Revising Selected Written Patient Education Materials Through Readability and Concreteness
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The current state of much research on written patient education materials (WPEM) suggests that they are written in a manner that is too difficult even for educated patients to understand and remember. Much of the research in this area is focused on modification of the readability of WPEM, which has shown to be relatively ineffective. In this study, an attempt was made to determine if a theory-based method in revising WPEM for improved comprehensibility and memorability was effective. The effectiveness of three versions of WPEM regarding breast self-exams (BSEs) was examined; the original version without illustrations obtained from the American Cancer Society website, a version that was written at a lower readability level as measured by the Flesch-Kincaid readability formula, and a version with a lower readability level as measured by the Flesch-Kincaid readability formula and the increased use of concrete language as suggested by Dual Coding Theory. The researcher compared the percentage of recall of idea units recalled by 76 participants at two time periods: immediately after reading the randomly assigned version of WPEM and seven days after the initial reading. The WPEM that contained the lower readability level and concrete language was most recalled by participants both at immediate recall and delayed recall. In fact, the delayed recall of the WPEM that contained the lower readability level and concrete language after the seven-day period was almost equivalent to the immediate recall of the participants in the other two groups. A significant main effect was found for the forms of WPEM, F(2, 73) = 27.69, p = .00, n2 p = .43 with an observed power of 1.00. A significant main effect was found for time, F(1, 73) = 161.94, p <.00, n2 p = .69 with an observed power of 1.00. A significant interaction of WPEM and time was found, F(2, 73) = 5.07, p = .01, n2 p = .12 with an observed power of .80. Reported levels of frequency of performing BSEs and levels of confidence in performing BSEs were also analyzed using the Wilcoxon Signed Ranks Test in relation to the three WPEM versions over time. Reported frequency was significantly greater after seven days, regardless of form of WPEM (WPEM A, p = .32; WPEM B, p = 1.00; WPEM C, p = .74). Levels of confidence were significantly greater after seven days, regardless of form of WPEM (WPEM A, p = ..02; WPEM B, p = .00; WPEM C, p = .00). Overall results indicate that combining reduced readability and increased concrete language is beneficial. The writing of WPEMs in a way that patients can understand should be supported by a theory, and infusing Dual Coding Theory in the writing of selected WPEMs may be beneficial for patients.
Goolsby, Rhonda Denise (2010). Revising Selected Written Patient Education Materials Through Readability and Concreteness. Doctoral dissertation, Texas A&M University. Available electronically from