Computerized versus hand-scored health literacy tools: a comparison of Simple Measure of Gobbledygook (SMOG) and Flesch-Kincaid in printed patient education materials.

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  • Author(s): Grabeel KL; Russomanno J; Oelschlegel S; Tester E; Heidel RE
  • Source:
    Journal of the Medical Library Association : JMLA [J Med Libr Assoc] 2018 Jan; Vol. 106 (1), pp. 38-45. Date of Electronic Publication: 2018 Jan 02.
  • Publication Type:
    Journal Article
  • Language:
    English
  • Additional Information
    • Source:
      Publisher: Medical Library Association Country of Publication: United States NLM ID: 101132728 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1558-9439 (Electronic) Linking ISSN: 15365050 NLM ISO Abbreviation: J Med Libr Assoc Subsets: MEDLINE
    • Publication Information:
      Original Publication: Chicago, IL : Medical Library Association, c2002-
    • Subject Terms:
      Comprehension*; Computer-Assisted Instruction/*standards ; Health Literacy/*organization & administration ; Patient Education as Topic/*methods ; Teaching Materials/*standards; Adult ; Female ; Humans ; Male ; Middle Aged ; Reading ; Tennessee
    • Abstract:
      Objective: The research compared and contrasted hand-scoring and computerized methods of evaluating the grade level of patient education materials that are distributed at an academic medical center in east Tennessee and sought to determine if these materials adhered to the American Medical Association's (AMA's) recommended reading level of sixth grade.
      Methods: Librarians at an academic medical center located in the heart of Appalachian Tennessee initiated the assessment of 150 of the most used printed patient education materials. Based on the Flesch-Kincaid (F-K) scoring rubric, 2 of the 150 documents were excluded from statistical comparisons due to the absence of text (images only). Researchers assessed the remaining 148 documents using the hand-scored Simple Measure of Gobbledygook (SMOG) method and the computerized F-K grade level method. For SMOG, 3 independent reviewers hand-scored each of the 150 documents. For F-K, documents were analyzed using Microsoft Word. Reading grade levels scores were entered into a database for statistical analysis. Inter-rater reliability was calculated using intra-class correlation coefficients (ICC). Paired t -tests were used to compare readability means.
      Results: Acceptable inter-rater reliability was found for SMOG (ICC=0.95). For the 148 documents assessed, SMOG produced a significantly higher mean reading grade level (M=9.6, SD=1.3) than F-K (M=6.5, SD=1.3; p <0.001). Additionally, when using the SMOG method of assessment, 147 of the 148 documents (99.3%) scored above the AMA's recommended reading level of sixth grade.
      Conclusions: Computerized health literacy assessment tools, used by many national patient education material providers, might not be representative of the actual reading grade levels of patient education materials. This is problematic in regions like Appalachia because materials may not be comprehensible to the area's low-literacy patients. Medical librarians have the potential to advance their role in patient education to better serve their patient populations.
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    • Publication Date:
      Date Created: 20180118 Date Completed: 20180827 Latest Revision: 20220311
    • Publication Date:
      20240104
    • Accession Number:
      PMC5764592
    • Accession Number:
      10.5195/jmla.2018.262
    • Accession Number:
      29339932