The gap between patient reading comprehension and the readability of patient education materials

Patient education materials and hospital forms are given to patients with little regard for their ability to read them. Nationwide sampling and data from the 1980 census suggest that a high proportion of patients cared for in public hospitals are functionally illiterate. In this study, 151 adult primary care patients in five different ambulatory care settings were tested for reading comprehension. Patient education materials and forms from each clinic were analyzed for readability using a standard computer program. A large discrepancy was found between the average patient reading comprehension and the ability levels needed to read patient education materials. The average reading comprehension of public clinic patients was 6th grade 5th month. Most tested patient education materials required a reading level of 11th to 14th grade, and standard institutional consent forms required a college-level reading comprehension. In the public clinics there was a gap of more than 5 years between patient reading levels and the comprehension levels required by written patient materials.     

Evaluating allied health inpatient rehabilitation educational materials in terms of health literacy

The purpose of this project was to assess and adapt inpatient rehabilitation educational materials in terms of reading level. Low health literacy has been shown to negatively impact health. Little health literacy research has been focused on rehabilitation settings. Written patient education materials were collected then analyzed for reading level. Focus groups were held with allied health practitioners to develop a plan to adapt them. A final focus group of former inpatient rehabilitation users was conducted to explore the end users perceptions of the original and revised materials. 90 pieces of patient education material were assessed. The average reading level of the original materials was 16th grade. A subset of 20 documents was chosen for revision. The average reading level was lowered to 5th grade with a range from 2nd to 8th. Clear communication for patient educational materials is a crucial first step to providing the best client-centered rehabilitation care. Vocabulary words, text formatting and "need to know" versus "nice to know" information were the most common problems in the original documents.     

Written health education materials: Making them more effective

Clients need high quality information if they are to make informed decisions about their health and to be actively involved in their care. Occupational therapists provide clients with education to equip them to participate in shared decision-making about their treatment as well to assist them with gaining specific skills and training. One method used to educate clients is to provide information in written form. However, for these materials to be effective, they must be written at a level able to be read and understood by clients. This can only be achieved if due consideration is given to clients' literacy levels, the readability level of the written information, and the overall design characteristics of the materials. In this paper, we review the literature in these areas and offer some guidelines that will help occupational therapists to provide clients with effective written materials.     

EVALUATION OF LITERACY LEVEL OF PATIENT EDUCATION PAGES IN HEALTH-RELATED JOURNALS

The purpose of this study was to evaluate the reading level of patient education material from selected current health care journals. Ten patient education pages from a variety of health care journals were entered into a Microsoft Word program. Applying the Flesch–Kincaid readability formula available from Microsoft Word, a reading level for each page was established and compared to recommended standards. Only 2 of 10 patient education pages fell within the recommended reading levels for health-related materials, and 5 of 10 were above the estimated mean U.S. reading level of 8th grade. A 5th to 6th grade level is recommended for patient education materials. This study suggests that although it is known that low health literacy is a widespread problem, it is not always considered when patient-targeted materials are developed. Health care professionals need to become more active in addressing the literacy needs of the intended receiver of written health-related information.     

Plain Language for Patient Education

Low health literacy continues to be a barrier in patient education. One solution to low health literacy is creating or providing patient education materials written in plain language. Plain language follows guidelines created for federal agencies to ensure that documents are written in clear and accessible language for all audiences. Health care professionals and librarians can locate or recommend plain language health information from many reputable consumer health websites.     

Literacy in primary care populations: is it a problem?

BACKGROUND: Almost half of Canadians experience difficulty using print media, according to the 1994 International Adult Literacy Survey. Our objectives were to estimate the prevalence of low-literacy patients in our practice, to determine whether reading grade level is associated with self-perceived health status in primary care, and to evaluate the reading difficulty of commonly used patient education pamphlets. METHODS: We surveyed a random sample of 229 patients aged 18 to 85 years presenting for scheduled and walk-in care. Main outcome measures were reading ability as estimated by word decoding skill with the validated Rapid Estimate of Adult Literacy in Medicine (REALM) and self-perceived health status using COOP/WONCA functional health measures. We assessed the reading difficulty of 120 commonly used patient education pamphlets using the Simple Measure of Gobbledygook (SMOG) formula. RESULTS: The prevalence of low-literate patients was 9%. Poor reading ability in English was most likely among patients under 45 years of age not having completed high school, and among those whose maternal language was neither English nor French (immigrants). REALM scores and self-perceived health were weakly correlated but not significant statistically. The mean reading grade level of pamphlets was grade 11.5 (SD: 1.5). Seventy-eight percent of pamphlets required at least a high school reading level. CONCLUSION: Literacy levels were higher than expected in our patient population; this finding may be due to the rapid assessment tool used, which may have underestimated the difficulty of using print media. Clearly, the vast majority of commonly used patient education materials would not meet the needs of low-literate patients, who may be more likely to experience poorer health. Providers need to be sensitive to the reading limitations of patients and patient education materials should be written at a lower reading level.     

(Un)organizing equal collaboration between users and professionals: on management of patient education in Norway

Background This is an article about how patient education is managed in Norway, but it also addresses a matter of broader relevance that of how an organization imbued with a request for rational choices is able to take on board a contradictory ideology. In Norway, patient education under the auspice of hospitals is to be conducted as an equal collaboration between users and professionals, posing challenges to the ethos of rationally justified choices within the hospital sector. This calls for an exploration of how the organization copes with the contradictory demands. Methods A theoretical approach on the basis of theories from Scandinavian institutional theory and science and technology studies, informed by documents, interviews and experiences from national, regional and local levels in Norway. Discussion The field of patient education is divided into three decoupled domains: one at management level, one at the practical level, and in the middle a domain that acts as an interface between management and practice. This interface mediates the relationship between ideas and practice, without making overt the fact that ideas might not be possible to put into practice and that practice might not reflect ideas. Conclusions The decoupling of practice and management allows patient education as equal collaboration between users and professionals to thrive as an idea, not subjugated by practical challenges. Thus, it can exist as a guiding star that both management and practitioners can attune to, but this situation might now be threatened by the demand for quality assurance in the field.     

Assessing the Cultural in Culturally Sensitive Printed Patient-Education Materials for Chinese Americans With Type 2 Diabetes

Type 2 diabetes affects Chinese Americans at an alarming rate. To address this health disparity, research in the area of cultural sensitivity and health literacy provides useful guidelines for creating culturally appropriate health education. In this article, we use discourse analysis to examine a group of locally available, Chinese- and English-language diabetes print documents from a surface level and deep structure level of culture. First, we compared these documents to research findings about printed health information to determine whether and how these documents apply current best practices for health literacy and culturally appropriate health communication. Second, we examined how diabetes as a disease and diabetes management is being constructed. The printed materials addressed surface level culture through the use of Chinese language, pictures, foods, and exercises. From a deeper cultural level, the materials constructed diabetes management as a matter of measurement and control that contrasted with previous research suggesting an alternative construction of balance. A nuanced assessment of both surface and deeper levels of culture is essential for creating health education materials that are more culturally appropriate and can lead to increased health literacy and improved health outcomes.     

南水北调水源区二级甲等医院住院患者就医体验关键驱动因素分析

目的 针对住院患者就医体验关键驱动因素进行重要性矩阵分析,以利于找到改进医疗服务质量的切入点,为提升南水北调水源区医院整体医疗服务质量提供科学合理的举措依据.方法 对南水北调水源区某二甲医院473名住院患者进行电子问卷测评,采用重要性矩阵分析方法进行住院患者就医体验关键驱动因素分析.结果 医院住院患者总体满意度为94....     

Patient satisfaction revisited: A multilevel approach

Patient satisfaction surveys are increasingly used for benchmarking purposes. In the Netherlands, the results of these surveys are reported at the univariate level without taking case mix factors into account. The first objective of the present study was to determine whether differences in patient satisfaction are attributed to the hospital, department or patient characteristics. Our second aim was to investigate which case mix variables could be taken into account when satisfaction surveys are carried out for benchmarking purposes. Patients who either were discharged from eight academic and fourteen general Dutch hospitals or visited the outpatient departments of the same hospitals in 2005 participated in cross-sectional satisfaction surveys. Satisfaction was measured on six dimensions of care and one general dimension. We used multilevel analysis to estimate the proportion of variance in satisfaction scores determined by the hospital and department levels by calculating intra-class correlation coefficients (ICCs). Hospital size, hospital type, population density and response rate are four case mix variables we investigated at the hospital level. We also measured the effects of patient characteristics (gender, age, education, health status, and mother language) on satisfaction. We found ICCs on hospital and department levels ranging from 0% to 4% for all dimensions. This means that only a minor part of the variance in patient satisfaction scores is attributed to the hospital and department levels. Although all patient characteristics had some statistically significant influence on patient satisfaction, age, health status and education appeared to be the most important determinants of patient satisfaction and could be considered for case mix correction. Gender, mother language, hospital type, hospital size, population density and response rate seemed to be less important determinants. The explained variance of the patient and hospital characteristics ranged from 3% to 5% for the different dimensions. Our conclusions are, first, that a substantial part of the variance is on the patient level, while only a minor part of the variance is at the hospital and department levels. Second, patient satisfaction outcomes in the Netherlands can be corrected by the case mix variables age, health status and education.     

Improving Health

Abstract

The Internet provides a ready source of patient education handouts specific to certain diseases or conditions. Patients and consumers can obtain clear, concise, and reliable information about their diseases or conditions and follow-up instructions for procedures and treatments. Patient education on the Internet can support patients or consumers in making informed health care decisions. Available day and night, patients can access this information at their convenience when they are most interested in learning. Included in this article are selected and annotated resources for locating patient education materials. Also included are Internet sites to locate materials for low literacy patient education.     

Patient medication education groups.

Much research documents the failure of discharged psychiatric patients to stay on recommended treatment regimens. In an effort to address this problem, and to decrease the rate of readmissions to the hospital, Logansport State Hospital in 1985 established patient medication education groups, conducted by nurses, in all of its patient care units. Today these groups continue as a successful therapy offered at the hospital.     

A winning combination: women,literacy, and participation in health care

Health information materials written at the appropriate reading level help individuals manage their own health care. In this study, we assessed the reading ability of clients and readability of the patient information materials at a rural women's health clinic. We administered a reading comprehension test to 50 subjects and tested the patient education materials using a readability formula. More than one in six women could not read all of the patient information, which could limit their understanding, and achievement of good health care. Commercially available materials can be checked readily for reading level using software installed in most computers. This software also allows clinicians who prepare their own materials for their patients to generate versions that are appropriate for different reading levels.     

Asthma information: can it be understood?

Asthma is an important public health problem in Australia onaccount of its prevalence, its under-recognition and inadequateself-management by many of those with the condition. There isa need for the development and dissemination of relevant andintelligible asthma education materials. However, a large proportionof written health education materials may not be understoodby the people who are exposed to them. This study examined thecomprehensibility of a variety of asthma education materials.The results suggest that most opportunities for asthma educationare lost on a general audience—they are written at a readingage well above that of the general community. Only two piecesof asthma material had similar FOG reading age scores to a typicalSydney newspaper. All the other asthma materials were at leasttwo reading grades higher. Non-parametric analysis suggestedthat these differences were all significant at the P< 0.01level, even with the small sample size used (n = 10 observationsper piece). It is recommended that careful attention be givento readability in the preparation of future asthma materials.The importance of readability assessment for other written healtheducation materials is stressed, or valuable opportunities forcommunity education will be wasted.     

A WINNING COMBINATION: WOMEN,LITERACY, AND PARTICIPATION IN HEALTH CARE

Health information materials written at the appropriate reading level help individuals manage their own health care. In this study, we assessed the reading ability of clients and readability of the patient information materials at a rural women's health clinic. We administered a reading comprehension test to 50 subjects and tested the patient education materials using a readability formula. More than one in six women could not read all of the patient information, which could limit their understanding, and achievement of good health care. Commercially available materials can be checked readily for reading level using software installed in most computers. This software also allows clinicians who prepare their own materials for their patients to generate versions that are appropriate for different reading levels.     

Drug-mineral interactions: a new responsibility for the hospital dietitian

Recent hospital accreditation guidelines encourage hospital dietitians to monitor patient drug therapy and provide education regarding drug-food interactions. However, information concerning these interactions is lacking, even though they can occur frequently. Minerals in foods can complex with drugs and/or alter the gastrointestinal environment to affect the normal absorption processes of drugs and minerals. There are three types of drug-mineral interactions: (a) malabsorption of the mineral and/or drug; (b) mineral depletion and retention; and (c) drug-mineral interactions induced by simultaneous antacid ingestion. It is recommended that oral drugs be administered on an empty stomach 1 hour before or 2 hours after a meal and at least 2 hours before or after antacid use. A small snack of refined carbohydrates with low nutrient density can be consumed with drugs that cause gastric upset when given on an empty stomach.     

Readability and content of postoperative tonsillectomy instructions given to patients in Scotland, a completed audit cycle

The aim of this study was to assess the impact of the recommendations and interventions of the 2003 audit of 'readability and content of postoperative tonsillectomy instructions, given to patients in Scotland'. A two-cycle audit of readability and content of postoperative tonsillectomy instructions was undertaken. All National Health Service (NHS) hospital wards and associated Otolaryngology Departments in Scotland where tonsillectomies were being performed were contacted. Interventions following the first cycle included the mailing copies of original audit results and conclusions to all ear, nose and throat wards in Scotland, presentation at a National Meeting and publication of results in a peer reviewed journal. While changes had occurred in 61% of the information sheets, and with six of the 31 (19%) postoperative information sheets now being written at or below the recommended reading level, the average reading grade/age required to understand these information sheets still remains above those recommended by patient education experts. In conclusion, the majority of postoperative tonsillectomy information sheets in Scotland remain written at a level above those recommended by patient education experts. The interventions undertaken in this audit were of limited success. The ENT-UK Tonsillectomy Information sheets (2006) are written at reasonable reading levels, have good content levels and we continue to recommend these information sheets.     

陕西省6所三级医院患者安全文化现状及影响因素研究

目的了解陕西省三级医院患者安全文化现状,分析影响因素,为推动医院文化建设、实现医院安全管理提供参考。方法于2018年7月-9月向陕西省6所三级医院的医务人员发放问卷进行横断面调查,运用SPSS 22.0软件对所获数据进行统计分析。结果调查医务人员共计1 065名。患者安全文化总体评分为（3.74±0.41）分,83.00%的医务人员认为患者安全等级“非常好”或“很好”。患者安全等级的影响因素有性别、最高学历、用工形式、参与6S培训（P＜0.05）。对错误的反馈与交流、医院交接班与转科程序、医院管理支持、对患者安全的全面理解和医院各部门之间的协作等维度与患者安全等级呈正相关（P＜0.05）。结论参与调查的医院患者安全文化总体水平中等偏上。医院应积极使用质量管理工具,针对不同人员采用个性化措施,加大管理支持力度,重视差错事件的持续改进,以不断提升患者安全管理水平。     

Patient education meets economic austerity,accountability demands,and staff burnout

Three non-mutually exclusive forces (economic austerity, accountability, and staff burnout) come together to demand a close look at the methods used to plan and evaluate patient education programs. A program development approach that focuses on the impact of patient education activities could respond to the demand of each of these forces. If patient educators can submit data on the impact their activities have on patients, they will be in a better position to compete for limited resources. If accountability is the obligation to disclose those acts for which an individual, group, or institution is responsible, then an approach that documents processes and outcomes will satisfy this demand. If such an approach enables patient educators to set goals and measure the success of programs, the staff burnout phenomenon can be diminished. Such a planning approach, together with an example, is described.     

Current oral contraceptive use instructions: an analysis of patient package inserts.

Oral contraceptive use instructions contained in manufacturers' patient package inserts (PPIs) are often inconsistent or conflicting, both among manufacturers and among different brands and regimens from the same manufacturer. Instructions on what to do about missed pills are often incomplete or inadequate, as are instructions on backup contraceptive use when pills are missed. The format of many PPIs is confusing and makes instructions difficult to find and read. Comprehending the PPIs requires the user to read at a 10th-12th-grade level, far higher than the generally accepted 5th-6th grade level considered standard for health education materials.