Readability of Educational Printed Material In Nursing Education

Nurses Educator 2

Printed Patient Educational Materials and Their Readability

Readability of Educational Printed Material In Nursing Education

Readability of Printed Health Education Materials,Patient Reading Ability and Printed Educational Material Issues,Patient Understanding and Grading of Printed Materials,Characteristic of Readable Printed Materials for Patient Education.

Readability of Printed Health Education Materials

    Many studies on literacy have attempted to document the disparity between the reading levels of consumers and the estimated readability demand of printed health information. Given that the health of people depends in part on their ability to understand information contained in food labeling, over the counter and prescription medication instructions, environmental safety warnings, discharge instructions, health promotion and disease prevention flyers, and the like, the focus of attention on identifying this discrepancy is more than warranted.

Patient Reading Ability and Printed Educational Material Issues

    A substantial body of evidence in the literature indicates that a significant gap exists between patients' reading and comprehension levels and the level of reading difficulty of PEMS (Agarwal et al., 2015; Andrus & Roth, 2002; Eltorai, Ghanian, Adams, Born , & Daniels, 2014; McClure et al., 2016; Ryan et al., 2014; Vallance et al., 2008; Weiss, 2007; Wilson, 2009; Winslow, 2001). A variety of educational materials available from sources such as the government, health agencies, professional associations, health insurance companies, and industries are written beyond the reading ability of many clients.

Patient Understanding and Grading of Printed Materials

    Healthcare providers are beginning to recognize that the reams of written materials many of them rely on to convey health information to consumers are essentially closed to those with illiteracy and low literacy problems. For example, look at the following text on information about colonoscopy:

    Does this passage make sense, or are you confused? If the words appear unreadable, that is what written teaching instructions may look like to someone who cannot read (Weiss, 2003).

    Many researchers have assessed specific population groups in a variety of healthcare settings based on the ability of clients to meet the literacy demands of written materials related to their care. These investigators used commonly accepted readability formulas to test consumers' understanding of printed health information. Their findings revealed the following information:

    Emergency department instructional materials (average 10th grade readability) are written at a level of difficulty out of the readable range for most patients (Duffy & Snyder, 1999; Ginde, Weiner, Pallin, & Camargo, 2008 Lerner, Jehle, Janicke, & Moscati, 2000; McCarthy et al., 2012; Williams et al., 1996). A significant mismatch exists between the reading ability of older adults and the readability levels of documents essential to their gaining access to health related services offered through local, state, and federal government programs (McGee, 2010; Sudore & Schillinger, 2009: Winslow, 2001). 

    A large discrepancy exists between clients' average reading comprehension levels and the readability demand of PEMs used in outpatient care and home care settings (Ache, 2009; Lerner et al., 2000; Schillinger et al., 2002; Walfish & Ducey, 2007) .

    Standard consent forms used in hospitals, private physician offices, and clinics, as well as by institutional review boards (IRBs) to protect potential research subjects, require high school to college level reading comprehension (Doak et al., 1998; Muir & Lee, 2009; Paasche Orlow, Taylor, & Brancati, 2003; Sudore, Landefeld et al., 2006).Physicians' letters to their patients required an average of 16th- to 17th grade reading ability; Likewise, health articles in newspapers ranged from 12th to 14th grade level (Conlin & Schumann, 2002).

    The reading grade levels of 15 psychotropic medication handouts for patient education ranged from 12th to 14th grade, well above the 5th grade level recommended by the National Cancer Institute guidelines (Myers & Shepard-White, 2004), Sixteen different patient education materials public ally available on the American Association for Surgery of Trauma website were evaluated for readability. 

    Researchers found the reading level of available materials ranged from grades 9.1 to 12.7, well above the recommended reading grade level for those with low literacy (Eltorai et al., 2014). An evaluation of 13 publicly available patient educational materials for sickle cell disease fell between the 8th- and 12th-grade reading level, which is above the ability of the target audience (McClure et al., 2016).

    As these examples demonstrate, numerous investigators have discovered that PEMs used to disseminate health information are written at grade levels that far exceed the reading ability of the majority of consumers. Results from these studies reveal that most health education literature is written above the 8th grade level, with the average level falling between the 10th and 12th grades. 

    Many PEMs exceed this upper range, even though the average reading level of adults falls at the eighth grade level. Millions of people in the population read at considerably lower levels and need materials written at the fifth grade level or lower (Brega et al., 2015; Brownson, 1998; Doak et al., 1998; ProLiteracy, 2017). 

    Furthermore, the health education literature indicates that people typically read at least two grade levels below their highest level of schooling and prefer materials that are written below their literacy abilities. In fact, contrary to popular belief, sophisticated readers find simplified PEMS acceptable and prefer them when ill because of low energy and concentration levels, and even when well because of the demands of their busy schedules and the fact that even highly educated people do not know the vocabulary of medicine, known as medicalese (Giorgianni, 1998; Meppelink, Smit, Buurman, & van Weert, 2015; Winslow, 2001).

Characteristic of Readable Printed Materials for Patient Education

    The conclusion to be drawn is that complex and lengthy PEMs serve no useful teaching purpose if healthcare consumers are unable to understand them or unwilling to read them. Literacy levels of clients compared with literacy demands of PEMS, whether in hospital or community based settings, are an important factor in the rehabilitation and recidivism of those who are recipients of healthcare services.The Internet is an excellent resource for nursing educators to locate easy to read PEMS. 

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