The readability of paediatric patient information materials: Are families satisfied with our handouts and brochures?

Abstract

Objectives: To determine the grade reading level of eight easily available patient handouts for parents of children with otitis media, to calculate the internal reliability and consistency of seven readability tests, and to explore the relationship between the grade reading level of a handout and parent satisfaction.

Methods: Eight patient handouts developed for the parents of children with otitis media were collected, stripped of all formatting and analyzed using seven different readability formulas. Cronbach's alpha and intraclass correlation coefficients (ICC) were calculated to determine the internal reliability and consistency of the seven formulas. Parents were surveyed on their satisfaction with three of the handouts, and their responses were compared with the handouts' reading grade levels using ANOVA.

Results: Only four of the eight handouts had a mean grade 8 or less reading level. None of the handouts had a grade 5 or less reading level. Cronbach's alpha was calculated to be 0.990, single measures ICC 0.931 and average class ICC 0.990, indicating extremely high internal reliability/consistency among the different readability tests. One-way ANOVA showed no evidence of a significant difference in parental satisfaction with the three handouts tested, despite their different grade reading levels (grades 7, 10 and 14) (P=0.24).

Conclusions: While many readability formulas are available, the high internal reliability/consistency among them indicates that only one formula needs to be used to assess readability (eg, the Flesch-Kincaid Grade Level formula). Because there was no difference in parental satisfaction among three patient handouts that had widely different grade reading levels, studies should explore whether writing patient information materials explicitly to achieve low grade reading level scores is a worthwhile strategy.

Keywords: Comprehension; Informatics; Literacy; Patient education handout; Readability.

Figures

Figure 1)

Cluster bar graph of reading grade level versus patient information handout. Each bar represents a different readability test. AAP American Academy of Pediatrics; ARI Automated Readability Index; CPS Canadian Paediatric Society; NIH National Institutes of Health; SMOG Simplified Measure of Gobbledygook

Figure 2)

Box plot of the usefulness (mm) of three selected patient information handouts. Empty circles represent outliers