Readability assessment of American Shoulder and Elbow Surgeons patient brochures with suggestions for improvement

BACKGROUND: Many Americans have limited literacy skills, and the National Institutes of Health (NIH) suggests patient educational material be written below the 8th grade level. Many orthopedic organizations provide print material for patients, but whether these documents are written at an appropriate reading level is not clear. This study assessed the readability of patient education brochures provided by the American Shoulder and Elbow Surgeons (ASES). MATERIALS AND METHODS: In May 2017, 6 ASES patient education brochures were analyzed using readability software. The reading level was calculated for each brochure using 9 different tests. The mean reading level for each article was compared with the NIH-recommended 8th grade level using 2-tailed, 1-sample t tests assuming unequal variances. RESULTS: For each of the 9 tests, the mean reading level was higher than the NIH-recommended 8th grade (test, grade level): Automated Readability Index, 14.1 (P < .05); Coleman-Liau, 14.2 (P < .05); New Dale-Chall, 13.2 (P < .05); Flesch-Kincaid, 13.7 (P < .05); FORCAST, 11.8 (P < .05); Fry, 15.8 (P < .05); Gunning Fog, 16.5 (P < .05); Raygor Estimate, 15.4 (P < .05); and Simple Measure of Gobbledygook (SMOG), 15.1 (P < .05). CONCLUSIONS: The ASES patient education brochures are written well above the NIH-recommended 8th grade reading level. These findings are similar to other investigations concerning orthopedic patient education material. Supplementary brochures and websites could be a useful source of information, particularly for patients who are deterred from asking questions in the office. Printed material designed for patient education should be edited to a more reasonable reading level. Further review of patient education materials is warranted.