Comprehension of Health-related Written Materials by Older Adults

Abstract

This study examined how Flesch Reading Ease and text cohesion affect older adults' comprehension of common health texts. All older adults benefited when high Flesh Reading Ease was combined with high cohesion. Older adults with small working memories had more difficulty understanding texts high in Flesch Reading Ease. Additionally, older adults with low verbal ability or older than 77 years of age had difficulty understanding texts high in text cohesion but low in Flesch Reading Ease. These results imply that writers must increase Flesch Reading Ease without disrupting text cohesion to ensure comprehension of health-related texts.Understanding health-related written materials, such as medication leaflets or health education brochures, is critical for older adults. Unfortunately, older adults often have difficulty comprehending written health information (Benson & Forman, 2002;Gazmararian et al., 1999;Williams et al., 1995). Comprehension problems are associated with poor health status and more hospital admissions (Baker et al., 2002;Baker, Parker, Williams, & Clark, 1998;Baker, Parker, Williams, Clark, & Nurss 1997;Schillinger et al., 2002). This issue has become a concern to the health care system because of the consequences of high health costs (Marwick, 1997). Improving comprehension by increasing the readability of health-related written materials is commonly suggested (Adams, Smith, Metts, & Ross, 1979;Cotugna, Vickery, & Carpenter-Haefele, 2005;Eaton & Holloway, 1980;Johnson & Stern, 2004;Singh, 2003). Readability is typically assessed in terms of grade level and recommendations are often specified relative to an eighth grade reading standard. However, this approach may be limited by the formulas used to assess readability.Readability formulas are generally a function of word length and sentence length, such as the Flesch Reading Ease index (Flesch, 1948). The number of syllables per word and the number of words per sentence capture only the shallow features of a text and do not directly reflect content and organization. Comprehension is a complex mental process that involves not only decoding words and sentences but also making connections of ideas and deriving meaning from a written text. Readability formulas may not, therefore, measure actual determinates of reading difficulty. Kintsch and Vipond (1979) suggested that researchers must look for other predictor variables to supplement readability formulas in order to determine the real readability of a text. One such variable may be text cohesion. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author ManuscriptText comprehension involves three hierarchical levels of processing and representation. The basic level is the surface form which represents the exact words and syntactic structures of the text. The second level is that of propositional abstraction which represents the idea units of the text in a textbase; propositions consist of predicates, corresponding to verbs, states, or properties, and arguments, corresponding to nouns. The t...

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