Clinical Orthopaedics and Related Research®

, Volume 468, Issue 10, pp 2572–2580 | Cite as

Assessing Readability of Patient Education Materials: Current Role in Orthopaedics

Symposium: ABJS Carl T. Brighton Workshop on Health Informatics

Abstract

Background

Health literacy is the single best predictor of an individual’s health status. It is important to customize health-related education material to the individual patient’s level of reading skills. Readability of a given text is the objective measurement of the reading skills one should possess to understand the written material.

Questions/purposes

In this article, some of the commonly used readability assessment tools are discussed and guidelines to improve the comprehension of patient education handouts are provided.

Where are we now? Several healthcare organizations have recommended the readability of patient education materials be no higher than sixth- to eighth-grade level. However, most of the patient education materials currently available on major orthopaedic Web sites are written at a reading level that may be too advanced for comprehension by a substantial proportion of the population.

Where do we need to go?

There are several readily available and validated tools for assessing the readability of written materials. While use of audiovisual aids such as video clips, line drawings, models, and charts can enhance the comprehension of a health-related topic, standard readability tools cannot construe such enhancements.

How do we get there?

Given the variability in the capacity to comprehend health-related materials among individuals seeking orthopaedic care, stratifying the contents of patient education materials at different levels of complexity will likely improve health literacy and enhance patient-centered communication.

References

  1. 1.
    Agency for Healthcare Research and Quality. U.S. Department of Health and Human Services Web site. Literacy and Health Outcomes. Available at: http://www.ahrq.gov/clinic/epcsums/litsum.htm. Accessed April 27, 2010.
  2. 2.
    Albright J, de Guzman C, Acebo P, Paiva D, Faulkner M, Swanson J. Readability of patient education materials: implications for clinical practice. Appl Nurs Res. 1996;9:139–143.CrossRefPubMedGoogle Scholar
  3. 3.
    Alexander RE. Readability of published dental educational materials. J Am Dent Assoc. 2000;131:937–942.PubMedGoogle Scholar
  4. 4.
    Badarudeen S, Sabharwal S. Readability of patient education materials from the American Academy of Orthopaedic Surgeons and Pediatric Orthopaedic Society of North America web sites. J Bone Joint Surg Am. 2008;90:199–204.CrossRefPubMedGoogle Scholar
  5. 5.
    Baker DW, Parker RM, Williams MV, Clark WS, Nurss J. The relationship of patient reading ability to self-reported health and use of health services. Am J Public Health. 1997;87:1027–1030.CrossRefPubMedGoogle Scholar
  6. 6.
    Baker DW, Williams MV, Parker RM, Gazmararian JA, Nurss J. Development of a brief test to measure functional health literacy. Patient Educ Couns. 1999;38:33–42.CrossRefPubMedGoogle Scholar
  7. 7.
    Bass L. Health literacy: implications for teaching the adult patient. J Infus Nurs. 2005;28:15–22.CrossRefPubMedGoogle Scholar
  8. 8.
    Berland GK, Elliott MN, Morales LS, Algazy JI, Kravitz RL, Broder MS, Kanouse DE, Munoz JA, Puyol JA, Lara M, Watkins KE, Yang H, McGlynn EA. Health information on the Internet: accessibility, quality, and readability in English and Spanish. JAMA. 2001;285:2612–2621.CrossRefPubMedGoogle Scholar
  9. 9.
    Bill-Harvey D, Rippey R, Abeles M, Donald MJ, Downing D, Ingenito F, Pfeiffer CA. Outcome of an osteoarthritis education program for low-literacy patients taught by indigenous instructors. Patient Educ Couns. 1989;13:133–142.CrossRefPubMedGoogle Scholar
  10. 10.
    Boulos MN. British internet-derived patient information on diabetes mellitus: is it readable? Diabetes Technol Ther. 2005;7:528–535.CrossRefPubMedGoogle Scholar
  11. 11.
    Centers for Disease Control and Prevention Web site. Scientific and Technical Information Simply Put. Available at: http://www.cdc.gov/DHDSP/cdcynergy_training/Content/activeinformation/resources/simpput.pdf. Accessed Dec 1, 2009.
  12. 12.
    Cooley ME, Moriarty H, Berger MS, Selm-Orr D, Coyle B, Short T. Patient literacy and the readability of written cancer educational materials. Oncol Nurs Forum. 1995;22:1345–1351.PubMedGoogle Scholar
  13. 13.
    Cotugna N, Vickery CE, Carpenter-Haefele KM. Evaluation of literacy level of patient education pages in health-related journals. J Community Health. 2005;30:213–219.CrossRefPubMedGoogle Scholar
  14. 14.
    Dale E, O’Rourke J. The Living Word Vocabulary: The Words We Know: A National Vocabulary Inventory Study. Elgin, IL: Dome Press; 1979.Google Scholar
  15. 15.
    D’Alessandro DM, Kingsley P, Johnson-West J. The readability of pediatric patient education materials on the World Wide Web. Arch Pediatr Adolesc Med. 2001;155:807–812.PubMedGoogle Scholar
  16. 16.
    Davis TC, Long SW, Jackson RH, Mayeaux EJ, George RB, Murphy PW, Crouch MA. Rapid estimate of adult literacy in medicine: a shortened screening instrument. Fam Med. 1993;25:391–395.PubMedGoogle Scholar
  17. 17.
    Davis TC, Mayeaux EJ, Fredrickson D, Bocchini JA, Jr., Jackson RH, Murphy PW. Reading ability of parents compared with reading level of pediatric patient education materials. Pediatrics. 1994;93:460–468.PubMedGoogle Scholar
  18. 18.
    Doak CC, Doak LG, Root JH. Teaching Patients With Low Literacy Skills. Philadelphia, PA: J.B. Lippincott; 1996.Google Scholar
  19. 19.
    DuBay W. The Principles of Readability. Costa Mesa, CA: Impact Information; 2004.Google Scholar
  20. 20.
    Fouad MN, Kiefe CI, Bartolucci AA, Burst NM, Ulene V, Harvey MR. A hypertension control program tailored to unskilled and minority workers. Ethn Dis. 1997;7:191–199.PubMedGoogle Scholar
  21. 21.
    Friedland R. Understanding Health Literacy: New Estimates of the Cost of Inadequate Health Literacy. Washington, DC: National Academy on an Aging Society; 1998.Google Scholar
  22. 22.
    Friedman DB, Hoffman-Goetz L. A systematic review of readability and comprehension instruments used for print and web-based cancer information. Health Educ Behav. 2006;33:352–373.CrossRefPubMedGoogle Scholar
  23. 23.
    Hoffmann T, McKenna K. Analysis of stroke patients’ and carers’ reading ability and the content and design of written materials: recommendations for improving written stroke information. Patient Educ Couns. 2006;60:286–293.CrossRefPubMedGoogle Scholar
  24. 24.
    Hussey LC. Minimizing effects of low literacy on medication knowledge and compliance among the elderly. Clin Nurs Res. 1994;3:132–145.CrossRefPubMedGoogle Scholar
  25. 25.
    Ivnik M, Jett MY. Creating written patient education materials. Chest. 2008;133:1038–1040.CrossRefPubMedGoogle Scholar
  26. 26.
    Jackson RH, Davis TC, Bairnsfather LE, George RB, Crouch MA, Gault H. Patient reading ability: an overlooked problem in health care. South Med J. 1991;84:1172–1175.CrossRefPubMedGoogle Scholar
  27. 27.
    Johnson K, Weiss BD. How long does it take to assess literacy skills in clinical practice? J Am Board Fam Med. 2008;21:211–214.CrossRefPubMedGoogle Scholar
  28. 28.
    Juzych MS, Randhawa S, Shukairy A, Kaushal P, Gupta A, Shalauta N. Functional health literacy in patients with glaucoma in urban settings. Arch Ophthalmol. 2008;126:718–724.CrossRefPubMedGoogle Scholar
  29. 29.
    Kemp EC, Floyd MR, McCord-Duncan E, Lang F. Patients prefer the method of “Tell Back-Collaborative Inquiry” to assess understanding of medical information. J Am Board Fam Med. 2008;21:24–30.CrossRefPubMedGoogle Scholar
  30. 30.
    Kripalani S, Bengtzen R, Henderson LE, Jacobson TA. Clinical research in low-literacy populations: using teach-back to assess comprehension of informed consent and privacy information. IRB. 2008;30:13–19.PubMedGoogle Scholar
  31. 31.
    Ley P, Florio T. The use of readability formulas in health care. Psychol Health Med. 1996;1:7–28.CrossRefGoogle Scholar
  32. 32.
    Lillington L, Royce J, Novak D, Ruvalcaba M, Chlebowski R. Evaluation of a smoking cessation program for pregnant minority women. Cancer Pract. 1995;3:157–163.PubMedGoogle Scholar
  33. 33.
    Mailloux SL, Johnson ME, Fisher DG, Pettibone TJ. How reliable is computerized assessment of readability? Comput Nurs. 1995;13:221–225.PubMedGoogle Scholar
  34. 34.
    McCray AT. Promoting health literacy. J Am Med Inform Assoc. 2005;12:152–163.CrossRefPubMedGoogle Scholar
  35. 35.
    Meade CD, Byrd JC. Patient literacy and the readability of smoking education literature. Am J Public Health. 1989;79:204–206.CrossRefPubMedGoogle Scholar
  36. 36.
    Meade CD, Diekmann J, Thornhill DG. Readability of American Cancer Society patient education literature. Oncol Nurs Forum. 1992;19:51–55.PubMedGoogle Scholar
  37. 37.
    Meade CD, Smith CF. Readability formulas: Cautions and criteria. Patient Educ Couns. 1991;17:153–158.CrossRefGoogle Scholar
  38. 38.
    Mulrow C, Bailey S, Sonksen PH, Slavin B. Evaluation of an Audiovisual Diabetes Education Program: negative results of a randomized trial of patients with non-insulin-dependent diabetes mellitus. J Gen Intern Med. 1987;2:215–219.CrossRefPubMedGoogle Scholar
  39. 39.
    Murero M, D’Ancona G, Karamanoukian H. Use of the Internet by patients before and after cardiac surgery: telephone survey. J Med Internet Res. 2001;3:E27.CrossRefPubMedGoogle Scholar
  40. 40.
    National Cancer Institute. Clear & Simple: Developing Effective Print Materials for Low-literate Readers. Bethesda, MD: National Cancer Institute; 1994.Google Scholar
  41. 41.
    National Center for Education Statistics. Adult Literacy in America: A First Look at the Results of the National Adult Literacy Survey. Washington, DC: U.S. Dept. of Education; 1993.Google Scholar
  42. 42.
    National Center for Education Statistics. A First Look at the Literacy of America’s Adults in the 21st Century. Washington, DC: U.S. Dept. of Education; 2006:28.Google Scholar
  43. 43.
    National Institutes of Health. How to Write Easy to Read Health Materials. National Library of Medicine Web site. Available at: http://www.nlm.nih.gov/medlineplus/etr.html. Accessed Feb 1, 2009.
  44. 44.
    Nielsen-Bohlman L, Panzer AM, Kindig DA. Health Literacy: A Prescription to End Confusion. Washington, DC: Institute of Medicine, National Academies Press; 2004.Google Scholar
  45. 45.
    Parker RM, Baker DW, Williams MV, Nurss JR. The test of functional health literacy in adults: a new instrument for measuring patients’ literacy skills. J Gen Intern Med. 1995;10:537–541.CrossRefPubMedGoogle Scholar
  46. 46.
    Ryan JG, Leguen F, Weiss BD, Albury S, Jennings T, Velez F, Salibi N. Will patients agree to have their literacy skills assessed in clinical practice? Health Educ Res. 2008;23:603–611.CrossRefPubMedGoogle Scholar
  47. 47.
    Sabharwal S, Badarudeen S, Unes Kunju S. Readability of online patient education materials from the AAOS web site. Clin Orthop Relat Res. 2008;466:1245–1250.CrossRefPubMedGoogle Scholar
  48. 48.
    Vives M, Young L, Sabharwal S. Readability of spine-related patient education materials from subspecialty organization and spine practitioner websites. Spine (Phila Pa 1976). 2009;34:2826–2831.Google Scholar
  49. 49.
    Wallace LS, Turner LW, Ballard JE, Keenum AJ, Weiss BD. Evaluation of web-based osteoporosis educational materials. J Womens Health (Larchmt). 2005;14:936–945.CrossRefGoogle Scholar
  50. 50.
    Wang SW, Capo JT, Orillaza N. Readability and comprehensibility of patient education material in hand-related web sites. J Hand Surg Am. 2009;34:1308–1315.CrossRefPubMedGoogle Scholar
  51. 51.
    Weiss BD. Health Literacy: A Manual for Clinicians. Chicago, IL: American Medical Association, American Medical Foundation; 2003.Google Scholar
  52. 52.
    Weiss BD, Blanchard JS, McGee DL, Hart G, Warren B, Burgoon M, Smith KJ. Illiteracy among Medicaid recipients and its relationship to health care costs. J Health Care Poor Underserved. 1994;5:99–111.PubMedGoogle Scholar

Copyright information

© The Association of Bone and Joint Surgeons® 2010

Authors and Affiliations

  1. 1.Cedars-Sinai Medical CenterLos AngelesUSA
  2. 2.Department of OrthopedicsUniversity of Medicine and Dentistry of New Jersey, New Jersey Medical SchoolNewarkUSA

Personalised recommendations