Effects of Text Cohesion on Comprehension and Retention of Colorectal Cancer Screening Information: A Preliminary Study

Figures & data

Figure 1 Conceptual framework.

Table 1. Group assignment and colorectal cancer prevention information

Group A	Group B
Subtopic 1: Locations of the colon and rectum.	Subtopic 1: Locations of the colon and rectum.
Text cohesion level: High	Text cohesion level: Low
“The colon is the part of the digestive system. The colon is where the waste material is stored. The rectum is the end of the colon adjacent to the anus. Together, the colon and rectum form a long muscular tube … .”	“The colon and the rectum are parts of the digestive system. Together, they form a long muscular tube called the large intestine. It also called the large bowel. The colon is the upper five to six feet of the large intestine … .”
Subtopic 2: Symptoms of colorectal cancer.	Subtopic 2: Symptoms of colorectal cancer.
Text cohesion level: High	Text cohesion level: Low
” … Colon cancer can be present for several years. The cancer can be present before symptoms develop. Symptoms vary according to where in the large bowel the tumor is located. The right colon is spacious. Cancers of the right colon can grow to large sizes before they cause any abdominal symptoms … .”	“There may be no symptoms with colorectal cancer. Warning signs to watch for may include: A change in bowel habits. Blood in, or on the stool (either bright red or very dark in color). Stools that are narrower than usual. Rectal bleeding … .”
Subtopic 3: Risk factors for colorectal cancer.	Subtopic 3: Risk factors for colorectal cancer.
Text cohesion level: Low	Text cohesion level: High
“Polyps. The vast majority of colorectal cancers develop in polyps. They are benign but they may become cancerous over time. Removing polyps is an important way to prevent colorectal cancer. Age. Colorectal cancers most often occur in people over the age of 50 … .”	“Some people are more likely to develop colorectal cancer than others. Factors that increase a person's risk of colorectal cancer include …. The presence of polyps in the large intestine. Most colon cancers develop in colon polyps. Therefore, removing benign colon polyps can prevent colorectal cancer … The extra tissue is called polyps. Colon polyps are initially benign. Over years, benign colon polyps can become cancerous.”
Subtopic 4. Colorectal cancer screening tests.	Subtopic 4. Colorectal cancer screening tests.
Text cohesion level: Low	Text cohesion level: High
” … Fecal Occult. Beginning at age 50, have a fecal occult blood test every year. This test checks for hidden blood in the stool. It is done because colorectal cancer may cause bleeding that cannot be seen. Sigmoidoscopy … .”	” … Fecal occult blood test. An important screening test for colorectal cancers and polyps is the stool occult blood test. Individuals over the age of 50 should have their stool tested for hidden or “occult” blood. Stool samples can be obtained to test for occult blood. Tumors of the colon and rectum tend to bleed slowly into the stool. The small amount of blood mixed into the stool is usually not visible to the naked eye … .”

Table 2. Participant characteristics, by group

	Participants who completed the in-person visit
Variable	Group A (n = 19)	Group B (n = 23)	Total (n = 42)
Sex, n
Male	5	12	17
Female	14	11	25
Race/ethnicity, n
Caucasian	8	11	19
African American	11	12	23
Health literacy, n
Less than adequate	0	1	1
Adequate	19	22	41
	M (SD)	M (SD)	M (SD)
Age in years	61.95 (8.53)	63.17 (8.58)	62.62 (8.47)
Years of education	13.05 (2.17)	12.65 (2.21)	12.83 (2.17)
Vocabulary score	27.53 (4.60)	26.65 (6.02)	27.05 (5.38)
Working memory ^a	6.05 (1.79)	6.32 (1.38)	6.20 (1.60)
Prior knowledge	5.42 (1.61)	5.70 (1.71)	5.57 (1.66)

Table 3. Means and standards deviations of reading time, text comprehension, word recognition, and recall scores

Group	Subtopic	Text cohesion level	Variable	n	M	SD
Group A	Locations of the colon and rectum (1), and symptoms of colorectal cancer (2)	High	Reading time (millisecond per letter)	19	111.18	38.95
			Text comprehension score: in-person visit	19	6.37	1.26
			Text comprehension score: follow-up	18	5.33	1.14
			Word recognition score	19	9.53	1.50
			Recall score: in-person visit	19	4.00	1.67
			Recall score: follow-up	18	2.83	1.29
	Risk factors for colorectal cancer (3), and colorectal cancer screening tests (4)	Low	Reading time (millisecond per letter)	19	101.72	33.58
			Text comprehension score: in-person visit	19	6.11	1.05
			Text comprehension score: follow-up	18	5.72	1.41
			Word recognition score	19	10.89	0.94
			Recall score: in-person visit	19	7.16	2.57
			Recall score: follow-up	18	4.94	1.70
Group B	Locations of the colon and rectum (1), and symptoms of colorectal cancer (2)	Low	Reading time (millisecond per letter)	23	117.39	42.79
			Text comprehension score: in-person visit	23	6.22	1.73
			Text comprehension score: follow-up	19	5.80	1.32
			Word recognition score	23	9.39	1.31
			Recall score: in-person visit	23	3.71	1.42
			Recall score: follow-up	19	2.89	1.76
	Risk factors for colorectal cancer (3), and colorectal cancer screening tests (4)	High	Reading time (millisecond per letter)	23	88.48	25.62
			Text comprehension score: in-person visit	23	6.13	1.55
			Text comprehension score: follow-up	19	5.70	1.69
			Word recognition score	23	11.04	1.07
			Recall score: in-person visit	23	7.57	3.19
			Recall score: follow-up	19	6.05	2.82

Table 4. Linear mixed model results in reading time, word recognition, and text comprehension scores

Outcome	Predictor	Parameter estimate	Parameter standard error	F	df	p
Reading time (millisecond per letter)	Text cohesionSubtopicText cohesion by subtopic	−13.2415.677.03	10.9810.9820.73	7.2228.090.11	414141	.010*< .001**.736
Text comprehension score: in-person visit	Text cohesionSubtopicText cohesion by subtopic	0.030.110.13	0.450.450.78	0.170.660.03	414141	.685.422.873
Text comprehension score: follow-up	Text cohesionSubtopicText cohesion by subtopic	–0.020.08–0.44	0.460.460.82	1.400.490.30	363636	.244.488.590
Word recognition score	Text cohesionSubtopicText cohesion by subtopic	–0.151.50–0.01	0.380.380.65	0.5461.610.00	414141	.465< .001**.983