title: A Mismatch Between Patient Education Materials About Sickle Cell Disease and the Literacy Level of Their Intended Audience.
abstract: Despite the first goal of the 2010 National Action Plan to Improve Health Literacy, the literacy demands of much health information exceeds the reading skills of most US adults. The objective of this study was to assess the health literacy level of publicly available patient education materials for people with sickle cell disease (SCD).
  
  
  
  We used 5 validated tools to evaluate 9 print and 4 online patient education materials: the simple measure of gobbledygook (SMOG) to assess reading grade level, the Peter Mosenthal and Irwin Kirsch readability formula (PMOSE/IKIRSCH) to assess structure and density, the Patient Education Materials Assessment Tool (PEMAT) to assess actionability (how well readers will know what to do after reading the material) and understandability, the Centers for Disease Control and Prevention's (CDC's) Clear Communication Index (Index) to obtain a comprehensive literacy demand score, and the Printed Cancer Education Materials for African Americans Cultural Sensitivity Assessment Tool.
  
  
  
  Materials' scores reflected high reading levels ranging from 8th grade to 12th grade, appropriate (low) structural demand, and low actionability relative to understandability. CDC suggests that an appropriate Index score should fall in or above the 90th percentile. The scores yielded by materials evaluated in this assessment ranged from the 44th to the 76th percentiles. Eight of the 13 materials scored within the acceptable range for cultural sensitivity.
  
  
  
  Reading levels of available patient education materials exceed the documented average literacy level of the US adult population. Health literacy demands should be a key consideration in the revision and development of patient education materials for people with SCD.
authors.affiliation: University of North Carolina at Chapel Hill - Epidemiology, 135 Dauer Dr, 2101 McGavran-Greenberg Hall, CB No 7435, Chapel Hill, NC 27599. Email: emcclure@unc.edu. Ms. McClure is also affiliated with Harvard TH Chan School of Public Health, Department of Social and Behavioral Sciences.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: McClure
authors.affiliation: Harvard TH Chan School of Public Health, Department of Social and Behavioral Sciences, Boston, Massachusetts.
authors.forename: Jared
authors.initials: J
authors.lastname: Ng
authors.affiliation: Harvard TH Chan School of Public Health, Department of Social and Behavioral Sciences, Boston, Massachusetts.
authors.forename: Kelly
authors.initials: K
authors.lastname: Vitzthum
authors.affiliation: Harvard TH Chan School of Public Health, Department of Social and Behavioral Sciences, Boston, Massachusetts.
authors.forename: Rima
authors.initials: R
authors.lastname: Rudd
mesh_terms: D000755:Anemia, Sickle Cell; D057220:Health Literacy / Q000592:standards*; D006801:Humans; D020407:Internet; D010353:Patient Education as Topic / Q000592:standards*; D011634:Public Health