Assessing Spanish-language Patient Education Materials for Comprehension: A Pilot Feasibility Study with Implications for Physical Activity and Wellness Promotion

Abstract

Physical activity, health literacy, and wellness promotion strategies target several health behaviors simultaneously (e.g., exercise and nutrition education). However, comprehension of Spanish-language patient education materials is rarely assessed directly with the cloze procedure (a fill-in-the blank reading test). This study's purpose was to evaluate the feasibility of adapting methods from one 1977 dissertation study, which evaluated comprehension of primary school education materials by comparing cloze and open-response recall scores. The present study used adult patient education materials on the health benefits of dietary fiber from two unaffiliated organizations: a mobile health unit (MHU) and a university hospital (UH). Materials had an 8th-grade reading level. Two groups of college adults, with varied Spanish literacy skills, participated in the study in August 2024 (n₁ = 4, n₂ = 6, counter-balanced design). Qualitative feedback was collected through an online questionnaire. Percent-correct scores from the cloze and open-response tests suggested inadequate to partial comprehension in general: MHU (cloze: M = 37.09%, SD = 9.59%; open-response: M = 36.67%, SD = 15.32%); UH (cloze: M = 33.78%, SD = 8.28%; open-response: M = 44.00%, SD = 18.38%). However, convergent validity between cloze and open-response scores was not well-supported through correlation tests, per Bonferroni correction. Replication was feasible. The study protocol took one hour to administer. Participants found tasks understandable and acceptable. The preliminary findings mirrored comprehension results of previous studies. Studies with larger sample sizes, however, should be used to confirm the cloze procedure's validity with Spanish-language patient education materials.