Academic journal article Journal of the Medical Library Association

Computerized versus Hand-Scored Health Literacy Tools: A Comparison of Simple Measure of Gobbledygook (SMOG) and Flesch-Kincaid in Printed Patient Education Materials

Academic journal article Journal of the Medical Library Association

Computerized versus Hand-Scored Health Literacy Tools: A Comparison of Simple Measure of Gobbledygook (SMOG) and Flesch-Kincaid in Printed Patient Education Materials

Article excerpt

INTRODUCTION

Medical librarians have played a crucial role in patient education for nearly a century. References to terms such as bibliotherapy, social hygiene, and consumer health are easily found in the literature to give a historical perspective [1-3]. However, the role of the medical librarian today has expanded to become embedded in both the academic and medical setting. In some settings, librarians are a part of the patient safety and quality improvement teams, and in provision of patient-and-family centered information to patients [4, 5]. In many settings, nurses depend on medical librarians to teach them the art of evaluating health information for patient care [6]. Librarians also impact patient care by teaching health care providers how to evaluate patient education material and by providing services to determine if the reading grade level of material is appropriate for the patient population.

Printed patient education materials are important aspects in patients' recovery in that they reinforce verbal communication and vital care instructions that patients receive from health care providers [7]. Goal two of the US Office of Disease Prevention and Health Promotion's "National Action Plan to Improve Health Literacy" promotes changes in health care systems that "improve health information, communication, and informed decision-making" [8]. Distributing patient education materials that are comprehensible to all patients is essential to achieving this national goal.

Research has indicated that patient education materials influence patient compliance. Mundt and colleagues studied the impact of patient education on patients' adherence to instructions and medication regimes. They found that the compliance rate for patients who completed the follow-up assessments were higher than for those who received normal care [9]. Another study concluded that patients who received educational materials on their aromatase inhibitor treatment for a specific form of breast cancer had a higher rate of compliance to physician recommendations for treatment than those who did not receive any educational material [10]. Lastly, a longitudinal study on asthma medication adherence, in which patients received an audiotape and educational booklet, determined that this intervention had a beneficial effect on asthma medication adherence over time [11].

Given the impact of patient education materials on patient compliance, the grade level at which the materials are written is crucial. The average American reads at the eighth- to ninth-grade level, while one of five reads at the fifth-grade level [12]. The National Institute of Health (NIH) and the American Medical Association (AMA) both recommend patient education materials be written at or below a sixth-grade reading level [13, 14], while the Joint Commission [15] recommends materials be written at a fifth-grade level or lower. Despite these recommendations, patient education materials continue to be written at grade levels beyond the average American's literacy skills [16].

Numerous readability formulas are available when assessing reading grade level of patient education materials. Simple Measure of Gobbledygook (SMOG) is an assessment tool that utilizes a hand-scored method. SMOG allows an evaluator to determine the grade level of patient education by counting 10 sentences at the beginning, the middle, and the end of a document. The evaluator counts every word of 3 or more syllables in those 30 sentences [17]. The number of syllables in each section is then totaled and converted to a corresponding reading grade level score [18]. Previous research suggests that SMOG is a useful tool when completing the reading grade level and predicts 100% comprehension [19].

The computerized Flesch-Kincaid (F-K) grade level method is another commonly used reading grade level assessment tool. F-K grade level is added to Microsoft Word through the Spelling and Grammar tool, in which readability statistics are displayed. …

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