Readability of self-care instructional pamphlets for diabetic patients

The readability of written instructional materials for diabetic patients is an important consideration in their use. We assessed the readability of six commonly used patient teaching guides on diabetic self-care. In addition, two pamphlets developed by our program for diabetic patients with fifth to tenth grade reading ability were also studied as controls. The difficulty of reading each pamphlet was estimated by a novel computer program which simultaneously measures readability by seven accepted formulas. The scores derived by each formula are expressed individually, in terms of grade level difficulty, and then computed to obtain a composite mean score for each text. The composite mean scores obtained are highly reliable (a = 0.95). The six commercial pamphlets were estimated to have reading difficulty levels ranging from 5.3 to 14.1 grades. A primary factor that contributed to reading difficulty was the frequent use of polysyllabic words, including technical words. Certain individual test scores, not judged to be out of range, deviated from the mean composite scores by as much as 41.2%. The two pamphlets designed by the Kentucky Diabetes Program had composite reading difficulties of 7.5 and 8.2 grade levels, respectively. These data suggest that the use of systematic readability analysis should be carried out and reported for patient instructional material. This assessment should be carried out by multiple formulas to produce a more representative index of reading difficulty than the application of a single test.