This study evaluated the effectiveness of direct instruction flashcards with oral supplemental sentence creation practice. The study was conducted over the course of eight weeks and evaluated the participants' spelling performance. The three participants were selected for the study based upon their low spelling performance. All participants had a disability that affected their academic performance; this study correlated with a goal in the participants' Individual Educational Plans. Therefore providing a link between the research and the goals for each participant in written communication. Baseline data were taken each week to determine the words that would enter intervention. The criterion for words to enter intervention was that three or more participants or students incorrectly spelled the word in baseline. Intervention began with participants and students chosen at random to identify the word and provide an original sentence. Following the oral sentence creation, the instructor would model of spelling the word, then the instructor lead the participants and students in spelling the word, and finally the participants and students spell the word independently. The intervention showed that this strategy was moderately effective. Participant 1's average percent correct improved from 13% in baseline to 64% during DI flashcards and constructing sentences using the spelling words. Participant 2's average correct improved from 0% percent in baseline to 27% during DI flashcards and requiring the students to create sentences from their spelling words. Participant 3's average correct from 47% in baseline to 96% during intervention.

A systematic, multi-faceted approach to designing health documents can promote online learning among older adults with diverse health literacy abilities.