C. A. Perkins1, A. Liwo1, C. A. Gamuko2, J. A. Cannon1, J. Grams1, G. Kennedy1, M. Morris1, J. Richman1, D. I. Chu1 1University Of Alabama At Birmingham,Department Of Surgery,Birmingham, Alabama, USA 2University Of Alabama at Birmingham,School Of Nursing,Birmingham, Alabama, USA
Introduction: Health literacy is a major determinant of health outcomes through its influence on patient understanding of their care and aftercare instructions. Patients’ understanding can be affected by the readability of health education material, which the American Medical Association (AMA) and National Institute of Health (NIH) recommends to be at a 6th grade reading level or lower. It is unclear whether surgical education materials follow this recommendation. We hypothesized that surgical patient education materials across surgical specialties are written above a 6th grade reading level.
Methods: Routine patient education materials were collected from surgical specialty clinics at a single, tertiary-care referral center. The Flesch-Kincaid Grade Level (FKGL) instrument was used to analyze the texts to generate a FKGL score without any correction of misspellings or grammatical errors. We averaged the FKGL for each sample to obtain a mean for each surgical specialty. Specialties were compared using two-sided one sample t-tests and ANOVA, as appropriate.
Results: We collected 112 patient education materials from 13 surgical specialties. Of these, 29 were pre-operative, 58 were post-operative and 25 were clinical in nature. The overall average FKGL for all the patient education materials was 8.08 (standard deviation [SD] 2.08), exceeding the NIH/AMA standards sixth grade level by an average of 2.08 grade levels (95% CI=7.69-8.47; P <0.0001). Among specialties, the highest mean FKGLs were Neurosurgery (mean=9.83, SD=3.29, CI=1.65-18.01) and Thoracic (mean=9.61, SD=0.75, CI=9.03-10.19) while the lowest were Plastic Surgery (mean=6.34, SD=1.54, CI=5.61-7.09) and Endocrine (mean=7.08, SD=1.62, CI= 5.92-8.24) (Table 1). Surgical specialties with the highest percentage of reading materials at or below a 6th grade level were Plastics (47.4%), ENT (25.0%), GI-General (23.1%), Endocrine (20.0%) and Transplant (12.5%). The other 8 specialties had no materials at or below a 6th grade level.
Conclusion: The readability of patient education material across surgical subspecialties at a single institution is poor and deviates significantly from AMA/NIH recommendations. No surgical specialties had a majority of their material at the recommended 6th grade level and all surgical specialties had an average FKGL above the 6th grade level. Targeting patient education material to reduce the FKGL may be an actionable improvement to impact health literacy and potentially health outcomes.
