Memory and comprehension for health information among older adults: distinguishing the effects of domain-general and domain-specific knowledge

While there is evidence that knowledge influences understanding of health information, less is known about the processing mechanisms underlying this effect and its impact on memory. We used the moving window paradigm to examine how older adults varying in domain-general crystallised ability (verbal ability) and health knowledge allocate attention to understand health and domain-general texts. Participants (n = 107, age: 60-88 years) read and recalled single sentences about hypertension and about non-health topics. Mixed-effects modelling of word-by-word reading times suggested that domain-general crystallised ability increased conceptual integration regardless of text domain, while health knowledge selectively increased resource allocation to conceptual integration at clause boundaries in health texts. These patterns of attentional allocation were related to subsequent recall performance. Although older adults with lower levels of crystallised ability were less likely to engage in integrative processing, when they did, this strategy had a compensatory effect in improving recall. These findings suggest that semantic integration during reading is an important comprehension process that supports the construction of the memory representation and is engendered by knowledge. Implications of the findings for theories of text processing and memory as well as for designing patient education materials are discussed

Cognition and health literacy in older adults' recall of self-care information

This article is free to read on the publishers website Purpose of the Study: Health literacy is associated with health outcomes presumably because it influences the understanding of information needed for self-care. However, little is known about the language comprehension mechanisms that underpin health literacy. Design and Methods: We explored the relationship between a commonly used measure of health literacy (Short Test of Functional Health Literacy in Adults [STOFHLA]) and comprehension of health information among 145 older adults. Results: Results showed that performance on the STOFHLA was associated with recall of health information. Consistent with the Process-Knowledge Model of Health Literacy, mediation analysis showed that both processing capacity and knowledge mediated the association between health literacy and recall of health information. In addition, knowledge moderated the effects of processing capacity limits, such that processing capacity was less likely to be associated with recall for older adults with higher levels of knowledge. Implications: These findings suggest that knowledge contributes to health literacy and can compensate for deficits in processing capacity to support comprehension of health information among older adults. The implications of these findings for improving patient education materials for older adults with inadequate health literacy are discussed

Comprehension of multimedia health information among older adults with chronic illness

The authors explored knowledge effects on comprehension of multimedia health information by older adults (age 60 or older). Participants viewed passages about hypertension, with text accompanied by relevant and irrelevant pictures, and then answered questions about the passage. Fixations on text and pictures were measured by eye-tracking. Participants with more knowledge of hypertension understood the passages better. This advantage was related to how they processed the passages: while knowledge differences were unrelated to overall time viewing displays, relationships between allocation and knowledge emerged when the data were partitioned into phases (during and after first reading the text). More knowledgeable participants spent relatively more time fixating text than pictures during the first pass. After this pass, they spent more time viewing the relevant picture rather than re-reading, with some evidence that this strategy was associated with comprehension. The findings have implications for designing multimedia education materials and analyzing eye-tracking measures during multimedia learning