Readability of Written Materials for CKD Patients: A Systematic Review.

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. STUDY DESIGN Systematic review. SETTING & POPULATION Patient information materials aimed at adults with CKD and written in English. SEARCH STRATEGY & SOURCES 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. ANALYTICAL APPROACH 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). LIMITATIONS 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.

[1]  R H Jackson,et al.  Rapid assessment of literacy levels of adult primary care patients. , 1991, Family medicine.

[2]  P. Ley,et al.  The use of readability formulas in health care , 1996 .

[3]  R. Buchbinder,et al.  Readability and content of supplementary written drug information for patients used by Australian rheumatologists , 2001, The Medical journal of Australia.

[4]  Sheida White,et al.  Assessing the Lexile Framework: Results of a Panel Meeting. Working Paper No. 2001-08. , 2001 .

[5]  R. Kessels Patients’ Memory for Medical Information , 2003, Journal of the Royal Society of Medicine.

[6]  K. Norris,et al.  A survey of kidney disease and risk-factor information on the World Wide Web. , 2004, MedGenMed : Medscape general medicine.

[7]  Hal Burdick,et al.  THE LEXILE FRAMEWORK AS AN APPROACH FOR READING MEASUREMENT AND SUCCESS , 2004 .

[8]  R. Buchbinder,et al.  A linguistic framework for assessing the quality of written patient information: its use in assessing methotrexate information for rheumatoid arthritis. , 2005, Health education research.

[9]  B. Weiss,et al.  Quick Assessment of Literacy in Primary Care: The Newest Vital Sign , 2005, The Annals of Family Medicine.

[10]  Rachelle Buchbinder,et al.  Toward a more valid account of functional text quality: The case of the patient information leaflet , 2006 .

[11]  William H Shrank,et al.  A critical review of FDA-approved Medication Guides. , 2006, Patient education and counseling.

[12]  Heidi Anne E. Mesmer Tools for Matching Readers to Texts: Research-Based Practices , 2007 .

[13]  J. Coresh,et al.  Prevalence of chronic kidney disease in the United States. , 2007, JAMA.

[14]  S de Lusignan,et al.  Chronic kidney disease management in the United Kingdom: NEOERICA project results. , 2007, Kidney international.

[15]  V. Bellizzi,et al.  [Prevalence of chronic kidney disease]. , 2008, Giornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia.

[16]  R. Buchbinder,et al.  Medication information leaflets for patients: the further validation of an analytic linguistic framework. , 2010, Communication & medicine.

[17]  E. Gordon,et al.  Health literacy and kidney disease: toward a new line of research. , 2009, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[18]  R. Buchbinder,et al.  Patient assessment of medication information leaflets and validation of the Evaluative Linguistic Framework (ELF). , 2009, Patient education and counseling.

[19]  Julie E. Owen,et al.  An implementation pathway for matching education material with the literacy level of dialysis patients , 2009 .

[20]  J. Bensing,et al.  Endpoints in medical communication research, proposing a framework of functions and outcomes. , 2009, Patient education and counseling.

[21]  Meg Wilson,et al.  Readability and Patient Education Materials Used for Low-Income Populations , 2009, Clinical nurse specialist CNS.

[22]  S. Rosas,et al.  Health literacy associated with blood pressure but not other cardiovascular disease risk factors among dialysis patients. , 2012, American journal of hypertension.

[23]  P. Ward-smith Health literacy. , 2012, Urologic nursing.

[24]  Corri Black,et al.  Measuring the population burden of chronic kidney disease: a systematic literature review of the estimated prevalence of impaired kidney function. , 2012, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[25]  张瑞玲,et al.  Health literacy , 2012 .

[26]  N. Powe,et al.  Assessment of Printed Patient-Educational Materials for Chronic Kidney Disease , 2013, American Journal of Nephrology.

[27]  M. Taal,et al.  PS25 Discontinuation of Antiepileptic Drugs in Pregnancy: A UK Population Based Study in the Health Improvement Network (THIN) , 2012, Journal of Epidemiology & Community Health.

[28]  J. W. Nunes Education of patients with chronic kidney disease at the interface of primary care providers and nephrologists. , 2013 .

[29]  K. Cavanaugh,et al.  Health literacy: emerging evidence and applications in kidney disease care. , 2013, Advances in chronic kidney disease.

[30]  M. Sevick,et al.  Original Investigation Associations of Health Literacy With Dialysis Adherence and Health Resource Utilization in Patients Receiving Maintenance Hemodialysis , 2013 .

[31]  Julie A Wright Nunes,et al.  Education of patients with chronic kidney disease at the interface of primary care providers and nephrologists. , 2013, Advances in chronic kidney disease.

[32]  L. Wallace,et al.  Application of the content expert process to develop a clinically useful low-literacy Chronic Kidney Disease Self-Management Knowledge Tool (CKD-SMKT). , 2013, Research in social & administrative pharmacy : RSAP.

[33]  Alessandra R Mesquita,et al.  The use of pictograms in the health care: a literature review. , 2014, Research in social & administrative pharmacy : RSAP.

[34]  김정희,et al.  조선족 중년여성 근로자의 심혈관질환 예방 교육자료 개발 및 평가: Patient Education Materials Assessment Tool for Printable Materials (PEMAT-P) 이용 , 2016 .