Does adding pictures to easy-to-read texts benefit comprehension for people with reading difficulties? A meta-analytic review
Roel Kooijmans, Ruth J. P. Dalemans, Judith van der Spek, Janneke P. C. Staaks, Peter E. Langdon, Xavier Moonen · Evidence-Based Communication Assessment and Intervention · 2024
Individuals with reading problems may experience communication problems in everyday life. Guidelines for creating accessible information generally include the use of visualizations. However, a synthesis of empirical evidence on the benefits of adding visualization to text on comprehension for people with reading difficulties was lacking. We systematically reviewed the research literature and conducted a quantitative (meta-)analysis of experimental studies that investigated the effect of visualization on text comprehension. Eight studies met our eligibility criteria, and 13 effect sizes were extracted and analyzed in a 3-level meta-analysis, following PRISMA guidelines. Study populations included adults with aphasia, intellectual disabilities, and adult non-native English speakers with low literacy. Quality of included studies was assessed using the RoB-2 risk of bias tool with added considerations regarding the quality of the visualizations used. The methodological quality of most studies was questionable. Visualizations used in the included studies were diverse, generally of dubious quality, and the justification for their choice was unclear. The findings from the meta-analysis did not support the assumption that adding visualizations to easy-to-read text improves understanding for people with reading difficulties, despite this being recommended in most guidelines on augmentative communication.