title: Health literacy demands of written health information materials: an assessment of cervical cancer prevention materials.
abstract: BACKGROUND
  Health literacy requires reading and writing skills as well as knowledge of health topics and health systems. Materials written at high reading levels with ambiguous, technical, or dense text, often place great comprehension demands on consumers with lower literacy skills. This study developed and used an instrument to analyze cervical cancer prevention materials for readability, comprehensibility, suitability, and message design.
  
  
  METHODS
  The Suitability Assessment of Materials (SAM) was amended for ease of use, inclusivity, and objectivity with the encouragement of the original developers. Other novel contributions were specifically related to "comprehensibility" (CAM). The resulting SAM + CAM was used to score 69 materials for content, literacy demand, numeric literacy, graphics, layout/typography, and learning stimulation variables. Expert reviewers provided content validation. Inter-rater reliability was "substantial" (kappa = .77).
  
  
  RESULTS
  The mean reading level of materials was 11th grade. Most materials (68%) scored as "adequate" for comprehensibility, suitability, and message design; health education brochures scored better than other materials. Only one-fifth were ranked "superior" for ease of use and comprehensibility.
  
  
  CONCLUSIONS
  Most written materials have a readability level that is too high and require improvement in ease of use and comprehensibility for the majority of readers.
authors.affiliation: Department of Family and Community Medicine, University of New Mexico, Albuquerque, NM 87131, USA. helitzer@salud.unm.edu
authors.forename: Deborah
authors.initials: D
authors.lastname: Helitzer
authors.forename: Christine
authors.initials: C
authors.lastname: Hollis
authors.forename: Jane
authors.initials: J
authors.lastname: Cotner
authors.forename: Nancy
authors.initials: N
authors.lastname: Oestreicher
mesh_terms: D032882:Comprehension; D004522:Educational Status; D005260:Female; D006801:Humans; D010174:Pamphlets; D010353:Patient Education as Topic / Q000379:methods*; D013664:Teaching Materials / Q000592:standards; D002583:Uterine Cervical Neoplasms / Q000517:prevention & control*