Health Literacy: Readability of ACC/AHA Online Patient Education Material

Abstract

Objectives: To determine whether the online patient education material offered by the American College of Cardiology (ACC) and the American Heart Association (AHA) is written at a higher level than the 6th-7th grade level recommended by the National Institute of Health (NIH). Methods: Online patient education material from each website was subjected to reading grade level (RGL) analysis using the Readability Studio Professional Edition. One-sample t testing was used to compare the mean RGLs obtained from 8 formulas to the NIH-recommended 6.5 grade level and 8th grade national mean. Results: In total, 372 articles from the ACC website and 82 from the AHA were studied. Mean (±SD) RGLs for the 454 articles were 9.6 ± 2.1, 11.2 ± 2.1, 11.9 ± 1.6, 10.8 ± 1.6, 9.7 ± 2.1, 10.8 ± 0.8, 10.5 ± 2.6, and 11.7 ± 3.5 according to the Flesch-Kincaid grade level (FKGL), Simple Measure of Gobbledygook (SMOG Index), Coleman-Liau Index (CLI), Gunning-Fog Index (GFI), New Dale-Chall reading level formula (NDC), FORCAST, Raygor Readability Estimate (RRE), and Fry Graph (Fry), respectively. All analyzed articles had significantly higher RGLs than both the NIH-recommended grade level of 6.5 and the national mean grade level of 8 (p < 0.00625). Conclusions: Patient education material provided on the ACC and AHA websites is written above the NIH-recommended 6.5 grade level and 8th grade national mean reading level. Additional studies are required to demonstrate whether lowering the RGL of this material improves outcomes among patients with cardiovascular disease.

Johnny Can't Read and It Is Killing Him

“…Moreover, the NIH suggests using a 6th grade level for medical material written for the public. Kapoor et al [5] revealed these startling facts in his paper in this issue of Cardiology . Furthermore, a 2006 report from the US Department of Health and Human Services found only 12% of adults in the US have proficient health literacy.…”

“…Furthermore, a 2006 report from the US Department of Health and Human Services found only 12% of adults in the US have proficient health literacy. More than a third of adults have low health literacy levels, which makes it difficult for them to deal with common health tasks, such as following directions for how to use prescription medications [5]. The problem is exacerbated in the elderly and in those patients whose primary language is not English.…”

“…I believe there is a tendency to place the blame for this on lack of education or intelligence. However, it is well recognized that health care literacy is not just a function of intelligence [5]. Despite a great emphasis placed on mastering communication skills, which begins in medical school, it is a common complaint by patients that physicians do not explain their issues well, if at all.…”

“…Therefore, it is not a quantum leap to wonder if this oftentimes overly complex and poorly written material influences how physicians ultimately communicate with their patients. Furthermore, with the increasing use of technology, the greater availability of information on the Internet and a patient-centric approach to health care being increasingly emphasized, it is progressively more challenging for the average person to navigate it all [5]. Clear, concise communication clearly needs to be a two-way street between patient (family) and physician.…”

“…There is a tendency to blame the patients for their failures especially given the very poor reading comprehension levels noted by Kapoor et al [5]. However, when one looks at the problem, it seems it is incumbent on the physician to be certain his/her instructions are followed correctly rather than expecting the comprehension level of the public is going to be raised anytime soon.…”