Text-based Instructions Research Articles

The Development and Evaluation of Alternative Communication Strategies to Facilitate Interactions with Refugees in Obstetric Triage: A Preliminary Study

Purpose: In this pilot study, we investigate the potential of pictographs to facilitate communication and accelerate care for non-English speaking birthing people in triage. The immigrant and refugee populations have been steadily increasing in the United States; reproductive age women are a large percentage of those who seek medical care. Barriers to care include timely access to interpreters, which can delay treatment. Pictographs have been used successfully in medicine in various situations such as pharmaceutical instruction and symptom description. We searched extensively for obstetric triage pictographs with little success. To address this, we created a pictograph sheet specifically for common obstetrical complaints. Methods: The most common reasons for visiting triage were ascertained. From these, key topics were identified for drawings. For each topic, the authors drafted scripts for a list of relevant actions. The actions for each topic were then represented by a professional illustrator in pictographs. Pictographs were developed using the following guidelines: focus on actions people should take, include prompts within pictures such as labels or arrows and exclude nonessential details such as room background and elaborate borders. After the pictographs were developed, its appropriateness, accuracy and relevance were reviewed and validated by two experts with experience in women’ care. The experts perceived that the drawings represented the actions well in a simple and clean manner. The following concerns were depicted: decreased fetal movement, abnormal vaginal discharge, rupture of membranes, vaginal bleeding, vision changes, shortness of breath, nausea, contractions, headaches, and overall assessment of wellbeing. Focus groups were developed collaboratively with Della Lamb, a resettlement agency. Inclusion criteria included women of reproductive age who are non-English speaking and currently pregnant. These focus groups were held at the University Health. Two focus groups were created: one with refugees from Afghanistan and one with refugees from the Congo. Each focus group was guided by a licensed medical interpreter of their native language: Dari and Swahili, respectively, and ranged from 3 to 4 participants. One by one the pictograms were introduced to the group. Each participant was asked what they think the illustration represents. For participants’ comfort, groups were not recorded; instead, notes were taken by observers during and after the discussion. The participants read the text and pictographs and were asked to identify if pictographs were clear, understandable, and acceptable. Results: Congolese Focus Group: Participants’ ages varied in their 30s. All had recently immigrated to the United States and lived in Missouri for less than 6 months. They were in the second trimester of their pregnancy and had at least one prenatal visit in the United States. They were all multiparous women with previous uncomplicated vaginal deliveries in their native country. All could read and write in Swahili but spoke no English. They all had no previous experience with the medical health system in the United States. Afghani Focus Group: Participants’ ages varied in their 20-30s. All had recently immigrated to the United States and lived in Missouri for less than 3 months. 3 women were in their second trimester, 1 was in her third trimester. Aside from 1, the rest (3) were multiparous women with previous uncomplicated vaginal deliveries in their native country. 3 of them could read and write in Dari but spoke no English. They all had no previous experience with the medical health system in the United States. Comprehension was significantly different between the two groups. Overall, the Congolese group of women misunderstood the purpose of the pictographs. No picture was understandable to the patients. It was also apparent that the patients did not realize these were issues for which to come to triage. There was also ambiguity regarding the color, i.e. they did not correlate green with nausea. The general prohibition sign was also absent in meaning for them. However, all of the patients expressed interest in learning what each picture meant and would like to have that option there if they came to triage and could not get an interpreter. The Dari group did not understand shortness of breath or nausea. However, they were familiar with the other symptoms and able to identify those as reasons to come to triage. The patients were also familiar with colors and scales. Conclusion: The pictograph-based approach might be an effective tool in developing health-care instructions for immigrant women with limited literacy skills. However, research is needed regarding limitations due to cultural backgrounds. Future research is also needed to compare the effect of pictograph-enhanced instructions with written text-based instructions on adherence to instructions and health outcomes.

Controllable Video Generation With Text-Based Instructions

Most of the existing studies on controllable video generation either transfer disentangled motion to an appearance without detailed control over motion or generate videos of simple actions such as the movement of arbitrary objects conditioned on a control signal from users. In this study, we introduce Controllable Video Generation with text-based Instructions (CVGI) framework that allows text-based control over action performed on a video. CVGI generates videos where hands interact with objects to perform the desired action by generating hand motions with detailed control through text-based instruction from users. By incorporating the motion estimation layer, we divide the task into two sub-tasks: (1) control signal estimation and (2) action generation. In control signal estimation, an encoder models actions as a set of simple motions by estimating low-level control signals for text-based instructions with given initial frames. In action generation, generative adversarial networks (GANs) generate realistic hand-based action videos as a combination of hand motions conditioned on the estimated low control level signal. Evaluations on several datasets (EPIC-Kitchens-55, BAIR robot pushing, and Atari Breakout) show the effectiveness of CVGI in generating realistic videos and in the control over actions.

Crowdsourcing Thumbnail Captions: Data Collection and Validation

Speech interfaces, such as personal assistants and screen readers, read image captions to users. Typically, however, only one caption is available per image, which may not be adequate for all situations (e.g., browsing large quantities of images). Long captions provide a deeper understanding of an image but require more time to listen to, whereas shorter captions may not allow for such thorough comprehension yet have the advantage of being faster to consume. We explore how to effectively collect both thumbnail captions—succinct image descriptions meant to be consumed quickly—and comprehensive captions—which allow individuals to understand visual content in greater detail. We consider text-based instructions and time-constrained methods to collect descriptions at these two levels of detail and find that a time-constrained method is the most effective for collecting thumbnail captions while preserving caption accuracy. Additionally, we verify that caption authors using this time-constrained method are still able to focus on the most important regions of an image by tracking their eye gaze. We evaluate our collected captions along human-rated axes—correctness, fluency, amount of detail, and mentions of important concepts—and discuss the potential for model-based metrics to perform large-scale automatic evaluations in the future.

Using Comic-Based Concussion Discharge Instructions to Address Caregiver Health Literacy in the Emergency Department

IntroductionThis study compared the effectiveness of comic-based with text-based concussion discharge instructions on improving caregiver knowledge. This study also examined the role of social determinants of health on comprehension instructions. MethodsThis was an observational study of the caregivers of pediatric concussion patients. Caregivers' health literacy and demographics related socioeconomic factors were obtained. After the patients’ evaluation in the emergency department, caregivers were given printed comic-based concussion discharge instructions. Caregivers were contacted 3 days later and tested overall knowledge of discharge instructions’ content. These survey results were compared with historical controls who received text-based instructions. ResultsA total of 120 participants were recruited, and 86 participants completed follow-up procedures. When comparing the caregivers’ recall ability with a comic-based vs traditional text-based instructions, caregivers with comic-based content were more likely to accurately recall overall discharge instructions (77.5% vs 44%, P < .001), particularly physical rest and activity restrictions (86.5% vs 63%, P < .001). Caregivers also were less likely to misidentify a red flag symptom (7.5% vs 19%, P < .04). Comic-based instructions did not increase recall of cognitive rest instructions or postconcussive symptoms. When examining demographic factors, caregivers who could not recall 3 postconcussive symptoms were more likely to be Hispanic or Black, less likely to be college educated, and more likely to have low health literacy. DiscussionNovel methods should be explored to adequately prepare caregivers for continuing postconcussive care at home. Discharge instructions must be tailored to address caregivers’ baseline health literacy and how caregivers digest and retain information.

A Study on the Usage of the Board Race Game; as a Grammar Retention Strategy for English as a Second Language (ESL) Learners

Language games are often recognized as one of the important components when teaching and learning English, in a Second Language classroom. Conversely, in the traditional classroom setting, playing games is believed to be highly unproductive. Given that, this study aims to evaluate the effectiveness of language games as a grammar retention strategy for ESL learners. The study was conducted at All Saints’ College, Sri Lanka using a mixed methods research approach where the sample groups were experimented and observed in two settings: the traditional classroom and the game-based approach. For data collection, all three classes of grade six, with 30 students in each, were classified randomly as the experimental group and the two control groups. While the experimental group was exposed to the game, “The Board Race” when teaching irregular past tense, the control groups were taught the same without the game. According to the results which were achieved from the t-test, through a comparison of the mean scores of the pre-test and two post-tests, the experimental group exceeded the two control groups with higher mean values, during the immediate retention stage and the delayed retention stages, proving that the two teaching methods have different influences on grammar retention. The above results were further confirmed by the positive responses of the experimental group in terms of behavioral, cognitive, and emotional engagement. Thus, this study suggests the need to incorporate games with text-based instructions in the ESL classroom, which is helpful for the students to retain grammar, in the long term.

SignText: a web-based tool for providing accessible text book contents for Deaf learners.

Lack of Sign Language-based learning tools is a hindrance in acquiring knowledge for deaf students. Technology-based tools have introduced innovative ways of learning textbook contents. Augmenting textbook contents with sign can significantly help in learning. This paper proposes SignText, a bilingual tool for learning textbook lessons. This web-based tool works on a web browser to provide sign language-based instructions. Along with signs, simultaneous text-based instructions are also provided to enhance learning. The effectiveness of this tool was studied using an experiment in which 34 deaf students participated. Both quantitative and qualitative studies were conducted to find the effectiveness of SignText. Results show that SignText improves learning for deaf students.

Development and Evaluation of a Mixed Reality Assistance System in the Context of Manual Assembly

Manufacturing environments face the challenge of ever-increasing complexity in their products due to the continuously increasing degree of individuality. Together with the demand for meeting high quality standards, this leads to the requirement to assist workers during a manufacturing process. Cognitive assistance systems which provide work-related information during their work tasks have been proven to be a successful aid for these challenges. Whenever a new emerging technology is applied for worker assistance, the technology should be tested to evaluate its positive or negative impact in a specified assembly process. This work aims to test the impact of an emerging technology, the Microsoft HoloLens 2 Head Mounted Display (HMD), in a manufacturing environment. Therefore, a prototypical Mixed Reality (MR) application is introduced which provides assembly-related information to support the worker during the work process and to ensure a zero failure culture. To evaluate the impact of the presented application a comparative study is conducted, comparing existing text-based instructions on touchscreens to the newly-integrated interactive 3D assembly instructions. Although an efficiency can not be shown in the presented study, a significant increase in quality of the assembled product was gained, leading the way into a zero failure culture.

A Usability Study of a Serious Game in Cognitive Rehabilitation: A Compensatory Navigation Training in Acquired Brain Injury Patients.

Acquired brain injury patients often report navigation impairments. A cognitive rehabilitation therapy has been designed in the form of a serious game. The aim of the serious game is to aid patients in the development of compensatory navigation strategies by providing exercises in 3D virtual environments on their home computers. The objective of this study was to assess the usability of three critical gaming attributes: movement control in 3D virtual environments, instruction modality and feedback timing. Thirty acquired brain injury patients performed three tasks in which objective measures of usability were obtained. Mouse controlled movement was compared to keyboard controlled movement in a navigation task. Text-based instructions were compared to video-based instructions in a knowledge acquisition task. The effect of feedback timing on performance and motivation was examined in a navigation training game. Subjective usability ratings of all design options were assessed using questionnaires. Results showed that mouse controlled interaction in 3D environments is more effective than keyboard controlled interaction. Patients clearly preferred video-based instructions over text-based instructions, even though video-based instructions were not more effective in context of knowledge acquisition and comprehension. No effect of feedback timing was found on performance and motivation in games designed to train navigation abilities. Overall appreciation of the serious game was positive. The results provide valuable insights in the design choices that facilitate the transfer of skills from serious games to real-life situations.

Effect of Pictograph-Based Discharge Instructions on Older Adults' Comprehension and Recall: A Pilot Study.

Many older adults return home with limited comprehension of hospital discharge instructions because current text-based instructions are difficult to understand. To address this issue, the author developed discharge instructions using pictographs (i.e., simple line drawings showing step-by-step discharge actions) for older adults under care of hip replacement surgery. The purpose of the current study was to examine the effect of pictograph-based discharge instructions on comprehension and recall of older adults with low literacy skills. A posttest-only comparison group design was used to compare pictograph-based (n = 21) to text-only (n = 21) discharge instructions at 4 weeks after discharge instruction education. Significantly greater improvements in scores on comprehension and recall were demonstrated by the pictograph group than the text-only group. A follow-up, full-scale study is suggested to examine the effect of pictograph-based instructions on adherence to instructions and health outcomes.

Using pictograms to assist caregivers in liquid medication administration: a systematic review.

It has been reported that more than 80% of out-of-hospital medication errors among the young children involve liquid formulations. The usefulness of pictorial aids to improve communication of medication instructions has not been extensively investigated for child health. The objective of this study was to determine the effectiveness of pictorial aids used to assist caregivers in the administration of liquid medications. MEDLINE, CINAHL, PsycINFO, ScienceDirect, Scopus and the Cochrane Library were searched for articles published up to February 2015. Studies that used pictorial aids with liquid medications and measured at least one of the following outcomes were included: dosing accuracy, comprehension of medication instructions, recall of information and adherence of caregivers. Two authors independently selected studies, extracted data and assessed methodological quality of studies using the Cochrane Collaboration's tool. Five experimental studies (four hospital based and one community based) with a total of 962 participants were included. A wide range of liquid formulations were studied, including both prescription and over-the-counter medications. The existing findings suggest that pictographic interventions reduced dosing errors, enhanced comprehension and recall of medication instructions and improved adherence of caregivers. Incorporating pictorial aids into verbal medication counselling or text-based instructions was more beneficial than using the single approach alone. Mixed results were identified for the relationship between health literacy of caregivers and effectiveness of pictorial aids. The evidence remains limited due to the small number of studies found and variations in methodological quality. This review suggests that pictorial aids might be potential interventions, but more high-quality studies are needed to support the routine use of any pictogram-based materials with liquid medications in the clinical settings.

Becoming ... Everything Else: Situating Performance in Public Space and Daily Life

BECOMING . . . EVERYTHING ELSE: SITUATING PERFORMANCE IN PUBLIC SPACE AND DAILY LIFE MICHAEL BOYD NE OF THE ISSUES that has strongly influenced my compositional activities since 2003 is the role of performers in the music-making process. Post-Romantic practices in Western art music typically segregate composer, performer, and audience into discrete roles that carry assumptions about the tasks associated with each. The composer is most often associated with the creative portions of the music-making process, and is credited with the creation of unique musical works. Performers, conversely, are normatively regarded as replicators, individuals whose task is to bring composers’ works to life without adding or altering them in any significant way. Indeed performing musicians in this tradition are limited to minimally modifying tempo and volume, incorporating a small degree of vibrato, and adding silent physical (“expressive”) gestures. Audience members are more often O 58 Perspectives of New Music than not assumed to comprise a single passive entity with uniform taste that centers on the late Baroque through Romantic Western art music canon. Such a configuration is hierarchical, essentially situating composers on a pedestal, and subordinating performers and, to an even greater degree, audience members. Since the mid-twentieth century, largely under the rubric of indeterminacy, some individuals have composed in a manner that has led to more collaborative models for music creation and reception. Prominent composers in this paradigm include members of the New York School, John Cage, Christian Wolff, Morton Feldman, and Earle Brown, as well as others such as Alvin Lucier, Pauline Oliveros, Karlheinz Stockhausen, and many more. My recent compositions extend this experimental tradition through the use of different types of graphic and text notation that examine interactions and relationships between multiple performers, performers and instruments, performers and sounds, performers and themselves, and so on. Such an approach immediately sheds many conventions of Western art music including the primacy of pitch and a roughly one-to-one correspondence between composer input and performer output, thereby increasing performer creative/interpretive agency, and enabling non-specialists and musicians with lesser technical facility to offer viable or “accurate” performances. I have also been drawn to installation art for some time, I think largely because this medium brings space, a facet of art and music typically assumed neutral and inert, to the foreground. In 2004 I decided to begin a large-scale installation project. Initially it seemed as though this endeavor would not be congruent with my interest in collaborating with and challenging live performers; most installations involve visual elements, live processed or fixed electro-acoustic sound, or both. After a period of time, it became apparent that one could essentially install performers in a space, and that precedents existed for this practice, some of which I was already familiar with. Eventually I customized and applied my preexisting compositional practices to the installation medium, creating Becoming . . . everything else (2004). In this essay, I will briefly examine a few works that mix performance and aspects of installation art, and then discuss Becoming at length, both the composition itself as well as three performances of it from 2005. John Cage’s Variations IV (1963) is a concert work for one or more performers that evokes aspects of installation art. Like other of Cage’s Variations, the score for this piece consists of text-based instructions and a set of transparencies, in this case featuring two circles and seven points. Unlike the well-known Variations II, which requires the performer to connect points and lines, measure the connecting lines, Situating Performance in Public Space and Daily Life 59 and use that data to determine parameters such as frequency and amplitude for sound events, Variations IV requires the performer(s) to acquire and use a map of the performance space to prepare each performance. Once a map of the space has been obtained, one places a circle on the map (within the performance space), drops the remaining transparencies (seven points and the other circle) on the map, and connects the initially placed circle with all seven points by drawing lines. Sound production is defined by Cage in the following manner: Sound(s) to be produced at any point on the lines outside the theatre...

Scaffolding Visitors' Learning through Labels

In museum literature, labels have been found to increase visitor learning and contribute to greater cognitive gains. In this study, we seek to understand how various labels support the visitors' learning experience, and specifically in regards to conceptual and cognitive learning. We investigated the increasing use of three types of labels (visual digital augmentations, text-based questions, and text-based instructions) by four groups of middle school students. Our analyses indicated that when labels were used, students experienced significant increases in both conceptual and cognitive understanding. Furthermore, in the group that received all three types of labels, students displayed more problem-solving behaviors and made more associations with their prior knowledge. This suggests that supplementing an exhibit with several types of labels may lead to increased visitor engagement and learning.

Scaffolding Visitors' Learning through Labels

In museum literature, labels have been found to increase visitor learning and contribute to greater cognitive gains. In this study, we seek to understand how various labels support the visitors' learning experience, and specifically in regards to conceptual and cognitive learning. We investigated the increasing use of three types of labels (visual digital augmentations, text-based questions, and text-based instructions) by four groups of middle school students. Our analyses indicated that when labels were used, students experienced significant increases in both conceptual and cognitive understanding. Furthermore, in the group that received all three types of labels, students displayed more problem-solving behaviors and made more associations with their prior knowledge. This suggests that supplementing an exhibit with several types of labels may lead to increased visitor engagement and learning.

Older Adults’ Perceptions of Pictograph-Based Discharge Instructions after Hip Replacement Surgery

Current text-based discharge instructions are unsuitable for low-literate older adults who have difficulty following written action-based instructions. To address this issue, we developed discharge instructions for low-literate older adults after hip replacement surgery using pictographs (i.e., simple line drawings with stick figures showing explicit care actions). The aim of this focus group study was to examine the acceptability and comprehension of these instructions to 15 low-literate older adults. Participants perceived that the pictograph-based discharge instructions helped them understand the intended health care messages, especially for step-by-step procedures of discharge actions. The black-and-white line drawings were well received by all participants of various race/ethnicity. A pictograph-based approach is an effective strategy for developing discharge instructions not only for patients with low literacy skills in acute health care settings, but also for immigrants with significant communication challenges. Future research is suggested to compare the effects of pictograph-based and text-based instructions on adherence to instructions and health outcomes.

Development and pilot test of pictograph‐enhanced breast health‐care instructions for community‐residing immigrant women

Current written text-based health-care instructions are not suitable for presenting lengthy, complex breast health-care instructions and are difficult for immigrant women with limited literacy skills. The aims of this study were to develop breast health-care instructions enhanced by pictographs (simple line drawings representing health-care actions) and pilot test the instructions in a sample of six immigrant women with limited literacy skills. Based on the Mayer's Cognitive Theory of Multimedia Learning, pictographs were developed in addition to low-literacy text. The text and the pictographs were then pilot tested with six immigrant women in community health centres for clarity, comprehension and acceptability through face-to-face interviews. Participants perceived that the drawings were engaging and enhanced clarity of the intended health-care messages. The black and white simple line drawings were well received by participants of varying race and ethnicity. The pictograph-based approach might be an effective tool in developing health-care instructions for immigrant women with limited literacy skills. Future research is needed to compare the effect of pictograph-enhanced instructions with written text-based instructions on adherence to instructions and health outcomes.

Automated computer-based feedback in expressive writing

Previous studies indicate that changing pronoun use can moderate the health benefits of expressive writing. Participants who change their pronoun use from essay to essay benefit more from the exercise. The current experiment attempted to improve the expressive writing paradigm by altering subjects’ focus (specifically self- and other-related focus) through text-based instructions. The automated language-based system was simple to implement, and it successfully changed participants’ pronoun use, but the intervention had no mood-related or subjective benefits. While the automated intervention system has promise in guiding people’s natural writing, future research must address the broader question of the inherent links between language use and substantive psychological change.

Learning and understanding science instructional material.

Learning and understanding of science instructional material was examined from a cognitive load perspective. It was suggested that instructions can be difficult to learn if multiple elements of information need to be simultaneously processed through limited working memory. Diagrams were expected to reduce cognitive load by allowing students to process information using fewer elements in working memory than an equivalent text-based format. However, if instructional information could be processed serially, then working-memory load should be light, and both diagrammatic and text-based instructions were hypothesized to be equally effective. Two experiments using different chemistry instructions confirmed these hypotheses and so highlight the role of cognitive load factors in instructional design. (PsycINFO Database Record (c) 2016 APA, all rights reserved)

Development and Evaluation of “Where are We?” Map-Skills Software and Curriculum

The Where are We? software and lessons are designed to help children in grades two through four learn to “translate” between the visually-perceived world that they sense around them, and the schematic representation of that landscape on a map. Formative evaluation of a prototype version of Where are We? resulted in the following improvements in the instructional materials: more and prompter feedback for students, additional assessment tools for teachers, development of lessons to model successful map-using strategies, development of lessons to overcome common misconceptions, and replacement of text-based instructions with a voiceover demo. To evaluate whether the skills practiced in Where are We? transfer to a real-world setting, we have developed field-based tests of the ability to absorb information in the real world and transfer it onto a ma and, conversely, the ability to absorb information from a map and transfer it into an action in the real world. In our reality-to-map test, students place colored stickers on a map to indicate the location of similarly colored flags in the real world; in the map-to-reality test, students place large, colored, numbered disks on the ground to indicate the location of similarly-colored, numbered stickers on a map. Average performance for a class of 24 fourth graders improved on both the map-to-reality and reality-to-map tests after using Where are We? Some children classified with learning disabilities performed extremely well both with the software and on the field-tests, supporting the idea that spatial skills are not closely connected to the verbal skills usually emphasized by school tasks. The persistence of certain kinds of misconceptions on the post-test, and the uneven improvement of subscores representing different aspects of map-to-reality correspondence, suggest directions for improvement in Where are We?

EFFECTS OF AGE AND INSTRUCTIONS ON TEACHING OLDER ADULTS TO USE ELDERCOMM, AN ELECTRONIC BULLETIN BOARD SYSTEM

This study focused on how to train older adults to perform computer procedures. Young-old (aged 60 74 years) and old-old (aged 75 years and older) adults were instructed on how to use ELDERCOMM , an electronic bulletin board system using one of two types of text-based instructions. The first set of directions consisted of illustrated, step-by-step instructions (simple condition). The second set of directions included the same step-by-step instructions as in the first set, but explanatory information about how the bulletin board system worked was added before the

An interactive learning environment in geographical information systems

Geographical Information Systems (GIS) are computer-based tools for the input, management, analysis, modelling and display of geographical data. GIS are applied in a wide range of organizations and disciplines, including central and local government, environmental agencies, transport planning and vehicle navigation, education and research, utilities management, resource management, and the financial and retail sectors. GIS is a field of constantly changing technology, and it has been recognized that GIS education needs to be more than a 'once in a lifetime' event (Muller, 1993). Consequently, GIS teachers have developed computer-based materials for learners at all levels, from school students to postgraduates, and for the independent professional updating their skills and knowledge. To date, these materials have followed a number of approaches. Initially demonstrations of GIS software and its capabilities addressed the need to increase awareness of GIS and its applications (DoE, 1987). Arcdemo (Green, 1987) was an innovative early example, providing a demonstration of the software package Arc/Info online. Training in particular software, and the need for hands-on experience, have been addressed with the production of software-specific educational materials which use primarily traditional text-based instructions for exercises with specially prepared data. Examples include Getting started in GIS (Langford, 1993), the Unitar workbooks for Idrisi (for example McKendry et al, 1992) and Understanding GIS: the Arc/Info Method (ESRI, 1990). These have proved particularly popular, and by directing learners through structured exercises allow new users to become familiar with complex software in a relatively short time. More recently, they have migrated to CD-ROM, with training materials such as Getting to know Arcview (ESRI, 1995) provided in this format, and combining software, data and demonstrations.DOI:10.1080/0968776980060204