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Patient comprehension of gastroenterology (GI) educational materials.

The purpose of this study was to describe patient comprehension of discharge instruction materials used by one gastroenterology department. Two conceptual frameworks, Orem's self-care model of nursing and Klare's reading comprehension model, were used to guide research design and to explain study findings. A descriptive correlational design was used to explore the relationship between years of schooling, word recognition, and reading comprehension. The study participants (n = 30) included 10 male and 20 female patients. Mean years of schooling was post-high school; mean word recognition score was high school level. Findings included moderate correlation between years of schooling and word recognition scores (r = .64) and strong correlation between word recognition and reading comprehension scores (r = .77-.82). Reading comprehension scores for the majority of participants (60%) were at the frustration comprehension level. Findings suggest that word recognition ability and educational level may be insufficient to ensure comprehension.

Adult↗

PubMed2026

Modulating sentence comprehension in people with aphasia through anodal tDCS: A double-blind randomized cross-over study.

This double-blind randomized cross-over study investigated the effects of perilesional anodal transcranial direct current stimulation (AtDCS) combined with speech-language therapy on sentence comprehension in eight individuals with chronic nonfluent agrammatic aphasia. The behavioral therapy consisted of an intensive comprehension treatment including drilling in sentence-to-picture matching and Mapping Therapy. Each participant underwent both the anodal tDCS and sham stimulation conditions (five received sham first followed by real stimulation, and the remaining three the reverse sequence), with each condition paired with the same behavioral treatment and separated by a four-month washout period. Stimulation was applied over the perilesional area (left BA6) for 20 min during daily 40-min therapy sessions over four consecutive weeks. Sentence comprehension was assessed with the RiComprendo battery and functional communication with the Communicative Effectiveness Index (CETI). Data were analyzed using paired t-tests, Bayesian analyses, and linear mixed-effects models to control for baseline performance and individual variability. Both stimulation conditions produced significant pre-to-post improvements in sentence comprehension, particularly for syntactically complex structures such as passives and center-embedded object relatives. However, gains were overall greater following AtDCS, as reflected in larger effect sizes, stronger Bayes factors, and a significant treatment effect in the mixed-effects models. Only the AtDCS condition yielded significant improvements in self-perceived comprehension abilities on the CETI. These findings suggest that AtDCS over perilesional cortical areas may boost the effects of traditional language therapy on sentence comprehension, supporting its feasibility and potential as an adjuvant intervention in post-stroke aphasia rehabilitation.

Humans↗

PubMed2003

Patient and physician factors predict patients' comprehension of health information.

While patients frequently do not comprehend health information, little is known about patient and physician factors that influence lack of comprehension. To assess effectiveness of health information exchange, 19 physicians and 145 patients were given post-encounter questionnaires to evaluate the preceding visit. We analyzed differences in beliefs between patients who comprehended health information and patients who did not, and whether physicians' attitudes and self-assessment of their educational abilities influenced this comprehension. Patients with insufficient comprehension were more likely to have schooling below college and cited language as a barrier. Physicians who believed health information delivery to be important had fewer patients with comprehension difficulties, while physicians who assessed themselves as very effective educators had significantly more patients with lack of comprehension, compared with physicians who did not feel as effective. Patients' comprehension of health information was associated not only with patient factors but also with physicians' attitude and self-assessment.

Adult↗

PubMed2003

Literacy and comprehension of Beck Depression Inventory response alternatives.

This study explored the relationship of literacy level to comprehension of response alternatives from the Beck Depression Inventory (BDI). Twenty-nine adult basic education students, 14 senior citizens, and 20 oncology patients were given a brief literacy assessment and a comprehension test of selected BDI response alternatives. Three raters with clinical experience assessed comprehension. Lower literacy was significantly associated with less comprehension, even when other factors were controlled, yet comprehension problems were still found among higher literacy groups. The percent of participants who correctly paraphrased the selected BDI response alternatives ranged from 0 to 60%. These preliminary results suggest that poor comprehension of mental health measures is not only prevalent, but also cannot be estimated from patients' education or assessed reading levels.

Adult↗

PubMed1995

Efficacy of comprehensive rehabilitation programs and back school for patients with low back pain: a meta-analysis.

BACKGROUND AND PURPOSE: The use of back school as a treatment for low back pain is widespread, but determining the efficacy of this approach is complicated by variations in back schools and study methods across clinical trials. The purpose of this study was to conduct a meta-analysis to synthesize existing evidence on the efficacy of back school as either a primary intervention or a part of a comprehensive rehabilitation program for patients with low back pain. METHODS: The results of 19 prospective randomized controlled trials were evaluated. Quantitative reviewing procedures were used to calculate the effect sizes that compared patients receiving back school with those in a control or comparison group. Effect sizes were computed for 206 hypothesis tests involving 2,373 patients. RESULTS: The average effect size for comprehensive rehabilitation programs that included back school (d = 0.28) was larger than the average effect size for programs that offered back school as the primary intervention (d = -0.14). When effect sizes were stratified by program type and outcome, the comprehensive programs were superior to primary back school programs with respect to pain reduction, increased spinal mobility, and increased strength. Both types of programs showed reasonable success with education/compliance outcomes (d = 0.27-0.28). Lower effect sizes were found among the types of programs for disability and work/vocational outcomes (d < or = 0.20). CONCLUSIONS AND DISCUSSION: Back schools were most efficacious when coupled with a comprehensive rehabilitation program. Efficacy was supported for the treatment of pain and physical impairments and for education/compliance outcomes. Work/vocational and disability outcomes, however, were not improved substantially beyond control levels in comprehensive or primary back school programs. [Di Fabio RP. Efficacy of comprehensive rehabilitation programs and back school for patients with low back pain: a meta-analysis.

Comprehensive Health Care↗

PubMed2006

Multidimensional structures of comprehensive accessibility of community support for people with mental disorders in Japan: a nationwide investigation.

The purpose of this study was to define the concept of comprehensive accessibility of community support for people with mental disorders and to clarify the multidimensional structures of comprehensive accessibility. We developed a self-administered questionnaire consisting of 47 items. A complete list of the municipalities in Japan was prepared, and the questionnaire was mailed to 3310 municipalities. Principal component analyses were applied to valid data in order to analyse the index and multidimensional structures of comprehensive accessibility. As a result, 14 principal components of community support for people with mental disorders were extracted. These principal components were interpreted as the scales for the evaluation of comprehensive accessibility. The two first principal component scores were interpreted as the index indicating the level of comprehensive accessibility. The other 12 principal components were interpreted as the scales constituting the multidimensional space of comprehensive accessibility.

Attitude of Health Personnel↗

PubMed2003

Perceived patient comprehension in acute and chronic cardiovascular clinical trials.

An anonymous patient perception comprehension and satisfaction questionnaire was sent to 438 patients 1-3 months after they had participated in a clinical cardiovascular trial to examine the level of patient comprehension as perceived by the patient. We compared perceived comprehension in acute (acute myocardial infarction) and chronic (outpatient heart failure) clinical trials. Partially or fully completed questionnaires were received from 220 patients (70 chronic, 150 acute). The findings were similar in the 2 patient groups. Perceived full comprehension (understood most or all) of the trial was reported by 18 (27%) of chronic and 40 (31%) of 129 acute patients, while almost 20% of both groups reported little or no understanding of the trial. The level of comprehension was related to the recollected duration of explanation (p = 0.003 chronic, p < 0.001 acute). Perceived comprehension was not related to the personnel explaining the study (physician or nurse) or to whether the explanation as recollected was oral or written. However, in both acute and chronic patients, the majority (51% chronic; 63% acute) preferentially recalled the oral rather than written explanation of the trial. The very similar findings in the acute and chronic situation suggest that perceived understanding reflects human nature and willingness to be involved in medical issues. Considerable effort should be directed to improve the duration of explanation (particularly oral), if we are to achieve our goal of true informed consent in clinical cardiovascular trials.

Cardiovascular Diseases↗

PubMed2006

Right hemisphere brain morphology, attention-deficit hyperactivity disorder (ADHD) subtype, and social comprehension.

Social comprehension involves empathy for others' experiences and appropriate responses to nonverbal cues. Previous research using magnetic resonance imaging (MRI) has suggested a relationship between brain morphology and psychiatric syndromes, such as attention-deficit hyperactivity disorder (ADHD), that typically entail social difficulties. The right hemisphere, specifically, has been associated with social skill deficits, and numerous studies have also associated ADHD with social skill deficits. No studies, however, have examined the association of ADHD subtype with both social comprehension and right-hemisphere morphology. Fifty-nine children (6-12 years old) underwent MRI, from which the right hemisphere was classified into four morphologic subtypes. Children were also grouped by ADHD subtype or clinical control status. From Behavior Assessment System for Children (BASC) items, a social comprehension subscale was constructed. Analyses revealed significant differences in social comprehension based on ADHD subtype. Differences in social comprehension based on ADHD status were especially pronounced in children with atypical right-hemisphere morphology. Thus, the diagnosis of ADHD might be associated with underlying risk in the area of social comprehension, especially for children with atypical right-hemisphere morphology.

Attention Deficit Disorder with Hyperactivity↗

PubMed2006

A systematic review of readability and comprehension instruments used for print and web-based cancer information.

Adequate functional literacy skills positively influence individuals' ability to take control of their health. Print and Web-based cancer information is often written at difficult reading levels. This systematic review evaluates readability instruments (FRE, F-K, Fog, SMOG, Fry) used to assess print and Web-based cancer information and word recognition and comprehension tests (Cloze, REALM, TOFHLA, WRAT) that measure people's health literacy. Articles on readability and comprehension instruments explicitly used for cancer information were assembled by searching MEDLINE and Psyc INFO from 1993 to 2003. In all, 23 studies were included; 16 on readability, 6 on comprehension, and 1 on readability and comprehension. Of the readability investigations, 14 focused on print materials, and 2 assessed Internet information. Comprehension and word recognition measures were not applied to Web-based information. None of the formulas were designed to determine the effects of visuals or design factors that could influence readability and comprehension of cancer education information.

Comprehension↗

PubMed2004

Mapping the brain's orchestration during speech comprehension: task-specific facilitation of regional synchrony in neural networks.

BACKGROUND: How does the brain convert sounds and phonemes into comprehensible speech? In the present magnetoencephalographic study we examined the hypothesis that the coherence of electromagnetic oscillatory activity within and across brain areas indicates neurophysiological processes linked to speech comprehension. RESULTS: Amplitude-modulated (sinusoidal 41.5 Hz) auditory verbal and nonverbal stimuli served to drive steady-state oscillations in neural networks involved in speech comprehension. Stimuli were presented to 12 subjects in the following conditions (a) an incomprehensible string of words, (b) the same string of words after being introduced as a comprehensible sentence by proper articulation, and (c) nonverbal stimulations that included a 600-Hz tone, a scale, and a melody. Coherence, defined as correlated activation of magnetic steady state fields across brain areas and measured as simultaneous activation of current dipoles in source space (Minimum-Norm-Estimates), increased within left- temporal-posterior areas when the sound string was perceived as a comprehensible sentence. Intra-hemispheric coherence was larger within the left than the right hemisphere for the sentence (condition (b) relative to all other conditions), and tended to be larger within the right than the left hemisphere for nonverbal stimuli (condition (c), tone and melody relative to the other conditions), leading to a more pronounced hemispheric asymmetry for nonverbal than verbal material. CONCLUSIONS: We conclude that coherent neuronal network activity may index encoding of verbal information on the sentence level and can be used as a tool to investigate auditory speech comprehension.

Acoustic Stimulation↗

PubMed2006

Ergonomic guidelines for traffic sign design increase sign comprehension.

OBJECTIVE: This research directly tests the relationship between comprehension probability of highway signs and the extent to which they comply with three ergonomic principles of design: sign-content compatibility, familiarity, and standardization. BACKGROUND: A recent study that evaluated comprehension of traffic signs in four different countries showed that comprehension level varies widely and is apparently related to the extent that the sign's design incorporates ergonomic guidelines for good design (D. Shinar, R. E. Dewar, H. Summala, and L. Zakowska 2003). METHOD: Participants were presented with 30 signs and asked to describe each sign's meaning. They then evaluated each sign in terms of each of three ergonomic principles. In addition, a group of human factors/ergonomics experts evaluated each sign on its standardization and compatibility. RESULTS: There were high correlations between the ratings of the students and the ratings of the experts on compatibility (rho = .94) and on standardization (rho = .84), validating the use of the students' evaluations of the signs on these variables. There was a great variability in signs' comprehension and high and statistically significant correlations between the comprehension level of each sign and the extent to which it complied with compatibility (R = .76), familiarity (R = .89), and standardization (R = .88) principles. CONCLUSIONS: The more signs conform to universal ergonomic principles of good design, the more likely they are to be comprehended by drivers of different cultural backgrounds. APPLICATION: Sign design should be guided by established ergonomics principles to enhance comprehension, especially for drivers who have not had any prior encounters with specific signs.

Adult↗

PubMed2003

Comprehension of safety signs for construction workers: comparison of existing and newly designed signs.

The comprehension of safety signs for construction workers was compared among existing and improved designs. Safety signs considered were existing signs, existing signs improved by adding text, existing signs improved by adding/changing pictorials, and existing signs improved by adding/changing pictorials and text. Three hundred and eighty-four construction workers were randomized for assignments into four groups. They were working on nine constructions work sites randomly selected from work sites located in Bangkok, Thailand. The number of workers in each work site was calculated for the proportion of the sample size and then they were randomized so that equal numbers of workers were included in the four groups. The four types of safety signs and an interview form were used to test their comprehension of safety signs. For data analysis, percentages, means, standard deviations, the chi-square test, the one-way ANOVA and LSD tests were applied. The results showed that the mean comprehension scores of the existing signs improved by adding text, the existing signs improved by adding/changing pictorials, and the existing signs improved by adding/changing pictorials and text were significantly higher than those of the existing signs. In addition, the mean comprehension scores of the existing signs improved by adding text and the existing signs improved by adding/changing pictorials and text were significantly higher than those of the existing signs improved by adding/changing pictorials. The highest mean comprehension score of safety signs for the construction workers was found in the existing signs improved by adding/changing pictorials and text. These results indicated that for construction workers, the comprehension of safety signs with pictorials and explanatory text was better than that of the existing signs.

Comprehension↗

PubMed1998

Sentence comprehension deficits in Alzheimer's disease: a comparison of off-line vs. on-line sentence processing.

Two studies explored whether sentence comprehension impairments in Alzheimer's disease (AD) are due to deficits in syntactic processing or memory. Study 1 used a picture-pointing sentence comprehension task to measure the final outcome of comprehension in an off-line fashion. It showed the comprehension of 30 patients with AD to be impaired, but suggested that the deficits could not be attributed solely to syntactic impairments. Study 2 investigated the effects of memory on sentence comprehension by comparing off-line (grammaticality judgment) with on-line (cross-modal naming) language processing in 11 AD and 9 control subjects. The results revealed impaired performance in the off-line task but normal performance in the on-line task using the same sentences. Performance on the off-line task correlated with independent measures of verbal working memory. These data are used to argue that sentence comprehension impairments are related to verbal working memory deficits in AD.

Aged↗

PubMed1998

Calibration of Comprehension: Research and Implications for Education and Instruction.

The ability to accurately evaluate one's understanding of text information is critical for optimum learning to take place. One widely used paradigm for examining the accuracy of individuals' self-assessed comprehension has been termed calibration of comprehension. In this paradigm, students read a passage and are asked to make predictions about their future performance on a comprehension test. Calibration of comprehension is the relation between students' confidence and performance or between predicted and actual performance. In the present paper we review research on calibration of comprehension, examining a number of variables that have been found to influence calibration ability. In the first three sections of our paper we focus on the effects of individual, task, and text variables on students' calibration of comprehension. In the final section, we discuss implications of research on calibration for education and instruction. Copyright 1998 Academic Press.

Journal Article↗

PubMed1999

Time Limitations Enhance Reading Comprehension.

Few studies in the domain of reading have explored the relation between time limitations and reading comprehension. Time limitations may enhance reading comprehension by promoting mindfulness in students, a construct which involves exertion of more effort and motivation. This study explored the effects of time constraints on reading comprehension in adult readers. Mild time constraints should create greater mindfulness in readers, resulting in enhanced comprehension. College students read passages under no time pressure, under mild time pressure, or under severe time pressure. Reading comprehension was assessed in each condition. The best reading comprehension was observed under mild time pressure. Implications are discussed. Copyright 1999 Academic Press.

Journal Article↗

PubMed2005

The evaluation of comprehensive cancer control efforts: useful techniques and unique requirements.

This article discusses evaluation of comprehensive cancer control efforts as developed in the United States by involved partners at all levels -- community, regional, state, tribal, territorial, and national. Evaluation of comprehensive cancer control can concern the evaluation of a program, a plan or activities from a plan. In its development, it is grounded in both theory and practice, and the results are used in program development and implementation to document activities, inform decision making, and demonstrate accountability. Various types of evaluation have been shown to be important. Challenges to evaluating comprehensive cancer control include incorporating and working with a broad group of stakeholders; developing an agreed upon plan and evaluation, ensuring the necessary infrastructure for overseeing, facilitating, and disseminating results of evaluations; conceptualizing and communicating desired changes; and potentially implementing (and evaluating) programs at the community, regional, tribal, territorial, state, or national level. Using the CDC Framework for Evaluation, selected examples of state program evaluations are presented. These examples show the use of both process and outcome evaluations to illustrate programmatic improvement and the accomplishment of proposed objectives. As evaluation of comprehensive cancer control continues to be developed and results communicated, our ability to evaluate comprehensive cancer control programs increases and the growth of comprehensive cancer control efforts are encouraged.

Forecasting↗

PubMed1992

Sentence comprehension in Parkinson's disease: the role of attention and memory.

Sentence comprehension is a complex process involving at least attentional, memory, grammatical, and semantic components. We report three experiments designed to evaluate the impairments underlying sentence comprehension difficulties in nondemented patients with Parkinson's disease (PD). In the first experiment, we asked patients to answer simple questions about sentences which varied in terms of grammatical complexity and semantic constraint. We found that PD patients are significantly compromised in their ability to perform this task. Their difficulties became more prominent as grammatical complexity increased, but they were significantly assisted by semantic constraints that limited possible interpretations of a sentence. Analyses of individual patient profiles revealed heterogeneous performance across the group of PD patients and somewhat inconsistent performance for patients across testing sessions. In the second experiment, we tested the possibility that patients' heterogeneous performance on the sentence comprehension task is due to an impairment in memory or attention, cognitive domains known to be compromised in some PD patients. Although PD patients and control subjects differed on one memory measure, there were no significant correlations between attention and memory performance and the results of the sentence comprehension task. In the final experiment, we manipulated the sentences used in the first experiment in a fashion that stressed the need for memory and attention in a sentence. The results indicated that PD patients are significantly compromised in their ability to attend to certain critical grammatical features of a sentence. A regression analysis identified specific grammatical, semantic, and attentional mechanisms as significant contributors to PD patients' overall sentence comprehension, accounting for over 97% of the variance in their performance. We conclude that there are multiple sources of cognitive difficulty underlying PD patients' sentence comprehension impairment.

Aged↗

PubMed1996

Working memory capacity predicts language comprehension in schizophrenic patients.

The association between language comprehension and working memory capacity was evaluated in 25 male DSM-III-R schizophrenic patients (14 inpatients; 11 outpatients), and in 11 male normal controls (no lifetime DSM-III-R disorder). Patients and controls did not differ significantly on age and education. Language comprehension was examined as a function of two types of processing demand: grammatical complexity (complex versus simple sentences) and presentation rate (accelerated versus conversational). Schizophrenic patients showed significantly reduced language comprehension and decreased working memory capacity for language, compared with controls. Patients showed general difficulty in comprehending accurately, rather than exhibiting problems with specific grammatical structures. Subject groups were highly accurate and did not differ in their ability to perceive the individual words in sentences presented at the accelerated rate (intelligibility). Presentation rate and grammatical complexity affected comprehension accuracy in all groups, however, with increases in rate and complexity producing decreases in understanding. Of most importance, theoretically, is the finding that working memory capacity predicted language comprehension accuracy in both schizophrenic patients and normal controls. Results suggest that language comprehension deficits in schizophrenic patients may involve a general dysfunction that is associated with working memory capacity for language.

Adult↗