Readability of patient education materials available at the point of care

Lauren M. Stossel, Nora Segar, Peter Gliatto, Robert Fallar, Reena Karani

Research output: Contribution to journalArticlepeer-review

157 Scopus citations


BACKGROUND: Many patient education materials (PEMs) available on the internet are written at high school or college reading levels, rendering them inaccessible to the average US resident, who reads at or below an 8th grade level. Currently, electronic health record (EHR) providers partner with companies that produce PEMs, allowing clinicians to access PEMs at the point of care. OBJECTIVE: To assess the readability of PEMs provided by a popular EHR vendor as well as the National Library of Medicine (NLM). DESIGN: We included PEMs from Micromedex, EBSCO, and MedlinePlus. Micromedex and EBSCO supply PEMs to Meditech, a popular EHR supplier in the US. MedlinePlus supplies the NLM. These PEM databases have high market penetration and accessibility. MEASUREMENTS: Grade reading level of the PEMs was calculated using three validated indices: Simple Measure of Gobbledygook (SMOG), Gunning Fog (GFI), and Flesch-Kincaid (FKI). The percentage of documents above target readability and average readability scores from each database were calculated. RESULTS: We randomly sampled 100 diseasematched PEMs from three databases (n=300 PEMs). Depending on the readability index used, 30-100% of PEMs were written above the 8th grade level. The average reading level for MedlinePlus, EBSCO, and Micromedex PEMs was 10.2 (1.9), 9.7 (1.3), and 8.6 (0.9), respectively (p≤0.000) as estimated by the GFI. Estimates of readability using SMOG and FKI were similar. CONCLUSIONS: The majority of PEMS available through the NLM and a popular EHR were written at reading levels considerably higher than that of the average US adult.

Original languageEnglish
Pages (from-to)1165-1170
Number of pages6
JournalJournal of General Internal Medicine
Issue number9
StatePublished - Sep 2012


  • Electronic health records
  • Health literacy
  • Patient education materials
  • Readability


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