Readability and Patient Education Materials Used for Low-Income Populations

UNLABELLED: More than 90 million Americans have low levels of health literacy that may contribute to poor health outcomes. Assessment of the readability of patient education materials (PEMs) is a vital component of health education. PURPOSE: The aim of this study was to describe the readability of PEMs used in community healthcare settings serving low-income populations to provide further insight into the complex area of health literacy. DESIGN: A descriptive, correlational, and nonexperimental design was used for this study. SETTING: The setting for this study was 5 free and low-cost community clinics in a Midwestern urban area. SAMPLE: Thirty-five unique PEMs produced by professional sources (government agencies, drug companies, and state/national organizations) or by providers comprised the final sample. METHODS: Readability was measured using Simple Measure of Gobbledygook (SMOG), Flesch-Kincaid, and Flesch Reading Ease. Significance was determined through t tests and Spearman rho correlations. FINDINGS: Variability in grade levels was noted using all measures. Mean Flesch-Kincaid grade level was 7.01, and that for SMOG was 9.89. Mean level for Flesch Reading Ease was 63.40, an estimated eighth and ninth grade level. The SMOG consistently measured 2 to 4 grades levels higher than did Flesh-Kincaid. Professionally developed PEMs had significantly higher reading levels using both SMOG and Flesch-Kincaid and were more difficult to read using Flesch Reading Ease when compared with those prepared by individual providers. CONCLUSIONS: Patient education materials were written at a level too high for the average adult. All PEMs should be analyzed carefully to ensure that they are at the recommended fifth grade level. Further understanding of available measures of readability is critical in the creation and/or assessment of PEMs that will strengthen services from safety net providers and support positive health outcomes. IMPLICATIONS: Nurses must expand their knowledge of all aspects of literacy and readability and take a proactive role in assessment and development of PEMs. Further research is needed to determine the best readability measures.