Not So Patient Friendly: Patient Education Materials in Rheumatology and Internal Medicine Fall Short of Nationally Recommended Readability Benchmarks in the United States.

Abstract

Patient education materials (PEMs) can help promote health literacy (HL) among patients. However, their use depends on how easily patients can read and comprehend the information. Several national organizations recommend that text be written at a sixth- to eighth-grade level. Herein, we assess and compare the readability and comprehension (RC) of PEMs for rheumatologic and general medical conditions. We used six standardized RC metrics including the well-known Flesch Kincaid Readability Ease and Flesch Kincaid Grade Level to evaluate the RC of PEMs (n = 175) on the American College of Rheumatology (ACR) (n = 86) and the Journal of the American Medical Association (JAMA) (n = 89) websites. Two-sided t-tests compared RC between the two resources. P ≤ 0.05 was considered significant. On all six standardized metrics used, the mean reading level of all PEMs ranged from high school to college level. For example, the mean ± SD of Simple Measure of Gobbledygook Index was 10.89 ± 1.88, corresponding to a 10th-grade education, and the mean ± SD of Gunning Fog Score was 14.39 ± 2.49, corresponding to a 14th-grade education required to understand the text. JAMA PEMs had significantly more difficult RC levels compared to ACR PEMs based on five of the six indices used (P < 0.05). PEMs available on the ACR and JAMA websites do not align with national organizations' recommendations for RC levels. To enhance patient understanding and promote HL, existing PEMs must be modified in line with these recommendations.