Health Literacy: A psycholinguistic and Cognitive Investigation

描述（由申请人提供）：健康素养的广义定义是认知技能、背景知识、社交能力和理解健康信息的动机，并利用这些信息促进和保持身体健康。卫生知识普及程度低与不良健康结果之间的关系已得到充分证明。在这个应用程序中，我们将重点放在健康素养方面，这与理解书面健康文本有关。如果个人要对自己的身体、情感和财务状况做出明智的决定，处理复杂的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（如文字解码技能、工作记忆能力）和与文本相关的属性（如句法复杂性、连贯性）之间复杂的相互作用。我们在这个应用程序的目的是应用心理语言学和认知的角度来研究健康文献。它具体解决了项目公告中描述的两个目标：我们“分析和衡量功能性‘健康素养’所需的能力和技能的组合”。

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.