Readability of skin cancer prevention brochures targeting parents of young children

Quality assessment of cancer patient education materials: the current state of systemic therapy patient education in fourteen cancer centres across Ontario, Canada

PURPOSE

Most patients diagnosed with cancer are administered systemic therapy and these patients are counselled and given printed education (PE) materials. High rates of low health literacy highlight the need to evaluate the quality of these PE materials.

METHODS

A current state assessment of the quality of PE materials was conducted in Ontario, Canada. Patient education leaders from 14 cancer centres submitted print materials on the topic of systemic cancer therapy to the assessment team. To report adherence to PE quality and health literacy best practices, the following validated measures were used: readability (FRY, SMOG and Flesch Reading Ease), understandability and actionability (Patient Education Materials Assessment Tool (PEMAT)). Materials at grade level 6 or lower and with PEMAT scores greater than 80% were considered to meet health literacy best practices.

RESULTS

A total of 1146 materials were submitted; 366 met inclusion criteria and 83 were selected for assessment. Most materials scored below the 80% target for understandability (x̄ = 73%, 31-100%) and actionability (x̄ = 68%, 20-100%), and above the recommended grade 6 readability level (x̄ = grade 9) meaning that the majority did not meet quality standards or best practices.

CONCLUSION

Results suggest that there is significant opportunity to improve the quality of PE materials distributed by cancer centres. The quality of PE materials is a critical safety and equity consideration when these materials convey important safety and self-care directives.

Online Tonsillectomy Resources: Are Parents Getting Consistent and Readable Recommendations?

Objective Parents frequently refer to information on the Internet to confirm or broaden their understanding of surgical procedures and to research postoperative care practices. Our study evaluated the readability, comprehensiveness, and consistency around online recommendations directed at parents of children undergoing tonsillectomy. Study Design A cross-sectional study design was employed. Setting Thirty English-language Internet websites. Subjects and Methods Three validated measures of readability were applied and content analysis was employed to evaluate the comprehensiveness of information in domains of perioperative education. Frequency effect sizes and percentile ranks were calculated to measure dispersion of recommendations across sites. Results The mean readability level of all sites was above a grade 10 level with fewer than half of the sites (n = 14, 47%) scoring at or below the eight-grade level. Provided information was often incomplete with a noted lack of psychosocial support and skills-training recommendations. Content analysis showed 67 unique recommendations spanning the full perioperative period. Most recommendations had low consensus, being reported in 5 or fewer sites (frequency effect size <16%). Conclusion Many online parent-focused resources do not meet readability recommendations, portray incomplete education about perioperative care and expectations, and provide recommendations with low levels of consensus. Up-to-date mapping of the research evidence around recommendations is needed as well as improved efforts to make online information easier to read.

Evaluation of the Readability of Dermatological Postoperative Patient Information Leaflets Across England

BACKGROUND

Postoperative patient information leaflets (PILs) provide important guidance to patients after skin surgery. Readability is a method of evaluating information for text comprehension. The recommended level for PIL readability is US grade ≤6.

OBJECTIVE

To evaluate the readability of public English dermatological postoperative PILs.

MATERIALS AND METHODS

All dermatology departments in England were requested to provide their postoperative PILs. Patient information leaflets were evaluated using Readability Studio (Oleander Software, Vandalia, OH). Two preselected parameters were also noted: whether the PIL was doctor or nurse-written, and whether the PIL was Information Standard hallmarked.

RESULTS

Eighty-five of one hundred thirty (65.4%) of PILs were evaluated. Only 29.4% of the PILs were grade level ≤6 with Flesch-Kincaid. The mean readability levels were 7.8 for Flesch-Kincaid, 67 for Flesch reading ease, 10.5 for Simple Measure of Gobbledygook (SMOG), 9.4 for Gunning-Fog, 8 for Fry, and 9.8 for FORCAST. No instruments demonstrated a significant difference between doctor (6) and nurse-written (7) PILs. Two instruments found that the 3 Information Standard hallmarked PILs had a higher (harder) readability than ordinary PILs (n = 82) (Gunning-Fog, p = .029*; SMOG p = .049*).

CONCLUSION

Most English postoperative dermatological PILs' readability levels exceed recommendations (US grade ≤6). Departmental PILs should be reviewed to ensure that they are comprehensible to their patients.

A systematic review of readability and comprehension instruments used for print and web-based cancer information

Adequate functional literacy skills positively influence individuals' ability to take control of their health. Print and Web-based cancer information is often written at difficult reading levels. This systematic review evaluates readability instruments (FRE, F-K, Fog, SMOG, Fry) used to assess print and Web-based cancer information and word recognition and comprehension tests (Cloze, REALM, TOFHLA, WRAT) that measure people's health literacy. Articles on readability and comprehension instruments explicitly used for cancer information were assembled by searching MEDLINE and Psyc INFO from 1993 to 2003. In all, 23 studies were included; 16 on readability, 6 on comprehension, and 1 on readability and comprehension. Of the readability investigations, 14 focused on print materials, and 2 assessed Internet information. Comprehension and word recognition measures were not applied to Web-based information. None of the formulas were designed to determine the effects of visuals or design factors that could influence readability and comprehension of cancer education information.

Patient information leaflets for prostate cancer: which leaflets should healthcare professionals recommend?

This study evaluated 31 patient information leaflets (PILs) discussing treatment options for prostate cancer. In stage one, the authors evaluated the leaflets' quality, readability and suitability using objective measures: the DISCERN instrument; Flesch formula; and the Suitability Assessment of Materials (SAM) instrument, respectively. Although the leaflets varied in terms of their scores on each measure, it was possible to identify the best five leaflets across the three conditions. In stage two, eight men with prostate cancer took part in a focus group discussion or individual interview to outline their views regarding a number of leaflets, including the best five booklets or leaflets identified in stage one of the study. The interviews were audiotaped and analysed using a template analysis. Patients were able to discriminate between the best five leaflets or booklets and identify their preferred booklets. These were the booklets: "Understanding cancer of the prostate" by CancerBACUP, "Prostate cancer: everything you need to know" by the Prostate Cancer Charity and "The treatment of prostate cancer. Questions and answers" by the Covent Garden Cancer Research Trust. On the basis of their high ratings for the objective measures and patients' views, healthcare professionals are advised to recommend these three booklets to men with prostate cancer who want written information about the disease. However, randomised controlled trials are needed to examine the impact of these booklets on the psychosocial outcomes of men with prostate cancer.

[Can patients read what we want them to read? Analysis of the readability of printed materials for health education]

OBJECTIVE

To analyze readability and legibility of a systematic sample of health education materials made available at a health center, and to propose recommendations for improvement.

DESIGN

Observational, descriptive study.

SETTING

An urban health center in Madrid, Spain.

MATERIAL

A sample of text from 326 health education documents.

MAIN MEASURES

The 326 texts were classified according to target reader, organism responsible for publication, topic, and date of publication. A sample of 500 words from each document was analyzed with Microsoft Word 2000 to determine the Flesch readability score and sentence complexity index, and to calculate the INLEG index. Print size and accompanying graphics were also analyzed.

RESULTS

Readability of the materials was generally acceptable, with a mean Flesch score of 13.56. However, the type tended to be too small (mean 11.37 points). In 32% of the documents there were no illustrations, and no date of publication was given in 46%. CONCLUSIONS. The readability and legibility in the group of documents we analyzed could both be improved by following the recommendations offered here. Further research is needed on the techniques used to analyze readability and legibility, especially with regard to the latter.

[Measurement of the legibility of written texts. Correlation between the Flesch manual method and computer methods]

OBJECTIVE

To compare, for the calculation of the Flesch legibility index, the original manual method and the computer programmes Word Perfect 7 and Microsoft Word 2000; and to correlate these with other computer measurements of legibility.

DESIGN

Descriptive, observation study.

SETTING

A Madrid Health Centre, within a study of the legibility of health education (HE) leaflets.

MATERIAL

A sample of text from 100 HE leaflets and 11 general control texts. Main measurements. The 11 texts were analysed through Flesch' s original manual method and the computer programmes mentioned, with which the number of words and sentences, the Flesch scores, the index of sentence complexity and the LEGIN index were calculated. Pearson's correlation coefficient was calculated for all the variables.

RESULTS

There was very good correlation between the manual measurement of the Flesch index, the number of words and sentences, and their determination by means of computers (r>0.75); and excellent correlation between the two programmes (r>0.9). The results support the cut-off scores in other studies for legibility measured by computer.

CONCLUSIONS

Measurement of legibility through the computer programmes used can reliably replace manual measurement of the Flesch index.