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Stroke education materials are crucial for the recovery of stroke patients, but their effectiveness depends on their readability. The American Medical Association (AMA) recommends patient education materials be written at a sixth-grade level. Studies show existing paper and online materials exceed patients' reading levels and undermine their health literacy. Low health literacy among stroke patients is associated with worse health outcomes and decreased efficacy of stroke rehabilitation. We reviewed the readability of paper (i.e brochures, factsheets, posters) and online (i.e American Stroke Association, Google, Yahoo!) stroke patient education materials, reading level of stroke patients, accessibility of online health information, patients' perceptions on gaps in stroke information, and provided recommendations for improving readability. A PRISMA-guided systematic literature review was conducted using PUBMED, Google Scholar, and EbscoHost databases and "stroke", "readability of stroke patient education", and "stroke readability" search terms to discover English-language articles. A total of 12 articles were reviewed. SMOG scores for paper and online material ranged from 11.0 - 12.0 grade level and 7.8 - 13.95 grade level respectively. Reading level of stroke patients ranged from 3rd grade to 9th grade level or above. Accessibility of online stroke information was high. Structured patient interviews illustrated gaps in patient education materials and difficulty with comprehension. Paper and online patient education materials exceed the reading level of stroke patients and the AMA recommended 6th grade level. Due to limitations in readability, stroke patients are not being adequately educated about their condition. [ABSTRACT FROM AUTHOR]

Background: Language differences and health literacy limit former refugees' access to health education messages and thus their success in achieving improvements in health behaviours. Method: A suite of simple oral health education resources consisting of dual Arabic/English language pamphlets suited to the needs of Syrian former refugees were co-developed, and feedback was provided by nine focus groups of former refugees. Results: Thirty-nine former refugees resettled in Dunedin, New Zealand provided their feedback. The majority of participants thought these were useful, easy to read, and worthwhile. Major themes included novelty and usefulness, clarity (language/readability) and cultural appropriateness, layout, graphics and format, alternative methods, and venues for distribution. The research confirmed the value of tailoring information to be targeted to specific populations. When treating resettled former refugees, health care providers should deliver information in a way that considers culture, language, education, and background of their clients. Conclusion: Although the participants considered the resources developed in this study to be appropriate and helpful, further research must investigate whether a change in behaviour will result from their utilisation. [ABSTRACT FROM AUTHOR]

This study modified the educational content of an evidence-based fall prevention intervention to make it visually accessible for older adults with low vision. We piloted the intervention on 9 older adults receiving low vision rehabilitation services. Following the intervention, participants demonstrated increased comprehension of the content, perceived a greater understanding of fall prevention strategies, and reported high satisfaction with the intervention's accessibility. Individuals with low vision may have difficulty reading and comprehending printed educational materials. Modifying print materials to improve readability may result in greater understanding of the educational content. [ABSTRACT FROM AUTHOR]

Online patient education materials (OPEMs) are an increasingly popular resource for women seeking information about breast cancer. The AMA recommends written patient material to be at or below a 6th grade level to meet the general public's health literacy. Metrics such as quality, understandability, and actionability also heavily influence the usability of health information, and thus should be evaluated alongside readability. A systematic review and meta-analysis was conducted to determine: 1) Average readability scores and reporting methodologies of breast cancer readability studies; and 2) Inclusion frequency of additional health literacy-associated metrics. A registered systematic review and meta-analysis was conducted in Ovid MEDLINE, Web of Science, Embase.com , CENTRAL via Ovid, and ClinicalTrials.gov in June 2022 in adherence with the PRISMA 2020 statement. Eligible studies performed readability analyses on English-language breast cancer-related OPEMs. Study characteristics, readability data, and reporting of non-readability health literacy metrics were extracted. Meta-analysis estimates were derived from generalized linear mixed modeling. The meta-analysis included 30 studies yielding 4462 OPEMs. Overall, average readability was 11.81 (95% CI [11.14, 12.49]), with a significant difference (p < 0.001) when grouped by OPEM categories. Commercial organizations had the highest average readability at 12.2 [11.3,13.0]; non-profit organizations had one of the lowest at 11.3 [10.6,12.0]. Readability also varied by index, with New Fog, Lexile, and FORCAST having the lowest average scores (9.4 [8.6, 10.3], 10.4 [10.0, 10.8], and 10.7 [10.2, 11.1], respectively). Only 57% of studies calculated average readability with more than two indices. Only 60% of studies assessed other OPEM metrics associated with health literacy. Average readability of breast cancer OPEMs is nearly double the AMA's recommended 6th grade level. Readability and other health literacy-associated metrics are inconsistently reported in the current literature. Standardization of future readability studies, with a focus on holistic evaluation of patient materials, may aid shared decision-making and be critical to increased screening rates and breast cancer awareness. • Average readability was 11.81, twice the recommended AMA 6th grade reading level. • Readability studies measure and report readability with variable methodologies. • Many readability studies (40%) do not measure additional health literacy metrics. • Standardizing readability studies may improve evaluation and usability of OPEMs. [ABSTRACT FROM AUTHOR]

Background: A medication guide (MG) is a form of FDA-approved labeling that provides patients with information about certain prescribed drugs so that patients can use these drugs safely and effectively. Given ongoing efforts by FDA and industry to continuously improve MG content and format, we hypothesized that more recently approved MGs for new molecular entities (NMEs) would be shorter and more readable compared to NME MGs approved earlier. Methods: We analyzed 53 NME MGs that were either approved in 2011 (n = 16), 2013 (n = 9), 2015 (n = 12), or 2017 (n = 16) to determine whether MG page length, word count, and readability scores differed by year. Readability was estimated by Flesch Reading Ease, Flesch–Kincaid Grade Level (FKGL), Fry graph (FRY), and Gunning's Fog Index (FOG) scores. Results: Mean page length was significantly lower in 2017 than in 2011 and 2013 (ps <.0001). Mean FKGL scores reflected sentences and words found in 8th grade textbooks, but mean FOG and FRY scores were consistent with sentences and words found in 10th and 11th grade textbooks. Conclusions: Although more recent NME MGs were shorter than older NME MGs, additional research is warranted to determine whether shorter MGs lead to improved readability. Developers choosing to estimate MG readability with equations should consider using multiple readability formulas and weigh the strengths and weaknesses of this approach. Using validated tools to more comprehensively assess MG readability should also be considered. [ABSTRACT FROM AUTHOR]

Background: Low literacy skills impact important aspects of communication, including health-related information exchanges. Unsuccessful communication on the part of physician or patient contributes to lower quality of care, is associated with poorer chronic disease control, jeopardizes patient safety and can lead to unfavorable healthcare utilization patterns. To date, very little research has focused on digital communication between physicians and patients, such as secure messages sent via electronic patient portals. Method: The purpose of the current study is to develop an automated readability formula to better understand what elements of physicians' digital messages make them more or less difficult to understand. The formula is developed using advanced natural language processing (NLP) to predict human ratings of physician text difficulty. Results: The results indicate that NLP indices that capture a diverse set of linguistic features predict the difficulty of physician messages better than classic readability tools such as Flesch Kincaid Grade Level. Our results also provide information about the textual features that best explain text readability. Conclusion: Implications for how the readability formula could provide feedback to physicians to improve digital health communication by promoting linguistic concordance between physician and patient are discussed. [ABSTRACT FROM AUTHOR]

Inpatient discharge education is often suboptimal. Measures of parents' perceived comprehension of discharge instructions are included in national metrics given linkage to morbidity; few studies compare parents' perceived and actual comprehension. We 1) compared parent perceived and actual comprehension of discharge instructions and 2) assessed associations between plan complexity and parent health literacy with overestimation of comprehension (perceive comprehension but lack actual comprehension). Prospective cohort study of English/Spanish-speaking parents (n = 192) of inpatients ≤12 years old and discharged on ≥1 daily medication from an urban public hospital. We used McNemar's tests to compare parent perceived (agree/strongly agree on 5-point Likert scale) and actual comprehension (concordance of parent report with medical record) of instructions (domains: medications, appointments, return precautions, and restrictions). Generalized estimating equations were performed to assess associations between low parent health literacy (Newest Vital Sign score ≤3) and plan complexity with overestimation of comprehension. Medication side effects were the domain with lowest perceived comprehension (80%), while >95% of parents perceived comprehension for other domains. Actual comprehension varied by domain (41%–87%) and was lower than perceived comprehension. Most (84%) parents overestimated comprehension in ≥1 domain. Plan complexity (adjusted odds ratio 3.6; 95% confidence interval 2.9–4.7) and low health literacy (adjusted odds ratio 1.9; 1.3–2.6) were associated with overestimation of comprehension. Parental perceived comprehension of discharge instructions overestimated actual comprehension in most domains. Plan complexity and low health literacy were associated with overestimation of comprehension. Future interventions should incorporate assessment of actual comprehension and standardization of discharge instructions. [ABSTRACT FROM AUTHOR]

Background: More patients are now taking high-risk medicines such as non–vitamin K oral anticoagulants (NOACs). Hence, patient education materials need to be in an understandable format so that they can be empowered to act on their knowledge. Factors such as health literacy and the design of the medicine information material may influence the patient's ability to understand and act on key information. Method: The PRISMA checklist was used to inform the study design. A structured search was conducted to obtain all freely accessible online educational resources designed for patients about the non–vitamin K antagonists (NOACs) during August 2018. Three search engines were used: Google, Yahoo! and Bing, using the search terms "NOAC" and "anticoagulant" combined with "patient/consumer information and patient/consumer resources."We applied the Patient Education Materials Assessment Tool (PEMAT) to evaluate web-based patient education materials in terms of understandability and actionability for patients taking NOACs. Results: Of the 35 materials included, the majority of the materials (n = 32, 91%) were rated as highly understandable (PEMAT score ≥ \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\ge $$\end{document} 70%), and more than three-quarters of all the materials (n = 29, 83%) were rated as poorly actionable (PEMAT score <70%). For understandability, the majority of materials neither provided a summary of the key points nor used visual aids for several items such as simple tables, illustrations, and photographs. For actionability, few materials provided a tangible tool, such as a checklist, to prompt the user into action (n = 4). Few used visual aids such as nonverbal cues to the written instructions (n = 4). Conclusion: To improve the understandability and actionability of most of the NOAC patient education materials, there is a need to include more summaries of information, visual aids, and tangible tools such as checklists. Further research is warranted where patients are involved in providing feedback on the design of medicine information materials for NOACs. [ABSTRACT FROM AUTHOR]

Background: The volunteers approached for participation in a clinical trial should be given detailed and understandable information about the study through an informed consent form (ICF) before enrollment. In this study, we evaluated clinical trial files submitted to the Turkish Medicines and Medical Devices Agency (TITCK) to investigate the compliance to legal legislation and readability of ICFs as well as the factors affecting them. Methods: This is a descriptive, cross-sectional study. We evaluated 160 ICFs in the phase II-IV clinical trial files submitted to TITCK in 2016 to determine their compliance to legislation (n = 160) and to assess their readability (n = 152) using Atesman formula. Overall compliance score was calculated. ICFs were also evaluated in terms of written format (font size, line spacing, section headings) and page count. Statistical analysis was performed with chi-square, Student's t test, analysis of variance, Mann-Whitney U, and Kruskal Wallis analysis. Results: Compliance to legislation and suitability of written format of international trial ICFs were significantly higher than those of national trial ICFs. Most of the national trials were investigator initiated. Readability was low in both national and international trial ICFs where the text was longer in the latter. Conclusion: Results showed that researchers need easy-to-read ICF writing training that fits legal regulations. [ABSTRACT FROM AUTHOR]

Objective: To apply "user testing" to maximize readability and acceptability of a Clinical Trial Results Laypersons Summary--a new European requirement. Methods: "User testing" (using questionnaire and semistructured interview) assessed whether people could find and understand key points. Findings were used to improve content and design, prior to retesting. Participants had a range of levels of health literacy and there was a higher education group. Participants accessed the summary on screen. In round 1 we tested 12 points of information. In round 2 a revised summary addressing round 1 findings was tested, leading to a third final version. Results: In round 1, 2 of 12 points of information did not reach the target and interviews raised further format and content issues (some distracting technical explanations and inability to find or understand the 2 main study purposes). These findings informed revisions for the version tested in round 2, with 2 different points not reaching the target (inclusion criteria relating to duration of seasonal allergies and how researchers found out about participants' symptoms). Identified problems in both rounds were addressed and reflected in the final version. Despite improvements, participants did not consistently understand that summaries were intended for the public, or to only interpret results of single trials in the context of additional trials. All readers, including those with higher education, found the clear and straightforward language acceptable. Conclusions: Applying "user testing" resulted in a largely health-literate summary suitable for people across a range of backgrounds. [ABSTRACT FROM AUTHOR]

Background: The ubiquity of the Internet is changing the way people obtain their health information. Although there is an abundance of heart failure information online, the quality and health literacy demand of these information are still unknown. Objective: The purpose of this study is to evaluate the quality and health literacy demand (readability, understandability, and actionability) of the heart failure information found online. Methods: Google, Yahoo, Bing, Ask.com, and DuckDuckGo were searched for relevant heart failure Web sites. Two independent raters then assessed the quality and health literacy demand of the included Web sites. The quality of the heart failure information was assessed using the DISCERN instrument. Readability was assessed using 7 established readability tests. Finally, understandability and actionability were assessed using the Patient Education Materials Assessment Tool for Print Materials. Results: A total of 46 Web sites were included in this analysis. The overall mean quality rating was 46.0 ± 8.9 and the mean readability score was 12.6 grade reading level. The overall mean understandability score was 56.3% ± 16.2%. Finally, the overall mean actionability score was 34.7% ± 28.7%. Conclusions: The heart failure information found online was of fair quality but required a relatively high health literacy level. Web content authors need to consider not just the quality but also the health literacy demand of the information found in their Web sites. This is especially important considering that low health literacy is likely prevalent among the usual audience. [ABSTRACT FROM AUTHOR]

Healthcare professionals teach patients and families about their health every day. Regulatory and accreditation organizations mandate patient and family education to promote better health outcomes. And recently, financial rewards for healthcare organizations are being tied to patient satisfaction (Hospital Consumer Assessment of Healthcare Providers and Systems--HCAHPS). A University of Pennsylvania Health System group of staff and patients, devoted to excellence in patient and family education, developed the graphic "R.E.A.C.H. to Teach." The purpose of the graphic is to make evidence-based practice (EBP) for patient and family education "stick" with staff. The group used concepts from the marketing book, Made to Stick, to demonstrate how to develop effective staff and patient and family education. Ideas (education) that survive ( "stick" ) have the following attributes: simple, unexpected, concrete, credible, emotional, and narrative (story). This article demonstrates how to apply these principles and EBP to patient and family education. [ABSTRACT FROM AUTHOR]

Objectives: To assess the effectiveness of an educational intervention on prescription (Rx) label comprehension and functional health literacy (FHL) in older adults. Outcomes were compared between current and redesigned Rx labels. Additional objectives were to examine the correlation between 2 outcome measures and to determine the characterizing variables that are predictors for the outcome measures.Setting: Southern California, January 2013 to March 2015.Practice Description: Older adults (>55 y) taking 2 or more Rx medications daily were recruited at senior and community centers by a trained data collection team.Practice Innovation: The validated Modified LaRue Tool (MLT) tested Rx label comprehension before and after a short, focused educational intervention and correlated it with FHL.Interventions: A simple one-on-one education provided by student pharmacists that was focused on critical elements of an Rx label.Evaluation: Short Test of Functional Health Literacy in Adults (STOFHLA) and MLT scores of all current and redesigned label participants at baseline and follow-up.Results: Participants using redesigned Rx labels (n = 90) showed significantly higher MLT scores than with current Rx labels (n = 28) both before (23.0 ± 2.3 vs. 21.0 ± 2.4; P <0.001) and after educational intervention (23.8 ± 1.7 vs. 22.1 ± 3.1; P <0.001). With the use of analysis of covariance, intervention participants using redesigned label (n = 48) showed significant improvement in both MLT (23.1 ± 2.0 to 24.3 ± 1.0; P <0.001) and STOFHLA (29.8 ± 7.5 to 31.5 ± 5.7; P = 0.011) scores, whereas intervention participants using current Rx label (n = 16) did not show significant improvement in either MLT (P = 0.530) or STOFHLA (P = 0.215) scores. Effect size of intervention (redesigned label) was 0.77, indicating practical significance. MLT and STOFHLA scores were significantly correlated with each other, and age and education level were common significant predictors for both outcomes.Conclusion: Older adults using redesigned Rx labels showed improved Rx label comprehension and FHL after educational intervention, as well as higher comprehension compared with those using current Rx labels. Use of a redesigned Rx label and a simple educational intervention should be encouraged to improve Rx label comprehension and FHL. [ABSTRACT FROM AUTHOR]

Background: Plain language summaries (PLSs) are intended to provide readers with a clear, nontechnical, and easily understandable overview of medical and scientific literature; however, audience preferences for specific PLS formats have yet to be fully explored.Objective: This study aims to evaluate the preferred readability level and format for PLSs of medical research articles of different disease states via a web-based survey of audiences of different age groups.Methods: Articles describing phase III clinical trials published in top-level, peer-reviewed journals between May 2016 and May 2018 were identified for 3 chronic disease states representing a range of adult patient age groups: (1) psoriasis, a skin disease representative of younger patients; (2) multiple sclerosis (MS), a neurological disease representative of middle-aged patients; and (3) rheumatoid arthritis (RA), a painful joint disease representative of older patients. Four PLSs were developed for each research article, of which 3 were text-only summaries (written with high, medium, and low complexity) and 1 was an infographic. To evaluate each of the 4 PLS formats, a 20-question open survey (specific to one of the 3 diseases) was sent to a representative sample selected via UK-based patient association websites, Twitter, and Facebook patient groups. A weighted-average calculation was applied to respondents' ranked preferences for each PLS format.Results: For all 3 articles, the weighted-average preference scores showed that infographic (psoriasis 2.91, MS 2.71, and RA 2.78) and medium-complexity text-based PLS (reading age 14-17 years, US Grade 9-11; psoriasis 2.90; MS 2.47; RA 2.77) were the two most preferred PLS formats.Conclusions: Audience preferences should be accounted for when preparing PLSs to accompany peer-reviewed original research articles. Oversimplified text can be viewed negatively, and graphical summaries or medium-complexity text-based summaries appear to be the most popular.Plain Language Summary: Patients and caregivers should have the chance to read about medical research in a format they can understand. However, we do not know much about the formats that people with different illnesses or ages prefer. Researchers wanted to find out more about this. They selected 3 medical articles about illnesses that affect different age groups: psoriasis (younger patients), multiple sclerosis (middle-aged patients), and rheumatoid arthritis (older patients). They created 4 summaries of each article. One was a graphical summary, and the other 3 were words-only summaries of high, medium, and low complexity. Then, the researchers posted surveys on UK patient group websites and Facebook patient groups to ask people what they thought of the summaries. The surveys were taken by 167 people. These people were patients with psoriasis, multiple sclerosis, or rheumatoid arthritis, or their caregivers. Most were women, and about half had a university degree. For each illness, most people preferred the graphical summary. Among the word-only summaries, most people preferred the medium-complexity wording written for a reading age of 14 to 17 years. People felt that the graphical and medium-complexity summaries were clear and concise, while the others used jargon or were too simple. Authors of medical articles should remember these results when writing summaries for patients. More research is needed about the preferences of other people, such as those with other illnesses. (See Multimedia Appendix 1 for the graphical summary of the plain language summary.). [ABSTRACT FROM AUTHOR]

Background: Lipoprotein(a) (Lp(a)) is a highly proatherogenic lipid fraction that is a clinically significant risk modifier. Patients wanting to learn more about Lp(a) are likely to use online patient educational materials (OPEMs). However, the readability of OPEMs may exceed the health literacy of the public.Objective: This study aims to assess the readability of OPEMs related to Lp(a). We hypothesized that the readability of these online materials would exceed the sixth grade level recommended by the American Medical Association.Methods: Using an online search engine, we queried the top 20 search results from 10 commonly used Lp(a)-related search terms to identify a total of 200 websites. We excluded duplicate websites, advertised results, research journal articles, or non-patient-directed materials, such as those intended only for health professionals or researchers. Grade level readability was calculated using 5 standard readability metrics (automated readability index, SMOG index, Coleman-Liau index, Gunning Fog score, Flesch-Kincaid score) to produce robust point (mean) and interval (CI) estimates of readability. Generalized estimating equations were used to model grade level readability by each search term, with the 5 readability scores nested within each OPEM.Results: A total of 27 unique websites were identified for analysis. The average readability score for the aggregated results was a 12.2 (95% CI 10.9798-13.3978) grade level. OPEMs were grouped into 6 categories by primary source: industry, lay press, research foundation and nonprofit organizations, university or government, clinic, and other. The most readable category was OPEMs published by universities or government agencies (9.0, 95% CI 6.8-11.3). The least readable OPEMs on average were the ones published by the lay press (13.0, 95% CI 11.2-14.8). All categories exceeded the sixth grade reading level recommended by the American Medical Association.Conclusions: Lack of access to readable OPEMs may disproportionately affect patients with low health literacy. Ensuring that online content is understandable by broad audiences is a necessary component of increasing the impact of novel therapeutics and recommendations regarding Lp(a). [ABSTRACT FROM AUTHOR]

The large number of studies on the readability and understandability of informed consent forms used in health research testifies to their problematic nature and to their authors' inability to simplify them. With the attendant risk to the lives of study participants, concern with health research consent forms extends to every individual and not only to those with low levels of education. Using readability theory, this study solicited the responses of eight final-year university students of reading with a view to acquainting them with readability issues in health research. The students volunteered to assess their comprehension of an informed consent (1C) form which targeted HIV/AIDS patients by responding to a cloze test and a comprehension quiz. As in other studies, findings confirmed that the form was difficult to read and that failure to understand the health research jargon hampered the good intentions of obtaining participants' valid informed consent. It is recommended that informed consent forms be prepared as rigorously possible so as to make them readable and understandable to participants unfamiliar with health research jargon. There is potential for graduate teachers working as resource persons for drafting and/or interpreting 1C forms. [ABSTRACT FROM AUTHOR]

Much of health literacy is predicated on being able to read and understand health information and instructions given during the patient-provider encounter. Older adults with low vision face barriers to attaining health literacy because they have difficulty reading and interacting with health providers. Health care professionals can facilitate health literacy by understanding how vision impairment potentially limits health literacy in older adults. The article describes simple strategies both to increase the visibility and readability of printed health information and to improve the quality of the encounter between the health care provider and the patient, using suggestions from persons with vision impairment. [ABSTRACT FROM AUTHOR]

Older adults are at greater risk for having limited health literacy than other populations and consequently experiencing poorer health outcomes. Many older adults seek the services of rehabilitation professionals whose management frequently focus on instruction and teaching of new skills and knowledge. Use of best practices in health literacy and adult learning by rehabilitation professionals is essential to optimize health outcomes in older adult clients. This article discusses practical, evidence-based, culturally appropriate strategies in health literacy and adult learning for rehabilitation professionals to incorporate into practice to promote communication with and learning in older adults. [ABSTRACT FROM AUTHOR]

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Adult literacy skills studies indicate that large percentage of adults in most industrialized nations have difficulty using print material to accomplish everyday tasks with accuracy and consistency. Words in signs, postings, and forms within health care settings establish a physical literacy environment and reflect the demands and expectations of the institutions. We report on an assessment of the literacy environment of 10 hospitals in Catalonia, Spain, to indentify factors that hinder or support the ability of people to make their way to and within, a hospital. The authors used standardized rating tools for the evaluation of navigation, specific readability tools for the assessment of written communication, and a patient survey for the evaluation of patients' perception of written and oral communication. Thematic analysis of results indicates insecurity and confusion in finding one's way throughout health care facilities. Readability assessment of selected health education materials and informed consent documents shows extensive use of scientific language that is inappropriate for the general public. Patients' assessment of oral communication was rated high although statistically significant differences exist between hospitals. This assessment offers insight into the literacy demands placed on patients and visitors. [ABSTRACT FROM AUTHOR]

For groups like the elderly who are at risk for low levels of health literacy, documents must be easily comprehensible, particularly as the information becomes increasingly complex. The current research focused on a multilevel examination of a procedural excerpt of a handbook on Medicare, the US government program providing financial assistance to senior citizens for healthcare. Complementing assessments of readability, syntax, and verb mood were content analysis and the validated SAM (suitability of materials) instrument. The research focused on techniques used within this document excerpt (excluding hyperlinks), along with suggested actions for improvement. The excerpt targeted an audience with average to low levels of literacy in terms of shorter words and paragraphs; proportions of complex sentences, conditional mood, and the subordinating conjunction 'if' signal potential difficulty in comprehension. Results from the SAM analysis identified specific improvements within the broad categories of organization, visualization, and simplification. Tools like the SAM instrument, in conjunction with related techniques, can assist in the design and revision of healthcare documents suitable to the target audience intended to benefit. [ABSTRACT FROM AUTHOR]

Background: Interventions to define medical jargon have been shown to improve electronic health record (EHR) note comprehension among crowdsourced participants on Amazon Mechanical Turk (AMT). However, AMT participants may not be representative of the general population or patients who are most at-risk for low health literacy.Objective: In this work, we assessed the efficacy of an intervention (NoteAid) for EHR note comprehension among participants in a community hospital setting.Methods: Participants were recruited from Lowell General Hospital (LGH), a community hospital in Massachusetts, to take the ComprehENotes test, a web-based test of EHR note comprehension. Participants were randomly assigned to control (n=85) or intervention (n=89) groups to take the test without or with NoteAid, respectively. For comparison, we used a sample of 200 participants recruited from AMT to take the ComprehENotes test (100 in the control group and 100 in the intervention group).Results: A total of 174 participants were recruited from LGH, and 200 participants were recruited from AMT. Participants in both intervention groups (community hospital and AMT) scored significantly higher than participants in the control groups (P<.001). The average score for the community hospital participants was significantly lower than the average score for the AMT participants (P<.001), consistent with the lower education levels in the community hospital sample. Education level had a significant effect on scores for the community hospital participants (P<.001).Conclusions: Use of NoteAid was associated with significantly improved EHR note comprehension in both community hospital and AMT samples. Our results demonstrate the generalizability of ComprehENotes as a test of EHR note comprehension and the effectiveness of NoteAid for improving EHR note comprehension. [ABSTRACT FROM AUTHOR]

Background: The language gap between health consumers and health professionals has been long recognized as the main hindrance to effective health information comprehension. Although providing health information access in consumer health language (CHL) is widely accepted as the solution to the problem, health consumers are found to have varying health language preferences and proficiencies. To simplify health documents for heterogeneous consumer groups, it is important to quantify how CHLs are different in terms of complexity among various consumer groups.Objective: This study aimed to propose an informatics framework (consumer health language complexity [CHELC]) to assess the complexity differences of CHL using syntax-level, text-level, term-level, and semantic-level complexity metrics. Specifically, we identified 8 language complexity metrics validated in previous literature and combined them into a 4-faceted framework. Through a rank-based algorithm, we developed unifying scores (CHELC scores [CHELCS]) to quantify syntax-level, text-level, term-level, semantic-level, and overall CHL complexity. We applied CHELCS to compare posts of each individual on online health forums designed for (1) the general public, (2) deaf and hearing-impaired people, and (3) people with autism spectrum disorder (ASD).Methods: We examined posts with more than 4 sentences of each user from 3 health forums to understand CHL complexity differences among these groups: 12,560 posts from 3756 users in Yahoo! Answers, 25,545 posts from 1623 users in AllDeaf, and 26,484 posts from 2751 users in Wrong Planet. We calculated CHELCS for each user and compared the scores of 3 user groups (ie, deaf and hearing-impaired people, people with ASD, and the public) through 2-sample Kolmogorov-Smirnov tests and analysis of covariance tests.Results: The results suggest that users in the public forum used more complex CHL, particularly more diverse semantics and more complex health terms compared with users in the ASD and deaf and hearing-impaired user forums. However, between the latter 2 groups, people with ASD used more complex words, and deaf and hearing-impaired users used more complex syntax.Conclusions: Our results show that the users in 3 online forums had significantly different CHL complexities in different facets. The proposed framework and detailed measurements help to quantify these CHL complexity differences comprehensively. The results emphasize the importance of tailoring health-related content for different consumer groups with varying CHL complexities. [ABSTRACT FROM AUTHOR]