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From: Sandra Smith <sandras@u.washington.edu>
To: Multiple recipients of list <nifl-health@literacy.nifl.gov>
Subject: [NIFL-HEALTH:2182] RE: JAMA's Patient Page fails readability test
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This article is from Prenatal Ed Update , the newsletter from
PrenatalEd.com http://www.prenataled.com/newsletters/v4n2/v4n2-2.htm.
SS
Sandra Smith, MPH, CHES
Health Education Specialist
University of Washington, Center for Health Education & Research
Clinical Instructor, School of Public Health, Health Services Dept
Editor, Beginnings: A Practical Guide Through Your Pregnancy
Editor, http://www.PrenatalEd.com
Mailing Address:
2821 2nd Ave #1601
Seattle WA 98121
206-441-7046
sandras@u.washington.edu
-----Original Message-----
From: Bob Pyke Jr [SMTP:repyke@akron.infi.net]
Sent: Thursday, February 17, 2000 1:19 PM
To: Multiple recipients of list
Subject: [NIFL-HEALTH:2178] JAMA's Patient Page fails readability
test
Fyi,
Bob Pyke Jr
JAMA's Patient Page fails readability test
JAMA--Journal of the American Medical Association-- recently
introduced
The Patient Page to increase doctor-patient communication on topics
important to health. JAMA says its weekly feature is "designed
specifically for
America's patients" and encourages doctors to copy and share the Page
with
patients. The AMA makes The Patient Page accessible to the public
online.
This is a good idea. Printed material can provide an opening for
discussion of
hard-to-talk-about topics and serve as a script for practitioners.
Patients can
take the same material home as a reminder and to share with
caregivers. We
wondered if The Patient Page would be a good resource for prenatal
care
providers, so we decided to evaluate the materials.
We chose alcohol as a test topic because it comes up first on the
public online
menu and it addresses a key message in prenatal education. We started
the
review by checking the readability level of the text. Readability is
only one of
many factors known to affect comprehension, but it is a deal breaker.
If the
materials exceed the literacy skills of intended readers, handing it
out becomes
an expensive gesture. We did a series of readability tests on the
Patient Page
entitled Do You Have a Drinking Problem..
Readability Testing Method
We analyzed the full text in three segments using Readability
Calculations
software from Micro Power & Light Co in Dallas, TX. We applied the
following formulas: Flesch Grade Level, Fog, SMOG, and the Extended
Fry
Scale. Each of these readability formulas produces a reasonable
estimate
--within a grade level-- of the educational achievement needed to
decipher the
words. Table 1 summarizes the readability scores.
Results
The Flesch formula may be most appropriate to this case since it is
designed to
evaluate adult materials and takes into account the fact that
conversational
writing is easier to read. The mean Flesch score for the three
sections of the
Patient Page is 12.47. This score shows that the information is
readable by
those with the reading skills of a college freshman. Since most
Americans read
three to five grades below their educational achievement, the Flesch
formula
suggests this information is suitable for the average college
graduate.
The mean SMOG score for this Patient Page is 13.37. SMOG stands for
simplified measure of gobbledygook. It predicts 90 to 100%
comprehension.
Like the Flesch formula, SMOG predicts that college level reading
skill is
required to understand the information.
The Fog formula is used primarily in education. In accord with the
other scales,
Fog predicts that The Patient Page requires a 15th grade reading
level.
The Extended Fry scale is the most widely used readability scale. It
is valid for
reading grade levels 1 through 17. In the JAMA alcohol information,
two
sections are off the Fry scale and the third section rates a 17th
grade reading
level.
Conclusion
As expected, the readability formulas produce slightly different but
reasonably
consistent results. You need a college education to understand the
Patient
Page on alcohol. Practitioners who use this Page as a model of
information
giving are likely to experience unsatisfying patient relations and
high levels of
non- compliance.
To improve this Patient Page:
Add periods to reduce sentence length to 10-15 words.
Use plain English. Say drugs instead of prescription medication.
Delete sentences that only reinforce the physician's dominant
position as
keeper of knowledge and power, e.g. A study in the April 14,
1999
issue of JAMA evaluated research studies from 1966 to the
present
to determine what medications are effective in treating adults
with
alcohol dependence.
Apply patient education and behavior change theory to increase
the
likely influence of the information on patients' behavior and
health.
Flesch Reading Ease Score for this article:
39.5, grade 11.7, Difficult
Reference:
Census Bureau - Education Statistics
http://www.census.gov/statab/www/part2.html#education
Doak, C.; Doak, L.; Root, J. (1996) Teaching Patients with Low
Literacy
Skills, Second Edition, Philadelphia: Lippincott. 1996
Shapiro, MC; Najiman, A; Change, J; Keeping, D; Morrison, J; Western,
JS.
(1983) Information control and the exercise of power in the
obstetrical
encounter. Soc Sci Med (17), 39-146. Abstract
http://www.prenataled.com/hpbib2.htm (#6.)
Effectiveness of Written Health Information ~Summary Literature
Review
http://www.prenataled.com/bibeff.htm
Table 1:
Readability ratings of The Patient Page
"Do You Have a Drinking Problem?" (JAMA
4/99)
Scale
*Score
Flesch Grade Level
12.47
SMOG
13.37
Fog
15.4
Extended Fry
17+
*Readability scores are expressed as school grades indicating the
skill level needed toread the material. For example 12.47 = reading
skill of the average college freshman.
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