title: Readability of patient education materials in ophthalmology: a single-institution study and systematic review.
abstract: BACKGROUND
  Patient education materials should be written at a level that is understandable for patients with low health literacy. The aims of this study are (1) to review the literature on readability of ophthalmic patient education materials and (2) to evaluate and revise our institution's patient education materials about glaucoma using evidence-based guidelines on writing for patients with low health literacy.
  
  
  METHODS
  A systematic search was conducted on the PubMed/MEDLINE database for studies that have evaluated readability level of ophthalmic patient education materials, and the reported readability scores were assessed. Additionally, we collected evidence-based guidelines for writing easy-to-read patient education materials, and these recommendations were applied to revise 12 patient education handouts on various glaucoma topics at our institution. Readability measures, including Flesch-Kincaid Grade Level (FKGL), and word count were calculated for the original and revised documents. The original and revised versions of the handouts were then scored in random order by two glaucoma specialists using the Suitability Assessment of Materials (SAM) instrument, a grading scale used to evaluate suitability of health information materials for patients. Paired t test was used to analyze changes in readability measures, word count, and SAM score between original and revised handouts. Finally, five glaucoma patients were interviewed to discuss the revised materials, and patient feedback was analyzed qualitatively.
  
  
  RESULTS
  Our literature search included 13 studies that evaluated a total of 950 educational materials. Among the mean FKGL readability scores reported in these studies, the median was 11 (representing an eleventh-grade reading level). At our institution, handouts' readability averaged a tenth-grade reading level (FKGL = 10.0 ± 1.6), but revising the handouts improved their readability to a sixth-grade reading level (FKGL = 6.4 ± 1.2) (p < 0.001). Additionally, the mean SAM score of our institution's handouts improved from 60 ± 7 % (adequate) for the original versions to 88 ± 4 % (superior) for the revised handouts (p < 0.001).
  
  
  CONCLUSIONS
  Our systematic review of the literature reveals that ophthalmic patient education materials are consistently written at a level that is too high for many patients to understand. Our institution's experience suggests that applying guidelines on writing easy-to-understand material can improve the readability and suitability of educational materials for patients with low health literacy.
authors.affiliation: Michigan State University College of Human Medicine, Grand Rapids, MI, USA.|Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Williams
authors.affiliation: Duke University Department of Ophthalmology, Durham, NC, USA.|Durham VA Medical Center, Health Services Research and Development, Durham, NC, USA.
authors.forename: Kelly W
authors.initials: KW
authors.lastname: Muir
authors.affiliation: Duke University Department of Ophthalmology, Durham, NC, USA. jullia.rosdahl@duke.edu.
authors.forename: Jullia A
authors.initials: JA
authors.lastname: Rosdahl
mesh_terms: D032882:Comprehension; D003194:Computer-Assisted Instruction / Q000592:standards; D005901:Glaucoma; D057220:Health Literacy; D006801:Humans; D020407:Internet; D010174:Pamphlets; D010353:Patient Education as Topic / Q000379:methods / Q000592:standards*; D011932:Reading