title: Literacy in patients with a chronic disease: systemic lupus erythematosus and the reading level of patient education materials.
abstract: OBJECTIVE
  (1) To assess literacy in a sample of patients with systemic lupus erythematosus (SLE); (2) to evaluate the reading level of patient education materials specific to SLE; and (3) to compare patient literacy levels to the readability of materials written for patients with SLE.
  
  
  METHODS
  Rapid Estimate of Adult Literacy in Medicine, a reading recognition test, was given to 94 patients with SLE. Socioeconomic status was assessed using Nam-Powers. Patient education materials frequently used with these patients were assessed for readability grade level.
  
  
  RESULTS
  The patients with SLE were reading on an average 7th-8th grade level; their average educational level (last grade completed in school) was 11.9. The average socioeconomic status (SES) according to the Nam-Powers assessment was 43, indicating high school completed, no college, an income range of $5000-$10,000, and occupations such as household workers and laborers. Multiple linear regression revealed that race and education correlated with reading (p < 0.001), but age, sex, and SES did not. The readability of surveyed SLE patient education materials ranged from 7th-15th grade level. Eighty-nine percent were written at a 9th grade level or above and were therefore inappropriate for about half the patients surveyed.
  
  
  CONCLUSIONS
  Reading skills below high school level existed for 48% of patients surveyed, yet only 11% of SLE patient education materials were written below a 9th grade level. Current SLE patient education materials are written on too high a level for many patients. Identifying patients with low literacy may help provide more appropriate patient education and better medical care.
authors.affiliation: Center of Excellence for Arthritis and Rheumatology, Department of Medicine, LSU Medical Center, Shreveport, Louisiana 71130-3932, USA.
authors.forename: M
authors.initials: M
authors.lastname: Hearth-Holmes
authors.forename: P W
authors.initials: PW
authors.lastname: Murphy
authors.forename: T C
authors.initials: TC
authors.lastname: Davis
authors.forename: I
authors.initials: I
authors.lastname: Nandy
authors.forename: C G
authors.initials: CG
authors.lastname: Elder
authors.forename: L H
authors.initials: LH
authors.lastname: Broadwell
authors.forename: R E
authors.initials: RE
authors.lastname: Wolf
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D004522:Educational Status; D005260:Female; D006801:Humans; D007258:Informed Consent; D016014:Linear Models; D008180:Lupus Erythematosus, Systemic / Q000523:psychology* / Q000534:rehabilitation; D008297:Male; D008875:Middle Aged; D010174:Pamphlets; D010353:Patient Education as Topic; D011932:Reading