Printed Material In Nursing Education Many studies on literacy have revealed a notable gap between the reading levels of healthcare consumers and the readability demands of printed health information. The ability to understand health-related information, such as food labeling, prescription medication instructions, discharge instructions, and health promotion materials, is essential for maintaining health. However, many printed patient education materials (PEMs) are written at a level beyond the comprehension of their intended audience, making it critical to address this issue.
Patient Reading Ability and Printed Educational Material Issues
A substantial body of evidence indicates a significant gap between patients’ reading and comprehension levels and the reading difficulty of PEMs (Agarwal et al., 2015; Andrus & Roth, 2002). Educational materials from various sources, such as government agencies, healthcare organizations, and health insurance companies, are often written at reading levels far exceeding the abilities of many patients. This can be a major issue, particularly in populations with low literacy or English as a second language (ESL), who may struggle to comprehend health information crucial to their care.
Patient Understanding and Grading of Printed Materials
Healthcare providers are increasingly recognizing that the vast amount of written materials they rely on to convey health information is often inaccessible to individuals with low literacy. A simple example from colonoscopy instructions illustrates how incomprehensible written instructions can be to someone who cannot read (Weiss, 2003).
Researchers have assessed the reading ability of various population groups to match the literacy demands of the health materials provided. Findings have revealed alarming mismatches. For instance, emergency department instructional materials are written at an average of a 10th-grade reading level, far beyond the readable range of most patients (Duffy & Snyder, 1999). Similarly, health service-related materials for older adults often exceed their comprehension abilities, which creates barriers to accessing necessary services (McGee, 2010).
Other studies highlight discrepancies in outpatient care and home care settings. Many PEMs, such as those used for patient education or consent forms, are written at a high school to college level (Doak et al., 1998). Consent forms, essential for ensuring patients’ understanding of procedures and treatments, often demand a high level of literacy, making it difficult for patients to fully comprehend what they are consenting to (Muir & Lee, 2009).
Even health professionals’ letters to patients and health articles in newspapers require reading skills beyond the typical patient’s ability, with an average reading ability between the 12th and 17th-grade level (Conlin & Schumann, 2002). Medication instructions, especially those for psychotropic drugs, are also typically written well above the recommended 5th-grade reading level (Myers & Shepard-White, 2004).
These findings demonstrate that PEMs often far exceed the average reading ability of consumers, with most written above the 8th-grade level. However, the average reading level of adults falls around the 8th grade, and many adults, particularly those with lower literacy levels, require materials written at a 5th-grade level or lower (Brega et al., 2015; ProLiteracy, 2017).
Characteristics of Readable Printed Materials for Patient Education
To address these issues, health education materials need to be written in a way that is accessible to patients. This involves not only lowering the reading grade level but also ensuring that materials are simple, clear, and concise. Complex and lengthy PEMs are ineffective if patients cannot understand them or are unwilling to read them.
Research shows that people tend to read two grade levels below their highest level of education. Furthermore, even highly educated individuals prefer simpler materials, especially when they are ill or dealing with complex medical conditions. In fact, sophisticated readers find easy-to-read materials more acceptable, particularly when they are overwhelmed or fatigued by illness (Giorgianni, 1998).
To create effective PEMs, healthcare providers must consider the literacy levels of their patients, whether in hospital or community settings. Simplified language, clear instructions, and culturally relevant materials are essential for helping patients understand their health needs and engage in self-care.
Readability Formulas and Testing
Several readability formulas can help healthcare providers evaluate the reading level of PEMs and ensure that they match the target audience’s literacy skills. Some of the most commonly used formulas include:
- Flesch Reading Ease: This formula rates text on a 100-point scale, with higher scores indicating easier-to-read materials.
- Flesch-Kincaid Grade Level: This tool converts the Flesch Reading Ease score to a U.S. grade level, allowing healthcare providers to match PEMs to a specific reading ability.
- SMOG (Simple Measure of Gobbledygook): This formula is commonly used to assess healthcare materials and provides a grade level based on the complexity of words in a text.
- Gunning Fog Index: This index estimates the years of formal education required to understand a text.
By using these formulas, healthcare providers can assess whether their materials are written at a level suitable for their patients. The goal is to create materials that are understandable, actionable, and patient-centered.
Addressing Cultural and Linguistic Diversity
In addition to readability, cultural and linguistic appropriateness is crucial for effective patient education. Materials should not only be written at an accessible reading level but also be culturally relevant and available in the patient’s preferred language. Healthcare providers should ensure that the language and tone of PEMs resonate with the patient’s cultural background to facilitate comprehension.
Conclusion
The readability of PEMs plays a critical role in patient education, compliance, and health outcomes. The mismatch between the reading ability of patients and the complexity of health materials can lead to misunderstandings, poor adherence to medical advice, and higher healthcare costs. Simplifying materials and ensuring cultural relevance are essential for improving health literacy and empowering patients to take control of their health.
As the healthcare landscape evolves and patient education becomes even more critical due to factors like early discharge and increased home care, it is vital that healthcare providers focus on the readability of PEMs. By ensuring that these materials are accessible to all patients, regardless of their literacy levels, healthcare professionals can promote better understanding, engagement, and health outcomes for their patients.