The Joint Commission on Accreditation of Healthcare Organization (JCAHO) mandates the availability of easily understandable patient information materials as part of the accreditation process for healthcare facilities. One of the main criticisms against the use of readability tools is that improving readability by simplifying text may make information too simple and difficult to convey accurate information [51]. Average number of syllables per word and average number of words per sentence. Another drawback of most readability formulas is that they are solely based on the length and structure of a sentence and ignore factors that influence comprehension such as illustrations, layout, and, most importantly, motivation of the reader [22, 34, 37]. Educational materials should be short, clear, and simple, and should include pictures.18 One randomized controlled trial19 demonstrated the effectiveness of a low-literacy educational handout in increasing pneumococcal vaccine rates. Do thorough research to get to know them, then write accordingly. Even the great Harvard Business Review finds itself in the junior high and high school zone for stretches of its website. Show or draw pictures to enhance understanding and subsequent recall. Baker DW, Parker RM, Williams MV, Clark WS, Nurss J. Visual acuity, literacy, and unintentional misuse of nonprescription medications. Students who learn and think differently may be working below grade level in some subjects. In general, long sentences should be avoided and typically contain no more than eight to ten words [26]. However, the ability to utilize online health information to make healthcare decisions depends on the ability to comprehend the material (8). Objectives: This content is owned by the AAFP. Mulrow C, Bailey S, Sonksen PH, Slavin B. Telephone: (301) 427-1364. 1st Grade (Spring) 6-7 years old. Patients with asthma and inadequate health literacy do not use their inhalers as well as patients with asthma and adequate literacy skills.11, Patients with health literacy problems are less likely to understand and participate in disease prevention and health promotion programs12,13 and are more likely to be hospitalized than those with adequate health literacy,14 resulting in an additional $69 billion in health care costs annually.4, A group of medical residents were asked to identify which of their patients had inadequate health literacy. Some of the these programs include Microsoft Word Office Package (Microsoft Corp, Redmond, WA), Corel WordPerfect Office X3 (Corel Corp, Ottawa, ON, Canada), Readability Calculations (Micro Power & Light Co, Dallas, TX), Readability Studio 1.1 (Oleander Solutions, Vandalia, OH), and InText (Social Science Consulting, Rudolstadt, Germany). National Library of Medicine Thus, anyoneregardless of backgroundcan experience limitations in health literacy. A few are great, while the rest are not. This test will determine which level of education you are at. The rationale for such an assessment is, as an individuals reading skills improve, their ability to choose the correct missing words should also advance. Books written at this level include: The Harry Potter series; most stuff by Tom Clancy; most stuff by John Grisham; The Great Gatsby; The Affordable Care Act, by contrast, is written at a 13th-grade level . An individuals health literacy is influenced by their general literacy, familiarity with the healthcare system and how the health information is presented and can predict their health status better than factors such as their age, economic status, educational level, or occupation [39]. In 1999, the AMA published a report that recommended increasing public awareness, educating the medical community, and encouraging research on health literacy.1The Joint Commission on Accreditation of Healthcare Organizations has added health literacy benchmarks for hospitals to achieve, and improving health literacy is one of the Healthy People 2010 goals. Williams MV, Baker DW, Parker RM, Nurss JR. The Department of Health and Human Services has issued a National Action Plan to Improve Health Literacy, with seven goals that prioritize many of the areas discussed above. Health literacy is defined as the capacity to obtain, interpret, and understand basic health information and services and the competence to use such information and services to enhance health [22, 44]. 4th-5th grade B. is . This study analyzed the patient education materials on the AAST website (http://www.aast.org/GeneralInterest/Links.aspx). 15 The PILs were also categorised using the Rudd health material classification framework: health promotion; health protection; disease prevention; health care and . Moreover, the complexity of modern health information and management can be difficult for anyone to process. Rozental TD, Bozentka DJ, Beredjiklian PK. However, most of the available patient education materials in orthopaedics are written at a reading level that does not meet these standards and may be too complex for comprehension by a substantial proportion of the population [4, 47, 48, 50]. Featured 6th Grade Games . A more recent article on health literacy is available. The FKGL for each document was automatically displayed after grammar and spelling were checked. Though the availability of written patient education articles has increased over the years, there is a wide gap between the reading skills of the patient population and the readability of patient education materials. Reading is a highly complex process. Avoid fragmentation and make available all patient education material in one location preferably Your Orthopaedic Connection website (, c. Websites should make available printer-friendly versions of patient education materials, a. Baker DW, Gazmararian JA, Williams MV, Scott T, Parker RM, Green D, et al. Thus, by using a multifaceted approach with judicious use of the available tools to enhance the readability and comprehension of health-related materials, clinicians can further improve communication with their patients and hopefully enhance clinical outcome. 2 adverbs, meeting the goal of 2 or fewer. School Level: Ease Level: Details: 100.0 90.0: 5th grade: Very Easy: Its very easy to read. Building the Case for Health Literacy: Proceedings of a Workshop. Several reports suggest guidelines regarding the appropriate use of diagrams and illustrations in patient education materials [11, 18, 51] (Table4). I usually write it at a 13th grade reading level, which is not only far too difficult for lower-literacy users, but too complicated for the mainstream B2C audience. Patient Education Materials, Online Health Information, Readability, Comprehension, Flesch-Kincaid Formula. Department of Health and Human Services . They found that reducing from the 9th to the 6th-grade reading level increased readership by 43% for an article on 'nylon'. All patients prefer reading medical information written in clear and concise language. FOIA The majority of patients older than 60 years perform at the lowest levels of literacy,6 and 80 percent have limited ability to fill out forms, such as the ones they are asked to complete in physician waiting rooms. Reader's Digest magazine has a readability index of about 65, Time magazine scores about 52, an average grade six student's written assignment (age of 12) has a readability index of 60-70 (and a reading grade level of six to seven), and the Harvard Law Review has a general readability score in the low 30s. Writing Act, Privacy Low reading levels may compromise interactions with health care providers and lead to safety problems. Creation of easily readable patient education materials, a. AAOS and subspecialty organizations should lead the effort through collaboration. Health literacy and ethnic disparities in health-related quality of life among rural women: results from a Chinese poor minority area. According to the Institute of Medicine, health literacy is a function of systems within and beyond health care, and it involves interaction between the individual patient and the health care system, as well as other social, cultural, and educational factors. Rockville, MD 20857 We did not specifically assess the reading skills of the websites readers as they may differ from the general population; however, trauma patients likely have similar or potentially lower rates of reading comprehension compared to the general public. This test rates text on a U.S. school grade level. Build bridges, conquer competitors, and explore while practicing math and reading skills for 6th grade and up. The standards provide a framework for curriculum development and selection, instruction, and student assessment in health education. This strategy is based on the placemat idea I talked about for math, and can help students of all ability levels dig into a complex text. Relationship of functional health literacy to patients' knowledge of their chronic disease. So website content thats accessible and easy to read will naturally reach a wider audience. What reading level should patient education materials be written? b. Online patient education materials should have a brief post-test survey to obtain feedback from patients directly related to that materials ease of readability and comprehension. Text from the website was copied in plain text format into individual Microsoft Office Word 2010 (Microsoft Corporation, Redmond, WA, USA) documents. Search All AHRQ The Living Word Vocabulary: The Words We Know: A National Vocabulary Inventory Study. In general, the score can also indicate the number of years of education required to fully understand and/or comprehend what is being said in the text. Others, including the elderly, unemployed, those from low socioeconomic status and school dropouts are also likely to have limited health literacy [51]. The American Medical Association (AMA) defines health literacy as a constellation of skills, including the ability to perform basic reading and numerical tasks required to function in the health care environment.1 Inadequate health literacy contributes to poor compliance, uncontrolled chronic disease, and rising health care costs. Readability of American Cancer Society patient education literature. A 12 th-grade reading level is often a good target to make text easy for readers with college degrees. Just as we have shifted from a focus on the individual to the function of the entire system as the locus of patient safety, experts have also long recognized that a systems approach is needed to address health literacy. Where: ASL = average sentence length ( the number of syllables per sentence time to literacy. 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