title: Readability, suitability, and characteristics of asthma action plans: examination of factors that may impair understanding.
abstract: OBJECTIVE
  Recognition of the complexity of asthma management has led to the development of asthma treatment guidelines that include the recommendation that all pediatric asthma patients receive a written asthma action plan. We assessed the readability, suitability, and characteristics of asthma action plans, elements that contribute to the effectiveness of action plan use, particularly for those with limited literacy.
  
  
  METHODS
  This was a descriptive study of 30 asthma action plans (27 state Department of Health (DOH)-endorsed, 3 national action plans endorsed by 6 states).
  
  
  METHODS
  (1) readability (as assessed by Flesch Reading Ease, Flesch-Kincaid, Gunning Fog, Simple Measure of Gobbledygook, Forcast), (2) suitability (Suitability Assessment of Materials [SAM], adequate: ≥ 0.4; unsuitable: <0.4), (3) action plan characteristics (peak flow vs symptom-based, symptoms, recommended actions).
  
  
  RESULTS
  Mean (SD) overall readability grade level was 7.2 (1.1) (range = 5.7-9.8); 70.0% were above a sixth-grade level. Mean (SD) suitability score was 0.74 (0.14). Overall, all action plans were found to be adequate, although 40.0% had an unsuitable score in at least 1 factor. The highest percent of unsuitable scores were found in the categories of layout/typography (30.0%), learning stimulation/motivation (26.7%), and graphics (13.3%). There were no statistically significant differences between the average grade level or SAM score of state DOH developed action plans and those from or adapted from national organizations. Plans varied with respect to terms used, symptoms included, and recommended actions.
  
  
  CONCLUSIONS
  Specific improvements in asthma action plans could maximize patient and parent understanding of appropriate asthma management and could particularly benefit individuals with limited literacy skills.
authors.affiliation: Department of Pediatrics, New York University School of Medicine and Bellevue Hospital Center, New York, New York 10016, USA. yinh02@med.nyu.edu
authors.forename: H Shonna
authors.initials: HS
authors.lastname: Yin
authors.forename: Ruchi S
authors.initials: RS
authors.lastname: Gupta
authors.forename: Suzy
authors.initials: S
authors.lastname: Tomopoulos
authors.forename: Michael S
authors.initials: MS
authors.lastname: Wolf
authors.forename: Alan L
authors.initials: AL
authors.lastname: Mendelsohn
authors.forename: Lauren
authors.initials: L
authors.lastname: Antler
authors.forename: Dayana C
authors.initials: DC
authors.lastname: Sanchez
authors.forename: Claudia Hillam
authors.initials: CH
authors.lastname: Lau
authors.forename: Benard P
authors.initials: BP
authors.lastname: Dreyer
mesh_terms: D001249:Asthma / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D032882:Comprehension; D019468:Disease Management; D004522:Educational Status; D057220:Health Literacy / Q000379:methods* / Q000592:standards; D006801:Humans; D010353:Patient Education as Topic / Q000379:methods* / Q000592:standards; D011932:Reading