A quantitative analysis of the readability of breast health patient information resources in Ireland

BACKGROUND: Accessible written information is fundamental to patient-centred care and informed decision-making, yet health materials frequently exceed the reading ability of their intended audiences. In breast health - where patient information leaflets are widely used to support screening, diagnosis and treatment decisions - readability assessments offer an objective measure of accessibility. AIMS: To evaluate the readability of breast health patient information leaflets (PILs) produced by two major Irish health information providers - the Health Service Executive (HSE) and the Irish Cancer Society (ICS) - and to assess their compliance with national literacy recommendations. METHODS: A cross-sectional readability analysis was conducted on 27 publicly available breast health PILs (13 HSE; 14 ICS). Text was extracted and assessed using five validated readability indices: Flesch Reading Ease Score (FRES), Flesch-Kincaid Grade Level (FKGL), Gunning Fog Index (GFI), Simple Measure of Gobbledygook (SMOG), and Coleman-Liau Index (CLI). Median readability scores and interquartile ranges were calculated, and differences between providers were analysed using Mann-Whitney U tests. RESULTS: Across all indices, both organisations' materials exceeded the recommended grade 7 readability threshold. ICS materials were significantly more difficult to read than HSE materials (p < 0.001). Median grade-level scores ranged from 7.1 (FKGL) to 9.0 (GFI) for HSE and 8.15 (FKGL) to 10.35 (GFI) for ICS. No significant differences were observed across topic categories. CONCLUSION: Most breast health PILs in Ireland exceed recommended readability levels, limiting accessibility for many patients. Routine readability assessment and plain-language revision are warranted to promote equitable, patient-centred communication.