Health Literacy: A psycholinguistic and Cognitive Investigation

描述（由申请人提供）：健康素养被广泛定义为认知技能，背景知识，社交能力和理解健康信息并将其用于促进和保持良好健康的动机。卫生知识普及程度低与不良健康结果之间的关系已有大量文献记载。在这个应用程序中，我们专注于健康素养的方面，这与书面健康文本的理解。 处理复杂的书面信息的能力是必不可少的，如果个人要做出明智的决定，他们的身体，情感和财务福祉。阅读涉及读者相关因素之间的复杂相互作用（例如，单词解码技能，工作记忆容量）和文本相关的属性（例如，句法复杂性、连贯性）。我们的目的是应用心理语言学和认知的角度来研究健康文学。它具体解决了计划公告中描述的两个目标：我们“分析和衡量功能性'健康素养'所需的能力和技能组合” 我们“研究为不同卫生知识水平的受众开发和传播有效信息来源和材料的最佳方法。“我们提出的研究从两个重要方面扩展了健康素养的研究。首先，我们研究特定的文本操作，以获得有关哪些最能提高个人读者的理解的信息，其次，常见的医学知识测试与其他读者的特征有关。到目前为止，文本一直使用可读性公式（减少句子的长度和单词的频率）进行操作。我们的研究是基于这样一个假设，即“一刀切”的可读性操作没有考虑到不同读者的优势和劣势，事实上，可能会减少一些读者的理解，因为最近的研究表明，在阅读理解的个体差异。我们基于心理语言学的研究，已经调查了影响阅读的特定子组件的因素，我们的文本难度的操作。词频只是这些因素之一。在句子一级确定了重要的变量（例如，句法嵌入的级别，使用句法结构来突出句子中语言元素的重要性）和文本级别的变量（例如，回指的明确性，必须整合到读者对文本的表征中的新实体的数量。我们调查这些操作如何不同的影响读者不同的语言和认知概况。第二，我们研究了医学知识的常见测试与其他读者特征的关系。这一点很重要，因为知识和基本的阅读技能往往是相互关联的。在背景知识测试中得分较低的读者，往往具有较差的单词解码技能，在工作记忆容量测试中得分较低，阅读经验较少，并且比在这些测试中得分较高的读者具有较差的单词知识。这使得很难确定哪些能力是识字的核心，哪些是衍生的。我们的目标是解开这些影响， 一个更集中的方法来操纵文本可读性和健康素养。 我们的应用程序有两个阶段。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）这些因素如何相互作用。我们应用一种称为多层次模型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）联合收割机文本属性（例如，词频、句法难度、照应参照）来影响“在线”阅读过程，这些过程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产生了很大的影响。重要的是，这些因素对阅读的影响并不一致。相反，它们的影响是随着工作记忆容量、解码能力和阅读经验的变化而变化的，这些都是众所周知的个体读者之间的差异。

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.