Readability of patient handout materials in a nationwide sample of alcohol and drug abuse treatment programs

Evaluation of the usability, content, readability and cultural appropriateness of online alcohol and other drugs resources for Aboriginal and Torres Strait Islander Peoples in New South Wales, Australia

OBJECTIVES

This study aimed to analyse the usability, content, readability and cultural appropriateness of alcohol and other drugs (AODs) resources for Aboriginal and Torres Strait Islander Peoples in New South Wales (NSW), Australia.

OUTCOME MEASURES

The content of 30 AOD resources for Aboriginal and Torres Strait Islander Peoples was analysed according to the following criteria: general characteristics; elements of graphical design and written communication; thoroughness and content; readability (Flesch-Kincaid grade level (FKGL), Gunning Fog index (Fog), Simplified Measure of Gobbledygook and Flesch Reading Ease); and cultural appropriateness.

RESULTS

Most resources displayed good usability, depicted by the use of headings and subheadings (n=27), superior writing style (n=19), relevant visuals (n=19) and use of colour support (n=30). However, some resources used at least one professional jargon (n=13), and many did not provide any peer-reviewed references (n=22). During content analysis, 12 resources were categorised into the alcohol group and 18 resources in the other drugs group. Impact of alcohol during pregnancy and breast feeding (n=12) was the most common included topics in the resources related to alcohol, while the physical impact of drugs (n=15) was the most discussed topics among the other drugs group. Based on the FKGL readability score, 83% of resources met the recommended reading grade level of 6-8 by NSW Health. Many resources (n=21) met at least half of the cultural appropriateness elements of interest. However, less than one-third were developed in collaboration with the local community (n=9), used local terms (n=5), targeted the local community (n=3), included an Aboriginal voice (n=2) and addressed the underlying cause (n=1).

CONCLUSIONS

Many AOD resources are developed specifically for Aboriginal and Torres Strait Islander Peoples, but their usability, content and readability differed, and they were not culturally appropriate for all communities. Development of a standardised protocol for resource development is suggested.

"It is not just about the alcohol": service users' views about individualised and standardised clinical assessment in a therapeutic community for alcohol dependence

Background

The involvement of service users in health care provision in general, and specifically in substance use disorder treatment, is of growing importance. This paper explores the views of patients in a therapeutic community for alcohol dependence about clinical assessment, including general aspects about the evaluation process, and the specific characteristics of four measures: two individualised and two standardised.

Methods

A focus group was conducted and data were analysed using a framework synthesis approach.

Results

Service users welcomed the experience of clinical assessment, particularly when conducted by therapists. The duration of the evaluation process was seen as satisfactory and most of its contents were regarded as relevant for their population. Regarding the evaluation measures, patients diverged in their preferences for delivery formats (self-report vs. interview). Service users enjoyed the freedom given by individualised measures to discuss topics of their own choosing. However, they felt that part of the standardised questions were difficult to answer, inadequate (e.g. quantification of health status in 0–20 points) and sensitive (e.g. suicide-related issues), particularly for pre-treatment assessments.

Conclusions

Patients perceived clinical assessment as helpful for their therapeutic journey, including the opportunity to reflect about their problems, either related or unrelated to alcohol use. Our study suggests that patients prefer to have evaluation protocols administered by therapists, and that measures should ideally be flexible in their formats to accommodate for patient preferences and needs during the evaluation.

Readability of Educational Materials to Support Parent Sexual Communication With Their Children and Adolescents

Sexual communication is a principal means of transmitting sexual values, expectations, and knowledge from parents to their children and adolescents. Many parents seek information and guidance to support talking with their children about sex and sexuality. Parent education materials can deliver this guidance but must use appropriate readability levels to facilitate comprehension and motivation. This study appraised the readability of educational materials to support parent sexual communication with their children. Fifty brochures, pamphlets, and booklets were analyzed using the Flesch-Kincaid, Gunning Fog, and Simple Measure of Gobbledygook (SMOG) index methods. Mean readability grade-level scores were 8.3 (range = 4.5-12.8), 9.7 (range = 5.5-14.9), and 10.1 (range = 6.7-13.9), respectively. Informed by National Institutes of Health-recommended 6th to 7th grade levels and American Medical Association-recommended 5th to 6th grade levels, percentages falling at or below the 7.0 grade level were calculated as 38%, 12%, and 2% and those falling at or below the 6.0 grade level were calculated as 12%, 2%, and 0% based on the Flesch-Kincaid, Gunning Fog, and SMOG methods, respectively. These analyses indicate that the majority of educational materials available online to support parents' communication with their children about sex and sexuality do not meet the needs of many or most parents. Efforts to improve the accessibility of these materials are warranted.

Measuring Accessibility of Written Communication for Parents of Students With Disabilities

Effective communication is essential for successful school–family partnerships. Written communication is most common due to the efficiency of written documents, but challenges include assuring the information disseminated to parents is accessible based on readability, clarity, complexity, and structure particularly for parents of students with disabilities and parents with low levels of literacy. The purpose of this review was to understand to what extent written communications intended to inform parents, particularly parents of students with disabilities, were accessible given recommendations regarding appropriate readability levels and document structure. Results from eight studies, published over 30 years, evaluated 461 documents and showed divergent trends in recommended and actual reading levels where written communication became less accessible over time. Recommended readability levels ranged from 5th to below 9th grade, yet actual readability levels were almost 11th grade on average. Implications specific to the readability and accessibility of written communication are discussed.

Readability and comprehension of self-report binge eating measures

The validity of self-report binge eating instruments among individuals with limited literacy is uncertain. This study aims to evaluate reading grade level and multiple domains of comprehension of 13 commonly used self-report assessments of binge eating for use in low-literacy populations. We evaluated self-report binge eating measures with respect to reading grade levels, measure length, formatting and linguistic problems.

RESULTS

All measures were written at a reading grade level higher than is recommended for patient materials (above the 5th to 6th grade level), and contained several challenging elements related to comprehension. Correlational analyses suggested that readability and comprehension elements were distinct contributors to measure difficulty. Individuals with binge eating who have low levels of educational attainment or limited literacy are often underrepresented in measure validation studies. Validity of measures and accurate assessment of symptoms depend on an individual's ability to read and comprehend instructions and items, and these may be compromised in populations with lower levels of literacy.

Readability levels of individualized family service plans

This descriptive study examined the readability levels of Individualized Family Service Plans (IFSPs). The readability of 85 de-identified IFSP documents developed by seven agencies that serve families and children enrolled in a county early intervention program was analyzed using Flesch Kincaid grade levels and Flesch reading ease scores. The average Flesch Kincaid grade level of the entire IFSP documents was 8.0, indicating that the text was written at the 8th grade reading level. The Flesch reading ease mean score for all of the IFSP documents was 58.6, indicating that the text was written at a moderate level of ease to read. The highest Flesch Kincaid grade level scores and lowest reading ease scores were found in sections that require descriptive documentation of IFSP activities and ideas, justification for services provided outside of the natural environment, the way in which outcomes would be met, and a description of the activities provided in the natural environment. The lowest Flesch Kincaid grade level and the highest reading ease level were found in the section involving gross motor development. There were no agencies that prepared IFSP documents at or below the recommended 5th grade reading level. The findings from this study indicated that on average the entire IFSP documents and most sections of the documents were written above a 5th grade reading level. Overall there were no agencies that wrote the IFSP documents at or below the recommended 5th grade reading level. Analysis of readability levels when preparing IFSP documents is recommended to optimize accessibility and usability.

Readability of out-patient letters copied to patients: can patients understand what is written about them?

The National Health Service Plan of 2000 proposed that patients should receive a copy of all correspondence regarding their care. There is concern that the readability of patients' letters may not be appropriate for many patients.

Materials and methods:

This study determined readability scores for sequential letters written to general practitioners and copied to patients, following ENT consultations at the Royal United Hospital in Bath. Intervention involved educating clinicians in techniques to improve readability.

Results and analysis:

A total of 295 letters from eight clinicians were assessed in the pre-intervention phase. The mean Flesch reading ease score was 61.8 (standard deviation 8.7) and the mean Flesch–Kincaid reading grade was 9.0 (standard deviation 1.7). Re-audit analysed a further 301 letters. There was no significant change in the readability of the letters post-intervention.

Discussion:

It may not be feasible to present medical information intended for general practitioners in a way that is readable to most of the UK adult population.