title: Readability, suitability and comprehensibility in patient education materials for Swedish patients with colorectal cancer undergoing elective surgery: a mixed method design.
abstract: OBJECTIVE
  To characterize education materials provided to patients undergoing colorectal cancer surgery to gain a better understanding of how to design readable, suitable, comprehensible materials.
  
  
  METHODS
  Mixed method design. Deductive quantitative analysis using a validated suitability and comprehensibility assessment instrument (SAM+CAM) was applied to patient education materials from 27 Swedish hospitals, supplemented by language technology analysis and deductive and inductive analysis of data from focus groups involving 15 former patients.
  
  
  RESULTS
  Of 125 patient education materials used during the colorectal cancer surgery process, 13.6% were rated 'not suitable', 76.8% 'adequate' and 9.6% 'superior'. Professionally developed stoma care brochures were rated 'superior' and 44% of discharge brochures were 'not suitable'. Language technology analysis showed that up to 29% of materials were difficult to comprehend. Focus group analysis revealed additional areas that needed to be included in patient education materials: general and personal care, personal implications, internet, significant others, accessibility to healthcare, usability, trustworthiness and patient support groups.
  
  
  CONCLUSIONS
  Most of the patient education materials were rated 'adequate' but did not meet the information needs of patients entirely. Discharge brochures particularly require improvement.
  
  
  CONCLUSIONS
  Using patients' knowledge and integrating manual and automated methods could result in more appropriate patient education materials.
authors.affiliation: Department of Colorectal Surgery, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden; Institute of Health and Care Sciences,Sahlgrenska Academy, University of Gothenburg, Sweden; University of Gothenburg Centre for Person-centred Care (GPCC), Sweden. Electronic address: frida.smith@vgregion.se.
authors.forename: Frida
authors.initials: F
authors.lastname: Smith
authors.affiliation: Department of Colorectal Surgery, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden; Institute of Health and Care Sciences,Sahlgrenska Academy, University of Gothenburg, Sweden; University of Gothenburg Centre for Person-centred Care (GPCC), Sweden.
authors.forename: Eva
authors.initials: E
authors.lastname: Carlsson
authors.affiliation: Språkbanken/Department of Swedish language, University of Gothenburg, Sweden.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Kokkinakis
authors.affiliation: Språkbanken/Department of Swedish language, University of Gothenburg, Sweden.
authors.forename: Markus
authors.initials: M
authors.lastname: Forsberg
authors.affiliation: Department of Colorectal Surgery, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden; Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Karl
authors.initials: K
authors.lastname: Kodeda
authors.affiliation: Trinity Western University, School of Nursing, Providence Health Care, Centre for Health Evaluation and Outcomes Sciences, Vancouver, Canada.
authors.forename: Richard
authors.initials: R
authors.lastname: Sawatzky
authors.affiliation: Institute of Health and Care Sciences,Sahlgrenska Academy, University of Gothenburg, Sweden; University of Gothenburg Centre for Person-centred Care (GPCC), Sweden; Department of Health Studies, Faculty of Social Sciences, University of Stavanger, Norway.
authors.forename: Febe
authors.initials: F
authors.lastname: Friberg
authors.affiliation: Institute of Health and Care Sciences,Sahlgrenska Academy, University of Gothenburg, Sweden; University of Gothenburg Centre for Person-centred Care (GPCC), Sweden; Palliative Research Centre, Ersta Sköndal University College and Ersta Hospital, Stockholm, Sweden.
authors.forename: Joakim
authors.initials: J
authors.lastname: Öhlén
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000601:surgery*; D032882:Comprehension; D017558:Elective Surgical Procedures; D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D057220:Health Literacy; D006801:Humans; D007802:Language; D008297:Male; D008875:Middle Aged; D010174:Pamphlets; D010353:Patient Education as Topic / Q000379:methods*; D011932:Reading; D015203:Reproducibility of Results; D013548:Sweden; D013664:Teaching Materials / Q000592:standards*
keywords: Colorectal cancer; Comprehensibility assessment in material; ERAS; Focus groups; Language technology analysis; Patient education materials; Readability assessment in material; Suitability assessment in material; Surgical care