Spanish-language patient materials written above recommended reading levels

Numerous studies have found that imaging-related educational materials are written in a way that is too complex for some patients to understand. Does this same issue apply to Spanish-language educational materials?

Researchers examined 134 Spanish-language articles available from the website RadiologyInfo.org to find out, sharing their findings in the Journal of the American College of Radiology.

“Because low health literacy has been associated with poor health outcomes, understanding the influence of including health care information in Spanish may positively influence outcomes for Spanish-speaking patients,” wrote author Sherwin A. Novin, BS, University of Wisconsin School of Medicine and Public Health in Madison, and colleagues.

Most adults, according to the authors, read at an eighth- or ninth-grade reading level. The American Medical Association (AMA) and National Institutes of Health (NIH) recommend materials be written at or below a sixth-grade reading level.

The researchers used four common readability scales—the Gilliam-Peña-Mountain scale, the Läsbarhets formula, the rate index formula and the SOL formula—to analyze the Spanish-language articles. Overall, the mean readability grade level of the articles was 10th grade or higher for all four scales. The average was a 12th-grade reading level. A single article was written at or below a sixth-grade reading level.

“These findings are consistent with English-language findings for RadiologyInfo.org, which showed readability levels between the 10th and 14th grade levels,” the authors wrote. “Our findings are also consistent with findings in other medical specialties, such as Spanish-language articles related to otolaryngology, which have also demonstrated high readability levels in excess of levels recommended.”

Novin and colleagues noted that poor health literacy has been associated with “increased frequency and length of hospitalizations, higher rates of complications and higher health care costs,” showing how important it is for all patients to fully comprehend educational materials related to their personal health.

“Furthermore, evaluating the readability of Spanish patient education materials is doubly important because Hispanics have the lowest health literacy of all racial/ethnic groups in the United States despite being the fastest growing minority group, suggesting that AMA and NIH readability recommendations may be an overestimate of readability levels easily comprehended by Spanish-speaking Hispanic patients,” the authors wrote.