Assessment of Commonly Available Education Materials in Heart Failure Clinics

Abstract

Background Health literacy (HL) is an established independent predictor of cardiovascular outcomes. Approximately 90 million Americans have limited HL and read at ≤ 5th grade-level. Therefore, we sought to determine the suitability and readability level of common cardiovascular patient education materials (PEM) related to heart failure and heart-healthy lifestyle. Methods and Results The suitability and readability of written PEMs were assessed using the suitability assessment of materials (SAM) and Fry readability formula. The SAM criteria are comprised of the following categories: message content, text appearance, visuals, and layout and design. We obtained a convenience sample of 18 English-written cardiovascular PEMs freely available from major health organizations. Two reviewers independently appraised the PEMs. Final suitability scores ranged from 12 to 87%. Readability levels ranged between 3rd and 15th grade-level; the average readability level was 8th grade. Ninety-four percent of the PEMs were rated either superior or adequate on text appearance, but ≥ 50% of the PEMs were rated inadequate on each of the other categories of the SAM criteria. Only two (11%) PEMs had the optimum suitability score of ≥ 70% and ≤ 5th grade readability level suitable for populations with limited HL. Conclusions Commonly available cardiovascular PEMs used by some major healthcare institutions are not suitable for the average American patient. The true prevalence of suboptimal PEMs needs to be determined as it potentially negatively impacts optimal healthcare delivery and outcomes.

Health Literacy Predicts Morbidity and Mortality in Rural Patients With Heart Failure

“…Prevailing evidence indicates that most heart failure patient education materials in hospitals and clinics do not meet criteria that make their content appropriate for most patients because of lack of understandability. [38] This finding suggests that all heart failure patient education materials need to be assessed for relevancy to those with low health literacy and revised, if needed, to make them useful. There are however, no studies in which revision of commonly used materials has been tested directly.…”

Assessment of Printed Patient-Educational Materials for Chronic Kidney Disease

“…These results are similar to scores that have been published from evaluations of PEMs for other medical conditions, suggesting high availability of health-related PEMs that are decent or good-enough, but relatively few that are outstanding. [15–17,20,21]…”

“…[14] This instrument was originally developed to evaluate the appropriateness and presentation of printed PEMs and has been adapted and validated for evaluation of health-related PEMs for many diseases including congestive heart failure,[15] hypertension,[16] and stroke. [17] The adapted SAM used in these analyses consisted of 26 items grouped into 4 different domains: message content (including learning stimulation and cultural suitability), text appearance/typography, visuals/graphics, and layout/design.…”

Readability of Patient Education Materials Available at the Point of Care

“…In 2004 Wallace et al 13 found that only 7% of the American Academy of Family Practice's PEMS were written below an 8 th grade reading level. Various subspecialties such as cardiology 14,15 , infectious disease, 16 plastic surgery, 17 dermatology, 18 orthopedics, 19,20 palliative care, 21 oncology 22,23 and obstetrics and gynecology 24,25 have studied the readability of the PEMs utilized in their fields, and findings consistently indicate that 9 th -12 th grade reading levels are necessary to read and comprehend these documents.…”