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Purpose: This study assesses readability, suitability, and accountability of online uveitis patient education materials (PEMs). Methods: Two uveitis specialists reviewed the top 10 websites on Google for keyword "uveitis," with a PubMed review control. Readability was assessed using an online calculator, suitability using the Suitability Assessment of Materials (SAM) tool, and accountability using JAMA benchmarks. Results: The mean SAM score was 21.05, indicating that websites were on average adequately suitable to educate patients. WebMD Uveitis website scored the highest at 25.5, while allaboutvision.org scored the lowest at 18.0. The average Flesch Reading Ease (FRE) score was 44.0 (95% CI: 34.2, 53.8). The average reading grade score was 11.0 (95% CI: 9.4, 12.6). WebMD Uveitis page scored highest on readability. The average accountability score among sites was 2.36 out of 4. Conclusions: Uveitis websites are only adequately suitable as PEMs, and all are above the recommended reading level. Uveitis specialists should advise patients on quality of online PEMs. [ABSTRACT FROM AUTHOR]

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]

The National Heart, Lung, and Blood Institute (NHLBI) Learn About Chronic Obstructive Pulmonary Disease (COPD) YouTube playlist educates the public on diagnosing, treating, and managing COPD. Despite its potential benefits, it is unknown if users with inadequate health literacy will likely understand and apply the information described in these videos. Assess the Learn About COPD playlist's readability, actionability, and understandability. Central tendency statistics were computed to describe the meta-data of 28 videos available as of April 2023. Assessments included the Patient Education Materials Assessment Tool for Audiovisual Materials (PEMAT-AV), Accessible Health IT for Limited-Literacy Populations Checklist (LLPC), and the Modified Centers for Disease Control and Prevention (CDC)-Clear Communication Index (CCI) for audiovisual materials. Playlist videos received an average of over 2,000 views (Mdn = 2,220, IQR = 496–8336), with very few "likes" (Mdn = 13, IQR = 1–48 "likes"). PEMAT-understandability (Mdn = 81.81%, IQR = 80–97.72%) and LLPC (Mdn = 87.50%, IQR = 75–93.75%) scores were high (above 80%). However, the modified CDC-CCI median score was 57.14% (IQR = 42.86–75%), and the median PEMAT-actionability score was 50% (IQR = 0–66.67%). The playlist earned passing understandability, acceptability, and usability scores but scored poorly on actionability and communication clarity. Findings could inform enhancements to NHLBI's Learn About COPD YouTube playlist. [ABSTRACT FROM AUTHOR]

Saudi Arabia has the second-highest prevalence of diabetes in the Middle East. Therefore, providing patients with high-quality materials is essential to help them understand their illness. The Patient Education Materials Assessment Tool (PEMAT) contrasts and evaluates materials regarding understandability and actionability. This study aimed to evaluate materials for type 2 diabetes using a printed version of the PEMAT. This observational study was conducted in Riyadh from December 2022 to May 2023. Sixty-nine samples were collected from hospitals affiliated with the Ministry of Health and the government sector. Materials evaluated in this study had an excellent understandability score of 78.9% and a low actionability score of 66.6%, with significant differences between the sources. Some of the materials (42%) achieved high quality regarding understandability and actionability. Less than half of the materials were considered high quality. Approximately 99% of the materials made their purposes completely evident and logically presented the information, and approximately 97% identified at least one action. However, only 17.4% of the materials provided summaries and tangible tools. Health Educators should consider including summaries and tangible tools when developing patient education materials to make them more understandable and actionable. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate the readability and reliability of online content related to cerebral palsy (CP) and to classify sites that contain quality and readable information. On April 30, 2022, the term "cerebral palsy" was searched on the Google search engine. The categories, quality, content, readability, Alexa rank values, and backlink numbers of the sites were analyzed. The Journal of American Medical Association score and HONcode seal were used for quality assessment, and the Flesch–Kincaid grade (FKG) and the Simple Measure of Gobbledygook (SMOG) were used for readability assessment. Of the 155 sites, 46 had high-quality content. The quality of health portal and scientific publishing sites appeared to be high. The top 10 sites were determined to be of significantly higher quality (p =.017) than the remaining sites. The average readability values of the sites were not at the recommended level. Despite the abundance of information available on CP-related websites, most of them were not of high quality. Additionally, many websites did not reach the recommended readability levels. Revision of existing online content related to CP and production of new high-quality content in line with readability recommendations is urgently required. [ABSTRACT FROM AUTHOR]

Patient education materials (PEMs) are often used in health education programs to empower patients to self-manage their disease for better health outcomes. Heart failure (HF) patients wanted more information about self-management and educational materials that were easy to understand. Programs with self-efficacy as the core component have proven to be effective in improving patients' self-management. To develop practical, efficacy-enhanced, tailored HF rehabilitation PEMs that satisfy our clients to drive long-lasting behavior change and evaluate the materials' quality (readability, understandability, actionability, and acceptability). Exploratory mixed methods study involving: i) semi-structured interviews; ii) evaluation of the PEMs; iii) revision and reevaluation of the PEMs; iv) publication. An appointed panel of experts evaluates content accuracy, understandability, and actionability. The Patient Education Material Assessment Tool assesses content understandability and actionability. The content readability was assessed using Flesch Kincaid Calculator. Clients' acceptability was assessed using Educational Material Acceptability tool. The newly developed PEMs have good understandability, actionability, readability, and acceptance. Patient-centered PEMs have good acceptance and satisfaction among clients. However, the effectiveness of tailored efficacy-enhanced PEMs for behavior changes needs further evaluation. All stakeholders should be included in developing PEMs. A AJHE Self-Study quiz is online for this article via the SHAPE America Online Institute (SAOI) [ABSTRACT FROM AUTHOR]

Three patient education texts from the National Cancer Institute (NCI) were subjected to a Coh-Metrix analysis, then further analyzed to obtain Gist Inference Scores (GIS), a new measure of the likelihood that readers will make appropriate inferences about a text's bottom-line meaning. In the GIS formula, the Coh-Metrix psycholinguistic variables referential cohesion, deep cohesion, and latent semantic analysis (LSA) verb overlap increase GIS because cohesive texts that describe related actions are likely to induce gist representations. The Coh-Metrix variables word concreteness, imagability for content words, and hypernymy for nouns and verbs are negatively weighted because they tend to promote verbatim mental representations. NCI texts were modified for a cloze procedure with every tenth word replaced by a blank starting with the second sentence. Participants in two studies received all three cloze-modified texts. Fuzzy-Trace Theory suggests that people are more likely to comprehend high GIS texts "in their own words," and thus fill-the-blanks with multiple words that differ from those omitted by the cloze procedure expressing comparable meaning. In Study One, non-native English speakers appropriately filled blanks with different words at the same rate for all three texts of low-, medium-, and high-GIS. In Study Two, replicating previous findings, for high GIS texts, native English speakers filled blanks appropriately with words other than those removed significantly more often than for medium- or low-GIS texts. High GIS texts apparently afford readers more semantic and lexical flexibility, but non-native English speakers may be ill-equipped to capitalize on this characteristic of high GIS texts. [ABSTRACT FROM AUTHOR]

To investigate whether the authoritative COVID-19 consumer health information provided by the Centers for Disease Control and Prevention (CDC) in the United States (U.S.) and the World Health Organization (WHO) is at low readability levels (i.e., at or below a sixth-grade reading level). Major public health organizations, such as these have quickly distributed authoritative COVID-19 health information on the Internet during the pandemic. However, scant research has assessed whether the information disseminated by these two major public health organizations enables access by adults from the general public. This study examines the Flesch-Kincaid grade levels of the COVID-19 health information in English distributed by the CDC and the WHO. The study is guided by communication and information science frameworks. It examines the reading level of the resources to see if they are compatible with the guidelines of the American Medical Association for patient education materials. The methodology used centered on content and document analyses. The samples analyzed were identified through accessing the COVID-19 health information shared on the websites of the public library systems of the twenty largest cities in the U.S. The results show that the documents reviewed in the study are not compatible with the sixth-grade reading level recommended by the American Medical Association for patient education materials. [ABSTRACT FROM AUTHOR]

Purpose: To assess the availability, quality, and readability of online patient education materials regarding uveitis medications. Methods: The top 10 Google search results for 10 commonly prescribed uveitis medications (prednisone, azathioprine, methotrexate, mycophenolate mofetil, cyclosporine, tacrolimus, chlorambucil, cyclophosphamide, adalimumab, and infliximab) were analyzed for readability and accountability. Readability was assessed with the Flesch reading ease score, Flesch-Kincaid grade level, Gunning Fog Index, Simple Measure of Gobbledygook Index, and Coleman Liau Index. JAMA benchmarks were used to assign websites accountability scores. Statistical analysis was performed with two-tailed t-tests. Results: Of 100 search results, none complied with the recommended sixth-grade reading level across all readability formulas. Only one website satisfied all 4 JAMA benchmarks, two websites were able to satisfy three benchmarks, and the remainder achieved two or less. Conclusions: Online information regarding uveitis medications lacks accountability and is not written at an appropriate level for the average patient. [ABSTRACT FROM AUTHOR]

Online health misinformation is a growing problem, and health information professionals and consumers would benefit from an evaluation of health websites for reliability and trustworthiness. Terms from the Google COVID-19 Search Trends dataset were searched on Google to determine the most frequently appearing consumer health information websites. The quality of the resulting top five websites was evaluated. The top five websites that appeared most frequently were WebMD, Mayo Clinic, Healthline, MedlinePlus, and Medical News Today, respectively. All websites, except Medline Plus, received HONcode certification. Based on DISCERN and CRAAP scores, MedlinePlus was found to be the most reliable health website. [ABSTRACT FROM AUTHOR]

Introduction: Individuals with co-morbid post-traumatic stress disorder (PTSD) and pain have higher disability, pain, and pain catastrophizing beliefs than patients without PTSD. Pain neuroscience education (PNE) may be an effective tool to help those with PTSD and pain reduce maladaptive beliefs about pain. The purpose of this paper is to report the development and evaluation of a PNE curriculum for participants with PTSD and pain. Methods: After writing an initial draft of PNE for PTSD and pain, a panel of medical experts in PNE, PTSD, and rehabilitation reviewed the booklet. After addressing recommendations from the medical panel (n = 29), individuals with (n = 13) and without (n = 20) PTSD reviewed the booklet. Results: Overall, 89% of participants recommended the PNE booklet and 90% thought it would help patients with PTSD and pain. Although patients with PTSD rated the PNE booklet more critically than other participants, a particular support group (n = 4) rated the PNE booklet significantly different (p <.05) than remaining participants with PTSD (n = 9). Individuals with PTSD and pain were able to comprehend the PNE booklet at a comparable rate to an expert medical panel and participants without PTSD after adjusting for education levels (p =.12). Conclusions: Many patients with PTSD and pain avoid painful activities because they believe they are harmful. This research demonstrates that individuals with PTSD and pain can comprehend PNE that challenges these beliefs. The PNE curriculum developed by this research may provide a logical explanation for the link between PTSD symptoms and pain and should be tested for clinical effectiveness. [ABSTRACT FROM AUTHOR]

This study examined health literacy of postpartum education materials assessing readability, understandability and cultural sensitivity using common health literacy measures. Materials examined rated poorly on measures of health literacy and cultural sensitivity using evidence-based measures including the Patient Education Materials Assessment Tool (PEMAT), Fry-based Readability and National Standards for Culturally and Linguistically Appropriate Services (CLAS). Findings suggested a need for health literate and culturally sensitive postpartum education. Materials and an App were developed for new moms to help them identify postpartum warning-signs and appropriate action moms should take to address symptoms or seek emergent care. [ABSTRACT FROM AUTHOR]

Many Americans use smartphone-based mobile applications to acquire health information. Our study evaluated the readability of mobile application-based patient educational materials (PEMs) about five prevalent cancers in the United States. The Apple and Google mobile application marketplaces were queried for breast, colon, lung, prostate, and stomach cancer-related applications, which were subsequently screened for PEMs and assessed with 10 validated readability assessments. Twenty-one pertinent applications yielded 249 articles that were written at an 11.8 ± 2.3 grade level; only 12 (4.8%) articles were written below an eighth grade level. The majority of cancer-related PEMs were written at too difficult reading levels for American patients. [ABSTRACT FROM AUTHOR]

Many Americans use smartphone-based mobile applications to acquire health information. Our study evaluated the readability of mobile application-based patient educational materials (PEMs) about five prevalent cancers in the United States. The Apple and Google mobile application marketplaces were queried for breast, colon, lung, prostate, and stomach cancer-related applications, which were subsequently screened for PEMs and assessed with 10 validated readability assessments. Twenty-one pertinent applications yielded 249 articles that were written at an 11.8 ± 2.3 grade level; only 12 (4.8%) articles were written below an eighth grade level. The majority of cancer-related PEMs were written at too difficult reading levels for American patients. [ABSTRACT FROM AUTHOR]

Background: Despite the importance of written healthcare information in improving an individual's health status, patients may not be able to sufficiently utilize available resources because of a disparity between the accessibility of online written materials and patients' ability to process that information. For individuals with impairments in written language comprehension, such as persons with aphasia, this disparity may be magnified. It is crucial that written health resources be cognitively accessible, accurate, and understandable for persons with aphasia. Aims: The aims of this study were to: (1) objectively measure the accessibility of current written educational materials for persons with aphasia and (2) examine the relationship between levels of readability, validity, and user-friendliness of materials accessed. Methods & Procedures: Aphasia-related webpages likely to be accessed during an Internet search were retrieved and analysed. These webpages were determined by selecting the first 10 search results generated from entering the terms: "aphasia", "aphasia treatment", and "aphasia help", into Google, Bing, and Yahoo. This method resulted in 30 website resources per search engine. For each webpage, readability was evaluated using the following readability formulae: Flesch-Kincaid Reading Ease, Flesch-Kincaid Grade Level (F-K), Simple Measure of Gobbledygook, and FORCAST. Additionally, validity and user-friendliness were evaluated for each webpage using the following measures: Site, Publisher, Audience, Timeliness (SPAT) and Suitability Assessment of Materials (SAM), respectively. Outcomes & Results: A significant disparity was found between the desired and current level of readability, validity, and user-friendliness of the written information provided within the top search results related to aphasia. Based on the readability formulae output the average reading grade level of 10th grade was well above the average 5th grade reading level recommended for written materials. A third of the websites were unacceptable using the SPAT's quality standards and overall user-friendliness was deemed poor with an average SAM score of 27.4 out of 52 total points. No relationship was found between the validity or user-friendliness of websites and their readability. Conclusions: These data clearly demonstrate inadequacies in written web-based information about aphasia across several measures and provide insight into how the presentation of this information can be improved to facilitate useful information dissemination. Highlighting these disparities is important for promoting increased consideration and improvement in the usefulness and accessibility of healthcare information for persons with aphasia. [ABSTRACT FROM AUTHOR]

Hospital patient education committees play a critical role in providing appropriate and easy-to-read patient education materials. As previous literature has noted, health literacy impacts individuals of all demographics and effects the patient’s ability to understand the patient education given to them at discharge. In keeping with the movement of organizational improvement regarding health literacy, creating a review process, potentially through a patient education committee, is essential. At one academic medical center, the Patient Centered Education Committee encourages staff members to write patient education geared towards the patient population. With the help of a librarian, these custom written patient education documents are reviewed for literacy. This paper will address the librarian’s role in changing the standard work to include literacy review as well as addressing health literacy. [ABSTRACT FROM AUTHOR]

There are many veterans’ health resources. These resources provide much needed information to veterans, their loved ones, and caregivers. Online materials are available from a wide range of organizations including the Department of Veterans Affairs (VA). Oftentimes, veterans’ health information is written at an advanced reading level using complicated terminology and not the recommended fifth to eighth grade reading levels. This article will provide a list of these resources and a discussion of their readability in comparison to MedlinePlus. [ABSTRACT FROM AUTHOR]

Readability is an important element of any published material. In recent years, various health organisations have utilised infographics to communicate important medical information. Established guidelines for readability suggest levels should be targeted between a 4th and 6th grade education level (United States) in order to avoid disadvantaging individuals with lower literacy skills. The purpose of this case study was to evaluate the readability levels of several published materials from the field of athletic training and demonstrate a model for evaluating readability levels in other medical and health professions. [ABSTRACT FROM AUTHOR]

Many library-subscribed clinical databases contain educational materials for physicians and librarians to share with patients. These materials are typically written in layperson language meant to be understood by the average, nonclinician person. However, the materials found in these online databases vary widely, and some are better than others. This article uses the Patient Education Materials Assessment Tool (PEMAT) to evaluate the patient education content of several popular clinical databases, including Access Medicine, Clinical Key, DynaMed Plus, Epocrates, and UpToDate. These databases are also evaluated on other, more basic criteria, including findability, content, printing to PDF, customizability, and available languages. [ABSTRACT FROM AUTHOR]

Background: Increasing transgender health care coverage has resulted in easier access to gender confirmation surgery. Patients considering surgery consistently access medical information online to improve knowledge regarding surgical options, complications, recovery, and life after transitioning. As a result, national health institutes recommend that patient educational materials be written at a sixth-grade–reading level. The purpose of this study is to assess the complexity of online gender confirmation surgery information. Methods: An Internet search was performed using the key phrase “transgender surgery”. Health care and non–health care websites were evaluated for pertinent articles regarding gender confirmation surgery. Readability analyses were conducted using Flesch-Kincaid Grade Level, Gunning Fog Index, Coleman-Liau Index, Simple Measure of Gobbledygook Index, and Automated Readability Index. A two-tailed z test was used to compare means; significance was set atp≤ 0.05. Results: A total of 108 articles from 87 websites were analyzed. The average readability for all online gender confirmation-surgery information was at an 11th-grade reading level. Materials written by health care entities were written at a 12th-grade–reading level compared to non–health care articles, which were written at a 10th-grade level (p< 0.001). Male-to-female surgery materials were written at a 12th-grade level, significantly higher than the 11th-grade reading level of female-to-male surgery materials (p= 0.04). Conclusion: Online information regarding gender confirmation surgery is written at a level that is too complex for patients to understand. Informational materials should be written at lower grade levels to improve patient education, informed consent, and outcomes. [ABSTRACT FROM PUBLISHER]

People with chronic kidney disease (CKD) need usable information on how to live well and slow disease progression. This information is complex, difficult to communicate, and changes during the course of the disease. We examined lifestyle-related printed CKD patient education materials focusing on actionability and visual aids. From a previous systematic review assessing readability of CKD patient information, we identified materials targeting nutrition, exercise, and self-management. We applied the Suitability Assessment of Materials (SAM) and Patient Education Materials Assessment Tool (PEMAT) to evaluate how easy materials were to understand (understandability) and act on (actionability). We created the 5C image checklist and systematically examined all visual aids for clarity, contribution, contradiction, and caption. Of the 26 materials included, one fifth (n = 5, 19%) were rated “not suitable” on SAM and fewer than half (n = 11, 42%) were rated “superior.” PEMAT mean subdomain scores were suboptimal for actionability (52) and visuals (37). Overall, more than half of all 223 graphics (n = 127, 57%) contributed no meaning to the text. Images in three documents (12%) directly contradicted messaging in the text. CKD lifestyle information materials require focused improvements in both actionability of advice given and use of visual aids to support people with CKD to self-manage their condition. The fifth C is culture and is best evaluated by user-testing. [ABSTRACT FROM PUBLISHER]

Patients are often given patient education documents to take home with them when they leave the hospital. It is important that these documents be at an appropriate grade level since some patients have low health literacy and may be unable to read the materials given to them. Evaluators can use readability tools to assess their patient education materials and make sure they are at a sixth- to eighth-grade reading level. The hospital librarian can play a large role in identifying the grade level of patient education materials. [ABSTRACT FROM PUBLISHER]

As more individuals turn to the Internet for health-related information and technology increases the availability and use of implantable medical devices (IMDs), the websites marketing these devices will increase. Healthy People 2020 mandates increased understandability and usability of health-related websites. This project used social cognitive theory (SCT) and health literacy constructs from the Institute of Medicine and National Institutes of Health to analyze eight IMD websites. Despite current recommendations, none of the websites considered for this study offered content of an appropriate reading level in conjunction with the United States average of eighth grade, and 75% of the sites failed to satisfy more than one health literacy construct. Most of the websites lacked many of the SCT constructs. More attention is needed to improve the usability of these and future IMD websites to simultaneously meet the goal of marketing IMDs and the Healthy People 2020 goals to educate patients and promote public health. [ABSTRACT FROM AUTHOR]

Hispanics who speak Spanish are at risk for low health literacy. We evaluated Spanish language hypertension (HTN) and diabetes mellitus (DM) patient education materials from U.S. federal agency public sector sources using the Suitability of Assessment (SAM) instrument. Mean readability for HTN materials was grade 7.9 and for DM materials was grade 6.6. Mean SAM score for HTN materials was 43.9 and for DM materials was 63.2. SAM scores were significantly better for DM than for HTN materials in overall score, content, graphics, layout, stimulation/motivation, and cultural appropriateness (p < .05). Clinicians should evaluate suitability of Spanish language HTN and DM materials that they use in patient teaching. [ABSTRACT FROM PUBLISHER]

Poor health literacy has been recognized as a limiting factor in the elderly’s ability to comprehend written or verbal medication information and also to successfully adhere to medical regimens. The objective of this study was to validate a set of pictograms depicting medication instructions for use among the elderly to support health literacy. Elderly outpatients were recruited in 3 community pharmacies in Canada. One-on-one structured interviews were conducted to assess comprehension of 76 pictograms from the International Pharmaceutical Federation. Comprehension was assessed using transparency testing and pictogram translucency, or the degree to which the pictogram represents the intended message. A total of 135 participants were enrolled in this study, and 76 pictograms were assessed. A total of 50 pictograms achieved more than 67% comprehension. Pictograms depicting precautions and warnings against certain side effects were generally not well understood. Gender, age, and education level all had a significant impact on the interpretation scores of certain individual pictograms. When all pictograms were included, younger males had a significantly higher comprehension score than older females, and participants with a higher level of education provided significantly higher translucency scores. Even when pictograms reached the comprehension threshold set by the International Organization for Standardization in the general populations, only 50 of these pictograms achieved more than 67% comprehension among the elderly, confirming that validation in this subpopulation should be conducted prior to using specific pictograms. Accompanying pictograms with education about these pictograms and important counseling points remains extremely important. [ABSTRACT FROM PUBLISHER]

Objectives: Patients should have access to high-quality health information websites on which to base their decision-making. There are concerns regarding the accuracy and quality of some health websites. We aimed to objectively measure website quality related to cochlear implantation.Methods: Selected patient-information websites were scored, depending on how highly they ranked on search engines and if they were ranked on more than one of the search engines used. The top 40 websites from three major search engines were analysed. The quality of each website was scored using the DISCERN tool and the readability was scored using the Flesch-Kincaid reading ease and the Gunning-Fog index.Results: The average Flesch-Kincaid score was 49.7, giving an average reading age of a 15-17 years old, and the average Gunning-fog score was 13.1, which equals that of an 18 years old.Conclusion: Internet-based information regarding cochlear implantation is of varied quality and is written above the expected reading level of an average person. [ABSTRACT FROM AUTHOR]

Patient materials are often written above the reading level of most adults. Tool 11 of the Health Literacy Universal Precautions Toolkit (“Design Easy-to-Read Material”) provides guidance on ensuring that written patient materials are easy to understand. As part of a pragmatic demonstration of the Toolkit, we examined how four primary care practices implemented Tool 11 and whether written materials improved as a result. We conducted interviews to learn about practices' implementation activities and assessed the readability, understandability, and actionability of patient education materials collected during pre- and postimplementation site visits. Interview data indicated that practices followed many action steps recommended in Tool 11, including training staff, assessing readability, and developing or revising materials, typically focusing on brief documents such as patient letters and information sheets. Many of the revised and newly developed documents had reading levels appropriate for most patients and—in the case of revised documents—better readability than the original materials. In contrast, the readability, understandability, and actionability of lengthier patient education materials were poor and did not improve over the 6-month implementation period. Findings guided revisions to Tool 11 and highlighted the importance of engaging multiple stakeholders in improving the quality of patient materials. [ABSTRACT FROM PUBLISHER]

Background:The recommended readability of patient education materials by the American Medical Association (AMA) and National Institutes of Health (NIH) should be no greater than a sixth-grade reading level. However, online resources may be too complex for some patients to understand, and poor health literacy predicts inferior health–related quality of life outcomes.Aim:This study evaluated whether the American Orthopaedic Society for Sports Medicine (AOSSM) website's patient education materials meet recommended readability guidelines for medical information. We hypothesized that the readability of these online materials would have a Flesch-Kincaid formula grade above the sixth grade.Methods:All 65 patient education entries of the AOSSM website were analyzed for grade level readability using the Flesch-Kincaid formula, a widely used and validated tool to evaluate the text reading level.Results:The average (standard deviation) readability of all 65 articles was grade level 10.03 (1.44); 64 articles had a readability score above the sixth-grade level, which is the maximum level recommended by the AMA and NIH. Mean readability of the articles exceeded this level by 4.03 grade levels (95% CI, 3.7–4.4;P< 0.0001). We found post-hoc that only 7 articles had a readability score ≤ an eighth-grade level, the average reading level of US adults. Mean readability of the articles exceeded this level by 2.03 grade levels (95% CI, 1.7–2.4;P< 0.0001).Conclusion:The readability of online AOSSM patient education materials exceeds the readability level recommended by the AMA and NIH, and is above the average reading level of the majority of US adults. This online information may be of limited utility to most patients due to a lack of comprehension. Our study provides a clear example of the need to improve the readability of specific education material in order to maximize the efficacy of multimedia sources. [ABSTRACT FROM PUBLISHER]

The higher the reading grade level of a document, the more difficult the material is for patients to read and understand. This study assessed the readability of patient information material concerning one topic—hip replacement surgery—found on the Web sites of 21 of the top adult orthopedic hospitals (ranked according to theU.S. News & World ReportBest Hospitals, Top-Ranked Hospitals for Orthopedics 2013–2014). The material was assessed using widely available online tools. The assessment showed that the reading grade levels ranged between 5.9 and 17.2. The overall average was a grade level of 11.9. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to analyse the content, design, and readability of printed hearing aid user guides to determine their suitability for older adults, who are the main users of hearing aids. Design: Hearing aid user guides were assessed using four readability formulae and a standardized tool to assess content and design (SAM - Suitability Assessment of Materials). Study sample: A sample of 36 hearing aid user guides (four user guides from nine different hearing aid manufacturers) were analysed. Results: Sixty nine percent of user guides were rated ʽnot suitable' and 31% were rated ʽadequate' for their suitability. Many scored poorly for scope, vocabulary, aspects of layout and typography, and learning stimulation and motivation. The mean reading grade level for all user guides was grade 9.6 which is too high for older adults. Conclusion: The content, design, and readability of hearing aid user guides are not optimal for older adults and thus may serve as a barrier to successful hearing aid outcomes for this population. [ABSTRACT FROM AUTHOR]

Ehlers-Danlos syndrome is a disorder of the connective tissue. There are six forms of the disease, with the vascular form being the most dangerous. Persons with this form of the disorder are often misdiagnosed. At times the first indication of the disease is arterial rupture, which is often lethal. The Ehlers-Danlos National Foundation was established to bring awareness, provide support, and raise funds for research. This nonprofit organization was founded in 1985 by one person and has grown to include many thousands of members that either have a form of the disorder or care for someone with it. [ABSTRACT FROM PUBLISHER]

The comprehension of numerical concepts that appear in written health educational materials is an important aspect of health literacy. Health materials that include many advanced numerical concepts may place high demands on readers, especially those with low health literacy levels. The purpose of this study was to examine and document the types of numerical concepts that appear in passages selected from written diabetes educational materials that varied in their type of content. Readability of the passages was also analyzed. One hundred and fifty passages of 100 words each were selected from 50 diabetes-related educational documents, produced by major health organizations. Passages were coded for type of numerical concept, SMOG Reading Grade Level, Flesch Reading Ease, and features that elaborated the numerical concepts, such as pictures or explanations. Findings indicate that passages containing general information about diabetes and its prevention contained significantly more advanced numerical concepts, the highest reading grade level, the lowest reading ease scores, and the lowest frequency of elaborative features, relative to many other types of content. Recommendations are made for enhancing the presentation of numerical concepts in written diabetes educational materials. [ABSTRACT FROM AUTHOR]

The availability of culturally appropriate written health information is essential for promoting health in diverse populations. Lack of English fluency has been shown to negatively impact health outcomes for Latinos in the United States. The authors conducted a needs assessment at a clinic serving Latino immigrants, focusing on patients' health and previous experiences with written health information. Based on these results and a literature review, we developed 10 Spanish language brochures to better serve the target population. This article outlines the process of developing and implementing this intervention, which can serve as a model for similar projects targeting diverse populations. [ABSTRACT FROM AUTHOR]

Commercial information products often have patient education handouts built into their systems. How readable are they to the average patient? This study attempts to answer this question by sampling and scoring handouts from three different producers. The patient education handouts from MD Consult, Micromedex Care Notes, and ADAM were analyzed and scored using the average of three reading level formulas. The results indicate that most handouts are above the average reading level of most patients, with Micromedex Care Notes scoring the best in this study. [ABSTRACT FROM PUBLISHER]

Approximately 78 million adult Americans suffer from the consequences of low health literacy, including poor health outcomes, frequent emergency visits, and hospitalizations. This article discusses the development of the Health Literacy Now Web site for improving communication between health care providers and patients with low health literacy. The Web site promotes health literacy through three interrelated components: clear health information on chronic diseases and their management, tools to improve the health literacy environment of a clinical setting, and development of a health literacy manual to provide a step-by-step guidance for health care providers to communicate effectively with their patients. The article describes the need for this Web site, the methods used to develop it, and its application in both the inpatient and outpatient settings for improving patient-provider communication. [ABSTRACT FROM AUTHOR]

The number of health literacy articles published each year in scientific journals has increased considerably in recent years. However, the content of those articles continues to focus on the same issues: developing instruments to assess health literacy skills, measuring the health literacy skills of patients, and measuring the reading level of patient education materials. We need to change the focus of health literacy research by studying which approaches to dealing with health literacy result in the best outcomes for patients—making them healthier, having fewer complications, and reducing their health care costs. There is a paucity of high-quality research on such issues, but that is the direction in which the field needs to go. [ABSTRACT FROM PUBLISHER]