Readability of Printed Education Material In Nursing Effective patient education relies on the clarity and accessibility of the materials used to convey important health information. Readability plays a significant role in determining whether patients will be able to understand and benefit from the information provided. This article delves into readability, its purpose in nursing education, and how it is measured using various readability formulas.
What Is Readability for Printed Educational Material?
Readability is not a new concept. It has long been a concern of educators and reading specialists. Historically, readability has been an area of study focused on determining how “easy” or “difficult” a text is for its intended audience to read. Readability is defined as “characteristics of reading materials that make material ‘easy’ or ‘difficult’ to read” (Kahn & Pannbacker, 2000, p. 3). Readability formulas were initially developed in the mid-20th century to objectively assess the complexity of texts used in education.
In the context of patient education materials (PEMs), readability refers to how easy or difficult it is for patients to understand the text. Readability is a critical component in healthcare because it directly impacts how well patients can comprehend important information regarding their diagnosis, treatment, and health management. If the materials are too complex, patients may not fully grasp the details of their care, which can lead to confusion, mismanagement, and poorer health outcomes.
Today, more than 40 different formulas exist to measure the readability of PEMs. These formulas consider factors such as word length, sentence structure, and the use of technical language to calculate the reading grade level required to understand a text. While readability formulas are useful tools, they do have limitations and should not be relied upon as the sole measure of how comprehensible a text will be to patients.
Purpose of Readability of Educational Material in Nursing Education
In nursing education, readability indices are used to determine the grade level demand of written materials. By measuring readability, educators and healthcare providers can better match the complexity of PEMs with the reading ability of their target audience, ensuring that the materials are comprehensible. Nurses are often at the forefront of patient education, and it is crucial that the materials they use are not just accurate but also accessible.
Readability indices can predict the level of reading difficulty based on an analysis of sentence structure and word length. However, they do not account for individual factors, such as a patient’s interest in or familiarity with the subject matter, or how the material is presented in a broader context. For example, a patient may have a high literacy level but still struggle to understand medical terminology or instructions if they are unfamiliar with the condition being discussed.
In nursing education, ensuring that PEMs are appropriately tailored to the literacy levels of patients is critical for promoting patient adherence to treatment plans, improving health literacy, and empowering patients to take an active role in their own healthcare. Effective patient education can lead to better health outcomes, reduced hospital readmissions, and improved overall patient satisfaction.
Measuring Readability by Formulas in Nursing Education
Readability formulas provide a method for objectively evaluating the complexity of printed educational materials. These formulas analyze features such as sentence length and word complexity to estimate the grade level required to understand the text. While they can be useful tools, readability formulas have limitations.
Not all readers will have equal competence in reading materials, even if the readability formula indicates that the material is at an appropriate grade level. For example, a patient who has been managing a chronic illness for many years may be more familiar with medical terminology and able to read more complex materials related to their condition than a newly diagnosed patient, even if both individuals have similar general literacy skills (Doak et al., 1985).
Additionally, readability formulas do not account for comprehension, meaning that even if a patient can read a text, they may not fully understand it. Comprehension depends not only on the readability of the text but also on factors such as prior knowledge, interest in the subject, and the way the information is presented. Therefore, while readability formulas are useful for assessing the complexity of text, they should be used in conjunction with other tools and strategies to ensure that patients are truly able to understand the material.
It is important for nursing educators to recognize that readability formulas, while practical, do not provide a comprehensive assessment of the quality or effectiveness of PEMs. They are one tool in a larger toolkit for assessing and improving patient education materials.
What Are Readability Formulas and How Are They Formed?
Readability formulas are mathematical equations designed to evaluate the readability of a text by analyzing features such as sentence length, word length, and vocabulary complexity. These formulas provide an estimate of the grade level required to read and understand the material.
The most widely used readability formulas include:
- Flesch-Kincaid Grade Level: This formula calculates the U.S. school grade level of the text based on sentence length and word syllable count.
- Gunning Fog Index: This formula estimates the number of years of formal education a reader needs to understand a text on the first reading.
- SMOG (Simple Measure of Gobbledygook): This formula is used to determine the readability of health-related materials and is one of the most popular formulas used in healthcare.
- Fry Readability Graph: This formula plots sentence length and the number of syllables per 100 words to estimate the reading grade level.
These formulas are used in healthcare to assess the readability of patient education materials, ensuring that the content is appropriate for the intended audience. For example, the National Institutes of Health (NIH) and the American Medical Association (AMA) recommend that PEMs be written at a 6th-grade reading level or lower to ensure that they are accessible to a wide audience.
However, while readability formulas are useful for estimating the reading difficulty of a text, they are not perfect. They cannot account for all the factors that influence a reader’s ability to comprehend the material, such as cultural background, prior knowledge, or motivation. Additionally, readability formulas do not measure how well a reader will understand the content, only how difficult the text is likely to be.
Limitations of Readability Formulas
While readability formulas provide a helpful estimate of the complexity of a text, they have several limitations. First, they do not account for the context in which the material is read or the reader’s familiarity with the subject matter. For example, a patient who has experience with a particular medical condition may find it easier to understand materials about that condition, even if the readability formula indicates a higher grade level.
Second, readability formulas focus on surface features such as sentence length and word complexity, but they do not consider other important aspects of text comprehension, such as the structure and coherence of the material, the use of visuals or illustrations, and the presence of supportive information such as summaries or glossaries.
Finally, readability formulas should not be the sole method used to assess PEMs. Nursing educators should also consider conducting usability testing with actual patients to ensure that the materials are not only readable but also understandable and actionable.
Conclusion
Readability is a critical factor in patient education. In nursing education, ensuring that PEMs are tailored to the literacy levels of patients is essential for promoting patient understanding and adherence to treatment plans. While readability formulas provide useful estimates of the complexity of a text, they are not sufficient on their own. Nursing educators and healthcare providers should use multiple methods to assess the readability and comprehensibility of PEMs, ensuring that patients are truly able to understand and use the information provided. By doing so, they can help improve health outcomes, reduce healthcare costs, and empower patients to take an active role in their own care.