Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations.
This study examined readability (grade level) and suitability (appropriateness) of 100 online patient education materials (PEMs) designed for older adults with age-related macular degeneration. Six PEMs met the recommended readability level (sixth grade) and suitability score (70%). Current guidelines do not consider how age and vision loss create barriers to health literacy. This proposal is needed to inform future research and guide selection of PEMs to meet the needs of this population.
Primary Author and Speaker: Jennifer Fortuna
Contributing Authors: Anne Riddering, Cassie Lopez-Jeng, Linda Shuster
BACKGROUND: Age-related macular degeneration (AMD) is a chronic eye condition that leads to permanent vision loss in the central visual field. Difficulty reading is the most common complaint from patients. Reading comprehension may be poorer due to slower reading speed, increased demands of decoding and poorer quality of visual input. Optical devices improve access to text; however, they do not increase understanding of complex written information such as patient education materials (PEMs). The internet has become the most widely accessible source of PEMs. Existing research has explored the readability of PEMs across a variety of health conditions and subspecialties. This is the first study to focus on the readability (i.e., grade level) and suitability (i.e., appropriateness) of online PEMs designed for older adults with AMD.
PURPOSE: This study aims to answer the following research questions: (1) What is the general readability and suitability of online PEMs designed for older adults with AMD? (2) What percentage of online PEMs designed for older adults with AMD achieve the recommended readability level and suitability score? This is the first study to focus solely on the readability and suitability of online PEMs designed specifically for older adults with AMD. This research is needed to fuel future research and meet the unique learning needs of older adults with AMD.
METHOD: A convenience sample of online PEMs was sourced from the websites of professional organizations and institutions providing online patient education on AMD. The Flesch-Kincaid Grade Level (FKGL) formula was used to measure readability of written text. The Suitability Assessment of Materials (SAM) instrument was used to assess the overall suitability of PEMs. Descriptive statistics determined the mean FKGL readability level, SAM suitability score and percentage of online PEMs designed for older adults with AMD. Percentage of PEMs achieving the suggested readability level (< sixth grade) and suitability score (> 70%) was also calculated.
RESULTS: One hundred online PEMs were evaluated from 16 professional organizations and institutions. Based on the FKGL formula, the mean readability level was 9.3 (range 5.0-16.6). Only six PEMs (6%) were below the sixth grade reading level suggested by the American Medical Association and National Institutes of Health. Results of the SAM instrument found a mean suitability score of 53% (range 18%-78%). In total, 15 PEMs met the recommended suitability score (> 70%) for ‘superior' material. Twenty-three PEMs were rated ‘not suitable.' Thirteen of the 17 PEMs (76%) written at college reading level received a SAM rating of ‘not suitable.' Only six PEMs met both the suggested readability level (< sixth grade) and suitability score (> 70%).
CONCLUSION: To promote health literacy, the readability of PEMs must match the reading ability of the audience. Evidence-based guidelines for promoting health literacy do not consider how age and visual impairment may create additional barriers to processing and understanding of PEMs. Future research should treat older adults with AMD as a unique group under the larger umbrella of low vision. Additional studies are needed to determine the optimal design and presentation of PEMs for this population. Future research should also evaluate the effectiveness of PEMs that have been modified based on guidelines for patients with low health literacy and low vision. This proposal is needed to inform future research and guide in the selection, creation and modification of PEMs designed for older adults with AMD.
References
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