College Reading Level Research Articles

Ethics, Equity, and English-Language Learners: A Decision-Making Framework

Ethics, Equity, and English-Language Learners: A Decision-Making Framework

National Survey of Patients’ Bill of Rights Statutes

BACKGROUNDDespite vigorous national debate between 1999–2001 the federal patients’ bill of rights (PBOR) was not enacted. However, states have enacted legislation and the Joint Commission defined an accreditation standard to present patients with their rights. Because such initiatives can be undermined by overly complex language, we surveyed the readability of hospital PBOR documents as well as texts mandated by state law.METHODSState Web sites and codes were searched to identify PBOR statutes for general patient populations. The rights addressed were compared with the 12 themes presented in the American Hospital Association’s (AHA) PBOR text of 2002. In addition, we obtained PBOR texts from a sample of hospitals in each state. Readability was evaluated using Prose, a software program which reports an average of eight readability formulas.RESULTSOf 23 states with a PBOR statute for the general public, all establish a grievance policy, four protect a private right of action, and one stipulates fines for violations. These laws address an average of 7.4 of the 12 AHA themes. Nine states’ statutes specify PBOR text for distribution to patients. These documents have an average readability of 15th grade (range, 11.6, New York, to 17.0, Minnesota). PBOR documents from 240 US hospitals have an average readability of 14th grade (range, 8.2 to 17.0).CONCLUSIONSWhile the average U.S. adult reads at an 8th grade reading level, an advanced college reading level is routinely required to read PBOR documents. Patients are not likely to learn about their rights from documents they cannot read.

Simplifying Text in Medical Literature

A text simplification system is developed that accepts as input a document written for college reading level, and converts it to high school reading level text using techniques in natural language processing. The achieved level of lexical and syntactic simplifications is dependent on the lexical and syntactic information stored in the system's knowledge sources. These knowledge sources can be updated when necessary, thus allowing the system to support varying input and output reading levels. Test results show that simplification can increase the reading ease score from as low 2.5% to a high 296%. Results also show that only 70% of the generated easier-to-read text will have a reading ease score higher than the original input sentence.

Parents' Rights in Special Education: The Readability of Procedural Safeguards

To make informed educational decisions, parents must be able to read and comprehend the information that is given to them by their school. The purpose of the current study was to examine the readability of Parents' Rights documents of all states. Results indicated that only 4% to 8% of Parents' Rights documents were written at the recommended reading level. To the contrary, 20% to 50% of the documents were written at a college reading level or higher, and other text characteristics may have added to their difficulty. These findings suggest that parents of students with special needs are likely to find Parents' Rights documents very difficult to read and understand. Parents' Rights documents should be rewritten to make them accessible to more parents.

Behavior treatment programs, readability, and treatment outcomes

Reading grade level and readability are rarely considered as important variables in the implementation and outcome of behavior treatment plans. In the first of two studies, we analyzed the reading level and readability of 20 behavior treatment plans developed by certified behavior analysts. We found that the behavior plans were written at college reading level—well above the reading level of the average frontline staff member. On a test of readability, none of the behavior plans met criterion on all 12 critical readability variables. To test if there was a correlation suggestive of a relationship among reading grade level, readability, and treatment outcomes, we divided the behavior treatment plans into two groups; 10 that had relatively high readability levels and 10 that had relatively low readability levels. A comparison of the two groups indicated that the average reading level of the behavior plans in both groups was about the same, and the higher readability had somewhat better treatment outcomes. In the second study, we used a multiple baseline design across four individuals to directly assess the effects of manipulating reading grade level and readability of behavior treatment plans on treatment outcomes. Results showed that these manipulations greatly enhanced treatment outcomes of all four individuals. Our data suggest that reading grade level and readability of behavior treatment plans are important variables that directly affect treatment outcomes.

Emergency department patient literacy and the readability of patient-directed materials.

There are 20 million American adults who cannot read. The demographics of the illiterate population suggest that they represent a significant proportion of patients cared for in a teaching hospital emergency department. This study was designed to assess whether readability of written material given to patients in a university hospital ED matched the literacy level of these patients. Data were gathered from 111 consecutive adult ED patients. Results of the survey showed that although the median education level of ED patients was 10th grade, more than 40% could not be expected to read at the 8th grade level, and at least 20% could be considered functionally illiterate. Readability of ED patient-directed materials was measured using the Fry index. Hospital and commercially generated patients education materials ranged from 8th to 13th grade level; a patient-directed brochure from Virginia ACEP is written at a college reading level. Comprehension of the "leaving against medical advice" (AMA) form or a consent for surgery would require at least an 11th grade education. This study shows that there is an alarming discrepancy between ED patient literacy levels in our sample and the reading skills required to comprehend important written medical and legal information. More than 50% of ED patients in a teaching hospital may read below the level required to understand standard discharge instructions. In addition, understanding the "operative consent" and leaving AMA forms requires a level of education beyond that of the majority of ED patients. If patient-directed written material is to serve its purpose, then ED patient populations should be surveyed and the reading level of written material adjusted accordingly.