IntroductionDespite the first goal of the 2010 National Action Plan to Improve Health Literacy, the literacy demands of much health information exceeds the reading skills of most US adults. The objective of this study was to assess the health literacy level of publicly available patient education materials for people with sickle cell disease (SCD).MethodsWe used 5 validated tools to evaluate 9 print and 4 online patient education materials: the simple measure of gobbledygook (SMOG) to assess reading grade level, the Peter Mosenthal and Irwin Kirsch readability formula (PMOSE/IKIRSCH) to assess structure and density, the Patient Education Materials Assessment Tool (PEMAT) to assess actionability (how well readers will know what to do after reading the material) and understandability, the Centers for Disease Control and Prevention’s (CDC’s) Clear Communication Index (Index) to obtain a comprehensive literacy demand score, and the Printed Cancer Education Materials for African Americans Cultural Sensitivity Assessment Tool.ResultsMaterials’ scores reflected high reading levels ranging from 8th grade to 12th grade, appropriate (low) structural demand, and low actionability relative to understandability. CDC suggests that an appropriate Index score should fall in or above the 90th percentile. The scores yielded by materials evaluated in this assessment ranged from the 44th to the 76th percentiles. Eight of the 13 materials scored within the acceptable range for cultural sensitivity.ConclusionReading levels of available patient education materials exceed the documented average literacy level of the US adult population. Health literacy demands should be a key consideration in the revision and development of patient education materials for people with SCD.

Since 1923, more than fifty countries have improved access to dental care by allowing midlevel providers-frequently called dental therapists-to offer preventive and restorative treatment, primarily in the public sector. A growing body of research has found that dental therapists provide high-quality, cost-effective care and improve access to care for underserved populations. This article explores the evolution of the dental therapy movement in the United States, where multiple barriers to oral health care have created persistent unmet needs. We examine developments since the 1940s that have led to the authorization of dental therapists in parts of Alaska and the states of Minnesota, Maine, and Vermont; and the approval of national accreditation standards for dental therapy training programs by dental educators. We also show how dental therapists might fit within a health care system that is being transformed.