Improving readability of an evaluation tool for low-income clients using visual information processing theories

Area of Science:

• Nutrition and Dietetics
• Health Literacy
• Human-Computer Interaction

Background:

• Literacy challenges impact low-income populations' ability to engage with health information.
• Existing evaluation tools, like food behavior checklists, may not be optimally designed for diverse literacy levels.
• Visual information processing theories offer a framework for improving information accessibility.

Purpose of the Study:

• To enhance the readability and effectiveness of a food behavior checklist for low-income audiences.
• To investigate the impact of different visual aids on checklist comprehension and user engagement.
• To refine the checklist through iterative client feedback and expert verification.

Main Methods:

• Group interviews with low-income clients (n=18) to evaluate four visual styles (text-only, text with B&W line drawings, text with grayscale photos, text with color photos).
• Cognitive interviewing with clients (n=25) to iteratively refine checklist text and visuals based on feedback.
• Verification of revised content by professional staff (n=7) and educators (n=10).

Main Results:

• The 'text plus color photographs' visual style was preferred by clients.
• Clients recommended simplifying text, modifying visuals, and replacing text with visuals for improved clarity.
• Revised checklist enhanced client attention, engagement, understanding of behaviors, and text comprehension.
• Readability scores improved by over two grade levels.

Conclusions:

• Visual design and simplified text significantly improve food behavior checklist usability for low-income populations.
• An iterative, client-centered approach is effective for enhancing health evaluation tools.
• The methodology can be replicated to improve other health-related assessment instruments.