E. R. Kaplan1, K. Perkins1, A. Liwo1, I. Marques1, J. A. Cannon1, G. D. Kennedy1, M. Morris1, J. Richman1, D. I. Chu1 1University Of Alabama at Birmingham,Birmingham, Alabama, USA
Introduction: Health literacy is a key determinant of health outcomes. Printed material, such as discharge instructions, are commonly utilized in healthcare, but it is unclear if these materials are health literate by readability/understandability standards. According to the American Medical Association (AMA) and National Institute of Health (NIH), a readable document is at or below the 6thgrade reading level. It is unclear whether discharge materials in surgery are at this recommended level. We hypothesized that discharge instructions on a gastrointestinal surgical division are written above a 6thgrade reading level and lack readability.
Methods: Patient discharge materials were collected from a single-institution surgical service line. Four instruments were used to assess the readability and understandability of the materials: (i) the Flesch-Kincaid Grade Level instrument, (ii) SMOG (Simple Measure of Gobbledygook), (iii) PEMAT (Patient Education Materials Assessment Tool), and (iv) Print Communication Rating (PCR) from the Health Literacy Environment of Hospitals and Health Centers (HLEHH). Two independent observers rated these education materials.
Results:We collected 42 printed education materials from the gastrointestinal surgical service line. Of these, 24 were pre-operative and 18 were post-operative instructions. The overall average FKGL for all materials was 6.90 (standard deviation [SD] ± 0.82), with 90% of the documents scoring higher than a 6thgrade reading level. Material describing vacuum-assisted closure therapy was the most readable (FKGL = 5.3), while the most unreadable material explained general anesthesia and wound care after surgery (FKGL =9. 7). None of the materials were at or below a 6thgrade reading level when analyzed with SMOG. The average SMOG reading grade level of all printed education materials was 10.79 ± 1.34 SD, exceeding the recommended reading grade level by an average of 4.79 grade levels. 40 out of the 42 materials collected were at or greater than a high school reading level. The average PEMAT understandability and actionability score was 57.96% ± 6.28 and 49.13% ± 14.35, respectively, both having a total possible score of 100%. For both understandability and actionability, all but two documents scored lower than 70%, which is unacceptable. The average PCR score was 49.38 ± 1.49 out of a possible 72 points.
Conclusion:The readability of patient discharge instructions on a surgical service deviates significantly from AMA/NIH recommendations. The majority of material was not at the recommended 6thgrade level. Additionally, all materials lacked understandability and tools for engagement for overall decision making. Increased efforts are needed to eliminate literacy-related barriers of discharge materials.