Why health information remains hard to read: The curse of knowledge as a structural barrier to patient education materials.

Abstract

Despite extensive guidelines, the readability of health information remains poor. This study addresses a persistent explanatory gap by shifting the focus from recipient-side limitations to producer-side cognitive frameworks, specifically the "curse of knowledge." Using a critical interpretive synthesis and inference to the best explanation, we reexamined recurring patterns of low readability identified in the existing literature (e.g., use of jargon, abstract statistics, and insufficient procedural context). We then comparatively assessed the explanatory scope of the curse of knowledge relative to traditional frameworks such as health literacy and the information deficit model. Existing frameworks explain why patients struggle to understand health information but provide limited insight into why experts consistently produce complex and inaccessible content. Our analysis suggests that the curse of knowledge-experts' structurally constrained inability to simulate a pre-knowledge state-operates as a central, generative mechanism alongside institutional and normative factors underlying this persistence. This manifests in the misattribution of obviousness to specialist terminology and concepts and the invisibility of tacit knowledge in procedural guidance. We also identify a paradox whereby experts, motivated by professional responsibility for accuracy, accumulate information and inadvertently increase recipients' cognitive load. Persistent limited readability of health information is not merely a technical or stylistic failure but a structural phenomenon rooted in the cognitive constraints of expertise. Therefore, readability challenges should be repositioned from individual efforts to the design of organizational information production systems. Improving readability requires a systemic redesign rather than isolated linguistic adjustments. Key strategies include: (1) institutionalizing patient and public involvement (PPI) as an external cognitive audit that surfaces experts' implicit assumptions, (2) implementing standardized templates for numerical and procedural information to reduce reliance on individual expert judgment, and (3) leveraging AI as a cognitive bridge to retranslate specialized knowledge into lay-accessible frameworks.