionnaire (CCUQ). Participants were 63 adult patients diagnosed with OSA who had never tried CPAP when initially recruited. The CCUQ was completed at 1 month after being prescribed CPAP. Exploratory factor analysis (EFA) showed a 3-factor structure of the 9-item CCUQ, with "Health Cues", "Partner Cues", and "Health Professional Cues" subscales accounting for 59.91% of the total variance. The CCUQ demonstrated modest internal consistency and split-half reliability. The questionnaire is brief and user friendly, with readability at a seventh-grade level. The most frequently endorsed cues for starting CPAP were Health Professional Cues (prompting by the sleep physician) and Health Cues such as tiredness and concern about health outcomes. This study validates a measure of an important motivational component of the Health Belief Model. Health Professional Cues and internal Health Cues were reported to be the most important prompts to commence CPAP by this patient sample.

Setting Standards: An Exercise in Futility?

THE BIOLOGY teacher was stunned when he saw the reading achievement levels of the 24 10th-graders in his class. He knew there were high and low performers, but the range, third-grade level at the bottom to a grade level of 18.6 at the top, was mind boggling. Maybe this was a reason the little prodigy was such a royal pain, and maybe this explained why a third of the class was having such difficulty meeting the biology standards required on the Gateway exam. No wonder a row of nearly comatose students arrayed along the back of the room required constant prodding from the teaching intern to even appear attentive. Maybe mastery of the biology standards was out of reach for many of his students. Nine students in the class were reading at or below the eighth-grade level. Seven were reading in the ninth- to 10thgrade range, and eight were at the 11th-grade level or higher. The biology text for the class had a 10.2 readability level. The teacher acknowledged that the textbook was too difficult for about one-third of his students, and he asked me if this remarkable range of reading proficiency was an aberration. I answered that it was not remarkable, not an aberration, and was indeed representative of the reading levels of 10th-graders across the country. It is an unfortunate fact that high school teachers in every state find themselves in the same position as this biology teacher. They do not know the reading levels of their students or how closely their instructional activities and materials match the abilities of their students. So let's consider some difficult and rarely asked questions. Why are we certain that student performance should have a minimum standard level set at each grade? Why aren't we as accepting of variation in the academic performance of children as we are of variation in their musical, mechanical, artistic, and athletic aptitudes? Why do we deny that children differ from one another in readiness for learning and in rates of mastering basic skills at least as much as they do in these other areas? The likely answer is that, like the 10thgrade biology teacher, we simply don't know how diverse our students are. What does the range of reading skills look like in each grade from first to 12th across the nation? Figure 1 illustrates graphically these grade-by-grade ranges. The data to prepare this figure were mined from the 1998 Normative Update for the Peabody Individual Achievement Test-Revised (PIAT-R). (1) [FIGURE 1 OMITTED] The chart reflects a representative sample of 3,184 students in kindergarten through grade 12. The horizontal lines indicate the range of reading achievement to be found at each grade level, extending from the first to the 99th percentile, so the range represents 98% of the students in each grade. (I removed the most exceptional performers at both ends of the scale.) The braces enclose the range of proficiency covered by the middle 50% of the students in each grade. The left-most brace is placed at the 25th percentile, and the right-most at the 75th. Notice that it is not until the fourth grade that we find no students at reading-readiness levels (all scores are at grade-1 level or above). The range in reading skill expands dramatically as students move up the grades. Because the range in the age of the students in each grade is only about 12 months, it is difficult for many educators to believe that the range in reading skill expands, not by months, but by years in grade-equivalents. The range increases from over four years in first grade to over 10 years by fifth grade. The PIAT-R has a ceiling score at 12.9. Notice that this level is reached by some students in the sixth grade, by more than 10% of eighth-graders, by a quarter of ninth-graders, and by more than a quarter of 10th-, 11th-, and 12th-graders. Notice, too, that a quarter of ninth-graders are reading at or below the seventh-grade level. Where then should we set our standards? …

Reading, Writing, and Assistive Technology: An Integrated Developmental Curriculum for College Students

An emerging body of research reports on the benefits of assistive technology for students with learning disabilities in a variety of academic tasks. This article describes use of such technology in an integrated reading, writing, and skills curriculum that supported college students whose reading scores were between fourth- and seventh-grade levels. Also included is a description of the benefits of common assistive technology software programs and examples of learning activities designed to scaffold students' comprehension and writing using this technology. Finally, the article reports the educational outcomes for eight students, highlighting the efficacy of combining well-documented learning strategies with assistive technology. This article adds to the growing body of evidence that points to the benefit of combining technology with solid instructional and learning strategies.

English language competency of self-declared English-speaking Hispanic patients

Study objectives: Hispanic patients compose the largest minority population in the United States. The federal government mandates that health care providers be able to communicate with those patients who have limited English ability. The primary purpose of this study is to assess the English-language proficiency of self-declared English-speaking Hispanic patients in the emergency department (ED). The secondary purpose is to determine concordance between patients' tested English proficiency and perceived proficiency by nurses and physicians. We hypothesize that many patients who state that they are able to speak English do not in fact possess sufficient ability to communicate in English. Methods: A convenience study was conducted in an urban Level I pediatrics and adult trauma center with 45,000 annual visits. Participants included adult patients and parents of pediatric patients, all of whom spoke Spanish as their first language. Patients were selected according to their Hispanic names. Research assistants administered the Rapid Estimate of Adult Literacy in Medicine (REALM) and the Short Test of Functional Health Literacy in Adults (STOFHLA) to assess the English comprehension of patients who stated that they spoke English. Score of seventh grade or higher on the REALM and 23 or higher on the STOFHLA was considered a level of English competency. Data were entered into SPSS software and analyzed for correlations. This study was institutional review board approved. Results: Three hundred fifty-four patients with Hispanic names were approached and asked whether they spoke English, Spanish, or both. One hundred five patients, all self-proclaimed English speakers, were enrolled in the study. Patients ranged from 18 to 89 years, with 37.1% (39/105) male patients and 62.9% (66/105) female patients. Forty-nine percent (49) of patients had completed only grade school; 66.3% (65 of 98) of self-proclaimed English speakers scored at or above a seventh-grade reading level on the REALM, and 72.0% (67 of 93) scored in the category of adequate or higher on the STOFHLA. There was a significant difference between patients' tested level of English competency and the physicians' and nurses' assessments of the patients' language competency ( P =.002). Conclusion: This study demonstrates that a significant number of patients who report English proficiency have an inadequate level of English comprehension. Furthermore, there is a discrepancy in the perceived English competency of the patients in the judgment of the physicians and nurses in the ED. This study demonstrates that emergency physicians and nurses are unable to judge a patient's language ability, and it suggests that a more liberal use of interpreters may be indicated.

Circles of Humanity

How does geometry appear through the eyes of a restless seventh grader? I tried to imagine it as I leafed through the Teacher's Edition in preparation for my first-ever encounter with teaching geometry. The pages of boring definitions and sterile, aloof diagrams gave a grim prognosis of glazed eyes and distant minds. There had to be more to it than this. The sign on the wall of my physics classroom reminded me of Einstein: “Geometry is the mathematics of space and time.” For a brief instant I considered trying to teach geometry through the topic of general relativity at a seventh-grade level—and although I came back down to earth from that idea quickly, the inspiration had served its purpose, sending me on an exploration to find more unique perspectives from which to teach and learn geometry. My discoveries evolved, and the consequent path that I took with my students turned out to be less abstract and esoteric than the fabric of space and time; instead, we delved into the topic of geometry as being a powerful sociological tool, solid yet enigmatic, a human and cultural representation of the world and the universe.

Advanced constructional play with LEGOs among preschoolers as a predictor of later school achievement in mathematics

The research question asked was “Will those children ages three and four who have intensive play experiences in play‐based preschools and who can perform at high levels of LEGO building as constructional play also show high levels of mathematical achievement later in formal school settings?”. Thus, this study attempts to establish a correlation between the levels of LEGO play performance of young children and their later school (elementary, middle, and high school) achievement in mathematics. The predictor variables of levels of LEGO play, while controlling for IQ, and gender, were measured in Fall 1982 by testing a group of 3‐year‐old and 4‐year‐old preschoolers (n = 47), and later, longitudinal effects were examined after these same participants had completed high school (n = 37). The dependent or outcome variables obtained from the participants' school cumulative records included: (1) results from the California Achievement Test, (2) the grades in mathematics courses, and (3) higher mathematics courses taken in high school.LEGO performance during the preschool years and the later variables of students' letter grades, and mathematical achievement on standardized tests did not demonstrate significance at the third and fifth grade levels. At the same time no significance was found at seventh grade levels on teacher‐awarded grades, but a clear significance was found for standardized testing at the seventh grade level. Also, since all other outcome variables at the middle school and high school levels such as number of mathematics classes taken, number of honors mathematics classes taken, average mathematics grades, and a combined weighted value of all mathematics courses taken were all significant, we may clearly state that there is a statistical relationship between early LEGO performance among preschool and achievement in mathematics, not seen during the elementary school years, but later developing at the middle and high school level.

The Multigroup Ethnic Identity Measure (MEIM): Psychometric Review and Further Validity Testing

This article examines the psychometric strengths and limitations of a widely used measure of ethnic identity development: the Multigroup Ethnic Identity Measure (MEIM). A review of 12 studies incorporating the MEIM found its two subscales—Ethnic Identity (EI) and Other-Group Orientation (OGO)—to be relatively distinct, have satisfactory levels of internal consistency, and have moderate degrees of construct and criterion-related validity. The first confirmatory factor analysis ( N=219) of the MEIM is reported, the results of which indicate that a two-factor structure is a better fit than a global model but that the goodness of fit is mediocre. A follow-up exploratory factor analysis identified weaker items, and suggestions for possible MEIM revision are presented. Finally, the first formal readability analysis of the MEIM places item difficulty at the sixth- to seventh-grade level.

A title I teacher's beliefs, decision‐making, and instruction at the third and seventh grade levels

The purpose of this study was to compare previous research findings (Mitchell, Konopak, & Readence, 1991) that examined the consistency between a Title I teacher's beliefs about reading and her instructional practices at the third and seventh grade levels. The researchers selected a pull‐out class to observe during five separate instructional sessions. All data were qualitatively analyzed by a research team that searched for meaningful patterns and trends. There was some variation between the Title I teacher's belief about reading and her instructional practices at the third and seventh grade levels, a result of the complex nature of the two schools. Results support (a) the need for teacher improvement programs to focus on the identification of constraints/opportunities that influence instructional decision‐making, ways to sort through dilemmas, and weigh alternatives, (b) the need to coordinate Title I instruction with regular classroom instruction, and (c) the importance of the study of teacher beliefs.

The extended satisfaction with life scale: Development and psychometric properties

The development and psychometric properties of the Extended Satisfaction With Life Scale (ESWLS) are described in detail. The ESWLS is a 50-item self-report scale that measures satisfaction with life in nine domains. It can be completed by most people in under 20 minutes and can be used by researchers and clinicians. The readability of the ESWLS was estimated to be between the seventh and tenth grade levels. Internal consistency, estimated by coefficient α, ranged from 0.81 to 0.96 for the individual subscales. Two-week test-retest reliability coefficients ranged from 0.74 to 0.87. Results of exploratory and confirmatory factor analyses strongly supported the factor structure of the ESWLS. Preliminary evidence of convergent and discriminant validity is provided as well as preliminary norms.

Reading Ability of Parents Compared With Reading Level of Pediatric Patient Education Materials

To test the reading ability of parents of pediatric outpatients and to compare their reading ability with the ability necessary to read commonly used educational materials; to compare individual reading grade levels with the levels of the last grade completed in school; and to further validate a new literacy screening test designed specifically for medical settings. Prospective survey. Pediatrics outpatient clinic in a large, public university, teaching hospital. Three hundred ninety-six parents or other caretakers accompanying pediatric outpatients. Demographics and educational status were assessed using a structured interview. Reading ability was tested using the Rapid Estimate of Adult Literacy in Medicine (REALM) and the Wide Range Achievement Test-Revised. Written educational materials were assessed for readability levels with a computer program (Grammatik IV). The mean score on the REALM for all parents placed them in the seventh to eighth grade reading range, despite the mean self-reported last grade completed in school being 11th grade 5th month. Wide Range Achievement Test-Revised scores correlated well with REALM scores (0.82). Eighty percent of 129 written materials from the American Academy of Pediatrics, the Centers for Disease Control, the March of Dimes, pharmaceutical companies, and commercially available baby books required at least a 10th grade reading level. Only 25% of 60 American Academy of Pediatrics items and 19% of all materials tested were written at less than a ninth grade level, and only 2% of all materials were written at less than a seventh grade level. This study demonstrates that parents' self-reported education level will not accurately indicate their reading ability. Testing is needed to screen at-risk parents for low reading levels. In a public health setting, a significant amount of available parent education materials and instructions require a higher reading level than most parents have achieved. In such settings, all materials probably should be written at less than a high school level if most parents are to be expected to read them. The REALM can easily be used in busy public health clinics to screen parents for reading ability.

The Biology of Developmental Dyslexia

Dyslexia is a relatively common disorder that, when severe, persists into adulthood. New evidence suggests that females are affected nearly as frequently as males. Neuropsychological studies characterize dyslexia as a language disorder that involves phonological deficits in particular. Educational therapies aimed at direct improvement of reading skill constitute the best available treatment. Variable genetic transmission leading to a final common pathway appears to involve deficits in phonological coding. Postmortem studies and in vivo anatomical imaging suggest altered asymmetry of structures in the temporal lobes, and neuroimaging with positron emission tomography indicates left temporoparietal dysfunction in particular. Neuromaging is providing a window into the brain that promises further insights into the biology of dyslexia.

Vocational education and students with learning disabilities.

This inquiry focuses on the status of nearly 500 students with learning disabilities in 17 state-operated regional vocational-technical schools in a northeastern state. The inquiry addressed four primary concerns: patterns of assessment, career choice, school marks, and attendance. The data indicate that a variety of instruments were used in the assessment process and that the overall grade equivalent levels of attainment ranged between fifth- and seventh-grade levels. Children defined as learning disabled participated in a large number of vocational trade specialties and some 50% or more had school marks indicating that they were passing in these areas. Attendance was high. Many children with learning disabilities successfully perform in competitive vocational education programs designed to produce proficiency at the level of journey person.

A School-Within-A-School Approach for At-Risk Urban Students

Based on the premise that fundamental changes in organizational and instructional arrangements are required to boost the performance of at-risk students in big cities, School-Within-a-School (SWAS) units have been established to help accomplish this goal at middle schools (grades six through eight) and high schools (grades nine through twelve) in the Kansas City, Missouri, school district. Designed for students with reading scores significantly below grade level, the SWAS program usually assigns eighty to one-hundred students at a given grade level to receive academic instruction from four or five teachers of English/language arts, math, reading, social studies, and, in some cases, science.' Each regular high school has a ninth-grade unit, and middle schools have operated a unit in either the seventh or eighth grades. Black students, who constitute nearly 70 percent of students in the Kansas City public schools, constitute an even higher percentage of enrollment in SWAS units. Placement in SWAS is based on academic achievement scores; teacher, counselor, and administrator judgment; attendance records; and other considerations, with particular attention given to functional comprehension scores on the Degrees of Reading Power test. Most ninth-grade participants have scores between the fourthand seventh-grade levels, and most middle school students in SWAS are at least one grade level below the national average in reading. (Students who are virtual nonreaders or who are severely disruptive generally are not assigned to SWAS because they require even stronger interventions.) Selection criteria are not viewed as consti-