Readability of education materials and informed consent forms for women seeking surgical sterilization

Indigenous Women's Resistance of Colonial Policies, Practices, and Reproductive Coercion

This analysis of urban Indigenous women's experiences on the Homeland of the Métis and Treaty One (Winnipeg, Manitoba, Canada), Treaty Four (Regina, Saskatchewan, Canada), and Treaty Six (Saskatoon, Saskatchewan, Canada) territories illustrates that Indigenous women have recently experienced coercion when interacting with healthcare and social service providers in various settings. Drawing on analysis of media, study conversations, and policies, this collaborative, action-oriented project with 32 women and Two-Spirit collaborators demonstrated a pattern of healthcare and other service providers subjecting Indigenous women to coercive practices related to tubal ligations, long-term contraceptives, and abortions. We foreground techniques Indigenous women use to assert their rights within contexts of reproductive coercion, including acts of refusal, negotiation, and sharing community knowledge. By recognizing how colonial relations shape Indigenous women's experiences, decision-makers and service providers can take action to transform institutional cultures so Indigenous women can navigate their reproductive decision-making with safety and dignity.

Readability of patient information pamphlets in urogynecology

OBJECTIVE

The purpose of this study was to determine the reading level of frequently used patient information pamphlets and documents in the field of urogynecology.

METHODS

Urogynecology pamphlets were identified from a variety of sources. Readability was determined using 4 different accepted formulas: the Flesch-Kincaid Grade Level, the simple measure of gobbledygook Index, the Coleman-Liau Index, and the Gunning Fog index. The scores were calculated using an online calculator (http://www.readability-score.com). Descriptive statistics were used for analysis. The average of the 4 scores was calculated for each pamphlet. Subsequently, Z-scores were used to standardize the averages between the reading scales.

RESULTS

Of the 40 documents reviewed, only a single pamphlet met the National Institutes of Health-recommended reading level. This document was developed by the American Urological Association and was specifically designated as a "Low-Literacy Brochure." The remainder of the patient education pamphlets, from both industry-sponsored and academic-sponsored sources, consistently rated above the recommended reading level for maximum comprehension.

CONCLUSIONS

The majority of patient education pamphlets, from both industry-sponsored and academic-sponsored sources, are above the reading level recommended by the National Institutes of Health for maximum patient comprehension. Future work should be done to improve the educational resources available to patients by simplifying the verbiage in these documents.

Informed consent: how much and what do patients understand?

OBJECTIVE

We sought to evaluate the degree of patients' understanding of several aspects of the informed consent process for surgery and clinical research.

METHODS

We conducted a systematic search of PubMed (1961-2006) to identify relevant articles.

RESULTS

We retrieved 23 and 30 eligible for inclusion articles regarding informed consent for surgery and clinical research, respectively. Regarding surgery, adequate overall understanding of the information provided and of the risks associated with surgery was shown in 6 of 21 (29%) and 5 of 14 (36%) studies providing relevant data, respectively. Regarding clinical research, adequate understanding of the aim of the study, the process of randomization, voluntarism, withdrawal, and the risks and the benefits of treatment was shown in 14 of 26 (54%), 4 of 8 (50%), 7 of 15 (47%), 7 of 16 (44%), 8 of 16 (50%), and 4 of 7 (57%) of studies providing relevant data, respectively. Satisfaction by the amount of the given information was shown in 7 of 12 (58%) studies involving surgery and 12 of 15 (80%) studies involving clinical research.

CONCLUSIONS

Further attention should be drawn on enhancing patients' understanding regarding several components of the informed consent process for surgery and clinical research.

Are patient-administered attention deficit hyperactivity disorder scales suitable for adults?

OBJECTIVE

This primary purpose of this study was to examine cognitive complexity and readability of patient-administered ADHD scales. The secondary purpose was to estimate variation in readability of individual ADHD scale items.

METHOD

Using comprehensive search strategies, we identified eight English-language ADHD scales for inclusion in our study. A complete copy of each ADHD scale was obtained from the most current publication. Cognitive complexity of individual ADHD scale items were assessed using three techniques (number of items, number of words, and linguistic problems), while readability was calculated using the Flesch-Kinkaid formula.

RESULTS

Total number of ADHD scale items ranged from 6 to 66. The ADHD scale items averaged from a low of 4.4+/-2.9 to a high of 18.7+/-4.4 words. Most individual ADHD scale items had between 1 to 3 linguistic problems. Although readability of ADHD scales ranged from approximately 5th to 8th grade, there was notable variation in readability across individual statements and questions.

CONCLUSION

Formatting characteristics, including linguistic problems and high readability, may interfere with patients' ability to accurately complete ADHD scales.

[Quality improvement of health information included in drug information leaflets. Patient and health professional expectations]

OBJECTIVE

To report on patient and professional opinions and expectations concerning the information included in drug package leaflets and to determine their readability.

DESIGN

Qualitative and quantitative study. PLACEMENT: Primary Care and Specialized Centres from Andalusia, Catalonia, Basque Country, Navarra, Aragon and Extremadura.

PARTICIPANTS

Patients from Primary Care Health Centers, physicians, pharmacists and citizen associations, using intentional sampling.

METHOD

Qualitative interviews. Flesch Readability Test is used to determine the leaflet readability.

RESULTS

There are different degrees of satisfaction between professionals and patients, concerning both quality and quantity of information leaflets. The use of technical language and a small lettering size was observed. The leaflet is considered an important source of information among professionals, but not among patients who prefer information from their physicians. The greatest comprehension difficulties appear in paragraphs on posology, secondary and adverse effects.

CONCLUSIONS

Health information must centre on practical aspects of the health-illness-care process. Leaflets must be adapted to the needs of the patients and professionals. Physicians are commonly consulted by patients, so it is important to ensure they have high communication skills. Patients have the need for constant information; therefore new information channels must be created.

Literacy Demands and Formatting Characteristics of Opioid Contracts in Chronic Nonmalignant Pain Management

Chronic nonmalignant pain affects a significant number of adults, with many requiring opioid medications to manage their symptoms. Although the content of typical opioid contracts (OCs) has been explored, no studies have examined the literacy demands and formatting characteristics of OCs currently used throughout the United States. We evaluated 162 English-language OCs submitted to us by current American Pain Society members residing in the United States. OCs were evaluated for reading grade level and formatting characteristics. The mean readability of OCs was at grade level 13.8 +/- 1.3 (range = 10-17), whereas the average text point size was 11.0 +/- 1.4 (range = 6-16). Active voice was used exclusively in almost half of OCs (n = 79, 48.8%). Most OCs contained not only sophisticated medical language but multisyllable, nonmedical terms and vocabulary not used in typical everyday conversation. Overall, most OCs reviewed presented information at much too high a reading grade level, and with formatting characteristics that probably would make these documents difficult for the average patient to fully comprehend.

PERSPECTIVE

This study indicates that there is a mismatch between the reading demands of most OCs and the actual health literacy skills of American adults. Accordingly, those developing OCs should be cognizant of the actual literacy abilities of their patient population and design and evaluate OCs accordingly.

Development and Validation of a Low-Literacy Opioid Contract

Opioid contracts (OPCs) are often used to outline the criteria and circumstances for which opioid medications are prescribed. The purpose of this study was to develop and validate an English-language, low-literacy OPC. Specifically, the low-literacy OPC was designed to outline proper administration of prescribed medication(s) as well as highlight patient responsibilities and expectations. A 4-step process was used to develop and validate the low-literacy OPC, including: (1) content identification; (2) attention to low-literacy guidelines; (3) evaluation based on Suitability Assessment of Materials (SAM) criteria; and (4) pilot testing with patients (n = 18) to assess comprehension. Final OPC content, presented largely in bulleted format, was based on current literature and consensus of the first 3 authors. The 4-part OPC was formatted on 8(1/2) x 11 inch paper using 16- to 24-point size Arial-style font. The 6-page OPC, written at the 7(th) reading grade level, included 12 recognizable clipart-type illustrations to supplement written text. Two reviewers scored the OPC in the superior range based on total SAM percentage scores. Nineteen (n = 19) of the 26 statements were comprehended by all patients completing the pilot testing. Overall, the low-literacy OPC is comprehensive, valid, readable, and formatted according to established low-literacy guidelines.

PERSPECTIVE

This study describes the development and validation of a low-literacy, English-language OPC. The OPC was formatted using low-literacy guidelines and validated with a sample of patients to confirm understanding of content. Accordingly, the low-literacy OPC is suitable for use in routine clinical practice.

[Can patients read what we want them to read? Analysis of the readability of printed materials for health education]

OBJECTIVE

To analyze readability and legibility of a systematic sample of health education materials made available at a health center, and to propose recommendations for improvement.

DESIGN

Observational, descriptive study.

SETTING

An urban health center in Madrid, Spain.

MATERIAL

A sample of text from 326 health education documents.

MAIN MEASURES

The 326 texts were classified according to target reader, organism responsible for publication, topic, and date of publication. A sample of 500 words from each document was analyzed with Microsoft Word 2000 to determine the Flesch readability score and sentence complexity index, and to calculate the INLEG index. Print size and accompanying graphics were also analyzed.

RESULTS

Readability of the materials was generally acceptable, with a mean Flesch score of 13.56. However, the type tended to be too small (mean 11.37 points). In 32% of the documents there were no illustrations, and no date of publication was given in 46%. CONCLUSIONS. The readability and legibility in the group of documents we analyzed could both be improved by following the recommendations offered here. Further research is needed on the techniques used to analyze readability and legibility, especially with regard to the latter.