Reading Level: Not the Only Determinant of Readability

摘要

Reading Level: Not the Only Determinant of ReadabilityTo the Editor:It was nice to learn that the reading demand of patient education materials (PEMs) created by the American Academy of Family Physicians (AAFP) has been improving in recent years. As reported by Schoof and Wallace1 in the April issue of Family Medicine, only 5% of those PEMs were written at or below the recommended sixth-grade level in 2004, while in 2012, 59% were at or below that level. That’s good news.But, it is important to keep in mind that reading level is not the whole story of what makes PEMs easy for patients to understand. Reading level is simply a computation based on things like number of letters per word and number of words per sentence. Thus, by using short words and short sentences, one can easily write text at a low grade level that is nonetheless incomprehensible. An example I often use to illustrate this point is the following sentence: “Muons are smaller than prions.” That’s at the first-grade level, but few people know what the words mean. An endless list of similarly incomprehensible words, like “hormone imbalance” or “microscopic parasite” still appear in the AAFP’s PEMs,2,3 even though, as reported by Schoof and Wallace, there has been great progress in decreasing the computed reading level of those PEMs.So, it is important to keep the focus not just on reading level of PEMs but also on the actual words used and whether they are relevant to patients. Word familiarity correlates more strongly than word length with perceived text difficulty.4 Similarly, avoiding unnecessary or irrelevant information allows readers—especially those with limited reading skills—to find important information more quickly.5 These facts should not be lost in the laudable goal, but unfortunately sometimes the only goal, of decreasing the computed reading level of PEMs.Barry D. Weiss, MDDepartment of Family and Community MedicineUniversity of ArizonaReferences