Do Your Patients Understand Your Educational Materials?
Grade-level readability does not always equal easy-to-understand health information.
As an associate editor for the JACR, I review manuscripts submitted to the journal and provide comments from a patient perspective. I recently reviewed a manuscript describing a study to assess the readability of radiology patient-education materials found online. The study team stripped out all of the images, figures, and tables — anything that was not text. From there, they evaluated the text using nine validated readability assessment tools. The methodology was similar to that of other readability studies.
I am encouraged that radiologists are interested in assessing patient-education materials. However, it seems to me that removing all of the non-text material — the illustrations, tables, videos, and graphs — is actually removing the elements of the education materials that may make it easy to understand for the patient, despite the readability level. Consequently, the assessment of whether the radiology patient material is easy to understand may not be accurate.
I recently had the opportunity to attend a Plain Language for Health class at Tufts University in Boston. The two-day class was taught by founders of Communicate Health, a health education and communication firm dedicated to "designing health information that is easy to understand and use." I found the class informative and actionable. The class provided tools and tips for designing easy-to-understand health information. Here are the 10 tips the speakers provided about designing easy-to-understand patient education materials:
Create an obvious path for the eye to follow. For example, most readers start at the top left corner, so put important information there instead of at the bottom of the page.
- Use visual hierarchy. Bigger text = more important.
- Use a grid to keep content and images aligned. For example, line up pictures and blocks of text in a grid pattern.
- Incorporate white space.
- Use bulleted and numbered lists.
- Use conceptual cues, such as a stoplight with red, yellow, and green to signify level of risk.
- Use images to facilitate understanding.
- Use icons or images to call out important content.
- Consider sans serif fonts, which are easier to read.
- Increase font size and spacing.
- Use active voice.
- Write in a friendly, conversational style.
- Keep sentences and paragraphs short.
- Organize the material into manageable chunks.
- Within a sentence, keep context first. For example, instead of writing "Call 1-800-222-5177 and ask for a radiologist if you have questions about your chest x-ray," consider using the following phrasing: "If you have questions about your chest x-ray, call 1-800-222-5177 and ask for a radiologist."
- Use familiar words and define technical terms.
- Use clear, simple numbers.
- Make it actionable.
- Be direct.
A more effective example uses simple and relevant illustrations, plain language, and active voice. The information is broken into digestible chunks.
The expert speakers in the courses did not recommend assessing readability or the grade level of the written material. However, they did recommend two tools to assess the ease of understanding the health information: the CDC Clear Communication Index Score Sheet and the Suitability Assessment of Materials. Additionally, I found another assessment tool that incorporates the plain language for health principles I learned at the class, the Patient Education Materials Assessment Tool.
I would encourage all of us to follow these principles when designing health information and to use the recommended assessments tools for evaluating radiology patient health education materials.