A Linguistic Analysis of Health Literacy Demands of Chronic Kidney Disease Patient Education Materials

Abstract

Background: Instruments to assess the quality and comprehensibility of printed patient education materials may lack proper consideration of how readers derive meaning from text. The Evaluative Linguistic Framework (ELF) considers how factors that influence readers' expectations about health care texts also affect their ability to understand them. The ELF has demonstrated value in improving the quality of patient materials about medication, consent, and self-reported questionnaires, but has not yet been used to evaluate a corpus of patient education materials about chronic disease self-management. Objective: This study sought to apply the ELF to examine specific elements of printed self-management patient education materials for chronic kidney disease (CKD) not captured by other tools. Methods: From a previously published systematic review, we identified 14 patient education materials (eight self-management, six diet and nutrition) for people with CKD. We used the ELF to identify the different ways the text could be structured, its intended purpose, the relationship established between reader and writer, presence of signposting, its complexity and technicality of language, and factual content. Key Results: Our analysis identified nine possible structural units, of which “introducing the problem” and “instructing the reader to self-manage” were common to all materials. However, there was no consistency or common sequence to these units of text. The intended readership and aims of the author(s) were not always clear; many materials made assumptions about what the reader knew, the language was often complex and dense, and the meta-discourse was sometimes distracting. Conclusions: Our analysis suggests CKD document developers can benefit from a theoretically grounded linguistic tool that focuses on the intended audience and their specific needs. The ELF identified structural units of text, aligned with rhetorical elements that can be uniformly applied for developing self-management education materials for CKD, and provided checks for language complexity. Further work can determine its usefulness for other (e.g., electronic) formats and other chronic diseases. [ HLRP: Health Literacy Research and Practice . 2018;2(1):e1–e14.] Plain Language Summary: Helping patients make meaning from information about their condition is a key goal of health care organizations. We analyzed chronic kidney disease patient education materials on self-management using the Evaluative Linguistic Framework. The purpose and intended audience were frequently unclear. We identified nine structural units of text that may assist information providers to plan and structure content.

An audit and analysis of electro convulsive therapy patient information sheets used in local health districts in New South Wales Australia

“…The aim of the information sheets was not clear. Attempting to accommodate multiple aims and purposes is known to impact upon the clear and factual nature the information sheets (Morony et al., 2018).…”

“…They are also entitled to know about the side effects that may result from this involuntary treatment. Other studies using the ELF have found that rhetorical functions should only be used in information sheets to increase clarity and reduce ambiguity of statements and to make information sheets actionable (Morony et al., 2018). It is a fundamental expectation that the language of a patient information sheet is neutral and accurate.…”

“…Following content analysis, the information sheets were re‐analysed using the Evaluative Linguistic Framework (ELF) tool (see Table 1) to assess comprehensibility and usability based on linguistic theory (Morony et al., 2018). The findings from both the content analysis and ELF were then discussed amongst the research team and considered from a mad studies perspective with an approach called ‘thinking with theory’ (Jackson & Mazzei, 2012).…”

“…For example, "a release of chemicals in the brain and helps restore normal functioning" #2 or "ECT corrects the levels of chemicals and hormones that control our mood" #4. While information sheets commonly asserted disproven claims linking 'brain chemicals' to depression, no information T A B L E 1 Evaluative Linguistic Framework (adapted from Morony et al, 2018). sheet acknowledged the proven association between life interrupting mental distress and human experiences of adversity and trauma.…”