title: An analysis of the readability of patient information materials for common urological conditions.
abstract: BACKGROUND
  Health literacy has been shown to be an important determinant of outcomes in numerous disease states. In an effort to improve health literacy, the Canadian Urological Association (CUA) publishes freely accessible patient information materials (PIMs) on common urological conditions. We sought to evaluate the readability of the CUA's PIMs.
  
  
  METHODS
  All PIMs were accessed through the CUA website. The Flesch Reading Ease Score (FRES), the Flesch-Kincaid Grade Level (FKGL), and the number of educational graphics were determined for each PIM. Low FRES scores and high FKGL scores are associated with more difficult-to-read text. Average readability values were calculated for each PIM category based on the CUA-defined subject categorizes. The five pamphlets with the highest FKGL scores were revised using word substitutions for complex multisyllabic words and reanalyzed. The Kruskal-Wallis test was used to identify readability differences between PIM categories and paired t-tests were used to test differences between FKGL scores before and after revisions.
  
  
  RESULTS
  Across all PIMs, FRES values were low (mean 47.5, standard deviation [SD] 7.47). This corresponded to an average FKGL of 10.5 (range 8.1-12.0). Among PIM categories, the infertility and sexual function PIMs exhibited the highest average FKGL (mean 11.6), however, differences in scores between categories were not statistically significant (p=0.38). The average number of words per sentence was also highest in the infertility and sexual function PIMs and significantly higher than other categories (mean 17.2; p=0.01). On average, there were 1.4 graphics displayed per PIM (range 0-4), which did not vary significantly by disease state (p=0.928). Simple words substitutions improved the readability of the five most difficult-to-read PIMs by an average of 3.1 grade points (p<0.01).
  
  
  CONCLUSIONS
  Current patient information materials published by the CUA compare favourably to those produced by other organizations, but may be difficult to read for low-literacy patients. Readability levels must be balanced against the required informational needs of patients, which may be intrinsically complex.
authors.affiliation: Departments of Urology and.
authors.forename: Katie
authors.initials: K
authors.lastname: Dalziel
authors.affiliation: Departments of Urology and; Oncology, Queen's University, Kingston, ON, Canada.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Leveridge
authors.affiliation: Departments of Urology and.
authors.forename: Stephen S
authors.initials: SS
authors.lastname: Steele
authors.affiliation: Departments of Urology and; Oncology, Queen's University, Kingston, ON, Canada;; Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Kingston, ON, Canada.
authors.forename: Jason P
authors.initials: JP
authors.lastname: Izard