ACQ Vol 12 No 3 2010

The National Health and Medical Research Council (NHMRC) states that different research questions require different kinds of supporting evidence (NHMRC, 2009). The issue here concerns the evidence around an intervention, that is, the effect of modifying written information for people with aphasia; therefore the NHMRC intervention hierarchy (NHMRC, 2009) was used to evaluate the 4 articles identified. Table 2 describes the level of evidence of each of the four articles and table 3 provides a critical appraisal of one article in more detail.

Table 3: Critically appraised article Article title The relationship between specific features of

aphasia-friendly written material and comprehension of written material for people with aphasia: An exploratory study Brennan, A., Worrall, L., & McKenna, K. (2005). The relationship between specific features of aphasia- friendly written material and comprehension of written material for people with aphasia: An exploratory study. Aphasiology , 19 (8), 693–711.

Citation

Table 2: Research articles identified Articles Purpose

Design

Case series pre test post test

Level of evidence (NHMRC, 2009)

identified

Level of evidence

IV

Rose, Worrall

Investigated the effect of

Level III-2

and McKenna aphasia-friendly written health (2003) information on people with aphasia

Participants 9 people with mild to moderately severe aphasia

Experimental People with aphasia given 90 different paragraphs to group read. Each set of 5 paragraphs were at a different level of complexity and had different aphasia-friendly features.

Egan, Worrall

Investigated the effect of an Level IV

and Oxenham accessible training package (2004) to help people with aphasia learn how to use the internet

Results:

Participants’ comprehension at grade 6 level was increased when paragraphs had a) simplified vocabulary and syntax or b) had large print or c) increased white space or d) all four aphasia-friendly features (simplified vocabulary and syntax, large print, increased white space and pictures). Participants’ comprehension of grade 5 and grade 7 level paragraphs was not enhanced with any modifications to the text. The authors suggested that this may have been due to ceiling effects at grade 5 level and self-selection bias at grade 7 level where many participants did not complete reading all the paragraphs. People with aphasia understood significantly more information when reading paragraphs that were modified.

Worrall and

Investigated the effect of specific features of aphasia- friendly written information on comprehension for people with aphasia

Level IV

Brennan, McKenna

(2005)

Worrall and colleagues

Provides a summary of these N/A

three studies

(Worrall, et al., 2005)

Clinical bottom line The clinical bottom line was drawn from all the research literature searched and secondary sources. The speech pathologist could present this information to her manager to argue the value of a communicatively accessible healthcare environment. There is a need for accessible information People with aphasia want to receive written information about their health (Rose, Worrall, Hickson, & Hoffmann, 2010). Family members of people with aphasia also want information about aphasia (Avent et al., 2005). Despite this, many people with aphasia are not adequately informed about their stroke and/or aphasia (Eames, McKenna, Worrall, & Read, 2003; Knight, Worrall, & Rose, 2006; Parr, Byng, Gilpin, & Ireland, 1997; Rose, Worrall, McKenna, Hickson, & Hoffmann, 2009). Those people with aphasia who do receive written health information often state that the information they receive is too complex (Rose et al., 2009). Accessible healthcare is multifaceted For healthcare information to be accessible it needs to be easily obtainable (Worrall, Rose, Howe, McKenna, & Hickson, 2007) and repeatedly provided throughout the continuum of care (Rose et al., 2010). It also needs to be available in a range of different formats such as written information and appropriately formatted DVDs and videos (Rose et al., 2010).

Summary:

Accessible healthcare makes a difference to the comprehension of a person with aphasia There is evidence that using simplified vocabulary and syntax, large print, increased white space and pictures can improve comprehension of written information for people with aphasia (Brennan et al., 2005; Rose et al., 2003). However accessible written information may have other benefits as well. People with aphasia have also reported feeling more confident responding to health questions after reading aphasia-friendly patient education materials, compared to standard written information (Rose et al., 2003). People with aphasia need a choice Rose and colleagues (2003) found that although aphasia- friendly information assisted people with aphasia to comprehend information, not all people with aphasia liked the aphasia-friendly health information. For example, some people with aphasia commented that the inclusion of several Microsoft ClipArt images and black and white line drawings in written health information was disrespectful (Rose et al., 2003). Therefore, wherever possible people with aphasia need to be given a choice regarding the type and format of

125

ACQ Volume 12, Number 3 2010

www.speechpathologyaustralia.org.au