Seven Design Elements to Improve the Readability of Patient Education for Pressure Ulcer Prevention

According to an Institute of Medicine (IOM) report, almost 50% of all American adults (~90 million people) “have difficulty understanding and using health information”.¹  Making patients an active part of their healthcare team is critical to ensuring that care is patient-centered, cost-effective and evidence-based.^I1  Patients that do not have health literacy are more likely to be hospitalized and use emergency services than those with greater health literacy.¹  Health literacy is more than just the ability to read information, it is “the degree to which individuals have the capacity to obtain, process, and understand basic information and services needed to make appropriate decisions regarding their health.”^I1

For greatest comprehension materials should be written at the sixth grade reading level or below, but how you present the information is just as important as what you say.  The Institute for Healthcare Improvement (IHI) recommends using a Design Readability Scorecard, created by Doug Seubert, to determine the overall readability of materials.  The scorecard identifies 7 design components that affect readability: a.) font, b.) paragraphs, c.) line length, d.) grouping, e.) graphics, f.) color and g.) white space.² Using a point system, the user scores the document to determine its readability (36 = hard to read, 65 = easiest to read). 

As part of a bundle for pressure ulcer prevention, a patient brochure was created.  It was first scored, minus references, using the Flesch-Kinkaid Grade Level Readability Test.  The brochure was a 6.2 grade level.  Next, the Design Readability Scorecard was used.  Initially, the brochure was rated at 58/65 (easy).  Using the tool to identify issues, fonts in the body of the brochure were changed to serif increasing the readability to 63/65 (easiest).  The brochure was then reviewed by risk management and staff RNs.  Next steps include obtaining patients feedback to verify readability.