title: Application of the cloze procedure to evaluate comprehension and demonstrate rewriting of pharmacy educational materials.
abstract: BACKGROUND
  Written materials are commonly used to communicate pharmacy-relevant information to patients. However, they are often composed at a level that limits comprehension, mitigating a well-intended effect.
  
  
  OBJECTIVE
  To (1) use the cloze procedure (a test designed to assess reading comprehension) to evaluate an individual's understanding of a pharmacy-relevant educational pamphlet; (2) compare results of the cloze procedure with the reading comprehension component of the Short Test of Functional Health Literacy in Adults (S-TOFHLA); and (3) use results to demonstrate rewriting of the educational pamphlet.
  
  
  METHODS
  The cloze procedure was applied to a pharmacy-relevant educational pamphlet describing safe medication practices. A total of 162 subjects were recruited from university faculty, staff, and students; a local adult literacy center; and community senior centers. Subjects completed a background interview, the S-TOFHLA, and cloze procedure for the pharmacy-relevant educational pamphlet. S-TOFHLA and cloze procedure scores were described and compared. Cloze procedure responses were used to demonstrate revision of the pamphlet.
  
  
  RESULTS
  Of the 154 subjects analyzed, mean +/- SD age was 56.5 +/- 20.4 years. Subjects were predominantly white (93.5%), female (71.4%), and college graduates (42.2%). Mean score on the S-TOFHLA was 92.1%. A majority (95.5%, 147/154) of subjects demonstrated adequate functional health literacy. In contrast, mean score on the cloze procedure was 53.3%. Internal consistencies of the S-TOFHLA and the cloze procedure were 0.92 and 0.90, respectively. Scores on the cloze procedure and the S-TOFHLA were highly correlated (r = 0.71, p < 0.001). Performance on the cloze procedure indicated that 55.2% of subjects required supplemental teaching.
  
  
  CONCLUSIONS
  In this highly educated, health-literate sample, a majority did not understand the pharmacy-relevant educational pamphlet despite adequate performance on a standard measure of health literacy. The cloze procedure can be used to assess comprehension of educational materials, solicit feedback from intended users, and guide the revision of educational materials.
authors.affiliation: Department of Pharmacy, Clinical and Administrative Sciences-Tulsa, The University of Oklahoma, USA. michael-miller@ouhsc.edu
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Miller
authors.forename: Jane E
authors.initials: JE
authors.lastname: DeWitt
authors.forename: Erin M
authors.initials: EM
authors.lastname: McCleeary
authors.forename: Kelly J
authors.initials: KJ
authors.lastname: O'Keefe
mesh_terms: D000328:Adult; D000368:Aged; D032882:Comprehension; D003430:Cross-Sectional Studies; D004522:Educational Status; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D010174:Pamphlets; D010353:Patient Education as Topic / Q000592:standards*; D011932:Reading