An assessment of printed diabetes-prevention materials available to a Northern Plains tribe

The purpose of this study was to characterize the literacy demands of print materials used to encourage diabetes prevention on the Crow Reservation. Diabetes-prevention materials included pamphlets, booklets, and fact sheets provided to Crow people. Readability was assessed using the SMOG formula. Diabetes related vocabulary was assessed to determine whether medical/scientific words were used and if they were defined. Numeracy demand was assessed by counting the number of times different numeracy concepts were used in each material. Lists, charts, and graphs were assessed using the PMOSE/IKIRSCH tool. We found that materials were written at a readability level higher than recommended. Across all materials, vocabulary terms were used often but not always defined. Numeric terms were not often used, but when used they were not defined. Most of the materials required the reader to read numbers or count. However, overall numeracy demand was relatively low. The PMOSE/IKIRSCH scores for materials were adequate. The authors found a mismatch between the level of skills required in some of the materials and the skills of the average person, including adults on the Crow Reservation. This study highlights the need for designing materials specifically for the intended audience, including rigorous pilot testing of materials.