An analysis of the readability of patient information materials for common urological conditions

Abstract

Introduction: Health literacy has been shown to be an important determinant of outcomes in numerous disease states. In an effort to improve health literacy, the Canadian Urological Association (CUA) publishes freely accessible patient information materials (PIMs) on common urological conditions. We sought to evaluate the readability of the CUA's PIMs. Methods: All PIMs were accessed through the CUA website. The Flesch Reading Ease Score (FRES), the Flesch-Kincaid Grade Level (FKGL), and the number of educational graphics were determined for each PIM. Low FRES scores and high FKGL scores are associated with more difficult-to-read text. Average readability values were calculated for each PIM category based on the CUA-defined subject categorizes. The five pamphlets with the highest FKGL scores were revised using word substitutions for complex multisyllabic words and reanalyzed. The Kruskal-Wallis test was used to identify readability differences between PIM categories and paired t-tests were used to test differences between FKGL scores before and after revisions. Results: Across all PIMs, FRES values were low (mean 47.5, standard deviation [SD] 7.47). This corresponded to an average FKGL of 10.5 (range 8.1-12.0). Among PIM categories, the infertility and sexual function PIMs exhibited the highest average FKGL (mean 11.6), however, differences in scores between categories were not statistically significant (p=0.38). The average number of words per sentence was also highest in the infertility and sexual function PIMs and significantly higher than other categories (mean 17.2; p=0.01). On average, there were 1.4 graphics displayed per PIM (range 0-4), which did not vary significantly by disease state (p=0.928). Simple words substitutions improved the readability of the five most difficult-to-read PIMs by an average of 3.1 grade points (p<0.01). Conclusions: Current patient information materials published by the CUA compare favourably to those produced by other organizations, but may be difficult to read for low-literacy patients. Readability levels must be balanced against the required informational needs of patients, which may be intrinsically complex.

Readability Assessment of Patient Education Material Published by German-Speaking Associations of Urology

“…Consistent with the results of previous English and German PEM readability assessments [11][12][13]16], only 13.8% (12/87 assessments; Table. 2) met the NIH readability recommendations of a 7th-8th grade reading level [15].…”

“…It has been shown that despite complex medical content, the readability of PEMs can be significantly improved by using simpler sentences and shorter words. Dalziel et al [12] reported on an average grade level improvement of 3.1 in PEM comprehension by simple substitution of multisyllabic words, with a further reduction by simplification of sentence structure [25,26]. These simple measures are easily applicable to German PEMs and might help to improve their readability significantly.…”

“…Several studies have investigated the readability of PEM in different fields of medicine [9,10]. Urological [11,12] and non-urological [13] trials concluded that the readability of English written information material was more difficult than the level of difficulty recommended by the American Medical Association [14] and National Institutes of Health (NIH) [15]. A similar conclusion was drawn for German-language hospital websites of surgical and ear, nose and throat departments, which addresses a target audience of over 100 million German native speakers [16,17].…”

Pharmacy hydroxyurea education materials for patients with sickle cell disease: An environmental scan and assessment of accuracy

“…20 Although limited data exist regarding the sources of information that pediatric patients with SCD and their families use to inform their decision-making surrounding medication acceptance, previous studies have found a positive association between accurate patient education about therapy and adherence. 15,21 Written information materials in particular have been shown to contribute to patient decision-making regarding therapy initiation in several other disease states [22][23][24] and serve as an influential adjunct to patient counseling. Therefore, the goal of this study was to evaluate the written material provided to patients with SCD by pharmacies to gain a better understanding of the information available to patients and to compare this information to a reference standard HU patient information handout (PIH) for patients with SCD.…”

CUA brochure readability: On the right track

“…1 Like many of my physician colleagues, I wrote patient information handouts on various topics to reinforce and supplement my verbal description presented at the office or the hospital. In June 1998, at the CUA Annual Meeting in Halifax, NS, I suggested to my mentor and then CUA President-Elect, Denis Hosking, that this was a project that the CUA could take on as a benefit to the membership.With its resources, the CUA could develop a product with improved graphic and text content and establish the required infrastructure for efficient distribution of printed patient information materials to urologists, who could hand them out to their patients.…”