A quantitative analysis of the readability of breast health patient information resources in Ireland

Accessible written information is fundamental to patient-centred care and informed decision-making, yet health materials frequently exceed the reading ability of their intended audiences. In breast health - where patient information leaflets are widely used to support screening, diagnosis and treatment decisions - readability assessments offer an objective measure of accessibility.

To evaluate the readability of breast health patient information leaflets (PILs) produced by two major Irish health information providers - the Health Service Executive (HSE) and the Irish Cancer Society (ICS) - and to assess their compliance with national literacy recommendations.

A cross-sectional readability analysis was conducted on 27 publicly available breast health PILs (13 HSE; 14 ICS). Text was extracted and assessed using five validated readability indices: Flesch Reading Ease Score (FRES), Flesch-Kincaid Grade Level (FKGL), Gunning Fog Index (GFI), Simple Measure of Gobbledygook (SMOG), and Coleman-Liau Index (CLI). Median readability scores and interquartile ranges were calculated, and differences between providers were analysed using Mann-Whitney U tests.

Across all indices, both organisations' materials exceeded the recommended grade 7 readability threshold. ICS materials were significantly more difficult to read than HSE materials (p < 0.001). Median grade-level scores ranged from 7.1 (FKGL) to 9.0 (GFI) for HSE and 8.15 (FKGL) to 10.35 (GFI) for ICS. No significant differences were observed across topic categories.

Most breast health PILs in Ireland exceed recommended readability levels, limiting accessibility for many patients. Routine readability assessment and plain-language revision are warranted to promote equitable, patient-centred communication.