Introduction: Colon cancer is the third leading cause of cancer death among women in Canada. Although regular screening beginning at age 50 years can significantly decrease risk of colon cancer mortality, many eligible Canadian women have never obtained screening. Cancer screening rates among immigrant women to Canada are even lower than for native-born women. Disparities in the use of preventive cancer services by immigrants have been linked to limited acculturation and speaking a language other than English. Poor prose comprehension may frustrate access and use of preventive cancer information by older ESL immigrant women to Canada. In order to develop useful and actionable cancer prevention information, it is necessary to understand the barriers ESL immigrant women face in obtaining and using health and cancer information. Therefore, the primary objective of this research was to assess the relationship of acculturation on the prose comprehension of older ESL immigrant women to Canada. Methods: Interviews were conducted with 78 older adult Spanish-speaking immigrant women (aged 45 to 73 years) residing in Kitchener-Waterloo, Ontario. Acculturation was inferred by length of Canadian residency and measured using the Bidimensional Acculturation Scale (BAS). Several measures were used to assess comprehension including the shortened Test of Functional Health Literacy in Adults (S-TOFHLA), the Rapid Estimate of Literacy in Medicine (REALM), the Newest Vital Sign (NVS), and a modified Cloze procedure. The modified Cloze procedure was constructed using a one-page colon cancer information sheet created for the public by the Canadian Cancer Society. Four multiple linear regression analyses were used to test the relationship between the independent variables of acculturation (BAS) and length of Canadian residency, age, Spanish language education, employment, and media variables (television and internet use) on each measure of prose comprehension (i.e., dependent variables of scores on S-TOFHLA, NVS, REALM and Cloze). Logistic regression was used to test whether acculturation and comprehension predicted screening intentions. Semi-structured interviews were conducted to identify the women’s cancer information needs and preferences as well as the barriers they experienced in obtaining and understanding English language cancer information. Results: Three significant models predicting comprehension of colon cancer and health information were identified. The independent variables BAS, Spanish language education and television viewing explained 23% of the variation in Cloze comprehension scores (F=6.76; df=3; p < 0.01; R2= 0.23). Approximately 42% of the variation in S-TOFHLA scores among older ESL immigrant women was explained by the independent variables BAS, age, television viewing and internet use (F=12.13; df=5; p < 0.01; R2=0.42). Using REALM as the dependent measure of comprehension, BAS and television viewing explained 17% of the variation in scores (F=7.54; df=2; p<0.01; R2=0.17). BAS was the only significant predictor of the dependent comprehension measure NVS (F=5.36; df=1; p=0.02; R2=0.07). Logistic regression models predicting colon cancer screening intentions were not significant. Qualitative data analyses revealed that women’s colon cancer information needs, preferences and perceived barriers accessing English language information did not vary according to BAS score or duration of residency in Canada. All women requested actionable information that was community and culturally specific. Additional factors related to older ESL immigrant women’s comprehension of cancer information were identified. These included self-efficacy, social networks and mode of information delivery. These additional modes of information delivery included receiving health information orally as compared to written information. Conclusion: Acculturation (as measured by BAS) significantly predicted prose comprehension by older ESL Spanish speaking immigrant women across four separate measurement tools (Cloze, S-TOFHLA, REALM, NVS). Yet, the proportion of the variance in comprehension scores explained by acculturation and other demographic variables was low to modest, ranging from 7-42%. In addition to acculturation, self-efficacy and social networks may also be associated with prose comprehension. Low self-efficacy among older ESL immigrant women may be a barrier to information seeking and perceived comprehension. However, strong social networks may provide women with the confidence and resources necessary to access health information and services. These results highlight the need for the additional research regarding the influence of self-efficacy on ESL immigrants’ ability to find and use health and cancer information. Recommendations: This research has important implications for public health educators. Health educators are encouraged to develop cancer and health information for ESL speakers in Canada that is community, culturally and linguistically specific and which provides actionable information. This is especially salient given the changing demographic and cultural profile of Canadians. Also, among older ESL immigrants who struggle with language barriers, receiving health information orally may be preferred.

Introduction: Colon cancer incidence and mortality rates in Canada are among the highest worldwide. If detected early colon cancer is highly curable and regular screening can significantly decrease risk of colon cancer mortality. Despite this, screening rates in Canada are consistently low and immigrant and senior populations are particularly vulnerable due to low health literacy and language barriers. This research consists of three studies that were designed to explore the cancer prevention experiences of older English-as-a-Second Language (ESL) Chinese immigrant women in Canada. This includes an investigation of colon and breast cancer screening utilization, health literacy skills and comprehension of colon cancer prevention information, and experiences and preferences when seeking cancer information by these immigrant women. Methods: A convenience sample of 110 Mandarin and Cantonese-speaking ESL immigrant women were recruited from two Southern Ontario communities. For study inclusion participants were required to: (1) be 50 years of age or older, (2) have immigrated to Canada, (3) have Cantonese or Mandarin as their first language and English as their second language, and (4) be able to read in English. Participants were excluded if they or their spouse had been previously diagnosed with any type of cancer. Participants completed a battery of questionnaires assessing demographic characteristics, use of breast and colon cancer screening, acculturation, self-efficacy, health beliefs and health literacy. Health literacy was assessed using the Short Test of Functional Health Literacy in Adults (S-TOFHLA) and comprehension of a colon cancer prevention information sheet from Cancer Care Ontario was assessed using the cloze procedure. Participants participated in a semi-structured interview to explore cancer information seeking preferences and experiences, and their understanding of cancer prevention information. Multivariate logistic regression was used to identify predictors of colon and breast cancer screening. To identify variables significantly associated with performance on the S-TOFHLA and cloze test regression analyses were performed. Directed content analysis was used to identify themes associated with barriers to cancer information seeking and understanding that emerged from the interviews. Results: Study #1: There was high self-reported screening for breast and colon cancer. Eighty-five percent of the women were current mammography screeners and 75% were current colon cancer screeners. Recommendation from a physician (OR=.140; 95% CI= .044, -.448), having a female physician (OR=.141; 95% CI= .033, .591), and high or moderate proficiency in English (OR=.283; 95% CI= .089, .902) significantly predicted mammography screening. Physician recommendation (OR=.103; 95% CI= .031, .349), first language (OR= 1.85; 95% CI= .055, .628) and higher self-efficacy (OR= 3.613; 95% CI= 1.179, 11.070) predicted use of colon cancer screening. Other important predictors included greater health literacy and longer residency in Canada. Study #2: Only 38.7% of the women had adequate health literacy on S-TOFHLA and 54.3% had adequate comprehension of the colon cancer information. Comprehension of the colon cancer information was significantly lower among women who received the information in English, compared to those who received the information in Chinese (p<0.01). Age, acculturation, self-reported proficiency reading English, and education were significant predictors of health literacy but varied depending on the measure (S-TOFHLA, cloze) and language of information (English, Chinese). Study #3: There were unique health information seeking preferences among the older Chinese immigrant women including a strong preference for interpersonal and interactive cancer information from their physician and trusted others, such as friends and family. Barriers to cancer information seeking included language difficulties and limited time with physicians. Differences in health literacy did not distinguish the women on any of the major themes. Conclusion: Language, culture, health literacy and the role of the physician emerged across all three studies examining the cancer prevention experiences of older Chinese immigrant women. While language concordant educational materials may improve understanding of cancer information, the results from this study suggest that it is important to consider factors other than language alone and to address important cultural issues that play a role in the access, use, and understanding of cancer information.

Lack of patient adherence with medication results in health care costs and adverse clinical outcomes. Although fear of side effects can contribute to non-adherence, being informed about them can actually improve matters. Nonetheless, questions persist as to the most efficient way to convey that type of information to patients for a given medication. Information on side effects is largely limited to a simple list in medication leaflets, often without frequency data (that is, lacking detail as to how often they might occur). The decision-making literature suggests that the interpretation of information varies depending on the presentation format or the frame used. This study examined the impact of providing numerical information for side effect frequency, levels of illness severity, and side effect framing on the likelihood of taking an OTC medicine.<p> Participants received a headache scenario with three drug options (X, Y and Z) to consider for use. These painkillers had three levels of potency (defined as 50, 75, and 100% effective) and were accompanied with three levels of side effects (two, four, and six items). When considering their drug choice for the headaches, participants received drug information written without side effect frequency data, then again with side effect frequency data. Subjects rated their likelihood of taking Drug X, Y and Z on a scale of 1 (very unlikely) to 100 (very likely). Participants were also asked to show their likelihood of taking a different set of two medications for headaches (coined Drug N and P) based on positively-slanted or negatively-slanted wording in relation to chances of experiencing a side effect (heartburn).<p> Thirty subjects from Saskatoon over 50 years of age participated. The average age was 66.6 years and 63.3 percent of participants were female. Less than half of participants (n=11) had previous experience with side effects. Most participants were using at least one medicine (whether OTC or prescribed) and described themselves as knowledgeable or somewhat knowledgeable.<p> Participants were more likely to take the hypothetical drugs in the situations described when they received frequency data for side effects (p<0.05). Also, there was a significant higher mean likelihood of use when the drug was framed positively (p<0.01).<p> When considering decisions involving drug effectiveness and their side effects, the provision of frequency data increased patient likelihood of use. Framing the context in positive format also increased patient likelihood to use a medicine. This information could be important for pharmacists counseling on medication side effects, especially for those patients with medication adherence problems.

The current state of much research on written patient education materials (WPEM) suggests that they are written in a manner that is too difficult even for educated patients to understand and remember. Much of the research in this area is focused on modification of the readability of WPEM, which has shown to be relatively ineffective. In this study, an attempt was made to determine if a theory-based method in revising WPEM for improved comprehensibility and memorability was effective. The effectiveness of three versions of WPEM regarding breast self-exams (BSEs) was examined; the original version without illustrations obtained from the American Cancer Society website, a version that was written at a lower readability level as measured by the Flesch-Kincaid readability formula, and a version with a lower readability level as measured by the Flesch-Kincaid readability formula and the increased use of concrete language as suggested by Dual Coding Theory. The researcher compared the percentage of recall of idea units recalled by 76 participants at two time periods: immediately after reading the randomly assigned version of WPEM and seven days after the initial reading. The WPEM that contained the lower readability level and concrete language was most recalled by participants both at immediate recall and delayed recall. In fact, the delayed recall of the WPEM that contained the lower readability level and concrete language after the seven-day period was almost equivalent to the immediate recall of the participants in the other two groups. A significant main effect was found for the forms of WPEM, F(2, 73) = 27.69, p = .00, n2 p = .43 with an observed power of 1.00. A significant main effect was found for time, F(1, 73) = 161.94, p <.00, n2 p = .69 with an observed power of 1.00. A significant interaction of WPEM and time was found, F(2, 73) = 5.07, p = .01, n2 p = .12 with an observed power of .80. Reported levels of frequency of performing BSEs and levels of confidence in performing BSEs were also analyzed using the Wilcoxon Signed Ranks Test in relation to the three WPEM versions over time. Reported frequency was significantly greater after seven days, regardless of form of WPEM (WPEM A, p = .32; WPEM B, p = 1.00; WPEM C, p = .74). Levels of confidence were significantly greater after seven days, regardless of form of WPEM (WPEM A, p = ..02; WPEM B, p = .00; WPEM C, p = .00). Overall results indicate that combining reduced readability and increased concrete language is beneficial. The writing of WPEMs in a way that patients can understand should be supported by a theory, and infusing Dual Coding Theory in the writing of selected WPEMs may be beneficial for patients.

Thesis (M.A.)--Indiana University, 2009. / Title from screen (viewed on February 1, 2010). Department of English, Indiana University-Purdue University Indianapolis (IUPUI). Advisor(s): Ulla M. Connor, Frank M. Smith, Honnor Orlando. Includes vitae. Includes bibliographical references (leaves 138-139).

Title: Hälsa i sociala medier - En kvalitativ studie om hur hälsoinformatörer upplever och påverkas  av hälsobudskap i sociala medier. Title: Health in social media - A qualitative study of how health communicators perceive and are affected by health messages in social media. Author: Anna Hedström Institute: Karlstad University. Faculty of health, nature and engineering sciences. Tutor: Owe Stråhlman Date: 150615 Number of pages: 34 Keywords: eHealth literacy, health communication, health informers, health literacy, health messages, media literacy, social media   Background: With an increased interest in diet and exercise, also health and fitness messages have increased in both traditional and social media. The general guidelines on physical activity and diet are forgotten as training tips increase in the media. Research shows that it is common for individuals to retrieve information from the media when it comes to their own health. In doing so media literacy, health literacy and eHealth literacy becomes increasingly important for health communicators and for those who receive health information.   Objectives: The aim of this study was to examine health communicators’ experiences of health messages in social media, and how they are affected by them.   Method: Qualitative interviews were chosen as a method to collect data. Six individuals participated in the study, four of them were females and two were men. The criterion for participation was to somehow work to inform about health. To analyze the data collected, qualitative contained analysis were used.   Results: The analysis revealed four categories; the health informer experiences of social media content, social media's impact on customers, social media's impact on the health informer work and the health informers use of social media in their work. The results show that health informers experience a certain lack of knowledge among health messages in social media and that many of them are too extreme. These health informers experience that their customers are more well-informed now than a few years ago, due to the use of Facebook, Instagram and blogs. Using social media to search information about diet and exercise is good because it is easily accessible and it is fast, but if one does not have the knowledge of what should be weeded out, these advantages can easily become disadvantages. Respondents feel that it has become a larger equality on diet and exercise that they believe may be due to health messages disseminated on social media. Health communicators can work with to get their customers to be more critical of what they read.   Conclusion: The conclusion of the result is that the health communicators indirectly affected by health messages on social media by their clients that often come with questions about things they read or want help to look like some bloggers they follow. Health communicators work is affected in the way that they need to take advantage of social media to help its customers as well as possible and they must also talk to their customers about the source criticism and that they should focus on what feels good for the customer .

Health literacy involves basic reading and numeracy, allowing people to function as health care consumers, reading, understanding, evaluating and using information in health documents. For thirty years, the gap between the reading level of most of the public, eighth grade, and the reading level of most written health information, above the tenth grade, has been perceived to prevent people from comprehending health instructions or educating themselves about health conditions.This study examined comprehension of health materials, using print environmental public health information about relatively obscure aspects of arsenic and ultraviolet light contamination. The research question was "to what extent are print materials for environmental health promotion comprehensible by the target audience of readers at the eighth grade reading level?" This study tested a hypothesis that materials written at the seventh grade level would be more comprehensible than those written at the twelfth grade level for individuals with an average reading level.Materials were located, assessed for reading level, rewritten to the seventh grade reading level, and vetted by environmental health experts. The mean reading level of the participants was eighth grade. The study used a pretest / posttest design with follow up interviews to asses some participants' perception of the reading materials and test. Data was analyzed using repeat measures ANOVA and content analysis.Contrary to anticipated results, the study showed when people with average reading ability read twelfth grade material, they were able to comprehend it as well as they did seventh-grade material. Two follow-up interviews provided anecdotal evidence indicating people with an average reading level would not voluntarily choose to read the twelfth grade material.Although the results of this small exploratory study found individuals, with average reading levels, can read and comprehend written information about environmental health topics, health literacy professionals cannot stop being concerned about the perceived mismatch between the reading levels of American adults and reading levels of environmental health information. It is important to undertake additional studies to better understand how much of an encumbrance hard-to-read information may be placing on individuals with a need to know about environmental hazards and their health.

Introduction: Colon cancer is the third leading cause of cancer death among women in Canada. Although regular screening beginning at age 50 years can significantly decrease risk of colon cancer mortality, many eligible Canadian women have never obtained screening. Cancer screening rates among immigrant women to Canada are even lower than for native-born women. Disparities in the use of preventive cancer services by immigrants have been linked to limited acculturation and speaking a language other than English. Poor prose comprehension may frustrate access and use of preventive cancer information by older ESL immigrant women to Canada. In order to develop useful and actionable cancer prevention information, it is necessary to understand the barriers ESL immigrant women face in obtaining and using health and cancer information. Therefore, the primary objective of this research was to assess the relationship of acculturation on the prose comprehension of older ESL immigrant women to Canada. Methods: Interviews were conducted with 78 older adult Spanish-speaking immigrant women (aged 45 to 73 years) residing in Kitchener-Waterloo, Ontario. Acculturation was inferred by length of Canadian residency and measured using the Bidimensional Acculturation Scale (BAS). Several measures were used to assess comprehension including the shortened Test of Functional Health Literacy in Adults (S-TOFHLA), the Rapid Estimate of Literacy in Medicine (REALM), the Newest Vital Sign (NVS), and a modified Cloze procedure. The modified Cloze procedure was constructed using a one-page colon cancer information sheet created for the public by the Canadian Cancer Society. Four multiple linear regression analyses were used to test the relationship between the independent variables of acculturation (BAS) and length of Canadian residency, age, Spanish language education, employment, and media variables (television and internet use) on each measure of prose comprehension (i.e., dependent variables of scores on S-TOFHLA, NVS, REALM and Cloze). Logistic regression was used to test whether acculturation and comprehension predicted screening intentions. Semi-structured interviews were conducted to identify the women’s cancer information needs and preferences as well as the barriers they experienced in obtaining and understanding English language cancer information. Results: Three significant models predicting comprehension of colon cancer and health information were identified. The independent variables BAS, Spanish language education and television viewing explained 23% of the variation in Cloze comprehension scores (F=6.76; df=3; p < 0.01; R2= 0.23). Approximately 42% of the variation in S-TOFHLA scores among older ESL immigrant women was explained by the independent variables BAS, age, television viewing and internet use (F=12.13; df=5; p < 0.01; R2=0.42). Using REALM as the dependent measure of comprehension, BAS and television viewing explained 17% of the variation in scores (F=7.54; df=2; p<0.01; R2=0.17). BAS was the only significant predictor of the dependent comprehension measure NVS (F=5.36; df=1; p=0.02; R2=0.07). Logistic regression models predicting colon cancer screening intentions were not significant. Qualitative data analyses revealed that women’s colon cancer information needs, preferences and perceived barriers accessing English language information did not vary according to BAS score or duration of residency in Canada. All women requested actionable information that was community and culturally specific. Additional factors related to older ESL immigrant women’s comprehension of cancer information were identified. These included self-efficacy, social networks and mode of information delivery. These additional modes of information delivery included receiving health information orally as compared to written information. Conclusion: Acculturation (as measured by BAS) significantly predicted prose comprehension by older ESL Spanish speaking immigrant women across four separate measurement tools (Cloze, S-TOFHLA, REALM, NVS). Yet, the proportion of the variance in comprehension scores explained by acculturation and other demographic variables was low to modest, ranging from 7-42%. In addition to acculturation, self-efficacy and social networks may also be associated with prose comprehension. Low self-efficacy among older ESL immigrant women may be a barrier to information seeking and perceived comprehension. However, strong social networks may provide women with the confidence and resources necessary to access health information and services. These results highlight the need for the additional research regarding the influence of self-efficacy on ESL immigrants’ ability to find and use health and cancer information. Recommendations: This research has important implications for public health educators. Health educators are encouraged to develop cancer and health information for ESL speakers in Canada that is community, culturally and linguistically specific and which provides actionable information. This is especially salient given the changing demographic and cultural profile of Canadians. Also, among older ESL immigrants who struggle with language barriers, receiving health information orally may be preferred.

Introduction: Colon cancer incidence and mortality rates in Canada are among the highest worldwide. If detected early colon cancer is highly curable and regular screening can significantly decrease risk of colon cancer mortality. Despite this, screening rates in Canada are consistently low and immigrant and senior populations are particularly vulnerable due to low health literacy and language barriers. This research consists of three studies that were designed to explore the cancer prevention experiences of older English-as-a-Second Language (ESL) Chinese immigrant women in Canada. This includes an investigation of colon and breast cancer screening utilization, health literacy skills and comprehension of colon cancer prevention information, and experiences and preferences when seeking cancer information by these immigrant women. Methods: A convenience sample of 110 Mandarin and Cantonese-speaking ESL immigrant women were recruited from two Southern Ontario communities. For study inclusion participants were required to: (1) be 50 years of age or older, (2) have immigrated to Canada, (3) have Cantonese or Mandarin as their first language and English as their second language, and (4) be able to read in English. Participants were excluded if they or their spouse had been previously diagnosed with any type of cancer. Participants completed a battery of questionnaires assessing demographic characteristics, use of breast and colon cancer screening, acculturation, self-efficacy, health beliefs and health literacy. Health literacy was assessed using the Short Test of Functional Health Literacy in Adults (S-TOFHLA) and comprehension of a colon cancer prevention information sheet from Cancer Care Ontario was assessed using the cloze procedure. Participants participated in a semi-structured interview to explore cancer information seeking preferences and experiences, and their understanding of cancer prevention information. Multivariate logistic regression was used to identify predictors of colon and breast cancer screening. To identify variables significantly associated with performance on the S-TOFHLA and cloze test regression analyses were performed. Directed content analysis was used to identify themes associated with barriers to cancer information seeking and understanding that emerged from the interviews. Results: Study #1: There was high self-reported screening for breast and colon cancer. Eighty-five percent of the women were current mammography screeners and 75% were current colon cancer screeners. Recommendation from a physician (OR=.140; 95% CI= .044, -.448), having a female physician (OR=.141; 95% CI= .033, .591), and high or moderate proficiency in English (OR=.283; 95% CI= .089, .902) significantly predicted mammography screening. Physician recommendation (OR=.103; 95% CI= .031, .349), first language (OR= 1.85; 95% CI= .055, .628) and higher self-efficacy (OR= 3.613; 95% CI= 1.179, 11.070) predicted use of colon cancer screening. Other important predictors included greater health literacy and longer residency in Canada. Study #2: Only 38.7% of the women had adequate health literacy on S-TOFHLA and 54.3% had adequate comprehension of the colon cancer information. Comprehension of the colon cancer information was significantly lower among women who received the information in English, compared to those who received the information in Chinese (p<0.01). Age, acculturation, self-reported proficiency reading English, and education were significant predictors of health literacy but varied depending on the measure (S-TOFHLA, cloze) and language of information (English, Chinese). Study #3: There were unique health information seeking preferences among the older Chinese immigrant women including a strong preference for interpersonal and interactive cancer information from their physician and trusted others, such as friends and family. Barriers to cancer information seeking included language difficulties and limited time with physicians. Differences in health literacy did not distinguish the women on any of the major themes. Conclusion: Language, culture, health literacy and the role of the physician emerged across all three studies examining the cancer prevention experiences of older Chinese immigrant women. While language concordant educational materials may improve understanding of cancer information, the results from this study suggest that it is important to consider factors other than language alone and to address important cultural issues that play a role in the access, use, and understanding of cancer information.

Inappropriate parental expectations of age-appropriate behaviors and unawareness of developmental milestones can increase instances of child maltreatment. Additionally, experiences of child maltreatment can have a negative impact on the developmental trajectory of a child. The present research describes a parental aide, the tDevelop, delivered to parents at risk for child maltreatment through SafeCare Parent-Child Interaction (PCI) training with the aim of increasing identification of developmental milestones and age-appropriate activities. Two high-risk families with children close to 24-months of age were recruited from a residential program for young mothers working to develop self-sufficiency skills. The families were presented with the tDevelop along with traditional PCI information, including Planned Activities Training and age-appropriate activities. Data from a multiple-probe, single-case experimental design, suggest that mothers are able to recognize developmental milestones with increased accuracy upon intervention with the tDevelop. These findings suggest that the enhanced PCI protocol may enhance parental identification of developmental milestones.