Computerized versus hand-scored health literacy tools: a comparison of Simple Measure of Gobbledygook (SMOG) and Flesch-Kincaid in printed patient education materials.

OBJECTIVE: The research compared and contrasted hand-scoring and computerized methods of evaluating the grade level of patient education materials that are distributed at an academic medical center in east Tennessee and sought to determine if these materials adhered to the American Medical Association's (AMA's) recommended reading level of sixth grade. METHODS: Librarians at an academic medical center located in the heart of Appalachian Tennessee initiated the assessment of 150 of the most used printed patient education materials. Based on the Flesch-Kincaid (F-K) scoring rubric, 2 of the 150 documents were excluded from statistical comparisons due to the absence of text (images only). Researchers assessed the remaining 148 documents using the hand-scored Simple Measure of Gobbledygook (SMOG) method and the computerized F-K grade level method. For SMOG, 3 independent reviewers hand-scored each of the 150 documents. For F-K, documents were analyzed using Microsoft Word. Reading grade levels scores were entered into a database for statistical analysis. Inter-rater reliability was calculated using intra-class correlation coefficients (ICC). Paired t-tests were used to compare readability means. RESULTS: Acceptable inter-rater reliability was found for SMOG (ICC=0.95). For the 148 documents assessed, SMOG produced a significantly higher mean reading grade level (M=9.6, SD=1.3) than F-K (M=6.5, SD=1.3; p<0.001). Additionally, when using the SMOG method of assessment, 147 of the 148 documents (99.3%) scored above the AMA's recommended reading level of sixth grade. CONCLUSIONS: Computerized health literacy assessment tools, used by many national patient education material providers, might not be representative of the actual reading grade levels of patient education materials. This is problematic in regions like Appalachia because materials may not be comprehensible to the area's low-literacy patients. Medical librarians have the potential to advance their role in patient education to better serve their patient populations.

Librarians Promoting Changes in the Health Care Delivery System through Systematic Assessment.

Patient engagement in health care decisions largely depends on a patient's health literacy and the health literacy attributes of the health care organization. Librarians have an established role in connecting patients with health information in the context of their care. However, librarians can play a larger role in helping to make changes in their organization's health literacy attributes. This article discusses one medical library's process of leading systematic assessment of their organization's health literacy attributes. Included in this discussion is the institutional support, timeline, assessment tool, the results for five areas of health literacy, marketing and the event-planning process to disseminate results. The systematic assessment process described employs the Health Literacy Environment of Hospitals and Health Centers document, which provides assessment tools for Print Communication, Oral Communication, Navigation, Technology, and Policies and Protocols.

Assessing the Print Communication and Technology Attributes of an Academic Medical Center.

BACKGROUND: Historically, health literacy has been viewed as the patient's problem; however, it is now accepted that the responsibility for improving health literacy lies with the health care professionals and systems. An Institute of Medicine report outlines the health literacy attributes, such as printed patient education and technology, which both play a role in patient decision-making and engaging them in their health care. Research suggests that patients who are engaged in their health care have improved health outcomes. For health care organizations to accommodate the needs of all patients, it is imperative that they determine the current organizational state and discover opportunities for improvement. METHODS: The Health Literacy Environment of Hospitals and Health Centers (HLEHHC) Print Communication Rating and Technology Rating Tool were used to measure the internal aspects of organizational health literacy at The University of Tennessee Medical Center (UTMC). Included in the print assessment were the 150 most distributed patient education handouts. Researchers also used the Simple Measure of Gobbledygook and Patient Education Materials Assessment Tool to assess print material. Technology was assessed using UTMC's website as the authoritative source. KEY RESULTS: The HLEHHC was useful for assessing print material and technology. Reviewing and reporting the data question-by-question revealed more granular, actionable information on where there are opportunities to improve the health care environment for all patients. This analysis resulted in proposing actions based on best practices that UTMC could implement in the coming year. The process is replicable in other settings. IMPLICATIONS: Responsibility for improving informed medical decision-making lies with health care organizations. Low health literacy influences the effectiveness of print patient education and technology in informing patients about their health. Assessing these aspects of the health care organization as part of quality improvement provides necessary data for improvements. The Health Literacy Environment of Hospital and Health Centers was a useful tool to measure characteristics of print and technology. [HLRP: Health Literacy Research and Practice. 2018;2(1):e26-e34.]. PLAIN LANGUAGE SUMMARY: A task force at an academic medical center assessed the health literacy attributes of their organization. Researchers assessed print patient education and patient-related technology. The researchers found areas for improvements to make health information easier to understand.