Improving Communication in Kinesiology through a Practicum Course

ABSTRACT

Trends about lay material quality suggest most college/university students enrolled in kinesiology programs are not taught about readability issues. Such trends are in diametric opposition to future graduates’ moral and legal mandate to communicate clearly (e.g., the 2010 US. Plain Writing Act). Numerous leaders in kinesiology have helped shine light upon the issue of readability and related barriers to translating knowledge from kinesiology into actions that serve the public. Following Thomas and Cardinal’s (2020) call to treat knowledge translation as the next frontier for kinesiology scholarship, we present one scaled-up approach that those in higher education could use to prepare students to be effective in lay communication, namely a practicum course on plain language communication. This article reports on our process to create an outline for a practicum course on plain language communication, which was designed for wide-scale adoption. Beyond the practicum course outline, we developed seven supplemental materials to aid delivery of the course – regardless of teaching experience or familiarity with the topic. We conclude with guiding discussion of the material we created for a kinesiology practicum course in lay communication, then we present recommendations for administrative action and future research.

KEYWORDS:

• Curriculum development
• higher education
• implementation science
• knowledge translation
• readability

Introduction

Readability refers to a person’s ability to read and understand written text (Albright et al., 1996). Thirty years ago, Cardinal and Sachs (1992) evaluated the readability of physical activity materials disseminated to the general public (i.e., lay materials). On average, they found the materials (N = 54) were written at the 11.33 (SD = 1.89) reading grade level, which is three grade levels higher than the maximum cut-point recommended (Han & Carayannopoulos, 2020). Typically, an eighth-grade cut-point is emphasized because most adults could easily read and understand content written at that level. Ease should not be understated, since most health-related decisions are made within a context filled with misinformation, a level of uncertainty, and competing priorities (Cardinal, 2016; Maneze et al., 2019). Often, the lay public is confused about what health terms mean (e.g., break vs. fracture), or lack complete awareness of health guidelines widely supported in the research literature, including for physical activity (Kampa et al., 2006; Piercy et al., 2020). When first read, it is crucial that health information from credible sources is easy to read if they are to support healthful behaviors (Wang et al., 2013).

Writing physical activity promotion materials above the level that most adults would easily perceive and understand their content is problematic. Even if the materials that kinesiology graduates produce or select are credible, the material will likely have low use if end-users must work hard to perceive and understand the material. To this point and concerning their results thirty years ago, Cardinal and Sachs wrote, “ … given the level at which these materials are written, their mass distribution would seem unwarranted and wasteful at this time” (Cardinal & Sachs, 1992, p. 188). Nearly three decades later, Thomas and Cardinal (2020) observed the same findings (i.e., M= 11.26, SD = 1.92) using a set of web materials produced by organizations (N = 139), suggesting that physical activity promotion material with low readability is an unabated problem. Material that is hard to read causes frustration. This may lead users to quit reading (Herber et al., 2014); or worse, such material could promote pessimism, which impedes adoption/continuation of health-related behaviors and raises risk for poor health outcomes (Herber et al., 2014).

At best, materials with low readability hinder knowledge translation in kinesiology (Thomas et al., 2021b). At worst, their dissemination is immoral, especially when the producers are trusted sources of health information (Fox & Jones, 2009; Harrison et al., 2019). End-users have a moral right to clear communication, as the information they seek is used to determine a safe, effective course for maintaining or promoting their health or the health of individuals in their care (Clarke et al., 2016). Clients and patients have a right to make informed decisions concerning their health care and behavioral choices (Watson, 2019), which is also a matter of health literacy. Recognizing that (health) literacy is largely shaped by social determinants of health and well-being (Santana et al., 2021), calls for the adoption of professional standards focused on intelligible communication to patients, clients, and the general public (i.e., clear, concise, non-technical) have been made (Coulter, 1998; Warde et al., 2018). This push to prepare kinesiology graduates to convey information plainly has come from within kinesiology, too. Initially, the focus on preparation concerned future and current researchers (Cardinal & Seidler, 1995; Cotton & Gallemore, 1984; Thomas & Cardinal, 2018), but has since expanded to include college students and professionals with diverse areas of interest (Paige et al., 2019; Ross & Thomas, 2022).

Preparation

Trends about the quality of lay material suggest most college/university students enrolled in kinesiology programs are not taught about readability issues (Thomas et al., 2021b). Little evidence exists that students who graduate from kinesiology degree, certificate, or continuing education programs leave equipped to provide clients with quality materials (e.g., materials that are easy to read, understand, and are visually appealing), let alone are they trained on how to revise materials in order to meet standards for lay communication (i.e., knowledge translation, plain language communication). Many employment sectors that kinesiology graduates work in have mandates to communicate with clients using plain langue (e.g., required by law or governmental funding agency, U.S. Institute of Medicine, 2012). Thus, there is a need to develop coursework that teaches kinesiology students how to design, modify, and or, select lay material.

Article purpose

Thomas et al. (2018, p. 507) document the creation of numerous “toolkits” over the years explicitly designed to teach practitioners how to communicate with clients in plain language. In support of training all kinesiology students in how to design and select quality lay material, we advocate for a scaled-up approach. Thus, the purpose of this article is to introduce an outline for a practicum course on plain language communication, which could be widely integrated into a variety of kinesiology programs (e.g., degree, minor, certificate). Specifically, we aimed to create a set of skill-building exercises that would permit delivering the practicum course for the duration of one standard academic term (e.g., 10 or 15 weeks). To meet the purpose of this article, a realistic but mock article was created to serve as case material for analysis.

The proposed practicum course has two objectives: (a) expose students to common readability problems and their solutions; (b) provide a set of exercises that help students learn to critically appraise lay material quality, then improve material quality through revision. Within the Materials and Methods section, we present the theoretical perspectives that guided our work. Then we provide results to our process in creating material for the practicum course. The Discussion section provides perspectives to support the practical application of the materials we created, as well as suggestions for future scholarship.

Materials & methods: Design of the practicum and mock materials

Background information

Theoretical paradigms

Three theoretical paradigms were used to guide the creation of the practicum exercises: (a) Suitability Assessment of Materials (SAM, Doak et al., 1996), (b) Universal Design for Learning (UDL, Center for Applied Special Technology [CAST], 2018), and (c) Bloom’s Taxonomy of Learning (Bloom, 1956; Cardinal, 2000).

SAM

The first paradigm (SAM) provides a reliable method for critically appraising the suitability of lay material (Tse et al., 2021). It is an established method used across diverse academic disciplines (Thomas & Cardinal, 2020), and the SAM method presents precise ways to revise material in order to meet adequate and optimal suitability standards, inclusive of readability. The practicum exercises were designed to introduce students to various dimensions of the SAM method (e.g., Content, Graphics, Literacy Demand).

UDL

Second, the UDL paradigm was employed to craft exercises that would help students become expert learners concerning the SAM method (Kennedy & Yun, 2019). Thus, the prompts contain messages and supplements that target the three core principles for universally designed learning environments: (a) diverse representation, (b) diverse action and expression, and (c) diverse engagement (Center for Applied Special Technology [CAST], 2018). The design of practicum exercises in accordance with UDL core principles builds upon previous research done in the physical domain (namely physical education settings; Van Munster et al., 2019).

Bloom’s taxonomy

Finally, Bloom’s Taxonomy of Learning was used to guide how exercise prompts were phrased (Bloom, 1956; Cardinal, 2000). Specifically, prompts were phrased to target basic knowledge and thinking skills (e.g., recall, understand). Several prompts were also developed to target higher-order cognitive skills, too (e.g., analyze, create).

Design of practicum and mock materials

Original mock material

To achieve the stated aims of the present article, a mock web article was developed. It was specifically developed to be a readily available artifact of lay material that students could use to complete activities of the practicum course (Thomas et al., 2021a). Additionally, the mock web article was planned to serve as a class example, whereby skills developed through the activities could be first demonstrated in revising the mock web article for improved readability. The next paragraph details development of the mock article. The subsequent paragraph details how it was prepared to be a class example.

On the basis of several systematic studies of lay resource material, the apriori goal was to develop a mock web article that employs a casual tone, second-person-voice writing style, and that is written at an 11th grade reading level (Thomas & Cardinal, 2020). The second author of the present article was the lead author of the case material (editorial support provided by the first author of the present article). The second author reviewed several contemporary lay web articles designed to promote physical activity among a general adult audience. This helped to engender an “intuitive sense” for how to craft messages akin to typical physical activity promotion materials (Kretchmar & Torres, 2018). Following this, the mock article went through multiple rounds of revision. Prior to finalization, volunteer undergraduates, who used their experience searching the internet for health-related advice articles for personal use, provided feedback on the mock article’s face validity; an anonymous online survey was used (Thomas et al., 2021a).

Revised mock material

The class example was to present a revised mock web article. An annotated article was created showing how the SMOG reading grade level formula was used to rewrite the mock article at/below the eighth-grade reading level. Theoretically, the provision of an exemplar revision would provide a situational reference point for learners, which could guide their future decision-making process focused on improving lay material readability (Ataman & Ibey, 2021). The exemplar revision would show a pattern of word substitution, judicious content omission (i.e., nice versus needed information), and sentence trimming.

Results: Process and outcome evaluation

Original mock material

Seven iterations were required to produce a realistic mock web article. Undergraduates piloting the materials as end users reported that the article appeared typical to what they would locate online, seemed interesting, and was helpful. The reading grade level of the finalized mock web article was 11.27, a typical level observed when using lay strategies to search the internet for physical activity promotion content (Thomas & Cardinal, 2020). Supplemental Content 1 presents the final draft of the mock web article.

Revised mock material

It took three iterations to create the exemplary revision with an eighth-grade reading level. The first revision got close (i.e., 8.41 reading grade level). Given that the eighth-grade reading level is a firm cutoff-point for lay material (Han & Carayannopoulos, 2020), the text was further revised accordingly. It took two additional trials to identify words and sentences that could be further simplified. With each revision, the primary focus was to remove polysyllabic words. Supplemental Content 2 presents an example list of words that were removed from the text partially or fully. Supplemental Content 3 illustrates the changes to text and reading grade level associated with each stage of revision. Supplemental Content 4 presents the mock web article with an equal to or less than eighth-grade reading level, in this case, a 7.57 reading grade level.

Practicum exercises

In total, 18 practicum exercises were created. All authors agreed that the wording and design of each activity was consistent with the three paradigms chosen for the project. There was 100% consensus that each activity would support a person in becoming an expert learner concerning plain language communication. Moreover, exercise prompts specific to basic and higher-order thinking skills were generated, respectively. Supplemental Content 5 presents the full set of practicum exercises.

Discussion: The practicum and its implementation

In this section, we discuss the practical application of the aforementioned materials. We then conclude this section with recommendations for administrative action and future research. At the outset, however, we acknowledge that implementing a full-scale practicum course may not be feasible (within the immediate future) for some faculty members. Such faculty should feel encouraged, nonetheless. Each exercise presented in this article is a stand-alone task. The activities can still be used, even if only as part of a single class session (e.g., Ross & Thomas, 2022) or a one-off event workshop (e.g., Kamp & Thomas, 2022; for further discussion, see the subsections of this section on administrative action and potential challenges). To optimize the effect a single event has on learning, however, the reader is encouraged to review the guidelines by Saunders et al. (2019), which were developed based on their systematic review of the research literature.

Course learning objectives

Course learning objectives could be derived from the premise of this article. Three example statements adapted from the work by Kamp and Thomas (2022) follow: (a) define plain language communication, (b) understand why lay material is not advised to exceed an eight-grade reading level, and (c) list at least two methods to improve readability in lay material.

Course design

Within the first class or before the practicum course starts, we advise kinesiology faculty to formally introduce students to the principles of, or the need for, plain language communication (for a list of example material, see Supplemental Content 6). Within the first class session, faculty could ask students to guess the reading grade level of the excerpt to each version of the mock article (see Supplemental Content 3). Before showing Supplemental Content 3, the bold text should be removed. Having students guess the reading grade level may reveal that most people cannot correctly discern the reading grade level of text. This might be a good time to mention the SMOG formula, specifically its focus on polysyllabic words and sentence length. As our exercises are based on the SMOG formula, it would be helpful to assign as homework learning how to use the formula by hand (National Literacy Trust, 2008), as well as to introduce the webtool employed in the present article (Adamovic, 2009).

In the next class session, students could use the SMOG formula to revise the original mock web article to be at an eighth-grade reading level (i.e., try to do it themselves). To make it a challenge, use of Supplemental Content 2 should be restricted. Instead, students could be asked to create their own list of word replacements for complex words (e.g., words with three-or-more syllables or jargon). Students should also be encouraged to record the number of trials it takes to get the mock article to an eighth-grade reading level. They can use the webtool to quickly check the grade level of their revised work (thus, students should be asked to bring a laptop, or the practicum should be administered within a computer lab space). The last 15-minutes of this class session could be devoted to a debrief, where students recount their experience, report their number of trials, and state how closely they got the material to an eighth-grade reading level. The next class could focus on the revised mock web article, specifically getting it to a fifth-grade reading level (note: at/below fifth grade is considered the optimal level; it is easier to read for people dealing with stress, who have low-health literacy or who speak English as a second language/with limited proficiency; Thomas et al., 2021b).

Faculty could then alternate the focus of the remaining class sessions to switch between activity (working on an exercise) and discussion (reflecting on the exercise experience). Among the list of exercises we created, there are several with tailored prompts for reflection (see Supplemental Content 5). Moreover, we also created a generic list of reflection questions that could be used with any exercise (see Supplemental Content 6). The individual or group reflection could be enlivened if students are asked to examine their previous work, too. If faculty elect to have students examine their previous work, we advise they restrict this to any material created for a lay audience (e.g., as part of a class, job, or personal interest). To deepen learning and provide closure, instructors could add a culminating presentation assignment after the completion of several exercises or at the end of the course. Lee et al. (2018) cataloged a set of principles for delivering a fast presentation, which could increase the likelihood that the presentations are educationally valuable to the audience and presenter(s).

Guided discussion and participation

Beyond a list of generic questions that could be used to facilitate discussion for any exercise, Supplemental Content 6 also provides a select list of media that could stimulate further discussion and deeper learning. Hersman and Schroeder (2017) provide a complementary set of principles for readers interested in creating an online version of the proposed practicum course. Moreover, Bennett (2018) catalogs ways to structure activities that involve debates, role-playing, and critical examination of media.

Evaluation and feedback

Supplemental Content 7 provides a simple rubric template that could be used to evaluate student submissions and provide them with constructive feedback. Simply “plug-in” the prompts of a given exercise into the rubric; one for each row. The rubric is easily modifiable. Other criteria could be added, such as those concerning standards for professional publication (e.g., formatting for figures and/or tables).

Recommendations for administrative action

Faculty should recognize their discretion to choose how they integrate our proposed course outline into their own teaching. The outline we created could be incorporated into an already existing stand-alone course, such as a generic course to provide practicum experiences, or the course outline could be the basis of a new course proposal. Additionally, faculty could choose to incorporate a subset of the exercises created for the outline, as well as their related materials, within an existing lecture-based course instead (e.g., exercise testing and prescription, worksite wellness promotion; Ross & Thomas, 2022). Faculty should also recognize their discretion to suggest when students complete the activities within the course sequence of their department/program’s curriculum.

Potential challenges to implementation

Beyond choosing if adopting some or all proposed exercises is (currently) viable, there are other factors which could affect faculty’s ability to successfully implement the practicum exercises. We acknowledge those factors here and present ways to help mitigate them (the list below is not in any particular order nor exhaustive).

Challenge #1: Constraints allowing for single-event instruction, only

This means faculty have only one class period to dedicate to the practicum experience.

Strategy

Fortunately, we can suggest a priority shortlist. However, what we suggest is not a hard rule. Doak et al. (1996), creators of the SAM method, suggest two no-go criteria: (a) reading grade level and (b) cultural appropriateness. If either criterion is not at least satisfactory, the material should be carefully considered if it is ready for lay dissemination (relatedly, those already in circulation should be reevaluated promptly; for further discussion, see, the Doak et al., 1996, chapter cited in this article). We advise faculty to pick Activity 1 from Supplemental Content 5, then assign students homework to learn about cultural appropriateness (a.k.a., cultural humility, or responsiveness, or competency; for further discussion, see, Cervantes & Clark, 2020). One homework idea is assigning a short video to watch, summarizing key ideas about cultural appropriateness.

Additional consideration

It is important to understand that cultural appropriateness is not delimited to social/societal experiences shaped by a person’s ethnicity or assumed race (Robey et al., 2013). Unfortunately, we were unable to locate educational videos on cultural appropriateness specific to physical activity promotion. Thus, we suggest scholars address this gap through future research (e.g., systematic internet search and scoping review), and or, creative activities (e.g., create and test their own educational video; Thomas et al., 2022).

Challenge #2: Time management

Faculty may find the time they allot for introducing and debriefing an exercise is not enough. Other challenges include limited time to adapt rubrics or complete grading for timely feedback to students.

Strategy

Faculty could portion some time during the next class period to debrief students on their experience, or a discussion board could be assigned to complete the facilitated debrief activity. A simpler rubric to the one we initially proposed could be adopted. Specifically, the evaluation levels could be: (a) task met, (b) task somewhat met, or (c) task not met (i.e., not attempted or largely incomplete; Dougherty, 2022). For task criteria, instructors could divi the stages listed for a given task into separate rows of the simplified rubric. Because the practicum is focused on experiential learning, the simplified grading rubric seems acceptable, especially since the goal is to inspire students to apply their learning to future professional settings.

Additional consideration

Through consultation with the instructional design expert(s) at their institution, faculty could gain additional tips for anticipating and mitigating any challenges with implementing any of the exercises presented in this article. Moreover, a short, no-stakes review quiz that is due before a class session, or by a homework deadline, could help ready students to understand and engage in a practicum activity (Center for Applied Special Technology [CAST], 2018; for an illustrative example, see, Davis, 2013). Term definitions and prevalence data shared in this article, or vis-à-vis the suggested materials within Supplemental Content 6, could be used to construct a review quiz for a given topic or activity.

Recommendations for future research

Adoption of the proposed practicum course in part, or in full, represents an opportunity to contribute to kinesiology scholarship focused on teaching and learning (Trigwell et al., 2000). We encourage kinesiology faculty to report on their process of integrating the proposed practicum into their teaching or program curriculum. Several efficacy studies evidence the potential of the proposed exercises to sensitize students to readability issues and increase their knowledge in how to address them (Kamp & Thomas, 2022; Ross & Thomas, 2022). Clearly, further scholarship in this area is needed (Saunders et al., 2019), including scholarship focused on the viability of materials that are created and/or revised through the practicum course to affect real end-users’ material comprehension and health literacy in a given topic area (Cardinal, 2000; Espigares-Tribo & Ensenyat, 2021).

Conclusion

This article attempts to address a void in how kinesiology students are prepared for professional life. By and large, evidence suggests that students are not taught about readability issues—which stunts the usefulness of most materials provided to clients. We developed a mock web article to expose students to common readability issues—so common that experts in physical activity promotion hardly take notice before passing materials onto clients. This uncritical transmission includes indirect routes, such as publications to online platforms (websites, social media) and when organizations adopt and use preexisting materials. Following the development of a mock web article, we presented 18 skill-building exercises that can be the basis of a kinesiology practicum course on plain language communication. The practical application of the materials created for the proposed practicum course were then discussed, followed by recommendations for administrative action and future research.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/24711616.2022.2141156

Additional information

Funding

This work received funding support from the William and Linda Frost Fund, in the form of a Frost Undergraduate Student Research Award awarded to the third author (CNS), who served as a Frost Research Fellow in the first author’s lab (JDT; 2021 Winter Quarter, 2021 Summer Session, College of Science and Mathematics, California Polytechnic State University, San Luis Obispo).