Beyond Reading Level: A Systematic Review of the Suitability of Cancer Education Print and Web-based Materials

Abstract

Background Consideration of categories related to reading comprehension—beyond reading level—is imperative to reach low literacy populations effectively. “Suitability” has been proposed as a term to encompass six categories of such factors: content, literacy demand graphics, layout/typography, learning stimulation, and cultural appropriateness. Our purpose was to describe instruments used to evaluate categories of suitability in cancer education materials in published reports and their findings. Methods We searched databases and reference lists for evaluations of print and Web-based cancer education materials to identify and describe measures of these categories. Studies had to evaluate reading level and at least one category of suitability. Results Eleven studies met our criteria.. Seven studies reported inter-rater reliability. Cultural appropriateness was most often assessed; four instruments assessed only surface aspects of cultural appropriateness. Only two of seven instruments used, the Suitability Assessment of Materials (SAM) and the Comprehensibility Assessment of Materials (SAM + CAM), were described as having any evidence of validity. Studies using SMOG and Fry reported higher average reading level scores than those using FK. Most materials failed criteria for reading level and cultural appropriateness. Conclusions We recommend more emphasis on the categories of suitability for those developing cancer education materials and more study of these categories and reliability and validity testing of instruments.

Mindfulness-Based Symptom and Stress Management Apps for Adults With Chronic Lung Disease: Systematic Search in App Stores (Preprint)

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Identifying Information Resources for Patients in the Intensive Care Unit and Their Families

“…Materials were distributed at the discretion of the clinician as a supplement to direct face-to-face communication. Suitability, in terms of content, literacy demand graphics, layout/typography, learning stimulation, and cultural appropriateness 18 also varied across sites. We concluded that the current state of providing information and education about an ICU stay was a clinician-driven process, which was used inconsistently and was potentially either inadequate or overwhelming for patients and families.…”

Informing Public Perceptions About Climate Change: A ‘Mental Models’ Approach

“…We recommend that communications be written at 5th-6th grade reading levels, because that can increase recipients' understanding without harming their perceptions of the communications' quality (Wong-Parodi et al 2013). The Flesch-Kincaid readability statistic can be used to assess the reading level needed to understand the presented text, and has been applied to evaluate the readability of surveys (Velez and Ashworth 2007), insurance policies (Dubay 2004), medical consent forms (Tait et al 2005), and patient education (Daraz et al 2011;Finnie et al 2010). This statistic has been reliably correlated with other established measures of readability, such as average word familiarity and passage length (Golinkoff 1975(Golinkoff -1976Kesselman et al 2007;Ley and Florio 1996;Spyridakis and Standal 1987;Surber 1992;Tuinman 1973).…”