title: Readability of Written Materials for CKD Patients: A Systematic Review.
abstract: BACKGROUND
  The "average" patient has a literacy level of US grade 8 (age 13-14 years), but this may be lower for people with chronic kidney disease (CKD). Current guidelines suggest that patient education materials should be pitched at a literacy level of around 5th grade (age 10-11 years). This study aims to evaluate the readability of written materials targeted at patients with CKD.
  
  
  METHODS
  Systematic review.
  
  
  METHODS
  Patient information materials aimed at adults with CKD and written in English.
  
  
  METHODS
  Patient education materials designed to be printed and read, sourced from practices in Australia and online at all known websites run by relevant international CKD organizations during March 2014.
  
  
  METHODS
  Quantitative analysis of readability using Lexile Analyzer and Flesch-Kincaid tools.
  
  
  RESULTS
  We analyzed 80 materials. Both Lexile Analyzer and Flesch-Kincaid analyses suggested that most materials required a minimum of grade 9 (age 14-15 years) schooling to read them. Only 5% of materials were pitched at the recommended level (grade 5).
  
  
  CONCLUSIONS
  Readability formulas have inherent limitations and do not account for visual information. We did not consider other media through which patients with CKD may access information. Although the study covered materials from the United States, United Kingdom, and Australia, all non-Internet materials were sourced locally, and it is possible that some international paper-based materials were missed. Generalizability may be limited due to exclusion of non-English materials.
  
  
  CONCLUSIONS
  These findings suggest that patient information materials aimed at patients with CKD are pitched above the average patient's literacy level. This issue is compounded by cognitive decline in patients with CKD, who may have lower literacy than the average patient. It suggests that information providers need to consider their audience more carefully when preparing patient information materials, including user testing with a low-literacy patient population.
authors: Screening and Test Evaluation Program (STEP), Sydney School of Public Health, Sydney, Australia; Centre for Medical Psychology and Evidence-Based Decision-Making (CeMPED), The University of Sydney, Sydney, Australia.
authors: Suzanne
authors: S
authors: Morony
authors: Sydney School of Public Health, The University of Sydney, Sydney, Australia.
authors: Michaela
authors: M
authors: Flynn
authors: Screening and Test Evaluation Program (STEP), Sydney School of Public Health, Sydney, Australia; Centre for Medical Psychology and Evidence-Based Decision-Making (CeMPED), The University of Sydney, Sydney, Australia.
authors: Kirsten J
authors: KJ
authors: McCaffery
authors: Screening and Test Evaluation Program (STEP), Sydney School of Public Health, Sydney, Australia; Centre for Medical Psychology and Evidence-Based Decision-Making (CeMPED), The University of Sydney, Sydney, Australia.
authors: Jesse
authors: J
authors: Jansen
authors: Sydney School of Public Health, The University of Sydney, Sydney, Australia; Centre for Transplant and Renal Research, Westmead Hospital, Westmead, New South Wales, Australia. Electronic address: angela.webster@sydney.edu.au.
authors: Angela C
authors: AC
authors: Webster
mesh_terms: D000328:Adult; D001315:Australia; D032882:Comprehension; D004522:Educational Status; D006801:Humans; D020407:Internet; D010353:Patient Education as Topic; D011932:Reading; D051436:Renal Insufficiency, Chronic; D013664:Teaching Materials / Q000592:standards*
keywords: Chronic kidney disease (CKD); Flesch-Kincaid; Lexile Analyzer; health literacy; literacy level; medical terminology; patient education; patient empowerment; patient information materials; readability; reading comprehension; renal disease; self-care; self-management of health care; shared decision making