Patient-literacy-appropriate health materials needed for ophthalmology patients

COS 2012, July 3 - Information pamphlets on glaucoma are more effective when written at a lower reading level, a recent Canadian study suggests.

When researchers tested the health literacy levels of 200 patients with glaucoma - ages 19 to 90 - in London and Windsor, Ont., they found that information pamphlets written at a Grade 5 reading level, instead of at the standard Grade 10 level, were better understood.

These findings come from a randomized study in which patients in the waiting rooms of a tertiary care glaucoma centre and a community ophthalmology clinic were approached and administered the S-TOFHLA (Short Test of Functional Health Literacy in Adults). They were also given, at random, one of two educational pamphlets (one at a Grade 5 reading level, the other at Grade 10 level) and tested on their comprehension.

A Cloze procedure (a tool for measuring reading comprehension) and a Likert scale were then administered to gauge their understanding and satisfaction with the reading materials.

While 23% of the London participants had marginal or inadequate functional health literacy and 8% had a barely adequate level, Windsor participants were ranked at 26% and 9%, respectively.

In London, patients in both groups performed similarly in terms of overall satisfaction with the pamphlets and in time spent on the Cloze procedure. However, study participants spent almost two minutes longer reading the Grade 10-level pamphlet than the Grade 5 version (4:58 versus 3:07 minutes). Overall comprehension levels, as measured by the Cloze procedure, were significantly different. For the Windsor group, results were similar.

"[W]e found that by giving [patients] an easier-to-read pamphlet... they can understand and recall more information from it in a shorter amount of time," said David Mikhail, a third-year medical student at the University of Western Ontario, London, Ont.

This sort of knowledge is important because health literacy is proving to be a health determinant in its own right. "We can't change how people are brought up and their education level per se; what we can do is try to communicate better at their level."

It is difficult for physicians and other health care providers to find the time to explain things to patients, but patients can at least take pamphlets home and reread them as needed. "In general, we know that the more patients understand [about] their health condition, the more they can be involved in their care, and the better the health outcomes," Mikhail noted.