Plain language and patient education:
A summary of current research

This is the first in a series of briefs that focus on evaluative research into the use of alternative means of health communication; they include plain language, audiotapes, videotapes, interactive media, and visual images. Searches of the medical and education literatures were conducted as part of a Health Literacy Project that is examining the communication needs of patients with limited literacy or other communication barriers. The guiding question for these searches was: ‘What impacts have been documented in relation to the identified target groups?’

The Health Literacy Project is a joint initiative of The Centre for Literacy of Quebec and the Nursing Department of the McGill University Health Centre (MUHC).

Introduction

While health education increasingly relies on print materials, little has been done to ensure that patients can actually understand the information. Relatively little research has examined how health care professionals can provide important health care information to patients with limited literacy or other communication barriers. Research has focussed on:

• how participants receive and understand the information;
• how information and forms can be simplified to improve readability;
• the gap between readability and comprehension; and
• other factors that affect patients’ use or disregard of print materials.

The issue of readability is particularly crucial when considering consent forms.

Methodology

This paper reviews 25 research articles and one abstract published in medical and education literatures on the subject of readability and patient understanding. Databases consulted in this search included: Aidsline, CancerLit, ERIC, Medline, PubMed. The studies included in this brief measure the effects of various facets of “readability” and “understandability,” such as simplified messages, lowered reading levels, writing style, the use of illustrated text and clear design concepts. A search for studies that measured the effects of easy-to-read health information on health status yielded no results.

Who was included?

Of the research we reviewed, most focussed on making health materials more readable for the general public. The majority of the studies included people who had completed at least nine years of schooling. While several studies acknowledged the correlation among poverty, lower levels of education and risk of poor health, only five looked specifically at patients with low reading abilities (Bell, Davis 1996, 1998a,1998b, Michielutte). Most of the studies explicitly excluded people who did not read and write English.

Few researchers consciously studied ethnically or economically diverse populations. One American study discovered that while there was no difference in comprehension between ethnic groups, white participants were more likely to read print materials than African Americans (Dowe).

Findings

The question most studies tried to answer was “What can we change about this material, manual or form so that the average person can read it more easily?” Researchers were startled to discover a great discrepancy between levels of education and reading level. In many cases, people were unable to understand materials which health professionals believed they “should” have been able to read. This raises questions about the ways in which patients interact with print, how materials can be made more readable, and other factors which could affect how patients interact with print. The results show that although some changes can make print materials more understandable, health professionals must also find other means of communicating with patients.