Tips for Improving Print Materials

  • Check the reading level of all print materials intended for patients using one of several readability formulas. Aim for a 6th to 8th grade reading level or below. The Internet provides a wealth of information about the range of readability formulas available. Assessing reading level via multiple formulas is probably the best way to get a reasonably accurate score. Several software packages provide multiple readability scores; among the most highly rated are Readability Plus and Readability Studio for Windows. (Microsoft Word™ provides a free readability assessment tool in its spell-check function—the Flesch-Kincaid grade level formula. While not necessarily the most accurate formula available, the Flesch-Kincaid assessment does provide both a “reading ease” and “grade-level” assessment of your written documents. It’s widely used because it’s free and easy. Simply select “show readability statistics” on the spelling & grammar tab of the Tool/Options window.)

  • ce335 Spelling Grammar
    • In addition to checking reading level, review print materials for overall suitability, including organization, layout, and design. The Suitability Assessment of Materials (SAM), developed by Cecilia and Leonard Doak, is one of the more comprehensive and widely used tools for this purpose. The SAM scores materials based on content and literacy demand, but also on graphics, layout and typography, learning stimulation, and cultural appropriateness. A full description and scoring sheet are available in Teaching Patients with Low Literacy Skills, Second Edition by Doak, Doak, and Root (now out of print but available for free download at: http://www.hsph.harvard.edu/healthliteracy/)
    • Replace and/or define medical terminology. In general, choose common, every day words. You might want to consult the HRSA Alternative Word Lists.
    • Use concise sentences with straightforward structure. Limit paragraphs to one main topic.
    • Put the most important information first and clearly emphasize anything that requires patient action.
    • Use active voice.
    • Use picture and diagrams, but only if they help to enhance meaning.
    • Put lists in bulleted format instead of embedding them in a long sentence or paragraph.
    • Make it look easy to read by using ample white space, simple fonts, and logical format.
    • Use clear headers that help explain what each chunk of text is about.
    • Pre-test each document as extensively as possible. At a minimum, ask a friend or neighbor to read it and point out anything that was confusing. When possible, field test the document with the intended audience and measure their comprehension.