Improving Readability of an Evaluation Tool for Low-income Clients Using Visual Information Processing Theories

• Published in: Journal of nutrition education and behavior 2008-05, Vol.40 (3), p.181-186
• Main Authors: Townsend, Marilyn S., PhD, RD, Sylva, Kathryn, MA, Martin, Anna, MA, Metz, Diane, MA, Wooten-Swanson, Patti, PhD
• Format: Article
• Language: English
• Subjects: Behavior Rating Scales; Check Lists; Client Characteristics; Cognitive Processes; community nutrition programs; Comprehension; Diet; Eating Habits; educational materials; Educational Status; EFNEP; Evaluation Research; exchange lists; Food; FSNE; Gastroenterology and Hepatology; Health Behavior; Health education; Health Education - methods; Humans; Information Processing; Internal Medicine; Interviews; Layout (Publications); Literacy; Low Income; Low income groups; low income households; low-literacy; Measures (Individuals); Nutrition; nutrition education; nutrition information; Nutritional Sciences - education; Patient Education as Topic; photographic interpretation; Photography; Poverty; Professional Personnel; Program Evaluation; Readability; Reading; Teachers; Test Construction; Use Studies; Visual Aids; visual information processing; Visual Stimuli; Vulnerable Populations
• ISSN: 1499-4046; 1878-2620; 1708-8259
• DOI: 10.1016/j.jneb.2007.06.011

Literacy is an issue for many low-income audiences. Using visual information processing theories, the goal was improving readability of a food behavior checklist and ultimately improving its ability to accurately capture existing changes in dietary behaviors. Using group interviews, low-income clients (n = 18) evaluated 4 visual styles. The text plus color photographs style was preferred over the other 3 visual styles: text only, text plus black and white line drawings, and text plus gray-scale photographs. Employing cognitive interviewing in an iterative process, clients (n = 25) recommended simplifying text for 10 items, modifying content for 15 of 16 visuals, and replacing text with visual content for 7 of 16 items. Professional staff (n = 7) and educators (n = 10) verified that visuals and revised text accurately reflected the content of each item. Clients reported that the revised checklist captured their attention, added pleasure to the evaluation process, improved their understanding of the behaviors in question, and facilitated comprehension of text. Readability scores improved by more than 2 grades. This process can be duplicated by others interested in enhancing the quality of existing evaluation tools.