Show, don’t just tell:Photo stories to support people with limited health literacy

Mensen met beperkte gezondheidsvaardigheden (ook wel: gezondheidsgeletterdheid) hebben vaak moeite met het begrijpen van informatie in folders en brochures én met gesprekken met zorgprofessionals. In dit proefschrift doen we verslag van onderzoek naar de vraag hoe we tot folders en brochures kunnen komen waar mensen met beperkte gezondheidsvaardigheden meer aan hebben. Daarbij kijken we naar methoden om de begrijpelijkheid van gezondheidsinformatie te vergroten en tegelijk naar methoden om gesprekken met zorgprofessionals te ondersteunen. Het centrale thema van dit proefschrift is het gebruik van fotostrips in gezondheidscommunicatie. Fotostrips zijn beeldende verhalen met foto’s en bijschriften. Eerder onderzoek laat zien dat zulke verhalen mensen met beperkte gezondheidsvaardigheden kunnen ondersteunen. In verschillende onderzoeken met deelnemers uit de doelgroep verkenden we wat het beste ontwerp voor fotostrips zou kunnen zijn en onderzochten we de effecten van zulke fotostrips over gesprekken met zorgprofessionals. Samen met ouderen creëerden we fotostrips over patiënt-doktergesprekken, waarin de thema’s en strategieën terugkwamen die ouderen zelf hadden ingebracht. Hoewel ouderen in een kwalitatief onderzoek de fotostrips duidelijk verkozen boven een vergelijkbare traditionele brochure vonden we in een kwantitatief onderzoek geen significante verschillen. Patiënten in wachtkamers van huisartsenprakijken rapporteerden echter dat zij de fotostrips in de wachtkamers vaker opmerkten dan de traditionele brochures. Samenvattend: fotostrips zijn een veelbelovend middel om mensen met beperkte gezondheidsvaardigheden te ondersteunen. Verder onderzoek is nodig om na te gaan wat de impact is van fotostrips op patiënt-doktergesprekken

Look before you leap:How enjambment affects the processing of poetry

This study describes two eye tracking experiments investigating the processing of poetry with and without enjambments. In Experiment 1, poetic fragments with authentic prospective (syntactically incomplete) or retrospective (syntactically complete) enjambments were investigated; in Experiment 2, enjambments were created - for the purpose of the experiment - from poetry that did not originally contain enjambments. We hypothesized that the layout of the text in poetic fragments would affect the degree to which integrative processes take place: in case of prospective enjambments, the syntactic incompleteness may preclude integration at the end of the line (before going to the next line), whereas retrospective enjambments may cause considerable re-interpretation at the next line. We indeed found significant differences in reading patterns between prose and poetry, poetry with and without enjambment, and poetry with prospective and retrospective enjambment. We interpret these results as favoring a dynamic model of language processing, where the amount and type of integration is determined by syntactic (in)completeness, semantic (in)completeness, but also the physical layout of the text

Sweet Temptations:How Does Reading a Fotonovela About Diabetes Affect Dutch Adults with Different Levels of Literacy?

Recent studies suggest that health-related fotonovelas-booklets that portray a dramatic story using photographs and captions-may be effective health communication tools, especially for readers with a low level of literacy. In this experiment, effects on knowledge and behavioral intentions were assessed of a fotonovela originally developed for a Latin-American audience. Dutch readers from a low literacy group (N = 89) and a high literacy group (N = 113) were randomly assigned to one of three conditions: a fotonovela condition (all captions translated into Dutch), a traditional brochure condition (also in Dutch), and a control condition. On knowledge about diabetes, participants in the fotonovela condition outperformed participants in both other conditions. This finding was consistent across literacy levels. On behavioral intentions, however, readers of the fotonovela did not score significantly higher than participants in the other conditions. We also evaluated hypotheses proposed in the Entertainment Overcoming Resistance Model (EORM; Moyer-Guse, 2008) on the possible mechanisms underlying persuasion through narratives. No support was found for the mechanisms proposed in the EORM. The outcomes of this study suggest that a fotonovela may be a valuable health education format for adults with varying levels of literacy, even if it was developed for a target group with a different cultural background.</p

Using Photo Stories to Support Doctor-Patient Communication:Evaluating a Communicative Health Literacy Intervention for Older Adults

Older adults often have limited health literacy and experience difficulties in communicating about their health. In view of the need for efficacious interventions, we compared a narrative photo story booklet regarding doctor-patient communication with a non-narrative but otherwise highly similar brochure. The photo story booklet included seven short picture-based stories about themes related to doctor-patient communication. The non-narrative brochure had comparable pictures and layout and dealt with the same themes, but it did not include any stories. We conducted two Randomized Controlled Trials (RCTs) among older adults with varying levels of health literacy: one RCT in Germany (N = 66) and one RCT in the Netherlands (N = 54); the latter one was followed by an in-depth interview study among a subset of the participants (81.5%; n = 44). In the RCTs, we did not find significant differences between the photo story booklet and the non-narrative brochure. In the interview study, a majority of the participants expressed a preference for the photo story booklet, which was perceived as recognizable, relevant, entertaining and engaging. We conclude that photo story booklets are a promising format but that there is room for improving their effectiveness

Een lege plek om te blijven. Een empirisch onderzoek naar de online verwerking van regelverdeling en enjambement in poëzie.

In dit onderzoek worden oogbewegingen van lezers vergeleken tijdens het lezen van authentieke fragmenten proza en poëzie met en zonder enjambement, gepresenteerd in de oorspronkelijke en een gemanipuleerde layout. Uit het experiment blijkt inderdaad dat leespatronen verschillen voor teksten die als proza, dan wel als poëzie met of zonder enjambement worden gepresenteerd. Het experiment wordt ingeleid door een literatuurstudie waarin de verschillende theoretische posities over het lezen van poëzie en eerder experimenteel onderzoek naar het betreffende leesproces aan bod komen.

Sweet Temptations: A study into the effects of a fotonovela about diabetes on low-literates

In this experiment the effectiveness of a fotonovela for Dutch low-literates was assessed and underlying mechanisms that could account for possible persuasive effects were studied. The Entertainment Overcoming Resistance Model (EORM; Moyer-Gusé, 2008) served as a theoretical framework. The fotonovela that was used was a Dutch translation of the diabetes fotonovela ‘Sweet Temptations’ developed and tested in the US. Participants were 92low-literates, randomly assigned to one of three groups: a group that read the fotonovela, a group that read a traditional diabetes brochure, and a control group that only answered questions about diabetes knowledge and behavioral intentions. Both the fotonovela and the traditional brochure produced more diabetes knowledge and stronger behavioral intentions than were measured in the control group. The fotonovela outperformed the traditional brochure in effects on diabetes knowledge. No support was found for propositions in the EORM concerning the role of mediators in the persuasive effects of processing a narrative message