SAN DIEGO -- Most patient education material on gynecologic society websites was too advanced for patients and did not meet the standard for health literacy, a small literature review found here.
In an analysis of more than 200 non-obstetric articles from six society websites, the average gynecologic society patient education materials were written at a seventh grade to college graduate reading level, and most far exceed the recommended sixth to eighth grade reading level accessible to patients, reported Nneoma Nwachuku, MD, of Howard University in Washington D.C., and colleagues.
Action Points
- Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
The National Academy of Medicine defines health literacy as "the degree to which an individual has the capacity to obtain, communicate, process and understand basic health information and services to make appropriate health decisions."
According to a 2003 Department of Education study, one in three people in the U.S. have "basic" to "below basic" levels of health literacy. Low or inadequate health literacy has been linked with poorer health outcomes, such as decreased use of preventive services, hospitalization, and chronic disease, Nwachuku said in a presentation at the American College of Obstetricians and Gynecologists (ACOG) annual meeting.
"Health information is not easily understandable by our patients," she said. "During typical clinical encounter, patients only understand less than half of what we communicate with them."
Nwachuku added that the standards for health literacy are recommended by the American Medical Association and the NIH, but that most material produced by non-gynecologic societies far exceed those organization's sixth grade level recommendations.
Researchers reviewed 279 non-obstetric articles from six gynecological society online sites -- ACOG, American Society for Reproductive Medicine, American Association of Gynecologic Laparoscopists, Society for Gynecologic Oncology, American Urogynecologic Society and the Association of Reproductive Health Professionals -- by visiting the patient education portal and downloading those articles. They used the Flesch-Kincaid score, which grades on sentence and word complexity, to make it easier to compare scores between societies.
The mean grade level was 10.7, with a range from fourth grade reading level to that suitable for someone graduating from college. Only 4% of these materials adhered to the recommendation to be at a sixth grade reading level. ARHP was the closest at a mean seventh grade reading level, followed by ACOG at a ninth grade reading level.
The authors then examined the material by subject matter and found that literature about contraception was the most understandable of all gynecology-related subjects (at a little over a mean seventh grade reading level). The most advanced materials were on gynecologic surgeries and menstrual/pelvic disorders, which were written for someone at a college reading level.
One ACOG attendee asked if it was reasonable to keep literature about surgical procedures at a sixth grade reading level, since they contain terms that patients might not be exposed to.
Nwachuku disagreed, saying that terms should be defined in simpler language or it "might become intimidating and patients might not access the content."
She said that her group is currently developing a Patient Education Materials Assessment Tool (PEMAT) to evaluate the understandability and actionability of these patient resources.
"We need to up our game with the understandability so we can get to that point where we're providing an effective service for our patients," Nwachuku said.
Primary Source
American College of Obstetricians and Gynecologists
Source Reference: Nwachuku N, et al "Readability of online patient educational materials provided by major gynecologic societies" ACOG 2017; Abstract 16OP.