Assessing reading levels of health information: uses and limitations of flesch formula

Abstract

FRE and FKRGL assign a grade level by measuring semantic and syntactic difficulty. They serve as a simple tool that provides some information about the potential literacy difficulty of written health information. However, health information documents often involve complex medical words and may incorporate pictures and tables to improve the legibility. In their assessments, FRE and FKRGL do not take into account (1) document factors (layout, pictures and charts, color, font, spacing, legibility, and grammar), (2) person factors (education level, comprehension, health literacy, motivation, prior knowledge, information needs, anxiety levels), and (3) style of writing (cultural sensitivity, comprehensiveness, and appropriateness), and thus, inadequately assess reading level. New readability measures incorporate pictures and use complex algorithms to assess reading level but are only moderately used in health-care research and not in clinical practice. Future research needs to develop generic and disease-specific readability measures to evaluate comprehension of a written document based on individuals' literacy levels, cultural background, and knowledge of disease.

Information Literacy of Nurses in Shaanxi Province, China: A Cross-sectional Descriptive and Multicentre Survey

“…On the other hand, nurses should strengthen the accumulation of information literacy in clinical nursing work which is consistent with Jindal's [44] ndings that there was an internal relationship between nurses' information literacy and reading behavior. Nurses should keep good reading habits in spare time, especially reading more about the advanced medical literature.…”

eHealth tool for patients with abdominal aortic aneurysm: development and initial evaluation

“…Patients’ ability to comprehend and make sense of information is not always a result of readability but can also be affected by familiarity with the vocabulary in a specific context, cultural background, motivation and anxiety levels . Furthermore, FRES and FKGL do not include illustrations and user interphase in the readability assessments, factors that may affect end‐users’ ability to assimilate information . In spite of these limitations to the FRES and FKGL, these instruments can provide guidance in the development of educational texts.…”

“…The Flesch–Kincaid Grade Level (FKGL) formula is well established and based on the FRE parameters. FKGL produces a score that estimates the grade level (years of education) required to fully understand the text . Health‐related organisations recommend a FKGL of 8 or lower for patient education materials .…”

What is the quality of drug safety information for patients: An analysis of REMS educational materials

“…The appropriate method in readability determination is to include nonsentences in the analysis. Since bullet points and headings usually consist of a few words, analyzing the text without modifying nonsentences may artificially lower the readability scores . Second, the 70% cutoff for the PEMAT scale scores for understandability and actionability has limited empirical basis .…”