Comprehension of discharge information for minor head injury: a randomised controlled trial in New Zealand.

AIMS: To investigate health literacy (i.e. understanding medical information) in North Shore Hospital's Emergency Medicine Department patients and to assess differences in comprehension between standard and simplified head injury advice sheets. METHODS: Prospective randomised controlled trial in a convenience sample of adult Emergency Medicine patients presenting to an urban emergency department (ED) in New Zealand. Consented patients were randomised to receive either the standard head injury advice sheet or a shorter, simplified sheet. Participants were asked 10 questions (to test comprehension of advice sheets), demographic data collected, and a Rapid Estimation of Adult Literacy in Medicine test administered. Data analysis included descriptive statistics with 95% confidence intervals, Mann Whitney U test, and regression model analysis. RESULTS: 200 participants. Mean age 43.4 years, 77.5% with 12 or more years of schooling, 84.5% with reading level of high school age or above. No significant differences in demographics, schooling, and reading levels were observed between study groups. The simplified form study group showed significantly higher comprehension scores (p<0.0001). In the regression analysis, factors associated with higher comprehension scores included: the simplified form, higher literacy level, more years of schooling, and younger age group. CONCLUSIONS: Previous studies have highlighted poor literacy levels in ED populations, a factor thought to affect understanding of discharge information. In this study population, where most read at high school level or above, the simplified advice sheet was still better understood. Recommendations for improving discharge information are discussed.