Readability of clinical letters sent from a young people's department

Predicting the readability of physicians' secure messages to improve health communication using novel linguistic features: Findings from the ECLIPPSE study

Background

Low literacy skills impact important aspects of communication, including health-related information exchanges. Unsuccessful communication on the part of physician or patient contributes to lower quality of care, is associated with poorer chronic disease control, jeopardizes patient safety and can lead to unfavorable healthcare utilization patterns. To date, very little research has focused on digital communication between physicians and patients, such as secure messages sent via electronic patient portals.

Method

The purpose of the current study is to develop an automated readability formula to better understand what elements of physicians' digital messages make them more or less difficult to understand. The formula is developed using advanced natural language processing (NLP) to predict human ratings of physician text difficulty.

Results

The results indicate that NLP indices that capture a diverse set of linguistic features predict the difficulty of physician messages better than classic readability tools such as Flesch Kincaid Grade Level. Our results also provide information about the textual features that best explain text readability.

Conclusion

Implications for how the readability formula could provide feedback to physicians to improve digital health communication by promoting linguistic concordance between physician and patient are discussed.

Readability of statutory letters issued by Forensic Services in NHS Scotland

Written material provides an important way for services to communicate with patients. Those who require detention under the Mental Health (Care and Treatment) (Scotland) Act 2003 or the Criminal Procedure (Scotland) Act 1995 in Forensic Services within NHS Scotland are usually issued with statutory letters that contain information about their detention. To ensure that letters are readable by patients, templates of such letters were obtained from all health boards in Scotland and analysed using readability indices. Response rate across health boards was 92% (12/13). The results were compared according to readability threshold, types of letters, legal orders and health boards. Between 11.9% and 57.6% of issued letters were found not to be readable. It was also found that there were significant differences in readability across health boards. The study modified the original template of letters, and post-modification readability significantly improved. It may be helpful for patients if NHS Scotland issued such letters with improved readability or introduced a standard template.