Readability of Infection-Related Patient Education Materials

Authors:
Krislynn Mueck, Lillian S Kao, Parker Towns, Stephanie Martinez Ugarte, William Rieger

Body of Abstract:
Background: Patient education materials (PEMs) are intended to increase patient understanding of their condition and to reduce readmissions. To maximize accessibility, PEMs should be readable at a grade level of 6 or below. Little information is available on the variation of PEMs across hospital types or infectious conditions. We hypothesize that the mean readability of infection-related PEMs does not meet the goal grade level of 6 or below.
Methods: PEMs were obtained from a tertiary referral center and a safety net hospital by searching existing electronic medical record-linked repositories with key words related to nosocomial infections: “infection,” “surgical site infection,” “urinary tract infection,” “pneumonia,” and “central line associate blood stream infection.” PEMs that did not explain the definition, prevention, or treatment of infections were excluded. Each PEM’s readability was assessed with 3 well-validated measures: Flesch Kincaid Grade Level (FKGL), Simple Measure of Gobbledygook (SMOG), and FORd-CAylor-STicht (FORCAST); each is based on a separate syntactical formula with lower grades indicating a text is easier to read. These measures were compared across hospitals systems, readability measure, and infection type. Descriptive analysis, univariate, and multivariable analysis were performed.
Results: Of 91 PEMs, 49 (53%) were from the safety net hospital; 13 (14%) focused on SSIs and 11 (12%) were designated as “easy to read” from the safety net hospital. The mean readability grade level for infection-related PEMS across all measures was 8.3 (SD 2.12) though using the FKGL measure alone demonstrated a lower median readability level of 5.8 (IQR 5.64-5.96). The different readability measures differed significantly in their scoring (X2 of 197, p<0.001), with the FKGL estimating the lowest grade level in 2-way and 3-way comparisons (p<0.001). “Easy-to-read” PEMs had a lower mean readability score of 7.2 (SD 2.05), compared to others at 8.46 (SD 2.05). PEMs from the tertiary referral center and safety net hospital demonstrated similar mean readability scores with a median of 8.35 (SD 1.99) and 8.26 (SD 2.23), respectively without a significant difference (t= -0.36, 95% CI -0.6 – 0.33, p=0.361). Conclusion: The readability of infection-related PEMs was similar across hospital settings and specific infections but differed based on assessment tool used. Although "easy-to-read" PEMs had lower readability grade level scores, consistent with their label, opportunity still exists across all infection-related PEMs for improvement. Further study is needed to determine if improving the readability of infection-related PEMs is associated with better understanding among patients with low health literacy.