Simplification of Printed Educational Material in Nursing Education

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Insurance and Guidelines for Printed Educational Material in Nursing Education

Simplification of Printed Educational Material in Nursing Education

Simplifying the Readability of Printed Education Materials,Identification of Target Population for Printed Educational Material,Role Nursing Educator in Development of Printed Educational Material,Insurance of Printed Educational Material Prior to Reach Target Population,General Guidelines for Printed Educational Material.

Simplifying the Readability of Printed Education Materials

    The suitability of written materials for different audiences depends not only on actual grade level demand, which can be measured by readability formulas, but also on those elements within a text such as technical format, concept density, and accuracy and clarity of the message. 

Identification of Target Population for Printed Educational Material

    It must never be forgotten that knowing the target audience in terms of the members' level of motivation, reading abilities, experiential factors, and cultural background is also of crucial importance in determining the appropriateness of printed health information as an effective communication tool (Meade & Smith, 1991; Weiss, 2007). Even good readers may fail to respond to important health education literature if they lack the motivation to do so or if the material is not appealing to them.

    Despite the well documented potential of written materials to increase knowledge, compliance, and satisfaction with care, PEMs are often too difficult for even motivated clients to read. Clearly, the technical nature of health education literature lends itself to high readability levels, often requiring college-level reading skills to fully understand (Winslow, 2001).

    Even though printed materials are the most commonly used form of media, as currently written, they remain the least effective means for reaching a large proportion of the adult population who have marginal literacy skills (Monsivais & Reynolds, 2003; Ryan et al. , 2014). Despite the well-documented potential of written materials to increase knowledge, compliance, and satisfaction with care, PEMs often are too difficult for even motivated patients to read.

    Agarwal, Hansberry, Sabourin, Tomei, and Prestigiacomo (2013) studied online patient education materials from 16 specialties, readability assessments found all materials to be well above the sixth-grade reading level. Stossel, Segar, Gliatto, Fallar, and Karani (2012) assessed 300 PEMs available to the public on the Internet and accessible to providers by a popular electronic medical record (EMR) vendor and found most of PEMs to be at reading levels much higher than the reading ability of the average American adult reader. 

Role Nursing Educator in Development of Printed Educational Material

    What the nurse in the role of educator must strive to achieve when designing or selecting health-based literature is a good and proper fit between the material and the reader. Choosing and designing PEMs is a difficult, time-consuming, and challenging task that often becomes the responsibility of the nurse (Winslow, 2001).

    Obviously, the best solution for improving the overall comprehension and reading skills of clients would be to strengthen their basic general education, but this process would require decades to accomplish. What is needed now are ways in which to write or rewrite educational materials commensurate with the current comprehension and reading skills of learners. 

    Nathaniel Hawthorne was once reported to have said, “Easy reading is damned hard writing” (Pichert & Elam, 1985, p. 181). He was correct in his perception that clear and concise writing is a task that takes effort and practice.It is possible, though, to reduce the disparity between the literacy demand of written instructional materials and the actual reading level of clients by attending to some basic linguistic, motivational, organizational, and content principles (Williams, Muir, & Rosdahl, 2016). 

    Linguistics refers to the type of language and grammatical style used. Motivation principles focus on those elements that stimulate the reader, such as relevance and appeal of the material. Organizational factors deal with layout and clarity. Content principles relate to load and concept density of information (Bernier, 1993). Wood, Kettinger, and Lessick (2007) describe the language, information, and design (LID) method to create easy to read materials. 

Insurance of Printed Educational Material Prior to Reach Target Population

    These elements are examined as they relate to designing or revising instructional materials for the marginally literate reader. Prior to writing or rewriting a text for easier reading, some preliminary planning steps need to be taken to ensure that the final written material will be geared to the target audience (Davis et al., 1998; Doak et al., 1996; Kessels, 2003):

1. Decide what the client should do or know. In other words, what is the purpose of the instruction? Which outcomes do you hope learners will achieve? 

2. Choose information that is relevant and needed by the client to achieve the behavioral objectives.

3. Limit or cut out altogether extraneous and nice-to-know information such as the history or detailed physiological processes of a disease. Include only survival skills and essential main ideas of who, what, where, and when, with new information related to what the reader already knows. Remember: A person does not have to know how an engine works to drive a car. 

    Select other media to supplement the written information, such as pictures, demonstrations, models, audiotapes (CDs), and videotapes (DVDs). Even poor readers will benefit from written material if it is combined with other forms of delivering a message. Consider the field of advertising, for example. Advertisers get their message across with relatively few words that are often combined with strong. Action packed visuals.

4.Organize topics into chunks that follow a logical sequence. Prioritize to present the most important information first. If topics are of equal importance, proceed from the more general as a basis on which to build to the more specific. Begin with a statement of purpose. In a list of items, place key facts at the top and bottom because readers best remember information presented first and last in a series.

5.Determine the preferred reading level of the material. If the readers have been tested, preferably write two to four grades below their reading grade-level score. If the audience has not been tested, the group is likely to display a wide range of reading skills. When in doubt, write instructional materials at the 5th-grade level, which is the lowest common denominator, keeping in mind that the average reading level of the population is approximately 8th grade, that more than 20% read below the 5th-grade level, and that fewer than 50% read above the 10th-grade level.

    To cover a wide range of reading skills, it is also possible to develop several sets of instructions one at a higher grade level, one at a medium grade level, and one at a lower grade level and allow patients to select the one they prefer. Once the reading grade level of a piece of written material is determined, it should be printed on the back of the document in coded form as, for example, RL = 7 (reading level = seventh grade), for easy reference. 

    The literature contains numerous references related to techniques for writing effective educational materials (Aldridge, 2004; Andrus & Roth, 2002; Doak et al., 1996; Doak et al., 1998; Doak & Doak, 2010; Duffy & Snyder, 1999; Horner et al., 2000; Mayer & Rushton, 2002; Monsivais & Reynolds, 2003; Pignone et al., 2005; Weiss, 2007, 2014). Recommendations have been put forth for developing written instructions that can be more easily understood by a wide audience.

General Guidelines for Printed Educational Material

    The strategies described in this section are specific to simplifying written health information for clients with low literacy skills. The key factor in accommodating low literate readers is to write in plain, familiar language using an easy visual format. The following general guidelines outline some basic linguistic, motivational, organizational, and content principles to adhere to when writing effective PEMs :

    Write in a conversational style using the personal pronoun you and the possessive pronoun you. Use an active voice in the present tense rather than a passive voice in the past or future tense. The message is more personalized, more imperative, more interesting, and easier to understand if instruction is written as “Take your medicine...” instead of “Medicine should be taken...”. 

    This rule is considered the most important technique to reduce the level of reading difficulty and also to improve comprehension of what is read. Directly addressing the reader through personal words and sentences engages the reader. See a less effective example from an American Cancer Society (1985) pamphlet, followed by a more effective example.

    Less effective people who sunburn easily and have fair skin with red or blonde hair are most prone to develop skin cancer. The amount of time spent in the sun affects a person's risk of skin cancer.

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