Question 2
One study showed that even though 78% of dietitians surveyed considered the reading level of materials they used with clients, 92% did not use readability assessment tools. Why do you think that is? Have you ever used one on education materials you have created or used with clients? Would you in the future?
posted by Anonymous @ 4:39 PM
36 comments
36 Comments:
Honestly, I have never used a readability assesment tool unless required by an asignment. I have, however, often considered the readability. I think it's important to keep in mind. Especially considering these findings in order to promote patient involvement.
Dietitians may think that their patients are generally well-read and educated individuals for the most part. But, the average American reads at the 8th-9th grade reading level. Health information can usually be written at a higher reading level. In general, most patients regardless of their reading level or language skills prefer their medical information to be simple and easy to understand. While working at Health Promotion and Wellness I find myself desperately trying to lower the level of difficulty of the information and be more clear and concise with health information. I have never used a readability assessment tool but will look into a reliable readability assessment tool for the materials that I create in the future.
Perhaps dietitians just don't consider or think about the readability of materials they create especially if they are use to working with highly educated people such as doctors and nurses. A simple check of reading level can be done using word and I have used this in creating education materials for WIC. If I remember correctly, WIC tries to get their materials at a 6-7 grade reading level. This is not always the easiest to do, the challenge in deducing already made materials to a lower reading level may also deter dietitians from using an assessment tool.
I always find myself questioning the readability and complexity of things that I am trying to teach, but I have never used a readability assessment tool. I honestly didn't know they existed. Considering that I am a young, moderately technology-literate person and that I've never heard of one of these tools, I would assume many other dietitians haven't either. This could be why they aren't using them. I will definitely look into them and use them in the future. From the small amount of clinical experience I have, I have often noticed that the complexity of the information offered to patients is often what causes them to lose interest.
I agree with Molly, that in general, most patients regardless of their reading level or language skills prefer their medical information to be simple and easy to understand. I observed an outpatient diabetes education once where the RD used a booklet of information given to the patient to guide her instruction. I saw the booklet ahead of time and thought it was very easy to understand and that whoever read it would most definitely be able to benefit from it. After the ~30 min instruction was over, the patient asked her to clarify how much a gram was again. They had been confused the entire time between the shift of talking about grams of certain foods, ounces of others, and phrases like "4 carbs per meal" and weren't able to really understand/absorb hardly any of the information taught. I think that due to the quickness of this instruction session, this would be enough to confuse even a highly-educated person.
I feel like the simplest answer for dietitians not using a readability assessment tool is that it takes time, energy, and money to use them. I also believe that after all of the education that R.D.s have to go through that they assume that since they wrote it in a clear manner as they were taught in school that most people would be able to read it. That always was my idea when I wrote material for the public. However, more recently at the CCC they have an assessment tool that tells you the grade level that the article is written in. I was surprised to find that most of the articles I wrote for the general public were at 11-12th grade reading levels. After using such tools I would highly suggest most people using them, and I love to use them myself now. It takes longer to write and article, and it also takes a lot of editing to bring the language down to 8-9th grade reading levels. Overall, I believe that it makes the information more relevant to the patients and more likely for them to read the information.
Emily, I also agree with you about many R.D.s simply not ever knowing that such technology existed. I feel like this should be a more main stream idea that should be presented at a conference or something to get the word out about such tools. I also did not know that word had a feature to do this Stephanie. This would be more great information for more R.D.s to have in order to make this a more mainstream practice that could give more patients the ability to learn from the materials we create to help them.
I think it is really time consuming to have to use an assessment tool to determine the reading level and then have to fix it. Although determining the reading level is a very important aspect of creating the material, I think dietitians are more concerned with making the materials available to their clients in a timely fashion. I have used the SMOG formula before when creating a client handout. It takes a lot of time and can be difficult to figure out how to fix the handout. In the end, it is worth it because the client better understands the material and is more likely to make a change. I will use an assessment tool in my future because I see it as an essential step in the process of education.
I agree with many of the comments stating that dietitians assume their clients are well educated. Many of them may be well educated but many aspects of nutrition can be a difficult topic to understand and get across to anyone. Therefore, readability assessments are necessary in my opinion.
Depending on my position and the clientele I had would determine if I would invest in a reading-assessment tool. Since, this is such a new parameter of measurement, I am not surprised that most RDs do not use this tool. It would certainly be up for consideration for those working with low socioeconomic clients.
I think that a lot of people assume that if they can read it, so can their clients, but they are forgetting the actual reading level of most of their clients. At WIC, for any education materials I made, I always used the readability/grade level tool in Microsoft Word. This was especially important given the low income client population. I most definitely will use this in making education materials in the future because it is simple and I can then be sure my clients will understand the information I provide to them.
Amanda, I agree with your statement that it would be good to use reading assessment tools especially when we are working with low income patients. But, I also think that pretty much anywhere we would work as dietitians, we cannot guarantee that our clients are health literate. Therefore, I think we should be cautious wherever we work about about the reading levels of the information we provide to our clients or patients.
I think that most RD's haven't heard of this assessment tool. I know I had not until right now. This is something I see as being a more effective outpatient tool. I would like to try using a readability assessment tool and see if it make a difference when educating.
Nate I think you make a good point that most of us do not realize that what we write is at a higher education level than what we realize. When I make material today I write a draft and then try to make it even simpler. We are always trying to be detailed in our work and show what we know. When making a handout it is important to make sure you do not isolate the patient. This may be the one tool they have to make a change so make sure it is usable.
I think there are a few main reasons why RDs do not use readability assessment tools: RDs are not aware of their existence, RDs do not want to invest the time to learn how to use/implement the tool, RDs never consider that the reading level may be inappropriate for their patient population. The obvious intervention point here is to educate nutrition students how to implement the tools, and continue to emphasize their use throughout the dietetic internship. I am a fan of such tools, and I agree with Amanda that it definitely comes down to the population if you use one or not. Since RDs get such little face-time with our patients and rely on education materials so heavily, it is absolutely imperative our clients are able to understand the material.
Stephanie,
Thanks for bringing up the MS Word readability assessment tool. This sparked my memory of when I learned about readability assessment tools during undergrad in my public health nutrition class. I believe the tool we were taught to use was the SMOG, and were instructed to compare the SMOG results to the Word results. I remember that the results were ~2 grade levels apart. So it is important that we, as nutrition professionals, decide on a standardized readability assessment tool to use.
Nate,
I agree that the top issue is that RDs do not want to invest the time and energy into implementing the readability assessment tools. While in a perfect world, every RD would assess each of their education materials, that is not likely to happen. If RDs are not going to use these tools with most of their materials, then we should at least be aware of what these tools are assessing. A quick scan through a document when you know what affects readability is better than nothing at all. What affects readability? Most popular formulas rely on two factors: polysyllabic words and length of sentences. If you notice you are using a lot of words with 3 or more syllables and long sentences with a lot of punctuation, chances are you need to streamline your writing a bit.
This was my major weakness discussed during my midterm. We write and speak at a high level and the materials that we read are also at that high level. It can be difficult translating the terminology into a middle schooler’s vocabulary. Often I feel we edit what we read for the consumer but if you do not have a middle schooler of your own, it has been too long to remember if what you are writing is at that level. Microsoft Word allows you to check the reading level of your document, as part of the spell check feature, also fun to try it with your thesis :)
Nate you are right it does take effort and time to be able to tailor it to that grade level. However like anything, practice makes it easier.
For my professional practice I created many educational materials for students with food allergies and also workers in the foodservice setting. I was always told to "make things simple" so everyone could understand the materials. When given this instruction, you use your best judgment! I think there needs to be more education about these assessment tools so there can be a reference when creating materials. What is the point of educating if the information cannot be accurately received and interpreted?
Taylor,
I agree that RD's may not realize that their material are inappropriate for their audience. I think we spend our time making sure that vital information is covered, which leaves less time to make sure that it is interpreted correctly by the patient.
I can't recall ever being introduced to a readability assessment tools in class. I think we do an OK job of discussing the need to make materials appropriate for the intended audience. Maybe this is a missing component of our education? As DI interns our reading level is considerably higher than the average of an 8th grade reading level stated in the article. I think having an assessment tool that is easy to use would be an asset to dietitians, and I would certainly be willing to use it.
I agree with Amanda and Brooke that it is particularly important to assess the readability for lower SES clients. I'll be at WIC this summer so I'm sure I'll get some first-hand experience with this. I also think we need to consider elderly patients in that equation. Thinking of my grandmother with only an 8th grade education, many people of her generation were not able to achieve a higher level learning.
I think dietitians do not realize that the information presented to clients can be difficult to understand, especially if the patients or clients have never seen some of the terms we regularly talk about. The only readability assessment tool I have used is the one in Word. I also believe that many dietitians do not know that these tools exist or even consider using them when making education al materials. I believe this is an extremely important topic because many people will stop reading if there are terms they do not understand.
I have not used readability assessment tools with handouts I have created. I think in a school setting we focus on what is acceptable for the grade and try to be as detailed as possible, yet when we get to actual clients we do not necessarily consider that their reading level could be significantly lower than ours. In clinical settings I have used educational material from the Nutrition Care Manual and haven't really thought about what level of readability those are. I do work very hard at explaining different health issues to clients in simple and straightforward ways so not to confuse them with medical terms. I think this is a topic that should be emphasized and practiced more in educational settings so that future dietitians this topic will not be an issue that is often overlooked.
Taylor, SMOG sounds like a tool that may be more reliable than a simple word check. Although MS word isn't a true readability assessment tool it gives you an idea of the reading level you are creating materials at and is easy, and available to all.
Angela-I completely agree with you. I think this is definitely a missing component of our education. I think I was taught how to use the Word readability assessment in high school but I don’t remember it ever being taught or stressed in my undergrad.
I believe that when you read something and understand it, it's easy to assume that others will understand it as well. We spend years in higher education to become fluent writers and speakers so it's easy to look over when reading/writing materials. I have worked with WIC in the past and have helped create self-study modules for clients. This was something where readability assessment tools are extremely important because these clients are doing the reading and work on their own. I would use assessment tools in the future because it's a waste of time to create materials that won't be understood by the majority of your clients/patients.
I agree with others comments about how dietitians assume that others have the same reading level as themselves. It's easy to assume that everyone else is similar to you.
I believe that R.D.’s do not use readability assessments because, like many others have said, it takes a lot of time and energy to use the assessment and then go back to the material and revise it, also it is a rather new tool. Many topics we learn are often at a higher level and it can be challenging to translate into simpler terms. I ran into this challenge when we were writing our script for National Nutrition Month, the script was based on Myplate information yet somehow we had to make sure that everything could be understood by 3rd, 4th, 5th graders. I would also like to use this assessment for things in the future.
I have never used a readability tool. However, if I was given access to one I would utilize it when counseling clients. I do consider readability when teaching education sessions, you can tell by the clients reaction, and their interest in the handout if they are able to interpret what they are looking at
Stephanie and Brook, you brought up WIC as a site that focuses more on readability and the WIC in Decatur also focused on this with their education tools. I think any community site needs to kept his in mind in order to be able to fully understand and relate to their clients
I have never had an issue with "readability" with clients in my volunteer experiences but I have had a similar experience when I tried to write an article about HFCS for the college newspaper. I wrote what I judged to be a fairly simple and straightforward wording of the issue but was told on several revisions that I was too technical and that I needed to revise it for a lower reading level. My thought was, "These are college students. Surely they can figure it out!". Yet, I think its really easy to take for granted what we know about nutrition and its hard to realize that it is NOT common knowledge. Communicating the issues that you know in a way that your clients can understand is a real challenge. - Amy Sammis
About Nate's comment - I think it would be wonderful to have a tool that tells you how to write to a certain grade level and its great that the CCC is using them. I am a little surprised that they choosed an 11-12th grade level when most other education materials are written for the 8th grade level. Is the population at the CCC different somehow?
Alana,
In my professional practice I also had to create various educational materials on recipes for diabetics, dining out tips, as well as grocery store information. I tried to make sure everyone would comprehend the topics I was trying to cover but I often felt unsure if I was being understood at all times. And I agree with your statement that it would be helpful to have a basic reference tool in order to ensure people’s understanding.
Stephanie,
Thank you for pointing out that Microsoft Word has a feature for reading level! I am not only going to use that feature in the future but will also recommend to the Health Promotion Office that we look into getting a readability assessment tool.
Angela,
From working at Evergreen Village Assisted Living I also have found that a lot of our elderly population did not receive a higher level of learning and are confused by what their dietitians tell them. I remember specifically one of them asking why there are "two different cholesterol numbers" and why one is "bad" and one is "good". We know a lot more now than when they lived independently on their own and now they are reliant on others to help make decisions impacting their health.
Post a Comment
<< Home