Health Literacy: A psycholinguistic and Cognitive Investigation

说明(申请人提供)：健康素养被广泛定义为了解健康信息并将其用于促进和维持健康的认知技能、背景知识、社交能力和动机。健康素养差与不良健康后果之间的关系是有据可查的。在这一应用中，我们将重点放在健康素养方面，这与书面健康文本的理解有关。如果个人要对自己的身体、情感和经济健康做出明智的决定，处理复杂书面信息的能力是必不可少的。阅读涉及与读者相关的因素(例如单词解码技能、工作记忆容量)和与文本相关的属性(例如句法复杂性、连贯性)之间的复杂交互作用。我们在此应用的目的是将心理语言学和认知学的视角应用于健康文学的研究。它特别提到了计划公告中描述的两个目标：“我们分析和衡量具备‘健康素养’所需的能力和技能的组合。” 我们还“研究了为不同健康素养水平的受众开发和传播有效信息来源和材料的最佳方法。”我们提出的研究在两个重要方面扩展了健康素养的研究。首先，我们检查具体的文本操作，以获得关于哪种操作最能提高个别读者的理解力的信息，其次，常见的医学知识测试与其他读者特征之间是如何联系的。到目前为止，文本一直使用可读性公式(减少句子长度和词频)进行处理。我们的研究是基于这样一种假设，即对可读性的一刀切处理没有考虑到不同读者的长处和短处，事实上，正如最近对阅读理解个体差异的研究所表明的那样，这可能会削弱一些读者的理解力。我们对文本难度的操作建立在心理语言学研究的基础上，该研究调查了影响阅读的特定亚成分的因素。词频只是这些因素中的一个。在句子层面上确定了重要的变量(例如，句法嵌入的层面，使用句法结构来突出句子中语言元素的重要性)，在语篇层面上确定了变量(例如，回指的明确性，必须整合到读者对文本的表述中的新实体的数量)。我们调查了这些操作如何不同地影响具有不同语言和认知特征的读者。其次，我们考察了常见的医学知识测试与其他读者特征之间的关系。这一点很重要，因为知识和基本阅读技能往往是相关的。与背景知识得分高的读者相比，背景知识得分较低的读者，单词解码技能往往较差，工作记忆容量得分较低，阅读经验较少，单词知识较差。这使得很难确定哪些能力是识字的核心，哪些是衍生的。我们的目标是理清这些影响，使 更有针对性地处理文本可读性和健康素养。我们的应用程序分为两个阶段。第一阶段包括调查(1)大样本读者的基本语言和认知能力，(2)影响文本难度的文本属性，以及(3)这些因素是如何相互作用的。我们应用了一种称为多水平建模的统计技术来研究读者的独特能力(例如单词解码技能、WMC、阅读经验)如何与文本属性(例如词频、句法难度、回指参考)相结合来影响在线阅读过程，这些因素如何影响对文本信息的后续记忆。本研究的第二阶段旨在考察不同读者群体在特定文本特征被操纵时的理解表现。我们从一个年轻人的样本中获得的初步数据表明，句子的长度、句子中新概念的数量、语义重叠和句法复杂性对阅读过程和随后的理解有很大的影响。重要的是，这些因素对阅读的影响并不一致。相反，它们的影响随着工作记忆容量、解码能力和阅读体验的不同而不同，这些都是已知在不同读者之间存在差异的。

DESCRIPTION (provided by applicant): Health literacy is broadly defined as the cognitive skills, background knowledge, social abilities, and motivation to understand health information and to use it in promoting and maintaining good health. The relation between poor health literacy and adverse health outcomes is well documented. In this application, we focus on the aspect of health literacy that is related to the comprehension of written health texts. The abilit to process complex, written information is essential if individuals are to make informed decisions regarding their physical, emotional, and financial well-being. Reading involves complex interactions between reader-related factors (e.g., word-decoding skill, working-memory capacity) and text-related properties (e.g., syntactic complexity, coherence). Our aim in this application is to apply a psycholinguistic and cognitive perspective to the study of health literac. It specifically addresses two of the goals that are described in the program announcement: we "analyze and measure the mix of abilities and skills required to be functionally 'health literate'" and we "examine the best methods of developing and disseminating effective information sources and materials for audiences with different levels of health literacy." Our proposed study extends research on health literacy in two important ways. First, we examine specific text manipulations to obtain information about which are best able to improve comprehension in individual readers, and second, how common tests of medical knowledge are related to other reader characteristics. To date, texts have been manipulated using readability formulas (reducing the length of sentences and the frequency of words). Our study is based on the assumption that 'one-size-fits-all' manipulations of readability do not take into account the strengths and weaknesses of different readers, and may, in fact, diminish comprehension for some readers, as recent research on individual differences in reading comprehension has suggested. We base our manipulations of text difficulty on psycholinguistic research that has investigated the factors that influence specific subcomponents of reading. Word frequency is only one of these factors. Important variables have been identified at the sentence level (e.g., level of syntactic embedding, use of syntactic structures to highlight the importance of a linguistic element in a sentence) and variables at the text level (e.g., the explicitness of anaphoric reference, the number of new entities that must be integrated into the reader's representation of a text). We investigate how these manipulations differentially affect readers with varying linguistic and cognitive profiles. Second, we examine how common tests of medical knowledge are related to other reader characteristics. This is important because knowledge and basic reading skills are often correlated. Readers who score low on background knowledge measures, tend to have poorer word-decoding skills, have lower scores on measures of working-memory capacity, have less reading experience, and poorer word knowledge than do readers who score high on these measures. This makes is difficult to determine which abilities are central to literacy and which are derivative. Our aim is to disentangle these effects, enabling a more focused approach to manipulations of text readability and health literacy. Our application has two phases. Phase one involves investigating (1) the basic linguistic and cognitive abilities of a large sample of readers, (2) the text properties that influence the difficlty of a text, and (3) how these factors interact. We apply a statistical technique called multilevel modeling to investigate how readers' unique abilities (e.g., word-decoding skill, WMC, reading experience) combine with text properties (e.g., word frequency, syntactic difficulty, anaphoric reference) to influence "on-line" reading processes how these influence subsequent memory for text information. The second phase of our study is designed to examine the comprehension performance of different groups of readers when specific characteristics of texts are manipulated. We have preliminary data from a sample of young adults suggesting that sentence length, the number of new concepts in a sentence, semantic overlap, and syntactic complexity exert a large influence on reading processes and subsequent comprehension. Importantly, these factors do not have uniform effects on reading. Rather, their influence varies as a function of working-memory capacity, decoding ability, and reading experience that are known to vary among individual readers.