Return-Path: <nifl-health@literacy.nifl.gov> Received: from literacy (localhost [127.0.0.1]) by literacy.nifl.gov (8.9.3/8.9.0.Beta5/980425bjb) with SMTP id HAA29445; Fri, 18 Feb 2000 07:05:20 -0500 (EST) Date: Fri, 18 Feb 2000 07:05:20 -0500 (EST) Message-Id: <20000218120202.99092.qmail@hotmail.com> Errors-To: listowner@literacy.nifl.gov Reply-To: nifl-health@literacy.nifl.gov Originator: nifl-health@literacy.nifl.gov Sender: nifl-health@literacy.nifl.gov Precedence: bulk From: "Roger Pebody" <roger_pebody@hotmail.com> To: Multiple recipients of list <nifl-health@literacy.nifl.gov> Subject: [NIFL-HEALTH:2184] Re: JAMA's Patient Page fails readability test X-Listprocessor-Version: 6.0c -- ListProcessor by Anastasios Kotsikonas Content-Type: text/plain; format=flowed Status: OR I found this piece interesting, but the recommendations are somewhat dishonest. Two are straightforward and are justified by the results of the analysis - reduce sentence length, and use plain english. But I'd be grateful if someone can explain how the information on readability justifies these two: (a) 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. (b) Apply patient education and behavior change theory to increase the likely influence of the information on patients' behavior and health. These two seem to be more about the author's personal opinion of the degree to which health education should use the most persuasive means possible for what is assumed to be a worthy end - and nothing about readability. The example sentence used in (a) is indeed a wordy one, but I would argue that the principle of stating where and how knowledge comes from is an important one. To do so begins to equip patients with the means to understand and question the views of physicians. To simply state "this is the truth" in fact reinforces the authority of the speaker, as if s/he simply knows BECAUSE of his/her status as a physician (rather than because research has demonstrated something). The recommendation (b) does in fact suggest that physicians DO know best and should simply strive to find the most effective techniques for getting the patient to "do best" - something quite different from true empowerment. These are important and debatable points, and depending on the health issue (specifically how certain medical knowledge is about it), my own opinion does change about the balance between empowerment and persuasion. However the key thing to say is that those two recommendations were in no way justified by the readability analysis that was done. yours, Roger Pebody Health First London, UK >From: Bob Pyke Jr <repyke@akron.infi.net> >Reply-To: nifl-health@literacy.nifl.gov >To: Multiple recipients of list <nifl-health@literacy.nifl.gov> >Subject: [NIFL-HEALTH:2178] JAMA's Patient Page fails readability test >Date: Thu, 17 Feb 2000 16:17:25 -0500 (EST) > >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 to >read the material. For example 12.47 = reading skill of the average college >freshman. > > ______________________________________________________ Get Your Private, Free Email at http://www.hotmail.com
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