Designing Dietary Education Materials for People With Chronic Kidney Disease: Recommendations for Improving the Quality of Resources

Abstract

The aim of this study is to quantify the readability, actionability, understandability, and overall quality of dietary education resources designed for patients and published in the Journal of Renal Nutrition. All patient education materials published in the "Patient Education" section of the journal from 2011 to 2021 were included. The readability, health literacy demand, and quality were evaluated using the Hemingway editor, Patient Education Materials Assessment Tool, and the Centers for Disease Control and Prevention Clear Communication Index (CDC CCI) respectively. Good quality materials were those with a reading grade level of ≤8; a Patient Education Materials Assessment Tool score of >70% (indicating materials were understandable and actionable), and a CDC CCI score >90%. A total of 42 resources were evaluated. Most materials (92%) were written at an appropriate level of readability (median grade 5, interquartile range [IQR: 5-7). The median understandability score was 71% (IQR: 60-81); however, only half (52%) of the materials met the 70% benchmark. Materials published performed poorly for actionability with the median actionability score of 37% (IQR: 20-83), and only 29% met the benchmark score. Overall quality was scored as low, with a median CDC CCI score of 65%, and only 10% of materials met the benchmark score. Areas for improvement were identified including providing a clear purpose, and summary of important points, explaining numbers and how to perform calculations, and including at least one action to take. Future efforts to improve actionability need to use the active voice, directly address readers, explain how to act, and describe the steps required. Patient education materials that are attentive to health literacy principles beyond readability may enhance patient engagement, confidence, and empowerment, and improve adherence to the kidney diet.