Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations.
National guidelines for promoting health literacy do not consider the needs of people with low vision. This study explored consumer perceptions of a patient handout that was simplified for people with low health literacy and low vision. The simplified handout elicited statistically significant improvement in readability, suitability, and comprehensibility. This is the first study to examine the readability of patient handouts designed for people with low health literacy and low vision.
Primary Author and Speaker: Jennifer Fortuna
Contributing Authors: Anne Riddering, Cassie Lopez-Jeng, and Linda Shuster
BACKGROUND: The ability to access, process and understand written patient education materials (PEMs) is important for achieving patient outcomes. Existing research shows PEMs are consistently written at a reading level too high for the average American adult to comprehend. Evidence-based guidelines recommend PEMs be written in plain language below the sixth grade reading level. The reading abilities of people with low vision are often overlooked during the development of PEMs. Difficulty reading is a common complaint for patients referred for low vision rehabilitation. Several gaps in the literature exist surrounding the health information needs of people with low vision.
PURPOSE: This study addressed the following research questions: (1) For older adults with AMD, is there a significant difference in the readability, suitability and perceived comprehensibility of simplified PEMs as compared to the original format? (2) What are patient perceptions of the design characteristics of simplified PEMs?
DESIGN: One PEM was simplified based on evidence-based guidelines for rewriting materials for people with low health literacy and low vision. A within-subjects study design was used to determine differences between the original and simplified PEM.
METHOD: Both PEMs were assessed for readability, suitability and comprehensibility prior to scheduling home visits with participants. Word count and readability (i.e., grade level) were calculated using an online readability calculator. The Suitability Assessment of Materials (SAM) instrument was used to rate suitability (i.e., appropriateness). The Consumer Information Rating Form (CIRF) was used to quantify comprehensibility (i.e., design quality and usefulness) as perceived by participants. Semi-structured interviews were used to gather input on the quality and usefulness of PEMs. Descriptive statistics were used to determine the mean differences in SAM and CIRF scores between the original and simplified PEMs. Thematic analysis of interview transcripts followed the steps of the Framework Method.
RESULTS: Twelve participants met the inclusion criteria for this study. The simplified PEM elicited a statistically significant improvement in readability, suitability and comprehensibility. Based on results of the interview, the majority of participants stated the simplified version was easier to read (75%), understand (83%), locate information (92%) and remember information (92%). Qualitative analysis also revealed themes related to reading challenges, optical devices and patient-provider interactions.
CONCLUSION: National guidelines for improving written health information do not consider how the physical properties of text (e.g., font style and size, contrast, spacing) could negatively influence reading performance and comprehension in people with visual impairment. Older adults with low vision are at higher risk for low health literacy. The APH Guidelines for Print Document Design were created so individuals with visual impairments could more easily access and understand written text. Applying the existing guidelines for low health literacy and low vision will assist health care providers in promoting health literacy in this unique population. This proposal is important because it is the first study to examine the readability of PEMs designed for people with low health literacy and low vision. Additional research is needed to determine the optimal design and presentation of PEMs provided to older adults with AMD.
References
Beverly, C. A., Bath, P. A., & Booth, A. (2004). Health information needs of visually impaired people: A systematic review of the literature. Health & Social Care in the Community, 12(1), 1-24. https://doi.org/10.1111/j.1365-2524.2004.00460.x
Doak, L. G., & Doak, C. C. (2008). Pfizer Principles for Clear Health Communication (2nd ed.). https://www.pfizer.com/files/health/PfizerPrinciples.pdf
Kitchel, J. E. (2011). APH guidelines for print document design. American Printing House for the Blind. https://www.aph.org/aph-guidelines-for-print-document-design/
Warren, M. (2013). Promoting health literacy in older adults with low vision. Topics in Geriatric Rehabilitation, 29(2), 107-115. https://doi.org/10.1097/TGR.0b013e31827e4840
