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. 2021 Mar 3:8:2374373521998847.
doi: 10.1177/2374373521998847. eCollection 2021.

Readability of Patient Education Materials From High-Impact Medical Journals: A 20-Year Analysis

Michael K Rooney  1 , Gaia Santiago  2 , Subha Perni  3 , David P Horowitz  4 , Anne R McCall  5 , Andrew J Einstein  6 , Reshma Jagsi  7 , Daniel W Golden  5
Affiliations

Readability of Patient Education Materials From High-Impact Medical Journals: A 20-Year Analysis

Michael K Rooney et al. J Patient Exp. .

Abstract

Comprehensive patient education is necessary for shared decision-making. While patient-provider conversations primarily drive patient education, patients also use published materials to enhance their understanding. In this investigation, we evaluated the readability of 2585 patient education materials published in high-impact medical journals from 1998 to 2018 and compared our findings to readability recommendations from national groups. For all materials, mean readability grade levels ranged from 11.2 to 13.8 by various metrics. Fifty-four (2.1%) materials met the American Medical Association recommendation of sixth grade reading level, and 215 (8.2%) met the National Institutes of Health recommendation of eighth grade level. When stratified by journal and material type, general medical education materials from Annals of Internal Medicine were the most readable (P < .001), with 79.8% meeting the eighth grade level. Readability did not differ significantly over time. Efforts to standardize publication practice with the incorporation of readability evaluation during the review process may improve patients' understanding of their disease processes and treatment options.

Keywords: health literacy; medical decision making; patient education; patient engagement.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article. All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr. Horowitz reported receiving consulting fees and travel reimbursement from Carl Zeiss and consulting fees from Champions Oncology. Dr. Einstein reported receiving grant funding for unrelated research from the National Heart Lung, and Blood Institute, the National Cancer Institute, the International Atomic Energy Agency, Canon Medical Systems, Roche Medical Systems, and W. L. Gore & Associates; he has received consulting fees from GE Healthcare and W. L. Gore & Associates. Dr. Jagsi has stock options as compensation for her advisory board role in Equity Quotient, a company that evaluates culture in health care companies; she has received personal fees from Amgen and Vizient and grants for unrelated work from the National Institutes of Health, the Doris Duke Foundation, the Greenwall Foundation, the Komen Foundation, and Blue Cross Blue Shield of Michigan for the Michigan Radiation Oncology Quality Consortium. She has a contract to conduct an investigator initiated study with Genentech. She has served as an expert witness for Sherinian and Hasso and Dressman Benzinger LaVelle. She is an uncompensated founding member of TIME’S UP Healthcare and a member of the Board of Directors of ASCO. Dr. Golden reported receiving grant funding from the National Institutes of Health, Radiation Oncology Institute, and Bucksbaum Institute for Clinical Excellence. He is manager of RadOncQuestions LLC and HemOncReview LLC. No other disclosures were reported.

Figures

Figure 1.
Figure 1.
Proportion of materials meeting national readability recommendations. AIM (Gen Ed) indicates Annals of Internal Medicine, General Patient Education; AIM (Research), Annals of Internal Medicine, Research Article Lay Summaries; AJRCC, American Journal of Respiratory and Critical Care Medicine; ARD, Annals of the Rheumatic Diseases; JAMA, Journal of the American Medical Association; JAMA IM, Journal of the American Medical Association, Internal Medicine. *Small sample size (n = 2).
Figure 2.
Figure 2.
Mean readability grade levels of materials over time, stratified by journal. The AMA recommends that patient materials be written at the sixth grade level (red dotted line); the NIH recommends the eighth grade level (blue dotted line). AIM (Gen Ed) indicates Annals of Internal Medicine, general patient education; AIM (Research), Annals of Internal Medicine, Research Article Lay Summaries; AJRCC, American Journal of Respiratory and Critical Care Medicine; ARD, Annals of the Rheumatic Diseases; JAMA, Journal of the American Medical Association; JAMA IM, Journal of the American Medical Association, Internal Medicine; NIH, National Institutes of Health.
Figure 3.
Figure 3.
Readability of materials as measured by the Raygor estimate. A, American Journal of Respiratory and Critical Care Medicine; (B) Annals of Internal Medicine (General Education); (C) Annals of Internal Medicine (Research Lay Summaries); (D) Annals of the Rheumatic Diseases; (E) Circulation; (F) Journal of the American Medical Association Network, including all subspecialty journals. Raygor estimates with high percentages of long words or short sentences are considered invalid.
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