O. Olaleye1, I. Marques1, L. Theiss1, C. Shao1, S. Bergstresser1, K. Hardiman1, D. Gunnells1, J. Cannon1, G. Kennedy1, M. Morris1, D. Chu1 1University Of Alabama at Birmingham,Division Of Gastrointestinal/Department Of Surgery,Birmingham, Alabama, USA
Introduction: According to the 2003 National Assessment of Adult Literacy (NAAL), 9 out of 10 U.S. adults have difficulty reading and understanding health information. Hospital discharge materials contain tremendous amounts of health information, but it is unclear if these materials are readable, understandable and actionable. The aim of this study was to assess surgical discharge materials for these parameters with the hypothesis that discharge materials are not readable, understandable or actionable.
Methods: Discharge materials for a colorectal surgery service were collected from a single-institution. Readability, understandability and actionability were assessed by 3 independent reviewers using validated and complementary instruments: (i) Flesch-Kincaid Grade Level (FKGL), (ii) Gunning-Fog Scale (GF), (iii) Coleman-Liau Index (CL), (iv) Simple Measure of Gobbledygook (SMOG), (v) Automated Readability Index (AR), (vi) Linsear Write Formula (LW), (vii) Flesch Reading Ease (FRE), (viii) Patient Education Materials Assessment Tool (PEMAT), and (ix) Print Communication Rating (PCR). Scores were averaged and compared across discharge materials to identify areas for improvement.
Results: 79 discharge items covering 131 pages were collected for analysis. On readability assessments, discharge materials were mostly written below the 8th grade reading level by all readability tests except the GF (9.82 ± 0.44) and CL (9.67 ± 0.15). On assessment of understandability and actionability, discharge materials scored poorly including 55.92% ± 5.34% understandability and 42.18% ± 7.03 actionability by PEMAT (indicating readers’ difficulty to process key points and identify their role within the information presented) and 73.24% ± 3.10 PCR (indicating adequate presentation of information or directions but in need of improvement). Lowest scoring domains were opioid pain medication instructions (9.8 GF, 10.1 CL, and 60.3 FRE), laparoscopic colectomy information (11.5 GF, 10.4 CL, and 62.8 FRE), and forms on topics ranging from tobacco use to a health app (10.5 GF, 11.5 CL, and 59.8 FRE).
Conclusion: While most discharge materials were written below the 8th grade reading level, major opportunities exist for improving their understandability and actionability. Key areas of improvement include using more visual aids, simplifying content, and providing examples for medical terminology. Future studies will focus on improving discharge materials to make them more understandable and actionable.