Health systems are heavily promoting patient portals. However, limited health literacy (HL) can restrict online communication via secure messaging (SM) because patients’ literacy skills must be sufficient to convey and comprehend content while clinicians must encourage and elicit communication from patients and match patients’ literacy level. This paper describes the Employing Computational Linguistics to Improve Patient-Provider Secure Email (ECLIPPSE) study, an interdisciplinary effort bringing together scientists in communication, computational linguistics, and health services to employ computational linguistic methods to (1) create a novel Linguistic Complexity Profile (LCP) to characterize communications of patients and clinicians and demonstrate its validity and (2) examine whether providers accommodate communication needs of patients with limited HL by tailoring their SM responses. We will study >5 million SMs generated by >150,000 ethnically diverse type 2 diabetes patients and >9000 clinicians from two settings: an integrated delivery system and a public (safety net) system. Finally, we will then create an LCP-based automated aid that delivers real-time feedback to clinicians to reduce the linguistic complexity of their SMs. This research will support health systems’ journeys to become health literate healthcare organizations and reduce HL-related disparities in diabetes care.

The Writing Pal (W-Pal) is an intelligent tutoring system (ITS) designed to provide students with explicit writing strategy instruction and practice. W-Pal includes a suite of educational games developed to increase writing engagement and provide opportunities to practice writing strategies. In this study, first (L1) (n = 26) and second (L2) language (n = 16) students interacted with W-Pal over eight sessions. We collected students’ daily self- reports of engagement, motivation, and perceptions of performance, as well as their reported game attitudes (difficulty, helpfulness for learning, and enjoyment). Results indicated that, for all students, interactions with W-Pal led to increases in writing performance and more positive attitudes towards the system (engagement, motivation, and perceived performance). For L1 students, game difficulty was a significant predictor of boredom; however, for the L2 students, game enjoyment predicted both their motivation and perceived writing improvement. Notably, the L2 students’ game ratings accounted for more variance in these daily reports than did the ratings of L1 students. This study suggests that L1 and L2 students experience similar benefits offered by game-based strategy practice in an ITS. Further, the link between game attitudes and overall daily perceptions of training may be stronger for L2 students than L1 students.