Readability following cultural and linguistic adaptations of an Internet-based Intervention for Tinnitus for use in the United States

Purpose: An Internet-based tinnitus intervention for use in the United States could improve the provision of tinnitus-related services. Although such interventions have undergone clinical trials in Europe, the UK, and Australia, their suitability for adults with tinnitus in the US has not been established. The aim of this study was to improve the cultural and linguistic suitability, and lower the readability level, of an existing program for tinnitus to ensure its suitability for US English-and Spanish-speaking populations. Method: Guidelines for cultural adaptation were followed and involved four phases: (i) cultural adaptations, as interventions targeted at specific cultures have been shown to improve outcomes; (ii) creating Spanish materials to improve access of the materials to the large Spanish-speaking population in the US; (iii) professional review of the materials for acceptability as an intervention tool for a US population; and (iv) literacy level adjustments to make the content accessible to those with lower levels of health literacy skills. Results: Cultural adaptations were made by using word substitutions, changing examples and modifying the spelling of certain words. The materials were then translated into Spanish and cross-checked. Professional review ensured suitability of the chapters. Literacy level adjustments ensured all chapters were within the guidelines for readability grade levels below the 6th-grade level. Conclusions: The previously developed tinnitus materials were revised to adhere to best practice guidelines and ensure cultural suitability for adults with tinnitus in the US. As it is also available in Spanish, members of the large Hispanic community also have access to the intervention in their first language. Further studies should determine whether these changes improve patients’ self-efficacy, engagement, and motivation to complete the intervention

Impact of web accessibility barriers on users with a hearing impairment

Several user tests were carried out on people with a hearing impairment to evaluate the impact of different web accessibility barriers on two similar web sites, one accessible and the other not accessible. The tests' focus was to analyze users' moods when faced with different accessibility barriers. Results show "complex text" and "multimedia content without text alternative" as the most critical barriers for users with this profile. Our investigation contributes to a better understanding of users when confronting accessibility barriers, and to emphasize the need of web content authors to use plain language and to provide captions and sign language alternatives in video content

Guidance on the principles of language accessibility in National Curriculum Assessments : research background

This review accompanies the document, which describes the principles which should guide the development of clear assessment questions. The purpose of the review is to present and discuss in detail the research underpinning these principles. It begins from the standpoint that National Curriculum assessments, indeed any assessments, should be: - appropriate to the age of the pupils - an effective measure of their abilities, skills and concept development - fair to all irrespective of gender, language, religion, ethnic or social origin or disability. (Ofqual, 2011) The Regulatory Framework for National Assessments: National Curriculum and Early Years Foundation Stage (Ofqual, 2011) sets out a number of common criteria which apply to all aspects of the development and implementation of National Assessments. One of these criteria refers to the need for assessment procedures to minimise bias: “The assessment should minimise bias, differentiating only on the basis of each learner’s ability to meet National Curriculum requirements” (Section 5.39, page 16). The Framework goes on to argue that: “Minimising bias is about ensuring that an assessment does not produce unreasonably adverse outcomes for particular groups of learners” (Annex 1, page 29). This criterion reinforces the guiding principle that any form of assessment should provide information about the knowledge and understanding of relevant content material. That is to say that the means through which this knowledge and understanding is examined, the design of the assessment and the language used should as far as possible be transparent, and should not influence adversely the performance of those being assessed. There is clearly a large number of ways in which any given assessment task can be presented and in which questions can be asked. Some of these ways will make the task more accessible – that is, easier to complete successfully – and some will get in the way of successful completion. Section 26 of the Fair Access by Design (Ofqual, 2010) document lists a number of guiding principles for improving the accessibility of assessment questions, although the research basis for these principles is not made completely clear in that document. The aim of the current review is to examine the research background more closely in order to provide a more substantial basis for a renewed set of principles to underpin the concept of language accessibility. In the review, each section will be prefaced by a statement of the principles outlined in Guidance on the Principles of Language Accessibility in National Curriculum Assessments and then the research evidence underpinning these principles will be reviewed

The impact of text segmentation on subtitle reading

Understanding the way people watch subtitled films has become a central concern for subtitling researchers in recent years. Both subtitling scholars and professionals generally believe that in order to reduce cognitive load and enhance readability, line breaks in two-line subtitles should follow syntactic units. However, previous research has been inconclusive as to whether syntactic-based segmentation facilitates comprehension and reduces cognitive load. In this study, we assessed the impact of text segmentation on subtitle processing among different groups of viewers: hearing people with different mother tongues (English, Polish, and Spanish) and deaf, hard of hearing, and hearing people with English as a first language. We measured three indicators of cognitive load (difficulty, effort, and frustration) as well as comprehension and eye tracking variables.  Participants watched two video excerpts with syntactically and non-syntactically segmented subtitles. The aim was to determine whether syntactic-based text segmentation as well as the viewers’ linguistic background influence subtitle processing. Our findings show that non-syntactically segmented subtitles induced higher cognitive load, but they did not adversely affect comprehension. The results are discussed in the context of cognitive load, audiovisual translation, and deafness

Line breaks in subtitling: An eye tracking study on viewer preferences

There is a discrepancy between professional subtitling guidelines and how they are implemented in real life. One example of such discrepancy are line breaks: the way the text is divided between the two lines in a subtitle. Although we know from the guidelines how subtitles should look like and from watching subtitled materials how they really look like, little is known about what line breaks viewers would prefer. We examined individual differences in syntactic processing and viewers’ preferences regarding line breaks in various linguistic units, including noun, verb and adjective phrases. We studied people’s eye movements while they were reading pictures with subtitles. We also investigated whether these preferences are affected by hearing status and previous experience with subtitling. Viewers were shown 30 pairs of screenshots with syntactically segmented and non-syntactically segmented subtitles and they were asked to choose which subtitle in each pair was better. We tested 21 English, 26 Spanish and 21 Polish hearing people, and 19 hard of hearing and deaf people from the UK. Our results show that viewers prefer syntactically segmented line breaks. Eye tracking results indicate that linguistic units are processed differently depending on the linguistic category and the viewers’ profile

Language Barriers in the Field of Audiology: Spanish-Speaking Patient & English-Speaking Audiologist

Language barriers in the healthcare system have been a continuously growing dilemma in the United States, affecting communication between a provider and patient, which leads to problems in healthcare delivery. Policies and regulations currently in place have attempted to decrease language barriers but several healthcare providers are not aware of the responsibility, have not prioritized the issue, or have not been held accountable through the enforcement of the laws. The goal of this paper was to provide best practices for audiologic testing that minimize language and cultural barriers and maximize the benefit the patient receives from the hearing evaluation. The focus was on English-speaking audiologists and Spanish-speaking patients. The importance has been exacerbated as Spanish is the second most spoken language in the United States and Hispanic/Latino communities continue to grow with a limited amount of bilingual audiologists. Audiologic research in this population was extremely limited with little information on prevalence of hearing impairment, epidemiology, risk factors, genetic basis of hearing impairment, and hearing aid use. Yet, options are currently available such as resources, educational interventions focused on overcoming language barriers, cultural competency, translators, and machine translators that can help decrease the negative impacts of a language barrier in the audiology field. The goal was to create an audiologic protocol for English-speaking audiologists to use when seeing Spanish-speaking patients to reduce the negative impacts of language barriers in health care

A good practice guide for translating and adapting hearing-related questionnaires for different languages and cultures

Objectives: To raise awareness and propose a good practice guide for translating and adapting any hearing-related questionnaire to be used for comparisons across populations divided by language or culture, and to encourage investigators to publish detailed steps. Design: From a synthesis of existing guidelines, we propose important considerations for getting started, followed by six early steps: (1) Preparation, (2, 3) Translation steps, (4) Committee Review, (5) Field testing and (6) Reviewing and finalising the translation. Study sample: Not applicable. Results: Across these six steps, 22 different items are specified for creating a questionnaire that promotes equivalence to the original by accounting for any cultural differences. Published examples illustrate how these steps have been implemented and reported, with shared experiences from the authors, members of the International Collegium of Rehabilitative Audiology and TINnitus research NETwork. Conclusions: A checklist of the preferred reporting items is included to help researchers and clinicians make informed choices about conducting or omitting any items. We also recommend using the checklist to document these decisions in any resulting report or publication. Following this step-by-step guide would promote quality assurance in multinational trials and outcome evaluations but, to confirm functional equivalence, large-scale evaluation of psychometric properties should follow

PLoS One

A major public health challenge is to communicate effectively with vulnerable populations about preparing for disasters and other health emergencies. People who are Deaf or Hard of Hearing (Deaf/HH) and older adults are particularly vulnerable during health emergencies and require communications that are accessible and understandable. Although health literacy studies indicate that the readability of health communication materials often exceeds people's literacy levels, we could find no research about the readability of emergency preparedness materials (EPM) intended for Deaf/HH and older adult populations. The objective of this study was to explore issues related to EPM for Deaf/HH and older adult populations, to assess the availability and readability of materials for these populations, and to recommend improvements. In two California counties, we interviewed staff at 14 community-based organizations (CBOs) serving Deaf/HH clients and 20 CBOs serving older adults selected from a stratified, random sample of 227 CBOs. We collected 40 EPM from 10 CBOs and 2 public health departments and 40 EPM from 14 local and national websites with EPM for the public. We used computerized assessments to test the U.S. grade reading levels of the 16 eligible CBO and health department EPM, and the 18 eligible website materials. Results showed that less than half of CBOs had EPM for their clients. All EPM intended for clients of Deaf/HH-serving CBOs tested above the recommended 4(th) grade reading level, and 91% of the materials intended for clients of older adult-serving CBOs scored above the recommended 6(th) grade level. EPM for these populations should be widely available through CBOs and public health departments, adhere to health literacy principles, and be accessible in alternative formats including American Sign Language. Developers should engage the intended users of EPM as co-designers and testers. This study adds to the limited literature about EPM for these populations.5P01TP000295/TP/OPHPR CDC HHS/United States23451029PMC358154

Quality is in the eye of the stakeholders: what do professional subtitlers and viewers think about subtitling?

Quality is a rather slippery concept, and its assessment in subtitling can be a challenging task, as its appreciation can easily vary depending on the diferent stakeholders involved in the production and reception of subtitles. In this paper, we evaluate quality indicators in subtitling as perceived by professional subtitlers and viewers. After exploring the various subtitle parameters that can have an impact on the quality of the end product (such as line breaks, synchronisation, display rates), we present the results of two qualitative studies conducted with professional subtitlers and subtitle viewers with diferent audiovisual backgrounds. The results yield some similarities and discrepancies, particularly in the way in which the strategy of condensation is perceived by the two groups, and they also help delineate the subtitle parameters that should be taken into consideration in order to improve the creative process as well as the reception of subtitles