Gerd M Flodgren What Works Global Summit London 26-28 September 2016 Can the use of a readability calculator improve communication with the public? Gerd M Flodgren What Works Global Summit London 26-28 September 2016

Interactive Health Literacy Framework Skills and abilities Demands and complexity “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions” Source: U.S. Department of Health and Human Services. 2000 Interactive health literacy framework.Source: Parker R. Measuring health literacy: what? So what? Now what? In Hernandez L, ed. Measures of health literacy: workshop summary, Roundtable on Health Literacy. Washington, DC, National Academies Press, 2009:91–98.

The European Health Literacy Survey Almost half of the adults had limited health literacy. Participating countries: Austria, Bulgaria, Germany, Greece, Ireland, the Netherlands, Poland and Spain 36% Source: Sørensen et al.2015 Health Literacy in Europe: comparative results of the European health literacy survey (HLS-EU)).European Journal of Public Health

Limited health literacy is linked to: less healthy choices riskier behaviour poorer health outcomes higher hospitalisation rates lower use of preventive services Source: World Health Organisation, 2013. The Solid Facts. Health Literacy

One tool to improve health literacy Please use plain language! I don’t get this. This is Greek to me!

What is plain language? «Plain language is communication that users can understand the first time they read (or hear) it. A plain language document is one in which people can find what they need, understand what they find, and act appropriately at that understanding» Source: Plain Language Action and Information network. What is plain language? Available at www.plainlanguage.gov.

Plain Language Expectations for Authors of Cochrane Summaries (PLEACS) One key point per sentence Use short paragraphs Avoid potentially misunderstood words Avoid hard words Introduce an acronym for repeated use Write for an international audience Use the active voice Recommend the use of a readibility calculator http://www.readabilityformulas.com/free-readability-formula-tests.php

Text Readibility Consensus Calculator Sentences Characters Words Syllables Consensus Reading Score 12 13 15 21

Example

The 7 readability scores

The Consensus Score

Word Statistics

Average Sentence Length

Average % of 3–syllable Words

Average Reading Level

Objectives To assess the readability of Cochrane Plain Language Summaries (PLS) using the text readability concensus calculator To pilot the readibility calculator on a convenience sample of PLSs judged difficult to read

Methods Sample: N=143 PLSs from Cochrane reviews (2-3/ group) published Oct 2015 to March 2016 Analysis: the PLSs were analysed using the Text Readability Consensus Calculator was (and a proof reading function in Word) Outcomes: words per sentence, proportion +3-syllable words, consensus readibility score (paragraph length, use of passive voice) Pilot: the calculator was used to improve the readability of eleven PLSs judged to be very difficult to read

RESULTS

Sentence length Mean number of words per sentence: 21.7 (SD: 4.0) Recommended length: 13-16 words Source: https://en.wikipedia.org/wiki/Longest_English_sentence

+3-syllable words Mean proportion: 21.7% Recommended proportion: <12-14% "The summit where Tamatea, the man with the big knees, the slider, climber of mountains, the land-swallower who travelled about, played his nose flute to his loved one". Sourse:https://en.wikipedia.org/wiki/Taumatawhakatangihangakoauauotamateaturipukakapikimaungahoronukupokaiwhenuakitanatahu

Readibility Concensus Score Average score: 14 (SD 2.0), range 9 to 21 Public reading level: 7-8 Sourse:https://www.google.no/search?as_st=y&tbm=isch&hl=en&as_q=someone+reading&as_epq=&as_oq=&as_eq=&cr=&as_sitesearch=&safe=images&tbs=sur:f#imgrc=AAU3JITwVX_nrM%3A

ADDITIONAL RESULTS

Paragraph length Average 3.4 sentences per paragraph (SD 1.5) (range 1.5 to 14) Almost all PLSs were structured with sub- headings

Passive Voice 20 % of sentences in passive voice (range 0 to 50%) https://www.google.no/search?q=monkey+and+a+typewriter&lr=&hl=en&tbs=sur:fm&source=lnms&tbm=isch&sa=X&ved=0ahUKEwi32bbKgqDPAhXEkSwKHWwdAowQ_AUICCgB&biw=942&bih=464#imgrc=fpmEqsr6MtoDEM%3A

Results of piloting of the tool It was very difficult to improve the readability score to below 14 Source:https://www.google.no/search?q=first+test+pilot+to+break+the+sound+barrier&lr=&hl=en&tbs=sur:f&source=lnms&tbm=isch&sa=X&ved=0ahUKEwi2tYecz4fPAhXSOSwKHQ2vDaMQ_AUICCgB&biw=911&bih=449#imgrc=PamwxpAfXqRC1M%3A

Conclusions Cochrane PLSs are very difficult to read The average reading level is 14 which is not suitable for the general public Too many hard words Too long sentences Passive voice is used too often It is difficult to get a readibility score below 14

Thank you for listening!