Fifth-grade Reading Level Research Articles

Utilizing Artificial Intelligence to Increase the Readability of Patient Education Materials in Pediatric Otolaryngology.

Objectives: To identify the reading levels of existing patient education materials in pediatric otolaryngology and to utilize natural language processing artificial intelligence (AI) to reduce the reading level of patient education materials. Methods: Patient education materials for pediatric conditions were identified from the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) website. Patient education materials about the same conditions, if available, were identified and selected from the websites of 7 children's hospitals. The readability of the patient materials was scored before and after using AI with the Flesch-Kincaid calculator. ChatGPT version 3.5 was used to convert the materials to a fifth-grade reading level. Results: On average, AAO-HNS pediatric education material was written at a 10.71 ± 0.71 grade level. After requesting the reduction of those materials to a fifth-grade reading level, ChatGPT converted the same materials to an average grade level of 7.9 ± 1.18 (P < .01). When comparing the published materials from AAO-HNS and the 7 institutions, the average grade level was 9.32 ± 1.82, and ChatGPT was able to reduce the average level to 7.68 ± 1.12 (P = .0598). Of the 7 children's hospitals, only 1 institution had an average grade level below the recommended sixth-grade level. Conclusions: Patient education materials in pediatric otolaryngology were consistently above recommended reading levels. In its current state, AI can reduce the reading levels of education materials. However, it did not possess the capability to reduce all materials to be below the recommended reading level.

Toward More Equitable Care: A Closer Look at Autism Clinic Intake Practices and Paperwork.

To describe intake requirements among autism clinics and to assess how well intake paperwork aligns with national standards for enhancing language and literacy accessibility. This was a survey of 126 autism clinics in the Children's Hospital Association, assessing intake processes and intake paperwork readability conducted between November 2021 and August 2022. Descriptive analyses characterized intake requirements and paperwork components. Free-text responses about intake support strategies were categorized into themes. Logistic regression models examined associations between clinic patient demographics and odds of requiring intake paperwork. Intake packet length, content, and reading grade level were examined. Of the invited clinics, 73% completed the survey. Among the participating clinics, 55% required intake paperwork before scheduling appointments, 34% offered English forms only, and 89% had no plain language forms. Clinic patient demographics were not associated with intake paperwork requirements. Analyzed intake packets (n = 67) averaged 11 pages long, and most were written above the fifth-grade reading level. Most packets solicited medical, developmental, and educational/therapy history. Many also requested psychoeducational evaluations and teacher rating forms. Reported intake support strategies for families with language or literacy needs included making ad hoc exceptions to the usual process, task shifting to outside organizations, providing support at family's request, and delegating to support staff. Many autism clinics nationwide require intake paperwork before diagnostic evaluation. Many clinics offer intake paperwork in English only, and paperwork often does not meet health literacy standards. Reducing paperwork requirements and providing more routine and robust intake support may facilitate equitable access to autism diagnostic evaluations.

Using ChatGPT to Improve Readability of Interventional Radiology Procedure Descriptions.

This project examines ChatGPT's potential to enhance the readability of patient educational materials about interventional radiology (IR) procedures. The descriptions of IR procedures from the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) were used as the original text. Readability scores were calculated using three metrics: Flesch Reading Ease (FRE), Gunning Fog (GF), and the Automated Readability Index (ARI) using an online calculator ( https://readabilityformulas.com ). FRE is scored on a scale of 0-100, where 100 indicates easy-to-read texts, and GF and ARI represent the grade level required to comprehend the text. The DISCERN instrument measured credibility and reliability. ChatGPT was prompted to simplify the texts to a fifth-grade reading level, with subsequent recalculation of readability and DISCERN scores for comparison. Statistical significance was determined using a Wilcoxon Signed-Rank Test. Articles were subsequently organized by subgroups and analyzed. 73 interventional radiology procedures from CIRSE were analyzed. The original FRE score was 47.2 (Difficult), improved to 78.4 (Fairly Easy) by ChatGPT. GF and ARI scores dropped from 14.4 and 11.2 to 7.8 and 5.8, respectively, after simplification, showing significant improvement (p < 0.001). However, the average DISCERN score decreased from 3.73 to 2.99 (p < 0.001) post-ChatGPT simplification. This study shows ChatGPT's ability to make interventional radiology descriptions more readable but highlights its struggle to maintain the original's reliability, suggesting the need for human review and prompt engineering to enhance outcomes. Level 6.

Completeness and readability of GPT-4-generated multilingual discharge instructions in the pediatric emergency department

Abstract Objectives The aim of this study was to assess the completeness and readability of generative pre-trained transformer-4 (GPT-4)-generated discharge instructions at prespecified reading levels for common pediatric emergency room complaints. Materials and Methods The outputs for 6 discharge scenarios stratified by reading level (fifth or eighth grade) and language (English, Spanish) were generated fivefold using GPT-4. Specifically, 120 discharge instructions were produced and analyzed (6 scenarios: 60 in English, 60 in Spanish; 60 at a fifth-grade reading level, 60 at an eighth-grade reading level) and compared for completeness and readability (between language, between reading level, and stratified by group and reading level). Completeness was defined as the proportion of literature-derived key points included in discharge instructions. Readability was quantified using Flesch-Kincaid (English) and Fernandez-Huerta (Spanish) readability scores. Results English-language GPT-generated discharge instructions contained a significantly higher proportion of must-include discharge instructions than those in Spanish (English: mean (standard error of the mean) = 62% (3%), Spanish: 53% (3%), P = .02). In the fifth-grade and eighth-grade level conditions, there was no significant difference between English and Spanish outputs in completeness. Readability did not differ across languages. Discussion GPT-4 produced readable discharge instructions in English and Spanish while modulating document reading level. Discharge instructions in English tended to have higher completeness than those in Spanish. Conclusion Future research in prompt engineering and GPT-4 performance, both generally and in multiple languages, is needed to reduce potential for health disparities by language and reading level.

Assessing the Application of Large Language Models in Generating Dermatologic Patient Education Materials According to Reading Level: Qualitative Study.

Dermatologic patient education materials (PEMs) are often written above the national average seventh- to eighth-grade reading level. ChatGPT-3.5, GPT-4, DermGPT, and DocsGPT are large language models (LLMs) that are responsive to user prompts. Our project assesses their use in generating dermatologic PEMs at specified reading levels. This study aims to assess the ability of select LLMs to generate PEMs for common and rare dermatologic conditions at unspecified and specified reading levels. Further, the study aims to assess the preservation of meaning across such LLM-generated PEMs, as assessed by dermatology resident trainees. The Flesch-Kincaid reading level (FKRL) of current American Academy of Dermatology PEMs was evaluated for 4 common (atopic dermatitis, acne vulgaris, psoriasis, and herpes zoster) and 4 rare (epidermolysis bullosa, bullous pemphigoid, lamellar ichthyosis, and lichen planus) dermatologic conditions. We prompted ChatGPT-3.5, GPT-4, DermGPT, and DocsGPT to "Create a patient education handout about [condition] at a [FKRL]" to iteratively generate 10 PEMs per condition at unspecified fifth- and seventh-grade FKRLs, evaluated with Microsoft Word readability statistics. The preservation of meaning across LLMs was assessed by 2 dermatology resident trainees. The current American Academy of Dermatology PEMs had an average (SD) FKRL of 9.35 (1.26) and 9.50 (2.3) for common and rare diseases, respectively. For common diseases, the FKRLs of LLM-produced PEMs ranged between 9.8 and 11.21 (unspecified prompt), between 4.22 and 7.43 (fifth-grade prompt), and between 5.98 and 7.28 (seventh-grade prompt). For rare diseases, the FKRLs of LLM-produced PEMs ranged between 9.85 and 11.45 (unspecified prompt), between 4.22 and 7.43 (fifth-grade prompt), and between 5.98 and 7.28 (seventh-grade prompt). At the fifth-grade reading level, GPT-4 was better at producing PEMs for both common and rare conditions than ChatGPT-3.5 (P=.001 and P=.01, respectively), DermGPT (P<.001 and P=.03, respectively), and DocsGPT (P<.001 and P=.02, respectively). At the seventh-grade reading level, no significant difference was found between ChatGPT-3.5, GPT-4, DocsGPT, or DermGPT in producing PEMs for common conditions (all P>.05); however, for rare conditions, ChatGPT-3.5 and DocsGPT outperformed GPT-4 (P=.003 and P<.001, respectively). The preservation of meaning analysis revealed that for common conditions, DermGPT ranked the highest for overall ease of reading, patient understandability, and accuracy (14.75/15, 98%); for rare conditions, handouts generated by GPT-4 ranked the highest (14.5/15, 97%). GPT-4 appeared to outperform ChatGPT-3.5, DocsGPT, and DermGPT at the fifth-grade FKRL for both common and rare conditions, although both ChatGPT-3.5 and DocsGPT performed better than GPT-4 at the seventh-grade FKRL for rare conditions. LLM-produced PEMs may reliably meet seventh-grade FKRLs for select common and rare dermatologic conditions and are easy to read, understandable for patients, and mostly accurate. LLMs may play a role in enhancing health literacy and disseminating accessible, understandable PEMs in dermatology.

Can Artificial Intelligence Improve the Readability of Patient Education Materials?

The recommended readability of online health education materials is at or below the sixth- to eighth-grade level. Nevertheless, more than a decade of research has demonstrated that most online education materials pertaining to orthopaedic surgery do not meet these recommendations. The repeated evidence of this limited progress underscores that unaddressed barriers exist to improving readability, such as the added time and cost associated with writing easily readable materials that cover complex topics. Freely available artificial intelligence (AI) platforms might facilitate the conversion of patient-education materials at scale, but to our knowledge, this has not been evaluated in orthopaedic surgery. (1) Can a freely available AI dialogue platform rewrite orthopaedic patient education materials to reduce the required reading skill level from the high-school level to the sixth-grade level (which is approximately the median reading level in the United States)? (2) Were the converted materials accurate, and did they retain sufficient content detail to be informative as education materials for patients? Descriptions of lumbar disc herniation, scoliosis, and spinal stenosis, as well as TKA and THA, were identified from educational materials published online by orthopaedic surgery specialty organizations and leading orthopaedic institutions. The descriptions were entered into an AI dialogue platform with the prompt "translate to fifth-grade reading level" to convert each group of text at or below the sixth-grade reading level. The fifth-grade reading level was selected to account for potential variation in how readability is defined by the AI platform, given that there are several widely used preexisting methods for defining readability levels. The Flesch Reading Ease score and Flesch-Kincaid grade level were determined for each description before and after AI conversion. The time to convert was also recorded. Each education material and its respective conversion was reviewed for factual inaccuracies, and each conversion was reviewed for its retention of sufficient detail for intended use as a patient education document. As presented to the public, the current descriptions of herniated lumbar disc, scoliosis, and stenosis had median (range) Flesch-Kincaid grade levels of 9.5 (9.1 to 10.5), 12.6 (10.8 to 15), and 10.9 (8 to 13.6), respectively. After conversion by the AI dialogue platform, the median Flesch-Kincaid grade level scores for herniated lumbar disc, scoliosis, and stenosis were 5.0 (3.3 to 8.2), 5.6 (4.1 to 7.3), and 6.9 (5 to 7.8), respectively. Similarly, descriptions of TKA and THA improved from 12.0 (11.2 to 13.5) to 6.3 (5.8 to 7.6) and from 11.6 (9.5 to 12.6) to 6.1 (5.4 to 7.1), respectively. The Flesch Reading Ease scores followed a similar trend. Seconds per sentence conversion was median 4.5 (3.3 to 4.9) and 4.5 (3.5 to 4.8) for spine conditions and arthroplasty, respectively. Evaluation of the materials that were converted for ease of reading still provided a sufficient level of nuance for patient education, and no factual errors or inaccuracies were identified. We found that a freely available AI dialogue platform can improve the reading accessibility of orthopaedic surgery online patient education materials to recommended levels quickly and effectively. Professional organizations and practices should determine whether their patient education materials exceed current recommended reading levels by using widely available measurement tools, and then apply an AI dialogue platform to facilitate converting their materials to more accessible levels if needed. Additional research is needed to determine whether this technology can be applied to additional materials meant to inform patients, such as surgical consent documents or postoperative instructions, and whether the methods presented here are applicable to non-English language materials.

Readability Analysis of Online Patient Educational Materials on Blepharoplasty

Blepharoplasty is a common procedure for correction of eyelid appearance. Online educational material among surgical procedures is often written higher than the recommended fifth-grade level. The objective of this study is to evaluate the readability of online patient education materials (OPEMs) available on Google for patients interested in blepharoplasty. Using 6 different pre-established readability scores, the top 100 Google results on blepharoplasty were screened for analysis. A total of 87 OPEMs were found to be relevant yielding an average grade reading level of 11.90 (range 7-20; 95% confidence interval [CI], 11.45-12.33). In addition, OPEMs readability scores were not influenced by whether the author was a medical provider. This study demonstrated the average reading level for available information on blepharoplasty is higher than the recommended fifth-grade reading level. Readability is only one metric for evaluating comprehendible information; however, authors of online medical education need to be more conscious of the public’s ability to comprehend and should tailor their content delivery appropriately.

50. Development and Validation of the Reproductive Health Knowledge Index (RHKI)

<h3>Background</h3> Reproductive knowledge is important for promoting fertility, preventing pregnancy, and adhering to contraceptive and medical treatment regimens. To date there are no studies that broadly assess reproductive knowledge in females largely due to the absence of a validated tool. Extrapolating from studies in female adults utilizing several limited tools, it is likely that reproductive knowledge is low in all females, including adolescents. Thus, the objective of this study is to develop and validate a tool that reliably measures reproductive knowledge among female adolescents. <h3>Methods</h3> Development and validation of the reproductive health knowledge index (RHKI) was achieved as follows. 1. Instrument Development: Multiple answer questions were written at a fifth-grade reading level to assess: female pelvic anatomy and function, menstrual physiology, conception, gestation, and contraception. The multiple answer format was selected to undermine the advantage of the process of elimination and allow detection of partial knowledge. 2. Content Validity: The RHKI was reviewed by an expert panel (pediatricians, general and pediatric OB/GYNs, and OB/GYN residents) for comprehensiveness, accuracy, and length. IRB approval was obtained. The tool was reviewed by 10 female adolescents to ensure readability. A 20-item tool was finalized according to all suggestions. 3. Internal validity: Two groups with perceived differences in knowledge level, namely adolescents and medical students, were queried to investigate internal validity. Forty female adolescents age 13 to 19 awaiting an appointment at a pediatric gynecology clinic as well as 20 female medical students rotating at the same site were recruited to participate in the study. The REALM-TEEN tool was used to exclude adolescents reading below a fifth-grade reading level to limit confounding from poor comprehension. A Pearson correlation coefficient with p value was then calculated between age and performance with a goal metric of r = 0.7 supporting internal validity. <h3>Results</h3> Thus far, 26 adolescents and all 20 medical students have been surveyed. Preliminary analysis of performance by age yields a correlation coefficient of 0.82 with a p value of 0.0001. Overall, the content validity and internal validity support the ability of the RHKI to measure reproductive knowledge in female adolescents. <h3>Conclusions</h3> As noted, reproductive knowledge is important for many reasons. Further study in this area requires a valid tool, like the RHKI, capable of measuring said knowledge. Such a tool will allow us to identify factors influencing reproductive knowledge, inform sexual education courses, and educate adolescents with eventual impact on their overall well-being and health.

A National Survey on Patient Provider Agreements When Prescribing Opioids for Chronic Pain.

Many national guidelines recommend the use of patient provider agreements (PPAs) when prescribing opioids for chronic pain. There are no standards for PPA content, readability, or administration processes. Conduct a national survey of providers who use PPAs to describe the process of administering them, assess views on their utility, and obtain PPAs to evaluate thematic content and readability. Cross-sectional electronic survey and request for PPAs. Registrants for the Safer/Competent Opioid Prescribing Education (SCOPE of Pain) Program between March 2013 and June 2017. Respondents' reports on how PPAs are administered and views on their usefulness. A sample of PPAs assessed for themes and readability. Using a convenience sample of 62,530 SCOPE of Pain registrants, we obtained a cohort of 430 individuals from 43 states who use PPAs. The majority of respondents worked in primary care (64%) and pain (18%) specialties. Reviewing PPAs with patients was primarily done by prescribers (80%), and the average perceived time to administer PPAs was 13 min. Although 66% of respondents thought PPAs were "often" or "always" worth the effort, only 28% considered them "often" or "always" effective in reducing opioid misuse. The PPA reading burden surpassed recommended patient education standards, with only 2.5% at or below fifth-grade reading level. PPAs focused more on rules and consequences of patients' non-compliance than on a shared treatment plan. Most respondents perceive patient provider agreements (PPAs) as time-consuming and minimally effective in reducing opioid misuse yet still view them as valuable. PPAs are written far above recommended reading levels and serve primarily to convey consequences of non-compliance. Because PPAs are recommended by national safer opioid prescribing guidelines as a risk mitigation strategy, it would be beneficial to develop a standard PPA and study its effectiveness.

A-188 Psychometric Characteristics of the Cognitive Difficulties Scale in a Clinical Referral Sample

Abstract Objective Evaluate the psychometric characteristics of the Cognitive Difficulties Scale (CDS; McNair &amp; Kahn, 1983), a 39-item Likert-type self-report instrument that requires a fifth-grade reading level. The CDS is a popular instrument that has been shown to predict cognitive decline. Evaluation included an exploratory factor analysis, measures of internal consistency, relation to demographics, criterion validity, and normative table for raw to T score/percentile transformation. Method Participants were 643 consecutive referrals (71&amp;#37; women, mean age 60.6 and education 14.6 years) for a neuropsychological examination in a memory disorders clinic as part of a broader neurodiagnostic workup for cognitive decline. A principal components analysis was conducted followed by varimax rotation (Kaiser). Factor scores were investigated in relation to multiple internal and external criteria. Results Six dimensions of cognitive complaint emerged accounting for 64% of the variance: Attention/Concentration, Fine Motor Skill, Prospective Memory, Speech Problems, Memory for Names, and Temporal Orientation. Factors showed good internal consistencies (alphas &amp;gt; .850). Correlations with Logical Memory, Visual Reproduction, and Digit Span were all nonsignificant. CDS factor scores were highly predictive of MMPI-2 measures of anxiety, depression, and somatic preoccupation. Percentiles and T-scores were derived for the CDS total score and its six component scales. Conclusion The CDS is a multidimensional measure of subjective cognitive complaints that provides clinicians with a psychometrically sound basis for deriving a profile with six subscale scores. The test has substantial clinical utility, and is a potentially useful tool in exploring subjective cognitive decline as a prodrome to dementia.

Impact of a novel smartphone application on low-income, first-time mothers’ breastfeeding rates: a randomized controlled trial

Low-income women are less likely to exclusively breastfeed at postpartum day 2 compared with high-income women, but focus groups of low-income women have suggested that on-demand videos on breastfeeding and infant behavior would support exclusive breastfeeding beyond postpartum day 2. Smartphone applications provide on-demand video. This study aimed to determine whether a novel smartphone application-Breastfeeding Friend-increases breastfeeding rates for low-income, first-time mothers. This double-blinded randomized trial recruited low-income, first-time mothers at 36 weeks' gestation. Consenting women received a complimentary Android smartphone and internet service before 1:1 randomization to Breastfeeding Friend or a control smartphone application. Breastfeeding Friend was created by a multidisciplinary team of perinatologists, neonatologists, lactation consultants, and a middle school teacher and was refined by end-user focus groups. Breastfeeding Friend contained on-demand education and videos on breastfeeding and newborn behavior, tailored to a fifth-grade reading level. The control smartphone application contained digital breastfeeding handouts. The primary outcome was exclusive breastfeeding at postpartum day 2; secondary outcomes were breastfeeding rates until 6 months postpartum and patient-reported best breastfeeding resource. Primary statistical analyses compared outcomes between study groups through intention-to-treat analysis; prespecified secondary analyses did so per protocol. A total of 170 women (85 per arm) were needed to determine whether Breastfeeding Friend increased exclusive breastfeeding at postpartum day 2 from 34% (known baseline) to 56%. A total of 253 women were approached; 170 women enrolled. Most participants were black, with more than half reporting annual household incomes of less than $25,000. Exclusive breastfeeding rates at postpartum day 2 were low and similar among Breastfeeding Friend and control smartphone application users (n=30 [36.6%] vs n=30 [35.7%]; relative risk, 1.02; 95% confidence interval, 0.068-1.53). Breastfeeding rates until 6 months postpartum were also similar between study groups: the rate of exclusive breastfeeding was 8.3% (n=5) and 10.4% (n=7) in the Breastfeeding Friend and control smartphone application groups, respectively (relative risk, 0.8; 95% confidence interval, 0.27-2.38). At 6 weeks postpartum, most Breastfeeding Friend smartphone application users (n=34 [52.3%]) rated their smartphone application as providing the best breastfeeding support. Excluding women who did not use their study smartphone application (Breastfeeding Friend, n=18 [21.4%]; control smartphone application, n=9 [10.6%]) did not affect outcomes. Neither of the smartphone applications improved breastfeeding rates among low-income, first-time mothers above the known baseline rates, despite user perception that Breastfeeding Friend was the best breastfeeding resource at 6 weeks postpartum. By demonstrating the feasibility of smartphone application-based interventions within a particularly high-needs population, our research supports efforts in obstetrics to examine whether mobile health improves peripartum health outcomes.

Family Learning on Asthma Topics

Background: Utilizing group education promotes problem solving, stimulates conversation, and provides shame free environments to decrease stigmas. Providing comprehensive education by an experienced certified asthma educator (AE-C) is an important step in supporting patients diagnosed with asthma. Methods: Patients 2 to 17 years of age who were prescribed ≥2 systemic steroid courses, had ≥ 2 emergency department visits, and/or ≥1 hospitalization for asthma exacerbation the preceding 12 months were identified having poorly controlled asthma. These patients and their legal guardian/caregiver were recruited from pulmonary clinic or inpatient services to participate in classroom asthma education provided by a AE-C to address real life problem-solving and promote self-awareness regarding medication use. Post card consent was obtained for the patient and legal guardian to attend 1-2 classes over a four-month period; complete a pre/post asthma knowledge assessment; and receive text/phone call reminders prior to each class. The classroom education materials included audio and visual learning tools written at a fifth-grade reading level in both English and Spanish. Results: Our goal was to recruit 50-75 patients over a 9-month period. Only eight patients were recruited for the study, four of them with their caregivers participated in the classroom education. Patients and caregivers who attended the class coincided with a clinic visit. Two of the four families completed the pre and post asthma knowledge survey. Revisit/readmissions were reviewed as a part of our outcome measures. None of the patients who participated in the classroom education had a revisit/readmission for asthma within 90 days and 100% of them attended their pulmonary clinic visit. One of the four patients who did not attend the classroom education had a revisit within 90 days and none of them have a scheduled specialist visit since enrolling. Conclusions: Due to the low enrollment and completion of the program we were not able to effectively evaluate the program. Caregivers felt the classroom education was well worth their time. Many families are not willing to participate in any educational sessions outside of scheduled clinic visits. Obtaining pre or post survey results was found to be successful only when provided in person rather than via phone call, email, or text. We believe convenience played a significant role in patient and caregivers’ engagement and participation.

Self-reported race and ethnicity of US biobank participants compared to the US Census.

Precision medicine envisions a future of effective diagnosis, treatment, and prevention grounded in precise understandings of the genetic and environmental determinants of disease. Given that the original genome-wide association studies represented a predominately European White population, and that diversity in genomic studies must account for genetic variation both within and across racial categories, new research studies are at a heightened risk for inadequate representation. Currently biological samples are being made available for sequencing in biobanks across the USA, but the diversity of those samples is unknown. The aims of this study were to describe the types of recruitment and enrollment materials used by US biobanks and the diversity of the samples contained within their collection. Biobank websites and brochures were evaluated for reading level, health literacy, and factors known to encourage the recruitment of minorities, such as showing pictures of diverse populations. Biobank managers were surveyed by mail on the methods and materials used for enrollment, recruitment, consent, and the self-reported race/ethnicity of biobank participants. From 51 US biobanks (68% response rate), recruitment and enrollment materials were in English only, and most of the websites and brochures exceeded a fifth-grade reading level. When compared to the 2015 US Census, self-reported race/ethnicity of participants was not significantly different for Whites (61%) and blacks (13%). The percentages were significantly lower for Hispanics and Latinos (18 vs. 7%, p=0.00) and Hawaiian/Pacific Islanders (0.2 vs. 0.01%; p=0.01) and higher for Asians (13 vs. 5%, p=0.01). Materials for recruitment predominantly in English may limit participation by underrepresented populations.

Quality assessment of online patient education resources for peripheral neuropathy

Given its practicality, the internet is a primary resource for patients afflicted with diseases like peripheral neuropathy. Therefore, it is important that the readily available online resources on peripheral neuropathy are tailored to the general public, particularly concerning readability. Patient education resources were downloaded from the US National Library of Medicine, Mayo Clinic, National Institute of Neurological Disorders and Stroke, Neuropathy.org, GBS/CIDP Foundation International, Hereditary Neuropathy Foundation, Charcot-Marie-Tooth Association, Foundation for Peripheral Neuropathy, and Neuropathy Action Foundation websites. All patient education material related to peripheral neuropathy was evaluated for its level of readability using the Flesch Reading Ease (FRE) and Flesch-Kincaid Grade Level. The FRE scores averaged 43.4 with only the US National Library of Medicine scoring above 60 (76.5). The Flesch-Kincaid Grade Level scores averaged 11.0. All scores were above a seventh-grade level except the US National Library of Medicine, which had a score of a fifth-grade reading level. Most Americans may not fully benefit from patient education resources concerning peripheral neuropathy education on many of the websites. Only the US National Library of Medicine, which is written at a fifth-grade level, is likely to benefit the average American.

Readability of Early Intervention Program Literature

Accessibility of early intervention program literature was examined through readability analysis of documents given to families who have a child served by the Birth to 3 program. Nine agencies that serve families in Birth to 3 programs located in a county in the Midwest provided the ( n = 94) documents. Documents were included in the analysis if they conveyed information about the nature of the program, the financial obligations of the family, intervention planning, and programmatic consent. The analysis indicated that a majority of the documents were written above the recommended fifth-grade reading level. Action steps to improve the accessibility of early intervention documents are discussed.

Consumer and Health Literacy: The Need to Better Design Tobacco-Cessation Product Packaging, Labels, and Inserts

Abstract Tobacco-cessation product packaging and instruction materials may not be appropriate for some smokers and may contribute to the underuse and misuse of evidence-based treatments. The dual goals of this project are to analyze literacy levels of Food and Drug Administration (FDA)–approved and non-approved tobacco-cessation product packaging, directions, and claims, and to identify and categorize claims found on product packaging. The Campaign for Tobacco Free Kids (CTFK) maintains the Quitting and Reducing Tobacco Use Inventory of Products (QuiTIP) database, which catalogs products marketed and sold to consumers to reduce or quit use of tobacco products. It also includes all medications approved by the FDA for tobacco cessation as well as a sample of non-approved products such as homeopathic, herbal, nutritional, or dietary supplements commonly marketed as either cessation aids or alternative tobacco/nicotine products. This paper assesses the reading levels required to understand product packaging, labeling, and instructions using the Simple Measure of Gobbledygook (SMOG) and identifies claims on the product package labels using standard qualitative methods. Key findings show that the average reading levels needed to understand instructions for both FDA-approved and non-approved cessation products are above the reading levels recommended to ensure maximum comprehension. Improving the packaging and directions of evidence-based tobacco-cessation products so that they are preferably at or below a fifth-grade reading level, along with using consumer-based design principles to develop packaging, may help smokers take advantage of and correctly use products that will greatly increase their chances of successful quitting.

Influence of consonantal context on the reading of vowels: Evidence from children

When college students pronounce nonwords, their vowel pronunciations may be affected not only by the consonant that follows the vowel, the coda, but also by the preceding consonant, the onset. We presented the nonwords used by Treiman and colleagues in their 2003 study to a total of 94 first graders, third graders, fifth graders, and high school students to determine when these context influences emerge. According to some theories of reading development, early decoding is characterized by context-free links from graphemes to phonemes. However, we found that even children reading at the first-grade level (6-year-olds) were influenced to some extent by a vowel’s context. The effect of context on vowel pronunciation increased in strength up to around the fifth-grade reading level (8- and 9-year-olds), and sensitivity to coda-to-vowel associations emerged no earlier than did sensitivity to onset-to-vowel associations. A connectionist model of reading reproduced this general pattern of increasing context effects as a function of training.

A low-literacy skin care manual for spinal cord injury patients

Most patient education materials are written at least two grade levels above the average grade achievement of health care consumers. This paper describes the development of a patient education manual for people with low literacy skills. The manual provides information about pressure ulcer prevention for patients with spinal cord injuries. Educational principles related to literacy skills were applied to produce a manual at the fifth-grade reading level.

Reading difficulty of MMPI-2 subscales

Average reading difficulty based upon the Lexile value was computed for the 567 items and 61 sub/special scales of the MMPI-2. The mean for all items was 600.02 (SD = 304.57), which roughly corresponds to a fifth-grade reading level. Approximately 90% of the items require less than a ninth-grade reading level; 3 items require a high-school education or more. The Amorality (Mal) subscale had an average reading level greater than eighth grade. Nine subscales had 25% or more items above an eighth-grade reading level. The Hypomania (MA) subscales were the most demanding. For persons with low reading proficiency, interpretation of the nine subscales should be made cautiously.