Readability Evaluations of Veterinary Client Handouts and Implications for Patient Care

Readability of postoperative discharge instructions is associated with complication rate in companion animals undergoing sterilisation

BACKGROUND

Readability of client communications is a commonly overlooked topic in veterinary medical education. In human medicine, it has been advised that the readability of patient materials should be at USA schooling sixth-grade level or below. We hypothesised that student written discharge instructions would be of an inappropriate readability level, and discharges scored with higher reading grade levels would be associated with more complications.

METHODS

The cohort comprised 149 dogs and cats presenting for sterilisation. The readability of discharge instructions was assessed using the Flesch Reading Ease (FRE) and Flesch-Kincaid Grade Level (FKGL) formulas. Records were examined for evidence of postoperative complications.

RESULTS

The mean FRE score of the discharge instructions was 61.97, with 30.87% being classified as 'difficult' or 'fairly difficult', 60.4% as 'standard' and 8.72% as 'fairly easy'. The mean FKGL was 8.64, with 98% being above reading level 6. Overall, there was an association between FKGL and complication occurrence (p = 0.005). Stratification by species demonstrated FRE and FKGL to be associated with complication occurrence in dogs (FRE score, p = 0.038; FKGL, p = 0.002), but not cats (FRE score, p = 0.964; FKGL, p = 0.679).

LIMITATIONS

Due to the retrospective nature of the study, there were difficulties associated with extracting relevant complication information from the medical records.

CONCLUSION

Only 2% of owner-directed discharge instructions were written at readability levels aligning with the recommendations set forth in the human guidelines.

Evaluating the readability of recruitment materials in veterinary clinical research

BACKGROUND

Owner comprehension is vital to recruitment and study success, but limited information exists regarding the readability of public-facing veterinary clinical trial descriptions.

OBJECTIVES

The current study sought to evaluate the readability of public-facing online veterinary clinical trial descriptions from academic institutions and private referral practices.

ANIMALS

None.

METHODS

This prospective study assessed readability in a convenience sample of veterinary clinical trial study descriptions using 3 common methods: the Flesch-Kincaid Grade Level (F-K), Flesch Reading Ease Score (FRES), and online Automatic Readability Checker (ARC). Results were compared across specialties and between academic and private institutions.

RESULTS

Grade level and readability consensus scores (RCSs) were obtained for 61 online clinical trial descriptions at universities (n = 49) and private practices (n = 12). Average grade-level RCS for study descriptions was 14.13 (range, 9-21). Using Microsoft Word, the FRES score was higher in descriptions from universities compared to private practices (P = .03), and F-K scores were lower in university compared to private practice descriptions (P = .03). FRES (P = .07), F-K (P = .12), and readability consensus (P = .17) scores obtained from ARC were not different between institution types. Forty-eight studies (79%) had RCSs over 12, equivalent to reading material at college or graduate school levels.

CONCLUSIONS AND CLINICAL IMPORTANCE

Similar to other areas in veterinary communication, the evaluated veterinary clinical trial descriptions used for advertising and recruitment far exceeded the recommended 6th-grade reading level for medical information. Readability assessments are straightforward to conduct, and ensuring health literacy should be a customary best practice in veterinary medicine and clinical research.

Discharge summaries provided to owners of pets newly diagnosed with cancer exceed recommended readability levels

OBJECTIVE

To analyze the readability of discharge summaries distributed to owners of pets newly diagnosed with cancer.

SAMPLE

118 discharge summaries provided to pet owners following initial consultation.

PROCEDURES

A database search identified records of new patients that had been presented to the North Carolina State Veterinary Hospital medical oncology service between June 2017 and January 2019. Owner-directed portions of the summaries provided at the time of discharge were copied and pasted into a document and stripped of all identifying information. Readability of summaries was assessed with the use of 2 previously established readability calculators: the Flesch-Kincaid Grade Level (FKGL) and Flesch Reading Ease (FRE) tests.

RESULTS

Mean ± SD FKGL was 11.9 ± 1.1 (median, 11.9; range, 8.6 to 15.5; target ≤ 6), and the mean ± SD FRE score was 43 ± 5.9 (median, 42.7; range, 25.5 to 58.1; target ≥ 60). There were no significant differences in FKGL or FRE scores among discharge summaries for patients with the 4 most common tumor types diagnosed or the described treatment options. Ninety-three percent (110/118) of summaries were scored as difficult or very difficult to read.

CLINICAL RELEVANCE

Owner-directed written information regarding a diagnosis of cancer at a single teaching hospital exceeded readability levels recommended by the American Medical Association and NIH and was above the average reading level of most US adults. Efforts to improve readability are an important component of promoting relationship-centered care and may improve owner compliance and patient outcomes.

Pets and people: information experience of multispecies families

Purpose

This paper introduces more-than-human perspective in information behaviour and information experience studies. The purpose of this paper is to contribute to understandings of the concept of multispecies families by exploring their significant dimensions related to information phenomena involving multiple contexts, situations, spaces, actors, species, and activities.

Design/methodology/approach

Based on previous research in human information behaviour and human-animal studies, our ideas around information experience of multispecies families are developed conceptually. The paper builds both on previous empirical findings about human information behaviour and the new domain of information experience.

Findings

The paper proposes a holistic approach both to information phenomena in everyday living with companion animals including embodied, affective, cognitive, social, digital, and objectual information that shapes pet care and management practices, and to the context of study, including work, domestic, and leisure aspects of multispecies family.

Originality/value

This study broadens our understanding of information phenomena in multispecies families, and so contributes to the field of information experience. It also provides insights for animal welfare scientists to help them understand the information behaviour of humans who are responsible for keeping and caring for animals.

Communication, Veterinary-Client-Patient Relationship, and Teledentistry

Communication is the basis of any relationship. Communication can help strengthen the relationship between veterinarians, their clients, and their colleagues throughout the profession. Different models of communication have been demonstrated including the directive model, consumerism model, and relationship-centered model. When veterinarians refer to a specialist, they view the referral as an extension of the care they provide. Therefore, developing a relationship with the specialist is an important facet of patient care. Creating an appropriate veterinary-client-patient relationship (VCPR) helps the patient receive the best care possible. This needs to be considered when offering telemedicine or teledentistry to clients or referring veterinarians.

Readability and content of online pet obesity information

OBJECTIVE

To assess the readability of pet obesity information, document the presence and absence of types of pet obesity information, and perform comparisons between dog and cat obesity information content on websites.

SAMPLE

68 websites containing pet obesity content.

PROCEDURES

Websites were systematically retrieved with a search engine and predefined search terms and phrases. For each website, pet obesity information was scored by use of 2 established readability tools: the simple measure of gobbledygook (SMOG) index and Flesch-Kincaid (FK) readability test. A directed content analysis was conducted with a codebook that assessed the presence or absence of 103 variables across 5 main topics related to pet obesity on each website.

RESULTS

The mean reading grade levels determined with the SMOG index and FK readability test were 16.61 and 9.07, respectively. Instructions for weight measurement and body condition scoring were found infrequently, as were nonmodifiable risk factors. There was a greater focus on addressing obesity through dietary changes than through increasing physical activity. Few websites recommended regular follow-up appointments with veterinarians. Weight management information and the emphasis on owners' commitment to achieve their pet's weight loss targets differed among dog- and cat-focused websites.

CONCLUSIONS AND CLINICAL RELEVANCE

Results indicated that pet obesity information on the studied websites was largely inaccessible to pet owners owing to the associated high reading grade levels. Readers of that information would benefit from clarification of information gaps along with provision of guidance regarding navigating online information and counseling on the importance of nutritional and dietary reassessments for individual pets performed by veterinarians.

Partners in Sickness and in Health? Relationship-Centered Veterinary Care and Self-Educated Pet Owners in Germany: A Structural Equation Model

In recent years, the web has become a widely used source for health information. Pet owners seem to respond to the supply of medical information on the Internet by increasing their self-education. However, after more than a decade of the digital revolution, little is known about the Internet's impact on the veterinarian-pet owner relationship. Recent research has raised concerns regarding the increase in self-education among pet owners. However, reasons suggest that the Internet might be a valuable source of pet-owner education for veterinarians. In particular, relationship-centered approaches of care might benefit from the information provided. Our study aimed to determine the perception of German veterinarians with regard to pet owners' self-education on different aspects of veterinary care. An online survey was conducted for German veterinarians from November 2016 to June 2017. Data were analyzed using exploratory factor analysis and structural equation modeling. Within the structural equation model, we evaluated how the veterinarians' attitude toward relationship-centered care might affect the evaluation of pet owners' self-education. A total of 585 valid questionnaires were completed. The majority of veterinarians (83.6%) welcomed the principles of shared decision-making. Practically, all veterinarians reported a noticeable increase in pet owners' self-education within the last few years. Perceptions on self-education's impacts on veterinary practice varied among the participants. A beneficial impact of self-education was reported regarding the general quality of veterinary care and quality of follow-up care. Most concerns were related to a negative impact on the veterinarian-pet owner relationship and the pet owners' demands on the veterinarians' work after self-education. Moreover, many participants were afraid that unfiltered information may unsettle pet owners and, therefore, advised them against self-education. The structural equation model confirmed the hypothesis that a veterinarian's positive attitude toward shared decision-making, empathic behavior, and his/her evaluation of self-education were associated. Therefore, we concluded that while there are beneficial potentials, there seem to be barriers that prevent the effective use of the Internet as a supportive medium in veterinary care. Further research and training are needed to enable the use of the Internet as an ancillary medium.

Veterinary allergy information has lower health readability than human allergy information: a comparative analysis of allergy education materials for pets and people

BACKGROUND

Pet owners frequently consult online sources of veterinary health information. However, there are limited data on the readability of these resources and whether the readability is appropriate for pet owner education levels.

OBJECTIVES

To evaluate the education level of the US pet-owning population, and determine the readability of pet allergy information and compare the readability of online pet allergy information with online human allergy information.

ANIMALS/SUBJECTS

A subpopulation of 4,933 adults, representative of a population of 208,525,282, answering National Health and Nutrition Examination Survey (NHANES) demographic and pet questions. Allergy information in 54 articles (28 veterinary, 26 human) from six health websites (three veterinary, three human).

METHODS AND MATERIALS

An analysis was performed on 10,294 NHANES questionnaire responses to identify the subpopulation of 4,933 pet-owning adults. Flesch Reading Ease Scores and Flesch-Kincaid Grade Level Scores were calculated on the pet and human allergy information to evaluate readability.

RESULTS

The age-adjusted prevalence of high school graduation was higher for adults with pets (85.8 ± 1.33%) compared to adults without pets (78.5 ± 1.5%, P < 0.0001). Allergy information on veterinary websites was more difficult to read (P = 0.0052) and written at a higher grade level (P = 0.0047) than that on human health websites. The average veterinary health information readability score was 45.9 ± 8.7 ("difficult to read") and written at an 11^th grade level or above (range: 8^th grade-college level).

CONCLUSIONS

Allergy information on veterinary websites was less readable than allergy information on human health websites. Online veterinary information may be written at a reading level that is inappropriate for pet owners.

[Compliance of dog and cat owners in preventive health care]

Regular preventive health care is an essential part of our pets' health and quality of life. Preventive healthcare appointments can result in the prevention of disease development as well as lead to the detection and subsequent treatment of existing health problems at an early stage. In order to achieve optimal health care, the owners' compliance is of most importance in addition to the veterinary advice. However, dog and cat owners often seem to be unaware of the necessity for preventive health care appointments, often as a result of poor communication by the veterinarian. Educational conversations concerning the necessity of regular preventive health examinations are therefore essential. Communication is one of the key factors in building an owner-veterinarian relationship. Veterinarians are advised to invest sufficient time for communication, be aware of their verbal and non-verbal statements, and enable the owner to participate in treatment decisions. Older animals are presented less often for preventive health care appointments than younger animals, although the prevalence of age-related and chronic diseases increases with age. Owners should therefore be informed on the fact that early detection and treatment of these diseases increases their animals' health and survival. Cats are seen less frequently in preventive health care than dogs; many owners are not aware of the characteristics of cats tending to hide signs of disease. Another reason lies in the fact that many cats are stressed by being captured and transported in addition to the visit in the veterinary practice itself. Veterinarians therefore should educate cat owners concerning stress-reducing transportation measures and design their practice in a more cat-friendly fashion. Compliance can also be influenced positively by appropriate practice management, such as offering monthly instalment payments, establishing annual preventive care plans, as well as regular re-scheduling strategies. In addition to enhancing the animals' health, this can also result in increased owner satisfaction.

Readability of consent forms in veterinary clinical research

Background

“Readability” of consent forms is vital to the informed consent process. The average human hospital consent form is written at a 10th grade reading level, whereas the average American adult reads at an 8th grade level. Limited information currently exists regarding the readability of veterinary general medical or clinical research consent forms.

Hypothesis/Objectives

The goal of this study was to assess the readability of veterinary clinical trial consent forms from a group of veterinary referral centers recently involved in a working group focused on veterinary clinical trial review and consent. We hypothesized that consent forms would not be optimized for client comprehension and would be written above the National Institutes of Health‐recommended 6th grade reading level.

Animals

None.

Methods

This was a prospective study assessing a convenience sample of veterinary clinical trial consent forms. Readability was assessed using 3 methods: the Flesch‐Kincaid (F‐K) Grade Level, Flesch Reading Ease Score (FRES), and the Readability Test Tool (RTT). Results were reported as mean (±SD) and compared across specialties.

Results

Fifty‐three consent forms were evaluated. Mean FRES was 37.5 ± 6.0 (target 60 or higher). Mean F‐K Grade Level was 13.0 ± 1.2 and mean RTT grade level was 12.75 ± 1.1 (target 6.0 or lower). There was substantial agreement between F‐K and RTT grade level scores (intraclass correlation coefficient 0.8).

Conclusions and Clinical Importance

No form evaluated met current health literacy recommendations for readability. A simple and readily available F‐K Microsoft‐based approach for evaluating grade level was in substantial agreement with other methods, suggesting that this approach might be sufficient for use by clinicians and administrators drafting forms for future studies.

Using readability software to enhance the health literacy of equine veterinary clients: An analysis of 17 American Association of Equine Practitioners' newsletter and website articles

BACKGROUND

Veterinarians often provide supplemental healthcare information to horse owners via newsletters and website articles. However, articles written above the reading level of the intended audience contributes to misunderstanding. To ensure that the text in equine healthcare articles and brochures is consistent with the literacy of clients, veterinarians can adopt guidelines set forth by the National Institutes of Health (NIH) and the American Medical Association (AMA) for a target 6th grade readability level.

OBJECTIVES

The goal of this study was to evaluate the readability levels of a sample of American Association of Equine Practitioners' (AAEP) newsletter and website articles prepared expressly for veterinarians to download and share with their clients. Examples from these handouts are used to illustrate principles and techniques veterinary professionals can use to align their writing with the literacy of their intended audience.

STUDY DESIGN

Software-based readability analysis of 17 AAEP newsletter and website articles.

METHODS

A free online readability calculator was used to generate a consensus grade level readability score for 17 downloadable AAEP veterinary newsletter and website articles.

RESULTS

Sixteen of 17 articles were written above the recommended 6th grade reading level.

MAIN LIMITATIONS

We propose that a 6th grade readability level, as set forth by the AMA, is a reasonable target for the diverse population that makes up veterinary clients; however, there is currently no research that establishes this target for veterinary clients and the American Veterinary Medical Association (AVMA) has yet to issue a consensus statement on the subject.

CONCLUSIONS

Awareness of the issue of client literacy and use of tools such as readability analysis software can help veterinarians provide clients with 'easy-to-read' written materials that deliver a message that clients can comprehend, thus improving their health literacy and empowering them as partners in the veterinary-client relationship.

Analysis of Final Year Veterinary Students' Telephone Communication Skills at a Veterinary Teaching Hospital

Client communication is a core clinical skill that is taught as part of the required curriculum at many veterinary colleges. Although much client communication occurs face-to-face, telephone communication is used to provide patient updates, relay results of diagnostic tests, and check on discharged patients. This research explored fourth year veterinary medical students' telephone communication skills. We recorded and analyzed the transcripts of 25 calls students made to clients of three different services in the Veterinary Teaching Hospital. Additionally, we explored the perspectives of veterinary educators by distributing a survey to university faculty and house officers (n = 57). Results indicate that students excelled at identifying the patient and purpose of the call and incorporating professional language and clear explanations. They require development in providing structure and incorporating core communication skills. Compared with our survey results, the student findings are at odds with clinicians' expectations of students' communication abilities. We conclude that additional training is required to familiarize students with expectations regarding telephone communication, including reviewing the case thoroughly, preparing to answer questions and provide explanations, following organizational protocol, and incorporating open ended questions, reflective listening, and empathy. This data will inform design, and help to measure the impact, of telephone communication education and training that will be incorporated into the existing veterinary communication curriculum.