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Literacy assessment is essential for effective literacy instruction and training. However, traditional paper-based literacy assessments are typically decontextualized and may cause stress and anxiety for test takers. In contrast, serious games and game environments allow for the assessment of literacy in more authentic and engaging ways, which has some potential to increase the assessment’s validity and reliability. The primary objective of this study is to examine the feasibility of a novel approach for stealthily assessing literacy skills using games in an intelligent tutoring system (ITS) designed for reading comprehension strategy training. We investigated the degree to which learners’ game performance and enjoyment predicted their scores on standardized reading tests. Amazon Mechanical Turk participants (n = 211) played three games in iSTART and self-reported their level of game enjoyment after each game. Participants also completed the Gates–MacGinitie Reading Test (GMRT), which includes vocabulary knowledge and reading comprehension measures. The results indicated that participants’ performance in each game as well as the combined performance across all three games predicted their literacy skills. However, the relations between game enjoyment and literacy skills varied across games. These findings suggest the potential of leveraging serious games to assess students’ literacy skills and improve the adaptivity of game-based learning environments. 

The present study examined the extent to which adaptive feedback and just-in-time writing strategy instruction improved the quality of high school students’ persuasive essays in the context of the Writing Pal (W-Pal). W-Pal is a technology-based writing tool that integrates automated writing evaluation into an intelligent tutoring system. Students wrote a pretest essay, engaged with W-Pal’s adaptive instruction over the course of four training sessions, and then completed a posttest essay. For each training session, W-Pal differentiated strategy instruction for each student based on specific weaknesses in the initial training essays prior to providing the opportunity to revise. The results indicated that essay quality improved overall from pretest to posttest with respect to holistic quality, as well as several specific dimensions of essay quality, particularly for students with lower literacy skills. Moreover, students’ scores on some of the training essays improved from the initial to revised version on the dimensions of essay quality that were targeted by instruction, whereas scores did not improve on the dimensions that were not targeted by instruction. Overall, the results suggest that W-Pal’s adaptive strategy instruction can improve the quality of students’ essays overall, as well as more specific dimensions of essay quality. 

Little quantitative research has explored which clinician skills and behaviors facilitate communication. Mutual understanding is especially challenging when patients have limited health literacy (HL). Two strategies hypothesized to improve communication include matching the complexity of language to patients’ HL (“universal tailoring”); or always using simple language (“universal precautions”). Through computational linguistic analysis of 237,126 email exchanges between dyads of 1094 physicians and 4331 English-speaking patients, we assessed matching (concordance/discordance) between physicians’ linguistic complexity and patients’ HL, and classified physicians’ communication strategies. Among low HL patients, discordance was associated with poor understanding ( P = 0.046). Physicians’ “universal tailoring” strategy was associated with better understanding for all patients ( P = 0.01), while “universal precautions” was not. There was an interaction between concordance and communication strategy ( P = 0.021): The combination of dyadic concordance and “universal tailoring” eliminated HL-related disparities. Physicians’ ability to adapt communication to match their patients’ HL promotes shared understanding and equity. The ‘Precision Medicine’ construct should be expanded to include the domain of ‘Precision Communication.’