Search

Troubleshooting is recognised to be a key laboratory learning objective within engineering education. However, little is known about how students taking introductory courses troubleshoot electronic circuits. The contribution of this study, therefore, is to use object-orientated focus groups with a think-aloud protocol to gather data while participants engage in the task of troubleshooting an electronic circuit. Content analysis was used to qualitatively analyse the gathered data based on a previously established cognitive task analysis (CTA) model. The findings, while limited by the sample size, indicate that participants tended to dive straight into the troubleshooting activity, and their troubleshooting process was mostly characterised by two phases of the CTA model, namely test along with repair and evaluate. Earlier phases of the process that involve specific actions, such as discerning the function of parts of the system, brainstorming causes and solutions, and developing a troubleshooting plan, received less attention. The primary implication is that formal troubleshooting instruction may need to be better embedded within introductory courses, though additional research is needed to validate this implication. [ABSTRACT FROM AUTHOR]

Objective: To develop a prototype of a decision aid to be used on a website for adults with hearing loss. Design: Development was guided by the International Patient Decision Aid Standards (IPDAS) and included a survey and think-aloud process. Study sample: A total of 153 participants completed a survey about what to include in the decision aid (111 adults with hearing loss, 21 family members of adults with hearing loss, and 21 professionals). Six adults with hearing loss and six family members participated in a think-aloud process to provide feedback as they used an initial version of the decision aid. Results: In the survey, 26 of the 38 potential items were identified as being highest priority and were included in the initial version of the decision aid. This initial version was then tested in the think-aloud sessions and a prototype of a web-based version was developed based on participant responses related to: 1) information on the decision aid, 2) ease of use, 3) layout and orders of the items, 4) satisfaction, 5) areas for improvement (e.g., need for graphics). Conclusions: The methodologies used in this study are recommended for developing decision aids for adults with acquired hearing loss. [ABSTRACT FROM AUTHOR]

Self-regulation has a positive impact on learning and academic achievement, but due to its nature, it is difficult to assess it in a valid and reliable manner. This study aims to explore the validity of three self-regulation assessment methods in text comprehension tasks (questionnaire, think-aloud and traces) as well as to identify the variables associated with reading performance. For this purpose, individual sessions were conducted with 96 sixth-grade primary education students, who were asked to read a text and complete two reading comprehension tasks working in a virtual environment. Task traces were recorded, think-aloud was recorded and coded, and participants answered a self-report questionnaire about the strategies used. A limited relationship was found between self-regulation measured by means of the questionnaire, think-aloud and traces, and the relationship between think-aloud and traces was moderate. Regarding the factors related to text comprehension task performance, think-aloud and task time measurements were found to be better predictors of performance than the questionnaire. [ABSTRACT FROM AUTHOR]

Studying texts constitutes a significant part of student learning in health professions education. Key to learning from text is the ability to effectively monitor one's own cognitive performance and take appropriate regulatory steps for improvement. Inferential cues generated during a learning experience typically guide this monitoring process. It has been shown that interventions to assist learners in using comprehension cues improve their monitoring accuracy. One such intervention is having learners to complete a diagram. Little is known, however, about how learners use cues to shape their monitoring judgments. In addition, previous research has not examined the difference in cue use between categories of learners, such as good and poor monitors. This study explored the types and patterns of cues used by participants after being subjected to a diagram completion task prior to their prediction of performance (PoP). Participants' thought processes were studied by means of a think-aloud method during diagram completion and the subsequent PoP. Results suggest that relying on comprehension-specific cues may lead to a better PoP. Poor monitors relied on multiple cue types and failed to use available cues appropriately. They gave more incorrect responses and made commission errors in the diagram, which likely led to their overconfidence. Good monitors, on the other hand, utilized cues that are predictive of learning from the diagram completion task and seemed to have relied on comprehension cues for their PoP. However, they tended to be cautious in their judgement, which probably made them underestimate themselves. These observations contribute to the current understanding of the use and effectiveness of diagram completion as a cue-prompt intervention and provide direction for future research in enhancing monitoring accuracy. [ABSTRACT FROM AUTHOR]

There is emerging evidence that post-traumatic growth is a relevant concept in addiction recovery. However, existing measures, such as the post-traumatic growth inventory, were designed to measure post-traumatic growth in general trauma populations. It is unclear if the post-traumatic growth inventory is suitable for individuals in recovery from substance-related addiction. The current study aimed to qualitatively assess the content validity of the post-traumatic growth inventory for individuals in addiction recovery. The think-aloud method was applied, and semi-structured interviews utilized, to collect data from 20 individuals in recovery from unhealthy alcohol and/or drug use. Reflexive thematic analysis was used to analyze data in relation to item interpretation and experience of post-traumatic growth. Qualitative assessment supported three out of five subscales on the post-traumatic growth inventory (new possibilities, personal strength and appreciation of life). Modifications were suggested on some items from the relating to others domain and responses to the spiritual change domain possibly reflected a cultural influence. There was an identified need to include items that account for positive changes in health behavior. The current study highlights domains of post-traumatic growth for those in addiction recovery and how the post-traumatic growth inventory may understate some forms of positive life change. Future research should focus on validating a revised version of the post-traumatic growth inventory for this population. [ABSTRACT FROM AUTHOR]

Because of the improvement-oriented nature of peer-feedback activities, students have to deal with errors (e.g., spelling and argumentation errors) when providing and processing peer-feedback on writing assignments. Despite the central role of errors in feedback activities, it is uncertain how students deal with errors and whether the dealing with errors is affected by interpersonal perceptions. Therefore, this study explores (1) whether cognitive sub-phases are distinguishable during the process of dealing with errors and (2) the extent to which dealing with errors is affected by interpersonal perceptions. Six dyads of Dutch 11th grade students provided and processed peer-feedback on argumentative texts while thinking-aloud, and they reflected on the processes in a post-interview. The think-aloud utterances and interviews were analyzed with a mixed-methods design, using quantitative content analyses, and qualitative thematic analyses. The dealing with errors during peer-feedback provision displayed two patterns: error identification either occurred simultaneously with the decoding and often any evaluation-related thoughts lacked, or error-identification occurred as a result of an interpreting/evaluating phase. Also during peer-feedback processing, two main patterns were observable: students either knew immediately whether they agreed with feedback, or they first had to study the feedback more thoroughly. Additionally, interpersonal perceptions seemed to affect most students implicitly during feedback provision, and most students explicitly during feedback processing. As such, this study provides empirical evidence for the existence of cognitive sub-phases in the process of dealing with errors during peer-feedback activities, and portrays how these activities may be affected by interpersonal perceptions. [ABSTRACT FROM AUTHOR]

BACKGROUND: Attention-deficit/hyperactivity disorder (ADHD) is a highly prevalent childhood and adult behavioral disorder. Internet searches for ADHD information are rising, particularly for diagnosis and treatment. Despite effective ADHD treatments, research suggests that there are delays in seeking help for ADHD. Identifying ways to shorten delays is important for minimizing morbidity associated with ADHD. One way to shorten these delays is to improve internet health information resources. Research shows that parents of children with ADHD feel that much of the information available is technical and not tailored for their childs needs and verbal instructions given by health care providers were too pharmacologically focused with limited information about how to manage and support ADHD symptoms in daily living. A majority of parents search the internet for general and pharmacological information for ADHD and prefer web-based resources for learning about ADHD, but web-based resources may be inaccurate and of low quality. Ensuring accurate information through the internet is an important step in assisting parents and adults in making informed decisions about the diagnosis and treatment of ADHD. OBJECTIVE: Although a great deal of information regarding ADHD is available on the internet, some information is not based on scientific evidence or is difficult for stakeholders to understand. Determining gaps in access to accurate ADHD information and stakeholder interest in the type of information desired is important in improving patient engagement with the health care system, but minimal research addresses these needs. This study aims to determine the information needs and formatting needs of web-based content for adults with ADHD and parents of children with ADHD in order to improve user experience and engagement. METHODS: This was a 3-phase study consisting of in-depth phone interviews about experiences with ADHD and barriers searching for ADHD-related information, focus groups where participants were instructed to consider the pathways by which they made decisions using web-based resources, and observing participants interacting with a newly developed website tailored for adults with potential ADHD and caregivers of children who had or might have ADHD. Phase 1 individual interviews and phase 2 focus groups identified the needs of the ADHD stakeholders related to website content and format. Interview and focus group findings were used to develop a website. Phase 3 used think-aloud interviews to evaluate website usability to inform the tailoring of the website based on user feedback. RESULTS: Interviews and focus group findings revealed preferences for ADHD website information and content, website layout, and information sources. Themes included a preference for destigmatizing information about ADHD, information specific to patient demographics, and evidence-based information tailored to lay audiences. CONCLUSIONS: ADHD stakeholders are specifically seeking positive information about ADHD presented in a user-friendly format.

AbstractThis research examined the impact of explicit reading strategy training on Ethiopian university students’ reading strategy use and critical reading ability in the English as a Foreign Language (EFL) context. Two intact classes, a control group (n = 35) and an experimental group (n = 45), participated in the study. The experimental group received 12 weeks of reading strategy training integrated into their English reading skills I classes. A mixed-method quasi-experimental design was employed, using a reading strategy questionnaire, a critical reading ability test, and a think-aloud technique for data collection. Students who received reading strategy instruction demonstrated notable improvements in reading strategy use and critical reading ability. The independent sample t-test and a paired sample t-test showed significant differences in both areas. Qualitative data highlighted compensation and memory strategies, which were not captured quantitatively. The think-aloud data revealed the predominant use of cognitive and metacognitive strategies, along with affective, social, memory, and compensation strategies. Cognitive strategies deepen understanding, and metacognitive techniques enhance interpretation in reading. These findings shed light on the responses of Ethiopian university students to explicit reading strategy training, emphasizing its significance in improving reading strategy use and critical reading ability in an EFL context.

This study examines the embodied ways in which learners monitor their cognition while learning about exponential functions in an immersive virtual reality (VR) based game, Pandemic by Prisms of Reality. Traditionally, metacognitive monitoring has been assessed through behavioural traces and verbalised instances. When learning in VR, learners are fully immersed in the learning environment, actively manipulating it based on affordances designed to support learning, offering insights into the relationship between physical interaction and metacognition. The study collected multimodal data from 15 participants, including think‐aloud audio, bird's‐eye view video recordings and physiological data. Metacognitive monitoring was analysed through qualitative coding of the think‐aloud protocol, while movement was measured via optical flow analysis and cognitive load was assessed through heart rate variability analysis. The results revealed embodied metacognition by aligning the data to identify learners' physical states alongside their verbalised metacognition. The findings demonstrated a temporal interplay among cognitive load, metacognitive monitoring, and motion during VR‐based learning. Specifically, cognitive load, indicated by the low‐ and high‐frequency heart rate variability index, predicted instances of metacognitive monitoring, and monitoring predicted learners' motion while interacting with the VR environment. This study further provides future directions in understanding self‐regulated learning processes during VR learning by utilizing multimodal data to inform real‐time adaptive personalised support within these environments. Practitioner notesWhat is already known about this topic Immersive virtual reality (VR) environments have the potential to offer personalised support based on users' individual needs and characteristics.Self‐regulated learning (SRL) involves learners monitoring their progress and strategically regulating their learning when needed.Multimodal data captured during VR learning, such as birds‐eye‐view video, screen recordings, physiological changes and verbalisations, can provide insights into learners' SRL processes and support needs.What this paper adds Provides insights into the embodied aspects of learners' metacognitive monitoring during learning in an immersive VR environment.Demonstrates how SRL processes can be captured via the collection and analysis of multimodal data, including think‐aloud audio, bird's‐eye view video recordings and physiological data, to capture metacognitive monitoring and movement during VR‐based learning.Contributes to the understanding of the interplay between cognitive load, metacognitive monitoring, and motion in immersive VR learning.Implications for practice and/or policy Researchers and practitioners can use the causal relationships identified in this study to identify instances of SRL in an immersive VR setting.Educational technology developers can consider the integration of online measures, such as cognitive load and physiological arousal, into adaptive VR environments to enable real‐time personalised support for learners based on their self‐regulatory needs. [ABSTRACT FROM AUTHOR]

Background: Sleep problems are common in adolescents and have detrimental impacts on physical and mental health and daily functioning. Evidence-based treatment like cognitive behaviour therapy for insomnia (CBT-I) is often hard to access, and adolescents may not engage in and adhere to longer, clinician-delivered interventions. Brief, self-guided, and accessible sleep interventions are needed. Objective: To explore the user experience of a prototype online self-help single session sleep intervention developed for adolescents. Methods: Eleven participants aged 17–19 years (8 females, 3 males) took part in online retrospective think-aloud interviews. Participants first completed the prototype intervention independently and were then shown the intervention page by page and asked to verbalise their thoughts and experiences. Transcripts were analyzed thematically. Results: Participants found the intervention helpful. Four themes were generated - 'Educative: Learning, but more fun', 'Effortless: Quicker and Easier', 'Personalization: Power of Choice', and 'Positivity: Just Good Vibes'. The theme 'Educative: Learning, but more fun' encompassed two sub-themes 'Opportunity to Learn' and 'Aesthetics and Learning'. These themes reflected participants' views that the intervention was educative, personalised, solution-oriented and easy to use, but could incorporate more graphics and visuals to aid in learning and could be made more effortless and positive through modifications to its design. Conclusions: Findings convey the importance of ensuring educative well-designed content, personalization, a positive tone, and ease of use while designing interventions targeting adolescents's sleep and mental health. They also indicate areas for further developing the intervention. [ABSTRACT FROM AUTHOR]

Regarding competency-oriented teaching in higher education, lecturers face the challenge of employing aligned task material to develop the intended competencies. What is lacking in many disciplines are well-founded guidelines on what competencies to develop and what tasks to use to purposefully promote and assess competency development. Our work aims to create an empirically validated framework for competency-oriented assessment in the area of graphical modeling in computer science. This article reports on the use of the think-aloud method to validate a competency model and a competencyoriented task classification. For this purpose, the response processes of 15 students during the processing of different task types were evaluated with qualitative content analysis. The analysis shed light on the construct of graphical modeling competency and the cognitive demand of the task types. Evidence was found for the content and substantive aspect of construct validity but also for the need to refine the competency model and task classification. [ABSTRACT FROM AUTHOR]

Introduction: Early recognition of pain in children is crucial, and their self-report is the primary source of information. However, communication about pain in healthcare settings can be challenging. For non-verbal communication regarding different symptoms, children prefer digital tools. The electronic Faces Thermometer Scale (eFTS) utilizes a universal design with colors, face emojis, and numbers on an 11-point scale (0-10) for pain assessment. The aim of this study was to establish content validity of the eFTS for pain assessments in children. Methods: A mixed methods design was used. The study took place at a university hospital in eastern Sweden, involving 102 children aged 8-17 years who visited outpatient clinics. Participants were presented with 17 pictures representing varying pain levels and asked to assess hypothetical pain using the eFTS. A think-aloud approach was employed, prompting children to verbalize their thoughts about assessments and the eFTS. Quantitative data were analyzed using descriptive and comparative statistics, together with a qualitative approach for analysis of think-aloud conversations. Results: A total of 1,734 assessments of hypothetical pain using the eFTS were conducted. The eFTS differentiated between no pain (level 0-1) and pain (level 2-10). However, no clear agreement was found in the differentiation between hypothetical pain intensity levels (level 2-10). The analysis revealed that children utilized the entire scale, ranging from no pain to high pain, incorporating numbers, colors, and face emojis in their assessments. Discussion: The variability in assessments was influenced by prior experiences, which had an impact on the statistical outcome in our study. However, employing the think-aloud method enhances our understanding of how children utilize the scale and perceive its design, including the incorporation of emotion-laden anchors. Children express a preference for using the eFTS to assess their pain during hospital visits. [ABSTRACT FROM AUTHOR]

The study of complex process models often encounters challenges in terms of comprehensibility. This paper explores using modularization as a strategy to mitigate such challenges, notably the reduction in complexity. Previous research has delved into the comprehensibility of modularized process models, yet an unresolved question about the cognitive factors at play during their comprehension still needs to be answered. Addressing the latter, the paper presents findings from an innovative study combining eye-tracking and concurrent think-aloud techniques involving 25 participants. The study aimed to comprehend how individuals comprehend process models when presented in three different modular formats: flattened process models, models with grouped elements, and models with subprocesses. The results shed light on varying comprehension strategies employed by participants when navigating through these modularized process models. The paper concludes by suggesting avenues for future research guided by these insights. [ABSTRACT FROM AUTHOR]

Traditionally, metaphors have been used as a pedagogical tool to facilitate the processes of educational mediation. From a medial perspective, there are various ways to implement educational mediation, and currently, we are witnessing an increase in the use of videos. Given the historical pedagogical role of metaphor and the widespread use of videos, we expected to find a significant amount of the scientific literature exploring metaphors in educational videos. However, studies establishing a direct connection are rare. Motivated by this gap, we decided to present users with a metaphorical educational video, intending to observe and analyze, through a phenomenological approach, how the metaphor is perceived by users. To gather data on users' experience, we applied the think-aloud protocol during video consumption and then we conducted semi-structured interviews. Subsequently, we analyzed the collected data using phenomenological procedures. Our results highlighted that the use of metaphor can stimulate engagement and facilitate the educational mediation, as long as the metaphor is shared and perceived as coherent by users. Finally, we have highlighted some distinctive aspects of using metaphor in educational videos, such as the ability to visually represent metaphors, create metaphorical contexts, and reinforce the processes of embodied simulation that occur during video viewing. [ABSTRACT FROM AUTHOR]

Regarding competency-oriented teaching in higher education, lecturers face the challenge of employing aligned task material to develop the intended competencies. What is lacking in many disciplines are well-founded guidelines on what competencies to develop and what tasks to use to purposefully promote and assess competency development. Our work aims to create an empirically validated framework for competency-oriented assessment in the area of graphical modeling in computer science. This article reports on the use of the think-aloud method to validate a competency model and a competency-oriented task classification. For this purpose, the response processes of 15 students during the processing of different task types were evaluated with qualitative content analysis. The analysis shed light on the construct of graphical modeling competency and the cognitive demand of the task types. Evidence was found for the content and substantive aspect of construct validity but also for the need to refine the competency model and task classification.

IntroductionEarly recognition of pain in children is crucial, and their self-report is the primary source of information. However, communication about pain in healthcare settings can be challenging. For non-verbal communication regarding different symptoms, children prefer digital tools. The electronic Faces Thermometer Scale (eFTS) utilizes a universal design with colors, face emojis, and numbers on an 11-point scale (0–10) for pain assessment. The aim of this study was to establish content validity of the eFTS for pain assessments in children.MethodsA mixed methods design was used. The study took place at a university hospital in eastern Sweden, involving 102 children aged 8–17 years who visited outpatient clinics. Participants were presented with 17 pictures representing varying pain levels and asked to assess hypothetical pain using the eFTS. A think-aloud approach was employed, prompting children to verbalize their thoughts about assessments and the eFTS. Quantitative data were analyzed using descriptive and comparative statistics, together with a qualitative approach for analysis of think-aloud conversations.ResultsA total of 1,734 assessments of hypothetical pain using the eFTS were conducted. The eFTS differentiated between no pain (level 0–1) and pain (level 2–10). However, no clear agreement was found in the differentiation between hypothetical pain intensity levels (level 2–10). The analysis revealed that children utilized the entire scale, ranging from no pain to high pain, incorporating numbers, colors, and face emojis in their assessments.DiscussionThe variability in assessments was influenced by prior experiences, which had an impact on the statistical outcome in our study. However, employing the think-aloud method enhances our understanding of how children utilize the scale and perceive its design, including the incorporation of emotion-laden anchors. Children express a preference for using the eFTS to assess their pain during hospital visits.

The think-aloud protocol is a valuable tool for investigating readers' cognitive processes during reading. However, its reliance on experienced human evaluators poses challenges in terms of efficiency and scalability. To address this limitation, this study proposes a novel application of natural language processing to automate the think-aloud protocol. Specifically, we use a sentence embedding technique to encode the stimulus text and corresponding readers' responses into high-dimensional vectors, and the similarity between these embeddings serves as a feature. The properties of the feature are investigated for word-frequency-based and contextualized embedding models. Differences in the sentence embedding-based feature between poor comprehenders and normal readers are investigated. Using these features, seven machine learning models were trained to classify readers into normal and abnormal groups. The highest F1 score of 0.74 was achieved with the contextualized embedding and random forest classifier. This highlights the effectiveness of the embedding technique in extracting useful features for automating the think-aloud protocol for assessing reading comprehension abilities. The potential benefits of this automated approach include increased efficiency and scalability, ultimately facilitating the early diagnosis of reading comprehension impairment and individualized interventions. [ABSTRACT FROM AUTHOR]

Teachers' self-regulated learning (SRL) plays a crucial role in developing technological pedagogical content knowledge (TPACK), a complex professional skill. It is crucial to identify teachers' SRL activities that may lead to favorable TPACK. Previous studies have focused on the analysis of individual data sources from self-reported surveys or log files, which are insufficient to capture all SRL activities in the TPACK context. While multimodal learning analytics (MMLA) has the potential to improve SRL measurement, it remains unknown how multimodal data collected from different sources can be combined to identify salient features of SRL activities and examine how TPACK outcomes can be predicted by SRL activities identified from multimodal data. This study combined multimodal data from computer logs and think-aloud data to analyze teachers' SRL activities in designing a technology-integrated lesson. We identified the salient features of SRL from the combined data and explored how identified SRL activities might predict TPACK outcomes reflected in teacher-generated lesson plans. The results of random forest regression analysis show that three SRL activities from the logs and two from the think-aloud data formed the best combination that explained a significant proportion of variances in TPACK performance. The impact of MMLA in SRL measurement and the implication of this study are discussed. [ABSTRACT FROM AUTHOR]

Purpose: The EQ-5D-5L is a preference-based instrument for measuring and valuing health-related quality of life (HRQoL). The EQ-5D-5L has been used extensively in economic evaluation, including in aged care. However, older adults' understanding of the EQ-5D-5L has not been comprehensively investigated to date. This research aimed to assess older adults' understanding of the EQ-5D-5L using a think-aloud protocol with two cognition groups: no cognitive impairment and mild/moderate cognitive impairment. Methods: Participants' cognition was assessed using the Standardised Mini-Mental State Examination (SMMSE). Face-to face interviews were conducted with concurrent and retrospective think-aloud encouraged through verbal probing. Audio recordings were transcribed, and qualitative analysis, informed by the Tourangeau four-stage Response Model (comprehension, retrieval, decision process, response process) was conducted in NVivo. Results: In total, 46 older adults (age 65 +) were recruited from 10 residential care facilities across South Australia (n = 25 no cognitive impairment, n = 21 mild/moderate cognitive impairment). Comprehension, retrieval, judgement and response mapping issues were common across all cognition levels and EQ-5D-5L dimensions. The two dimensions resulting in the most response issues were usual activities and personal care. Conclusion: Older adults may bring a different understanding to the EQ-5D-5L descriptive system than that expected given testing with general population samples. Dimension descriptors that are more relevant to this population may facilitate responses that better align with the underlying EQ-5D-5L concept model. [ABSTRACT FROM AUTHOR]

Researchers who investigate value-laden professional practices face the challenge of creating a space in which to explore workplace priorities. Education professionals, for example, are keyed to the development and wellbeing of their students, yet frequently work in environments in which there are constraints on their practice. These professionals often have to find a balance among priorities, a process accompanied by reflection and professional conversations. For researchers seeking insight into the work of these professionals, accessing these reflections is not necessarily straightforward. This paper presents a method whereby sorting and think-aloud techniques were combined to create a space in which professionals could share reflections on professional priorities. Employing a magnetic board representing normative dimensions of high importance/low importance, and should/should not, participants were able to decide where to place magnetic labels capturing different aspects of their work. While interacting with the sorting task, participants verbalized their deliberations which were recorded, along with their label placements. Meaningful qualitative data were elicited through this process. We experienced that this combination of techniques offered an effective way of eliciting reflections and deliberations that throw light on aspects of professional work which may be less readily accessed through a traditional interview technique. [ABSTRACT FROM AUTHOR]

Data-driven learning (DDL), the direct use of corpus by learners in the second language classroom, has been shown to be effective in improving learners' acquisition of various English linguistic items (Boulton & Cobb, 2017). However, it is still limited to our knowledge regarding how learners interact with DDL-related materials or tools and how DDL works in the learning/teaching of languages other than English. This study aims to closely examine the cognitive processes of six learners of Chinese in using printed concordance-based materials to learn Chinese resultative constructions. These materials contained adapted complete concordance sentences drawn from the Lancaster Corpus for Mandarin Chinese (McEnery & Xiao, 2004). The results show that in general, learners employed various strategies when scrutinising the concordance lines, particularly cognitive strategies such as summarising and grouping. Differences among individual learners were also found: learners who used more diverse strategies with higher frequencies could successfully infer the regularities, which led to learning gains. The study provides some implications for effective teacher guidance in DDL. [ABSTRACT FROM AUTHOR]

This qualitative study aimed to identify and analyse reading comprehension strategies used by five deaf adults, 22–47 years old, who were close to complete or had already completed their studies at a higher education institution. The method chosen was a partial replication of the one used by Banner and Wang (2011) in their think-aloud study to describe cognitive and metacognitive reading comprehension strategies use among deaf students and adults. The present study included similar interview questions and think-aloud procedures, which were conducted by a deaf teacher, native user of Chilean Sign Language (LSCh). Participants read informational texts and were interrupted three times during the reading task to answer questions about their cognitive and metacognitive processes. Results showed that these deaf adults can use strategies from all the categories identified by Pressley and Afflerbach (1995): constructing meaning, monitoring and improving comprehension, and evaluating comprehension. Some strategies described in the study from Banner and Wang were observed only in individual cases, and some of them were not used at all. The deaf participants of this study also used some strategies that were not included in some previous studies. Since very few deaf adults in Chile have completed higher education, the information provided by this study could be useful in guiding interventions aimed to improve reading comprehension in elementary, high school, and college DHH students. The relevance of early experiences with reading, and motivational factors associated to reading achievement are discussed. [ABSTRACT FROM AUTHOR]

Skin cancer patients increasingly search the internet to acquire disease-related information. However, information on the internet may be misleading. Recently, SKINFO has been launched, a website exclusively created for German-speaking skin cancer patients providing information as well as additional resources of verified quality. Here, we describe the results of the first usability test of SKINFO using a mixed-methods approach. Ten adult patients with skin cancer were recruited for usability testing in the skin cancer units of the University Hospitals of Erlangen and Dresden, Germany. Testing consisted of three different scenarios where patients were asked to find specific information on the SKINFO website guided by the think-aloud method. Descriptive analysis and content analyses were performed. All patients would recommend SKINFO and appreciated its content, design, and structure. Think-aloud analysis identified the topics layout, navigation, and content and structure which would benefit from refinement. Major criticism included the navigation through the website, and the desire for more specific information addressing patients' relatives and the latest, up-to-date information. Overall, usability testing showed that the unique web-based information platform has the potential to support patients coping with skin cancer and thus strengthen informed decision-making. [ABSTRACT FROM AUTHOR]

The think-aloud method requires participants to verbalize all their thoughts while solving problems. This study examines the influences of the think-aloud protocol on task performance and the relationship between individual differences in utterance levels and working memory capacities. In the experiment, participants solved a version of the Remote Associates Test (RAT) where they were instructed to verbalize their thoughts aloud while required to think of a single Chinese character associated with several presented Chinese characters. The participants were subsequently divided into low and high working-memory capacity groups based on the results of a verbal working-memory span task. The results showed that the degree of utterances de- creased with increases in task difficulty in the high working-memory capacity participants but increased in the low working-memory capacity participants. This finding indicates that verbalizing aloud while executing a task may differ as a function of working-memory capacity and as task difficulty varies. Moreover, the results also showed that response times tended to be longer with verbalizations, which indicates that thinking-aloud may interfere with task performance. [ABSTRACT FROM AUTHOR]

Introduction: During recent years, health care organizations have paid increasing attention to onboarding because of recruitment challenges. Organizational initiatives are frequently monitored and evaluated using questionnaire data, and to produce high-quality data, reliable instruments are paramount. We aimed to investigate the content validity and reliability of the Danish Onboarding Questionnaire, including cognitive interviewing and test–retest analyses. Method: We investigated content validity, including face validity and the content validity index, and reliability for the percentage of agreement. To analyze the cognitive interview data, thematic analysis was applied, followed by the question-and-answer model to categorize the problems revealed. To test reliability, the percentage of agreement was calculated with an accepted deviation of 1 on test–retest data. Results: Regarding the mental processes, multiple items were identified to be challenged regarding comprehension (clarification of concepts and understanding), judgment (ambiguity and relevance), and response (anonymity and personal information). The mental process retrieval was not represented. The subscale content validity index/Ave was found to be 0.935, representing a “good” level of content validity. With an accepted deviation of 1, the mean agreement was 97.7%. Discussion: Questionnaire items causing uncertainties or challenges are potential sources of deteriorated content validity and should be revised. We suggest that the Danish Onboarding Questionnaire-34 undergo an item reduction, which might increase its validity and reliability. [ABSTRACT FROM AUTHOR]

The proliferation of online eHealth has made it much easier for users to access healthcare services and interventions from the comfort of their own homes. This study looks at how well one such platform—eSano—performs in terms of user experience when delivering mindfulness interventions. In order to assess usability and user experience, several tools such as eye-tracking technology, think-aloud sessions, a system usability scale questionnaire, an application questionnaire, and post-experiment interviews were employed. Participants were evaluated while they accessed the first module of the mindfulness intervention provided by eSano to measure their interaction with the app, and their level of engagement, and to obtain feedback on both the intervention and its overall usability. The results revealed that although users generally rated their experience with the app positively in terms of overall satisfaction, according to data collected through the system usability scale questionnaire, participants rated the first module of the mindfulness intervention as below average. Additionally, eye-tracking data showed that some users skipped long text blocks in favor of answering questions quickly while others spent more than half their time reading them. Henceforth, recommendations were put forward to improve both the usability and persuasiveness of the app—such as incorporating shorter text blocks and more engaging interactive elements—in order to raise adherence rates. Overall findings from this study provide valuable insights into how users interact with the eSano's participant app which can be used as guidelines for the future development of more effective and user-friendly platforms. Moreover, considering these potential improvements will help foster more positive experiences that promote regular engagement with these types of apps; taking into account emotional states and needs that vary across different age groups and abilities. [ABSTRACT FROM AUTHOR]

Abstract Objective Participants Methods Results Conclusions To develop an online discrete choice experiment (DCE) to elicit preferences for the format and content of tobacco treatment and determine the feasibility of the survey in face-to-face online interviews among college students.A convenience sample of 28 college students.A pilot online DCE survey with sixteen choice sets was developed. The feasibility was assessed by: 1) ease of reading the survey descriptions, 2) ease of completing the DCE survey, and 3) appropriateness of the number of choice sets. Think-aloud data were analyzed to understand decision-making processes.All participants completed the DCE survey and reported that it was very easy to read and complete and that the number of sixteen choice sets was appropriate. Such results support the feasibility of our online DCE survey. Five decision-making strategies were identified.An online DCE survey administered during online interviews may replace in-person interviews for college students. [ABSTRACT FROM AUTHOR]

Preparing students for informed democratic citizenship by learning about contemporary political and social issues requires the ability to critically evaluate online data visualisations. This study examines 25 social studies teachers' perceptions of online data visualisations as informational resources for teaching, and how these perceptions influence their reading of online data visualisations. The goal is to examine teacher understandings of the influence of fake news, how they understand issues of bias and credibility for data visualisations, and how their perceptions influence their interpretive practices. The study employed semi-structured interviews and a think aloud protocol. The think aloud involved the reading and analysis of a single online data visualisation. The findings provide insights into the ways that social studies teachers think about the role of data visualisations and online information in social studies education, their challenges to read and interpret online data visualisations, and implications for teaching. [ABSTRACT FROM AUTHOR]

Contemporary research indicates that student creativity is crucial to the success of arts education. Self-regulated learning has become one of educational psychology's most critical research areas. However, there is limited research on creativity in arts education in self-regulated learning. Therefore, this study aims to define the creativity characteristics that determine the quality of students' work. This study implemented a creative competition in painting and composition for first-year undergraduates. It was conducted at a Chinese university with the participation of 178 first-year students aged 18 to 26. It evaluated the characteristics of creativity during the three main phases of the task: planning, execution, and completion. We investigated the subject by employing semi-open questionnaires (n = 178) and using the content analysis method and quantitative analysis. According to the competition results, the students with the highest scores in flow, inspiration, and idea generation in the performance phase had the best quality work. In the forethought phase, analogical thinking and idea generation worked best for most students, while in the performance phase, flow sense, idea generation, and idea manipulation worked best. Data on creativity characteristics at different work phases and final quality might adequately guide and organize educational procedures. These findings can serve as a theoretical foundation for quantifying the creativity phase in self-regulated learning and offer arts educators a reference for creativity instruction. [ABSTRACT FROM AUTHOR]

Traditionally, metaphors have been used as a pedagogical tool to facilitate the processes of educational mediation. From a medial perspective, there are various ways to implement educational mediation, and currently, we are witnessing an increase in the use of videos. Given the historical pedagogical role of metaphor and the widespread use of videos, we expected to find a significant amount of the scientific literature exploring metaphors in educational videos. However, studies establishing a direct connection are rare. Motivated by this gap, we decided to present users with a metaphorical educational video, intending to observe and analyze, through a phenomenological approach, how the metaphor is perceived by users. To gather data on users’ experience, we applied the think-aloud protocol during video consumption and then we conducted semi-structured interviews. Subsequently, we analyzed the collected data using phenomenological procedures. Our results highlighted that the use of metaphor can stimulate engagement and facilitate the educational mediation, as long as the metaphor is shared and perceived as coherent by users. Finally, we have highlighted some distinctive aspects of using metaphor in educational videos, such as the ability to visually represent metaphors, create metaphorical contexts, and reinforce the processes of embodied simulation that occur during video viewing.

Background: Canada's 24-Hour Movement Guidelines for Adults have shifted the focus from considering movement behaviours (i.e., physical activity, sedentary behaviour, and sleep) separately to a 24-h paradigm, which considers how they are integrated. Accordingly, primary care providers (PCPs) have the opportunity to improve their practice to promote all movement behaviours cohesively. However, PCPs have faced barriers to discussing physical activity alone (e.g., time, competing priorities, inadequate training), leading to low frequency of physical activity discussions. Consequently, discussing three movement behaviours may seem challenging. Tools to facilitate primary care discussions about physical activity have been developed and used; however, few have undergone usability testing and none have integrated all movement behaviours. Following a synthesis of physical activity, sedentary behaviour, and sleep tools for PCPs, we developed the Whole Day Matters Tool and User Guide that incorporate all movement behaviours. The present study aimed to explore PCPs' perceptions on the usability, acceptability, and future implementation of the Whole Day Matters Tool and User Guide to improve their relevancy among PCPs. Methods: Twenty-six PCPs were observed and audio–video recorded while using the Tool and User Guide in a think-aloud procedure, then in a near-live encounter with a mock service-user. A debriefing interview using a guide informed by Normalization Process Theory followed. Recordings were transcribed verbatim and analysed using content analysis and a critical friend to enhance rigour. Results: PCPs valued aspects of the Tool and User Guide including their structure, user-friendliness, visual appeal, and multi-behaviour focus and suggested modifications to improve usability and acceptability. Findings are further discussed in the context of Normalization Process Theory and previous literature. Conclusions: The Tool and User Guide were revised, including adding plain language, reordering and renaming sections, reducing text, and clarifying instructions. Results also informed the addition of a Preamble and a Handout for adults accessing care (i.e., patients/clients/service-users) to explain the evidence underpinning the 24-Hour Movement Guidelines for Adults and support a person-centered approach. These four resources (i.e., Tool, User Guide, Preamble, Handout) have since undergone a consensus building process to arrive at their final versions before being disseminated into primary care practice. [ABSTRACT FROM AUTHOR]

The think-aloud (TA) approach is a qualitative research method that allows for gaining insight into thoughts and cognitive processes. It can be used to incorporate a respondent's perspective when developing resource-use measurement (RUM) instruments. Currently, the application of TA methods in RUM research is limited, and so is the guidance on how to use them. Transparent publication of TA methods for RUM in health economics studies, which is the aim of this paper, can contribute to reducing the aforementioned gap. Methods for conducting TA interviews were iteratively developed by a multi-national working group of health economists and additional qualitative research expertise was sought. TA interviews were conducted in four countries to support this process. A ten-step process was outlined in three parts: Part A 'before the interview' (including translation, recruitment, training), Part B 'during the interview' (including setting, opening, completing the instrument, open-ended questions, closing), and part C 'after the interview' (including transcription and data analysis, trustworthiness). This manuscript describes the step-by-step approach for conducting multi-national TA interviews with potential respondents of the PECUNIA RUM instrument. It increases the methodological transparency in RUM development and reduces the knowledge gap of using qualitative research methods in health economics. [ABSTRACT FROM AUTHOR]

The think-aloud method is a widely used method for evaluating the usability of websites and software. However, it can also be used with cartographic products, an area which has been neglected up to now. It is a method in which test participants verbalise all their thought processes aloud. The participants are given a test scenario containing tasks to be completed. The method aims to reveal the participants' subjective attitudes toward a product in order to evaluate its usability. The present paper describes the use of the think-aloud method to evaluate the usability of a cartographic work—the regional atlas of the Moravian-Silesian Region. The study includes (I) a complete review of the method, based on the studies conducted; (II) testing tools for working with recorded data; (III) designing an experiment for evaluating the usability of the atlas; and (IV) the resulting qualitative and quantitative evaluation of the atlas based on the obtained results. During the study, three approaches were proposed to process and analyse the audio recordings. The first option was to separate the audio recordings into individual annotations and analyse them. The second option was to convert the recordings to text and perform a linguistic analysis. The third supplementary option was to use all the material produced and to analyse it subjectively and retrospectively, from the researcher's perspective. All three options were used in the final assessment of the atlas. Based on the participants' statements, any shortcomings in the studied atlas were identified for each topic (e.g., non-dominant maps or exceedingly complex infographics), and recommendations for their elimination were proposed. [ABSTRACT FROM AUTHOR]

Abstract Background Antimicrobial stewardship programs (ASPs) play a big role in minimizing antimicrobial resistance. Pharmacists are essential members of the health care team and in order for them to fulfill roles on ASP teams and become antimicrobial stewards, they must be prepared adequately by pharmacy schools prior to entry into actual practice. Although programming has been implemented into entry-to-practice programs worldwide, little is known about how students interpret antimicrobial stewardship (AMS) data and arrive at clinical decisions. We aimed to explore students’ cognitive processes and determine how they formulate therapeutic decisions when presented with AMS cases. Methods This was a qualitative study conducted using a case study approach, in which a sample (n=20) of pharmacy students was recruited to interpret AMS cases. Semi-structured 1-on-1 interviews were arranged with each participant. A think-aloud procedure with verbal protocol analysis was adopted to determine students’ decision-making processes. Thematic analysis was used to interpret themes from the interview data. Results Two themes were interpreted from the data: students’ focus and students’ approach to case interpretation. Students’ focus relates to external factors students consider when interpreting AMS case data and use to make and justify therapeutic decisions including patient-centered factors, drug-related factors, AMS interventions, and pharmacist’s role. Students’ clinical reasoning describes the approach that students use to interpret the data and the decision-making processes they employ to arrive at a clinical decision including a systematic approach versus non-systematic approach. Conclusions Students vary in their focus and the cognitive strategies used to interpret AMS cases. Findings support the notion that clinical reasoning and decision-making should be explicitly taught in pharmacy curricula, in order to help students become aware of their own cognitive processes and decision-making abilities.

• We examined older adults' information processing. • We categorized older adults into veracity detective vs. misjudgment wanderer. • Veracity detectives tended to use evidence derived from message arguments. • Misjudgment wanderers mostly relied on surface cues to evaluate information. • Detectives were more open-minded; wanderers were vulnerable to logical fallacy. Older adults are vulnerable to online health misinformation. This study fills a research gap by exposing older adults to a mixture of health-related misinformation and factual information and employing the think-aloud protocol in a semi-structured interview to understand information processing and evaluation in the moment of information engagement. The participants were categorized into two groups based on their abilities to discern misinformation. Via thematic analysis, we compared the two groups and found distinctive information processing patterns between them. We propose guidelines for evaluating online misinformation based on the best practices of those who have a high capacity to discern the veracity of the information and pitfalls to avoid based on the experience of those who failed to correctly differentiate true and misinformation. [ABSTRACT FROM AUTHOR]

The think-aloud protocol is a valuable tool for investigating readers’ cognitive processes during reading. However, its reliance on experienced human evaluators poses challenges in terms of efficiency and scalability. To address this limitation, this study proposes a novel application of natural language processing to automate the think-aloud protocol. Specifically, we use a sentence embedding technique to encode the stimulus text and corresponding readers’ responses into high-dimensional vectors, and the similarity between these embeddings serves as a feature. The properties of the feature are investigated for word-frequency-based and contextualized embedding models. Differences in the sentence embedding-based feature between poor comprehenders and normal readers are investigated. Using these features, seven machine learning models were trained to classify readers into normal and abnormal groups. The highest F1 score of 0.74 was achieved with the contextualized embedding and random forest classifier. This highlights the effectiveness of the embedding technique in extracting useful features for automating the think-aloud protocol for assessing reading comprehension abilities. The potential benefits of this automated approach include increased efficiency and scalability, ultimately facilitating the early diagnosis of reading comprehension impairment and individualized interventions.

This systematic review examines 35 empirical studies featuring the use of think‐aloud interviews in computational thinking (CT) research. Findings show that think‐aloud interviews (1) are typically conducted in Computer Science classrooms and with K‐12 students; (2) are usually combined with other exploratory CT assessment tools; (3) have the potential to benefit learners with special needs and identify the competency gaps through involving diverse participants; (4) are conducted in the absence of cognitive models and standard procedures; and (5) display insufficient definitional and methodological rigor. Theoretically, this review presents a systematic assessment about the application of think‐aloud interviews in CT studies and identifies the limitations in existing CT‐related think‐aloud studies. Practically, this review serves as a reference for studying the cognitive processes during CT problem‐solving and provides suggestions for CT researchers who intend to incorporate think‐aloud interviews in their studies. [ABSTRACT FROM AUTHOR]

Background: Sore throat is a common problem and a common reason for the overuse of antibiotics. A web-based tool that helps people assess their sore throat, through the use of clinical prediction rules, taking throat swabs or saliva samples, and taking throat photographs, has the potential to improve self-management and help identify those who are the most and least likely to benefit from antibiotics. Objective: We aimed to develop a web-based tool to help patients and parents or carers self-assess sore throat symptoms and take throat photographs, swabs, and saliva samples for diagnostic testing. We then explored the acceptability and feasibility of using the tool in adults and children with sore throats. Methods: We used the Person-Based Approach to develop a web-based tool and then recruited adults and children with sore throats who participated in this study by attending general practices or through social media advertising. Participants self-assessed the presence of FeverPAIN and Centor score criteria and attempted to photograph their throat and take throat swabs and saliva tests. Study processes were observed via video call, and participants were interviewed about their views on using the web-based tool. Self-assessed throat inflammation and pus were compared to clinician evaluation of patients' throat photographs. Results: A total of 45 participants (33 adults and 12 children) were recruited. Of these, 35 (78%) and 32 (71%) participants completed all scoring elements for FeverPAIN and Centor scores, respectively, and most (30/45, 67%) of them reported finding self-assessment relatively easy. No valid response was provided for swollen lymph nodes, throat inflammation, and pus on the throat by 11 (24%), 9 (20%), and 13 (29%) participants respectively. A total of 18 (40%) participants provided a throat photograph of adequate quality for clinical assessment. Patient assessment of inflammation had a sensitivity of 100% (3/3) and specificity of 47% (7/15) compared with the clinician-assessed photographs. For pus on the throat, the sensitivity was 100% (3/3) and the specificity was 71% (10/14). A total of 89% (40/45), 93% (42/45), 89% (40/45), and 80% (30/45) of participants provided analyzable bacterial swabs, viral swabs, saliva sponges, and saliva drool samples, respectively. Participants were generally happy and confident in providing samples, with saliva samples rated as slightly more acceptable than swab samples. Conclusions: Most adult and parent participants were able to use a web-based intervention to assess the clinical features of throat infections and generate scores using clinical prediction rules. However, some had difficulties assessing clinical signs, such as lymph nodes, throat pus, and inflammation, and scores were assessed as sensitive but not specific. Many participants had problems taking photographs of adequate quality, but most were able to take throat swabs and saliva samples. [ABSTRACT FROM AUTHOR]

What do people in different cultures do when they encounter complex problems? Whereas some cross-cultural research exists about complex problem-solving predictors and performance, the process has rarely been studied. We presented participants from Brazil, Germany, the Philippines, and the United States with two computer-simulated dynamic problems, one where quick action was required - the WinFire simulation - and one where cautious action was required - the Coldstore simulation. Participants were asked to think aloud in their native language while working on these two tasks. These think-aloud protocols were digitally recorded, transcribed, and coded by coders in each country in terms of the steps involved in complex problem solving and dynamic decision making. For the current study, we developed a program to calculate transition frequencies from one problem solving step to another and analyzed only those protocols with more than 15 transitions. For WinFire, these were 256 think-aloud protocols from the four countries with a total of 12,542 statement, for Coldstore, these were 247 participants with a total of 15,237 statements. Based on previous, limited cross-cultural research, we predicted that after identifying a problem, Brazilians would make emotional and self-related statements, Germans would engage primarily in planning, Filipinos would gather additional information, and Americans would primarily state solutions. Results of latent transition analysis partially support these hypotheses, but only in the highly uncertain Coldstore situation and not in the more transparent WinFire situation. Transition frequencies were then also analyzed regarding community clusters using the spinglass algorithm in R, igraph. Results highlight the importance of process analyses in different tasks and show how cultural background guides people's decisions under uncertainty. [ABSTRACT FROM AUTHOR]

This study explored the use of machine translation (MT) for reading in college English classes. A possible mechanism of MT use at play during L2 reading was explained based on Kintsch's Construction Integration model. Framed in dynamic assessment (DA), intercorrelations between students' vocabulary knowledge, independent reading scores (IRS), MT-mediated reading scores (MTRS), and learning potential scores (LPS) were analyzed to explain a possible role of MT in L2 reading. Students' perceptions of MT use were investigated via surveys after the MT-mediated reading assessment and the MT-mediated think-aloud reading (TAR) task as self-instructional training. One hundred ten students participated in the DA task, and one hundred three, in the TAR task. The findings confirmed the role of MT as an L2 proficiency mediating tool in reading assessment. Students' perceptions of MT use were positive overall. Clarifying meanings of unfamiliar words and difficult sentences was reported to be the areas where the participants benefited most from MT use during the assessment. The positive effects of the MT-mediated TAR task were found to be improved English proficiency, increased sensitivity to self-monitoring, development of global competence, convenience, enhanced self-directed learning, and increased familiarity with English. Pedagogical implications of the findings are discussed. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to gain insight into decision-making strategies individuals used when evaluating pairs of SF-6Dv2 health states in discrete choice experiments (DCEs).Methods: This qualitative, cross-sectional, noninterventional study asked participants to use a think-aloud approach to compare SF-6Dv2 health states in DCEs. Thematic analysis focused on comprehension and cognitive strategies used to compare health states and make decisions.Results: Participants (N = 40) used 3 main strategies when completing DCEs: (1) trading, (2) reinterpretation, and (3) relying on previous experience. Trading was the most common strategy, used by everyone at least once, and involved prioritizing key attributes, such as preferring a health state with significant depression but no bodily pain. Reinterpretation was used by 17 participants and involved reconstructing health states by changing underlying assumptions (eg, rationalizing selecting a health state with significant pain because they could take pain medications). Finally, some (n = 13) relied on previous experience when making decisions on some choice tasks. Participants with experience dealing with pain, for instance, prioritized health states with the least impact in this dimension.Conclusions: Qualitatively evaluating the decision-making strategies used in DCEs allows researchers to evaluate whether the tasks and attributes are interpreted accurately. The findings from this study add to the understanding of the generation of SF-6Dv2 health utility weights and the validity of these weights (e.g., reinterpreting health states could undermine the validity of DCEs and utility weights), and the overall usefulness of the SF-6Dv2. The methodology described in this study can and should be carried forth in valuing other health utility measures, not just the SF-6Dv2. [ABSTRACT FROM AUTHOR]

Background: The effectiveness of virtual reality exposure (VRE) in the treatment of anxiety disorders is well established. Several psychological mechanisms of VRE have been identified, whereby both emotional processing and the sense of presence play a key role. However, there are only few studies that contribute to our knowledge of examples of implementation in the case of VRE for claustrophobia based on patients' experiences and the perspective of therapists. Objective: This study asks for key elements of a VRE app that are necessary for effective exposure for people with claustrophobic symptoms. Methods: A mixed methods design was applied in which patients (n=15) and therapeutic experts (n=15) tested a VRE intervention of an elevator ride at 5 intensity levels. Intensity was varied by elevator size, duration of the elevator ride, and presence of virtual humans. Quantitative measures examined self-reported presence with the Igroup Presence Questionnaire (IPQ) ranging from 0 to 6 and 15 Likert-scaled evaluation items that had been developed for the purpose of this study, ranging from 1 to 5. In both measures, higher scores indicate higher levels of presence or agreement. Think-aloud protocols of the patients and semistructured interviews posttreatment of all participants were conducted to gain in-depth perspectives on emotional processes. Results: The intervention induced a feeling of presence in patients and experts, posttreatment scores showed a high IPQ presence score (mean 3.84, SD 0.88), with its subscores IPQ spatial presence (mean 4.53, SD 1.06), IPQ involvement (mean 3.83, SD 1.22), and IPQ experienced realism (mean 2.75, SD 1.02). Patients preferred a setting in the presence of a therapist (mean 4.13, SD 0.83) more than the experts did (mean 3.33, SD 1.54). Think-aloud protocols of the patients revealed that presence and anxiety both were achieved. Qualitative interviews of patients and experts uncovered 8 topics: feelings and emotions, personal story, telepresence, potential therapeutic effects, barriers, conditions and requirements, future prospects, and realization. The intensity levels were felt to appropriately increase in challenge, with ambivalent results regarding the final level. Virtual humans contributed to feelings of fear. Conclusions: Key elements of a VRE app for claustrophobic symptoms should include variation of intensity by adding challenging cues in order to evoke presence and anxiety. Virtual humans are a suitable possibility to make the intervention realistic and to provide a sense of closeness; however, some of the fears might then be related to symptoms of social phobia or agoraphobia. Patients may need the physical presence of a therapist, though not all of them share this view. A higher degree of sophistication in the intensity levels is needed to deliver targeted help for specific symptoms of anxiety. [ABSTRACT FROM AUTHOR]

In this experiment we investigated whether the presentation of domain principles within one text facilitates reading to learn from multiple exemplar texts that feature the importance of the principles. There were five texts about natural selection: a principles text, which described principles of natural selection, and four exemplar-based texts about specific animals. These exemplar texts illustrated natural selection in different species but did not explicitly reference natural selection. Undergraduates were randomly assigned to one of three groups: principles-text-first (n = 27), principles-text-last (n = 27), or no principles text (n = 27). Participants completed different topic knowledge tests before and after reading. During reading, we used a think-aloud protocol to assess cognitive processing. The principles text promoted learning and readers' attempts to integrate ideas between texts, but only when the principles text appeared before the exemplar texts. The three conditions did not differ in their use of intertext bridges between the exemplar texts, nor did they differ in their use of knowledge-based bridges (elaborations). However, the principles-text-first group generated more bridges between the principles text and the exemplar texts than the principles-text-last group. This suggests that a principles text can be an advance organizer that supports the integration of text ideas and learning from multiple complementary texts when students read a principles text first. Educational Impact and Implications Statement: The present study suggests that for maximum benefit, relevant information (principles) should appear before readers comprehend multiple complementary texts. Reading about principles of natural selection, for example, before reading illustrative examples of species who have experienced natural selection may be beneficial for students who have limited knowledge about the topic. This can help readers see connections between ideas in texts to support learning more effectively. [ABSTRACT FROM AUTHOR]