A Systematic Review of Readability and Comprehension Instruments Used for Print and Web-Based Cancer Information

Abstract

Adequate functional literacy skills positively influence individuals' ability to take control of their health. Print and Web-based cancer information is often written at difficult reading levels. This systematic review evaluates readability instruments (FRE, F-K, Fog, SMOG, Fry) used to assess print and Web-based cancer information and word recognition and comprehension tests (Cloze, REALM, TOFHLA, WRAT) that measure people's health literacy. Articles on readability and comprehension instruments explicitly used for cancer information were assembled by searching MEDLINE and Psyc INFO from 1993 to 2003. In all, 23 studies were included; 16 on readability, 6 on comprehension, and 1 on readability and comprehension. Of the readability investigations, 14 focused on print materials, and 2 assessed Internet information. Comprehension and word recognition measures were not applied to Web-based information. None of the formulas were designed to determine the effects of visuals or design factors that could influence readability and comprehension of cancer education information.

Are Patient-reported Outcome Measures in Orthopaedics Easily Read by Patients?

“…Graphic scales or pictograms were removed from all questionnaires and text was edited to include only words as per guidelines in the readability literature [38]. The extracted text was inserted in the same online FRES calculator after a Google search (www.readability-score.com), generating a score [84].…”

Assessing Readability of Patient Education Materials: Current Role in Orthopaedics

“…However, there is no consensus as to which readability formula is best suited for assessing patient education materials. Some of the readability assessment tools used in the healthcare setting include the Flesch Reading Ease scale [22], Flesch-Kincaid Grade [22], Fry Readability Graph [11], McLaughlin's SMOG grading [40], Gunning Fog Index [22], Dale-Chall Readability formula [19], and Suitability Assessment of Materials [18] (Table 1). In general, it is preferable to use more than one readability method to improve the validity of the results.…”

“…Furthermore, readability formulas use different comprehension levels to compute grade level. The Flesch Reading Ease (FRE) score, the earliest of the commonly used tools to assess readability, gives a score on a scale ranging from 0-100, with 0 being unreadable and 100 being most readable [22]. It is based on the average number of syllables per word and the average number of words per sentence.…”

“…For instance, if a particular material has SMOG readability grade of 6, it means it will be comprehensible to all individuals with sixth-grade reading skills [31]. The Gunning Fog index is based on the average words per sentence and the percentage of polysyllable words [22]. The New Dale-Chall Readability formula was developed specifically for evaluating health education materials and has the highest validity when tested for reader comprehension [19,50].…”

“…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]. Poor health literacy is estimated to contribute more than 73 billion dollars of additional burden to the US healthcare system [19,51].…”