title: Patient-appropriate health literacy educational materials in ophthalmology.
abstract: OBJECTIVE
  To evaluate the literacy level of patients with glaucoma in a tertiary care teaching centre compared with a rural community centre and to assess comprehension of and preference for educational material written at different reading levels.
  
  
  METHODS
  Prospective, randomized, double-blinded study.
  
  
  METHODS
  Patients with glaucoma presenting for routine examination or referral at a tertiary care academic centre in southwestern Ontario and a single general ophthalmology clinic located in a moderately sized suburban community in Ontario, Canada, were invited to participate in this study. Patients aged 19 to 90 with sufficient visual acuity to read the pamphlets were recruited.
  
  
  METHODS
  Eligible and consenting participants underwent a validated literacy study, and their literacy levels were classified as adequate, barely adequate, marginal, or inadequate. They were then randomized to receive educational pamphlets written at either a grade 5 (intervention group) or grade 10 (control group) reading level. Comprehension of and preference for the material were determined by analysis of cloze testing and a feedback questionnaire.
  
  
  RESULTS
  Of 199 participants, 179 were included in the analysis. The literacy testing found that 35% of patients in the community practice and 30% in the tertiary care academic centre had "marginal" or "inadequate" literacy skills, but there was no significant difference between sites (p = 0.77). Comprehension of the educational material was higher in the intervention group versus the control group (p = 0.0057), with a mean cloze score of 57.9% in the intervention group and 48.3% in the control group. The intervention group spent significantly less time reading the pamphlets (p < 0.0001), with an average of 2.52 minutes compared with 4.51 minutes. The feedback survey indicated that patients found the pamphlet with the lower reading level easier to read (p = 0.02), which was reflected in their comments as well.
  
  
  CONCLUSIONS
  In both academic and community practice settings, about 30% of patients with glaucoma have marginal or inadequate literacy skills. However, regardless of practice, all patients better comprehend, and were more receptive to, educational material written at grade 5 reading level with illustrations, regardless of initial literacy level.
authors: Schulich School of Medicine and Dentistry, Western University, London, Ont.; Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ont.. Electronic address: dmikhail2013@gmail.com.
authors: David
authors: D
authors: Mikhail
authors: Schulich School of Medicine and Dentistry, Western University, London, Ont.; Department of Medical Imaging, Schulich School of Medicine and Dentistry, Western University, London, Ont.
authors: Kari L
authors: KL
authors: Visscher
authors: Schulich School of Medicine and Dentistry, Western University, London, Ont.
authors: Nancy
authors: N
authors: Chen
authors: Schulich School of Medicine and Dentistry, Western University, London, Ont.
authors: Joy
authors: J
authors: Wang
authors: Schulich School of Medicine and Dentistry, Western University, London, Ont.; Department of Ophthalmology, Schulich School of Medicine and Dentistry, Western University, London, Ont.
authors: Barry Y
authors: BY
authors: Emara
authors: Schulich School of Medicine and Dentistry, Western University, London, Ont.; Department of Ophthalmology, Schulich School of Medicine and Dentistry, Western University, London, Ont.
authors: Cindy M
authors: CM
authors: Hutnik
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D032882:Comprehension; D004311:Double-Blind Method; D004521:Educational Measurement; D004522:Educational Status; D005260:Female; D005901:Glaucoma; D006266:Health Education / Q000592:standards*; D057220:Health Literacy / Q000592:standards*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009885:Ophthalmology / Q000193:education*; D010174:Pamphlets; D010353:Patient Education as Topic / Q000592:standards*; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D013664:Teaching Materials / Q000592:standards*; D055815:Young Adult