Research in Social and Administrative Pharmacy
Original ResearchAssessing readability formula differences with written health information materials: Application, results, and recommendations
Section snippets
Background
Given that approximately 36% of the U.S. population has basic or below basic health literacy,1 the grade level of readability is a major area of focus when developing written health information. Ensuring adequate readability supports the first goal of the National Action Plan to Improve Health Literacy that is to “Develop and disseminate health and safety information that is accurate, accessible, and actionable.”2 Unfortunately, commonly used health information is often written at reading grade
Objectives
This research sought to (1) identify commonly used readability formulas reported in the health care literature, (2) demonstrate the use of the most commonly used readability formulas on written health information, (3) compare and contrast the differences when applying common readability formulas to identical selections of written health information, and (4) provide recommendations for choosing an appropriate readability formula for written health-related materials to optimize their use.
Formula identification and selection
There are numerous readability formulas available. However, this study sought to examine the most commonly used readability formulas reported in the health care literature and to apply them to a common set of written health information materials. Therefore, this study firstly assessed the frequency of readability formula use in health care literature from 2005 to 2008. These years were chosen because at the time of the study, they represented complete years after the release of the 2003
Formula identification
The literature search initially identified 272 articles in Medline and 38 articles in International Pharmaceutical Abstracts that used readability formulas between 2005 and 2008. After applying the exclusion criteria and eliminating duplicate articles, 155 articles were evaluated. The most commonly used readability formulas were the Flesch-Kincaid (57.42%), Flesch Reading Ease (44.52%), SMOG (25.81%), Fry (11.61%), Fog (10.32%), and Dale-Chall (2.58%). Approximately 7% of formulas used were
Discussion
This study illustrates that reading grade level estimates vary by formula, even when applied to the same written health information. The results are not surprising because each readability formula applies different calculations and methods for validation. Although results may be expected to differ by the type of formula used, it is important to understand the criteria on which they are validated, how they are applied, and under what context they were developed before implementing them in
Limitations
A classical study in readability identified 288 aspects that contribute to the ability of readers to understand written text, which can be further categorized into 4 major categories: content, style and presentation, format, and organization.59 Readability formulas, for the most part, only address semantic and syntactic aspects found in the style and presentation category.59, 60 The use of readability formulas combined with other methods, such as a suitability assessment of materials, and, if
Conclusion
Although the Flesch Reading Ease and Flesch-Kincaid are more commonly used readability formulas, the SMOG formula appears to be more ideally suited for use in a health care context, as it has been validated against 100% comprehension, is based on more recent criteria for determining reading grade level, and is the easiest formula to use in practice. The use of the other commonly used readability formulas may produce suboptimal results for health care-related written information. Regardless of
Acknowledgments
This research has been presented, in part, at the 2010 Annual Meeting & Exposition of the American Pharmacists Association in Washington, DC.
References (60)
- et al.
A critical review of FDA-approved medication guides
Patient Educ Couns
(2006) - et al.
Evaluation of written prescription information provided in community pharmacies: a study in eight states
J Am Pharm Assoc (2003)
(2003) - et al.
Expert and consumer evaluation of patient medication leaflets provided in U.S. pharmacies
J Am Pharm Assoc (2003)
(2005) - et al.
Suitability and readability assessment of educational print resources related to physical activity: implications and recommendations for practice
Patient Educ Couns
(2008) - et al.
Readability formulas: cautions and criteria
Patient Educ Couns
(1991) - et al.
The Health Literacy of America's Adults: Results From the 2003 National Assessment of Adult Literacy (NCES 2006-483)
(2006) National Action Plan To Improve Health Literacy
(2010)- et al.
The readability of pediatric patient education materials on the World Wide Web
Arch Pediatr Adolesc Med
(2001) - et al.
Readability standards for informed-consent forms as compared with actual readability
N Engl J Med
(2003) - Kimberlin CL, Winterstein AG. Expert and consumer evaluation of consumer medication information—2008 (Final report to...
State Official's Guide to Health Literacy
The Principles of Readability
The Technique of Clear Writing
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Lit Discuss
A new readability yardstick
J Appl Psychol
A Formula for Predicting Readability (Research Bulletin)
McCall-Crabbs Standard Test Lessons in Reading
SMOG grading: a new readability formula
J Read
A recalculation of four adult readability formulas
J Educ Psychol
Readability Revisited: The New Dale-Chall Readability Formula
The use of readability formulas in health care
Psychol Health Med
A systematic review of readability and comprehension instruments used for print and web-based cancer information
Health Educ Behav
Teaching Patients With Low Literacy Skills
How reliable is computerized assessment of readability?
Comput Nurs
Assessing readability of patient information materials
Am J Hosp Pharm
Assessing readability of patient information materials
Pediatr Nurs
Information from your family doctor. Depression in children and teens
Am Fam Physician
Information from your family doctor. Depression: what you should know
Am Fam Physician
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