Inadequate health literacy is an important barrier to self-care, having been linked to various poor self-care behaviors and health outcomes. Low levels of health literacy likely compromise self-care by impacting patients’ ability to comprehend health-related texts that could otherwise inform self-care behavior. Chronically ill older adults, who are the individuals who most need self-care information, are also those less likely to have the literacy skills and cognitive resources required to comprehend health texts. A valuable strategy for supporting comprehension is to present materials in a multimedia format, and here we focus on supplementing health texts with picture. While much is known about how younger adults benefit from multimedia formatting, significantly less is known about how older adults’ text comprehension processes are impacted by the presence of pictures, especially with regard to health-related materials. In this study, we studied how hypertensive older adults understood multimedia (text and picture) displays of hypertension-related information, using eye tracking to investigate relationships between reading processes, health literacy/health knowledge, and comprehension. Elders’ eye movements were analyzed as participants read different types of text-picture passages at their own pace. Eye movements were analyzed using a re-reading analysis paradigm, adapted for application to the processing of multimedia. We found evidence that when processing multimedia health information, individuals with varying levels of health literacy and health knowledge appear to implement different reading strategies across two phases of situation model construction. Based upon their health literacy/health knowledge levels, readers used pictures differently and at different points of processing.
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Health literacy and older adults' comprehension of multimedia health information
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