Article

Five-step Methodology for Evaluation and Adaptation of Print Patient Health Information to Meet the < 5th Grade Readability Criterion

Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, MD 21287, USA.
Medical care (Impact Factor: 3.23). 02/2012; 50(4):294-301. DOI: 10.1097/MLR.0b013e318249d6c8
Source: PubMed

ABSTRACT

In the setting of declining U.S. literacy, new policies include use of clear communication and low-literacy accessibility practices with all patients. Reliable methods for adapting health information to meet such criteria remain a pressing need.
To report method validation (study 1) and method replication (study 2) procedures and outcomes for a 5-step method for evaluating and adapting print health information to meet the current low-literacy criterion of <5th grade readability.
Sets of 18 and 11 publicly disseminated patient education documents developed by a university affiliated medical center.
Three low-literacy criteria were strategically targeted for efficient, systematic evaluation, and text modification to meet a <5th grade reading level: sentence length <15 words, writing in active voice, and use of common words with multisyllabic words (>2-3 syllables) minimized or avoided. Interrater reliability for the document evaluations was determined.
Training in the methodology resulted in interrater reliability of 0.99-1.00 in study 1 and 0.98-1.00 in study 2. Original documents met none of the targeted low literacy criteria. In study 1, following low-literacy adaptation, mean reading grade level decreased from 10.4±1.8 to 3.8±0.6 (P<0.0001), with consistent achievement of criteria for words per sentence, passive voice, and syllables per word. Study 2 demonstrated similar achievement of all target criteria, with a resulting decrease in mean reading grade level from 11.0±1.8 to 4.6±0.3 (P<0.0001).
The 5-step methodology proved teachable and efficient. Targeting a limited set of modifiable criteria was effective and reliable in achieving <5th grade readability.

    • "Our experimental texts were carefully developed, resulting in a non-difficult message, that was easy to understand but definitely not infantile. Although the use of readability levels to test for comprehensibility is often recommended in low health literacy interventions (Hill Briggs, Schumann, & Dike, 2012), research has shown that, in cancer communication, readability and comprehensibility are not always related (Friedman & Hoffman-Goetz, 2007). Therefore, we primarily chose to pretest the messages extensively for difficulty. "
    [Show abstract] [Hide abstract]
    ABSTRACT: It is often recommended that health information should be simplified for people with low health literacy. However, little is known about whether messages adapted to low health literacy audiences are also effective for people with high health literacy, or whether simple messages are counterproductive in this group. Using a two (illustrated vs. text-only) by two (nondifficult vs. difficult text) between-subjects design, we test whether older adults with low (n = 279) versus high health literacy (n = 280) respond differently to colorectal cancer screening messages. Results showed that both health literacy groups recalled information best when the text was nondifficult. Reduced text difficulty did not lead to negative attitudes or less intention to have screening among people with high health literacy. Benefits of illustrations, in terms of improved recall and attitudes, were only found in people with low health literacy who were exposed to difficult texts. This was not found for people with high health literacy. In terms of informed decisions, nondifficult and illustrated messages resulted in the best informed decisions in the low health literacy group, whereas the high health literacy group benefited from nondifficult text in general, regardless of illustrations. Our findings imply that materials adapted to lower health literacy groups can also be used for a more general audience, as they do not deter people with high health literacy.
    No preview · Article · Sep 2015 · Health Communication
  • [Show abstract] [Hide abstract]
    ABSTRACT: BACKGROUND: In 2006, the Heart Rhythm Society (HRS) recommended that cardiovascular implantable electronic device (CIED) manufacturers use advisory notification letters to communicate with affected patients. OBJECTIVE: To evaluate the readability of the HRS sample "Patient Device Advisory Notification" letter and those created by 1 CIED manufacturer. METHODS: The HRS sample letter and 25 Boston Scientific Corporation letters dated from 2005 through 2011 were evaluated using 6 readability tests. RESULTS: Readability (Flesch-Kincaid score) of the HRS sample letter was grade level 12.5, and median readability of the device manufacturer letters was grade level 12.8 (range, 10.8-18.9). Similar results were obtained using other readability scales. No letters had readability scores at the National Work Group on Literacy and Health's recommended reading level-5th grade; the letters' readability exceeded this recommended level by an average of 7.7 grades (95% CI, 6.9-8.5; P<.001). Likewise, no letters had readability scores at the average reading level of US adults-8th grade; the letters' readability exceeded this level by an average of 4.7 grades (95% CI, 3.9-5.5; P<.001). CONCLUSION: The readability of the HRS sample letter and those created by a CIED manufacturer significantly exceeded the recommended and average US adults' reading skill levels. Such letters are unlikely to be informative to many patients. CIED manufacturers should ensure that advisory letters are comprehensible to most patients.
    No preview · Article · Dec 2012 · Heart rhythm: the official journal of the Heart Rhythm Society
  • [Show abstract] [Hide abstract]
    ABSTRACT: Purpose: To determine the readability of Internet-based patient education materials (IPEMs) created by United States hospitals and universities and clinical practices and miscellaneous health care-associated Web sites regarding uterine artery embolization (UAE) as a marker for IPEMs in general. Methods and methods: Two hundred unique Web sites were evaluated for patient-related articles on UAE. Web sites produced by US hospitals and universities and clinical practices, as well as miscellaneous health care-associated Web sites meeting the Health on the Net Foundation Code of Conduct criteria were included in the database. By using mathematical regression algorithms based on word and sentence length to quantitatively analyze reading materials for language intricacy, readability of 40 UAE-related IPEMs was assessed with four indices: Flesch-Kincaid Grade Level (FKGL), Flesch Reading Ease Score (FRES), Simple Measure of Gobbledygook (SMOG), and Gunning Frequency of Gobbledygook (GFOG). Scores were evaluated against national recommendations, and intergroup analysis was performed. Results: None of the IPEMs were written at or below the sixth-grade reading level, based on FKGL. The mean readability scores were as follows: FRES, 43.98; FKGL, 10.76; SMOG, 13.63; and GFOG, 14.55. These scores indicate that the readability of UAE IPEMs is written at an advanced level, significantly above the recommended 6th grade reading level (P<.05) determined by the United States Department of Health and Human Services. Conclusions: IPEMs related to UAE generated by hospitals, clinical practices, and miscellaneous health care-associated Web sites are written above the recommended sixth grade level. IPEMs for other disease entities may also reflect similar results.
    No preview · Article · Feb 2013 · Journal of vascular and interventional radiology: JVIR
Show more