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Patient Education: Why the Reading Level Isn’t Everything

Just about every health literacy guideline, tool kit, or checklist says that patient-directed information should be written at a 6th-grade reading level or below. And it doesn’t stop there; it’s recommended across the board—from the news and political speeches to marketing campaigns and sales efforts. Everything.

If you’ve written patient education (or anything), you know it’s no easy task to stay at a 6th-grade reading level! So—have you ever wondered why this recommendation exists?

a study

Unlike other recommendations in the medical community, the reasoning here isn’t all that complex. It’s simply based on the fact that most people in the United States read at an 8th-grade level or below.

In general, any writer’s primary goal is to be simple, clear, and concise in order to keep the reader’s attention. But in healthcare, the goal is more than just holding someone’s attention; patients need understandable information that enables them to engage in their care and take action for their health.

Yet, numerous research studies have proven that patient-directed medical materials rarely comply with the reading level recommendations. If you don’t believe us, here are a couple of examples.

Despite the consensus on reading level recommendations, why has medical information universally “failed” to hit the benchmark? Is it simply too hard? Is it impossible? Or maybe the score doesn’t even matter?

We argue that the reading level isn’t everything! And we’re about to tell you why.

First, let’s make one thing clear: we aren’t saying you can completely disregard the principles of readability scores. We want to highlight that the score itself can be misleading when it comes to patient education.

Why is this? Well, one of the most important aspects of a readability score is avoiding words with more than two syllables. So, the fewer the syllables per word, the better your score.

Now think about how many medical terms are two syllables or fewer. Even terms and concepts with straightforward definitions like "self-examination"(SELF IG-ZAM-IN-A-SHUN) — Using your hands to feel for abnormal tissue in your breast don’t pass this test.

The reverse can also be misleading—words with only a couple of syllables can have very complex meanings. For example, “platelets.” The average American doesn’t know what platelets(PLATE-LITS) — Cells in the blood that prevent bleeding means any more than they know what apoptosis(A-POP-TOE-SIS) — The programmed death of a cell; when a normal cell is expected to die means. In these cases, the score could give a false sense of readability.

people reading a book
We hope we have your attention now!

A common practice to beat the test is to replace the more complex medical words with simpler ones. In other words, dummy it down. While the content has "passed the test,” it’s not accomplishing your goal. The reader isn’t going to learn one of the most critical aspects of the education—the terms.

Regardless of what’s included in the education, providers will use the actual medical terms when speaking with their patients. If we don’t teach patients the vocabulary their providers use, patients are no better off communicating about their health.


So, what’s the solution?

At Leveling Health, we employ many learning and teaching techniques that allow us to use the big, scary, doctor words, while never sacrificing readability (even if the score doesn’t show it—yes, we’re also guilty). We never simply dummy down information for the sake of the score. Effectiveness always wins.

Additionally, we recognize that not all medical terms are created equally. We intelligently select the important medical terms and concepts to include in our patient education materials. Then, we apply multiple techniques to teach the reader what the words mean and what they truly need to know.

water-color dandelion

When it comes to readability, our most effective techniques are definitions, pronunciations, and analogies. Definitions are within the copy, pulled aside on-page, and sometimes included in a dictionary appendix. Analogies, metaphors, and stories accompany explanations and definitions to help with memory and understanding. Finally, a phonetic pronunciation is provided for all the hard-to-say words so that when providers say the terms, patients recognize and connect them to everything they’ve heard and learned.

Creating excellent patient education can be overwhelming. We know how hard it is to find the perfect balance. But we have it down to a science.

Let Leveling Health help you upgrade your patient education—your patients will love you for it.

  1. Tran BNN, Ruan QZ, Epstein S, Ricci JA, Rudd RE, Lee BT. Literacy analysis of National Comprehensive Cancer Network patient guidelines for the most common malignancies in the United States. Cancer. 2017;124(4):769-774. doi:10.1002/cncr.31113.
  2. Stossel LM, Segar N, Gliatto P, Fallar R, Karani R. Readability of Patient Education Materials Available at the Point of Care. Journal of General Internal Medicine. 2012;27(9):1165-1170. doi:10.1007/s11606-012-2046-0.
  3. Eltorai A, Ghanian S, Adams C, Born C, Daniels A. Readability of Patient Education Materials on the American Association for Surgery of Trauma Website. Archives of Trauma Research. 2014;3(1). doi:10.5812/atr.18161.

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