r r d r r r r r r Developing a p actical ea ability tool fo assessing w itten o al health p omotion mate ial fo
r people with low lite acy
dr M d
An ea . e Silvaa,b, Jacqueline . a tin-Ke yM M r rr c Kelly Vand Shalika Heg ed d an A ina Heilb unn-d d r Langd
aInstitute fo Safety, Compensation & Recove y Resea ch, Geelong, Aust aliar r r r bMelbou ne Dental School, Unive sity of elbou ne, Ca lton, Aust aliar r M r r r cDepa tment of Health Sciences, Unive sity of Yo k, Yo k, Unite King omr r r r d d
dCent e fo Applie O al Health Resea ch an Evaluation, Dental Health Se vices Victo ia, Ca lton, r r d r r d r r r r
Aust alia
r Abst act
Objective: O al health p omotion esou ces nee to be simple, useful, accessible an r r r r d d
d r d r d r r r
un e stan able to be effective. The impo tance of this is magnifie fo population g oups who a e
r d r r r r r rr r
at inc ease isk of poo o al health, have low lite acy o language ba ie s. Consultation with
r r d r d d d r r d d
health se vice p ovi e s i entifie the nee fo a ea ability tool to assist them to assess an develop app op iate o al health p omotion esou ces to ensu e they we e w itten using language r r r r r r r r r
d r d r d d r
that was easy to un e stan by those with high o al health nee s an low lite acy levels. The
d d d d r d r d d
objective of this stu y was to i entify an a apt existing health lite acy an ea ability tools, an
d r r r r r r r
pilot the tool to ete mine its app op iateness fo use in o al health p omotion ta geting those
r d d r
with high o al health nee s an low lite acy levels.
Design: This pape epo ts the evelopment of an o al health ea ability tool.r r r d r r d
Metho s: d Existing r dea ability tools we e i entifie th ough elect onic sea ching an eviewe fo r d d r r r d r d r
r r r r r d r r r
suitability. In pa allel, w itten o al health esou ces use in Aust alia specifically ta geting efugee
d r r d d r d r r
an asylum seeke population we e i entifie th ough iscussions with o al health se vice
r d r d r r r r
p ovi e s an an online g ey lite atu e sea ch.
Results: No single tool was i entifie which coul be ea ily use to sc een an assess w itten o ald d d r d d r d r r
r r r r d r d r
health esou ces. Two existing tools, the F y ea ability fo mula an a suitability checklist, we e
r r d d d r d r d d
the efo e a apte an integ ate into one tool. This new ea ability tool was then pilote by
r r r r r rr r r r
sc eening ten w itten o al health esou ces cu ently in use in the public o al health secto fo refugee an asylum seeke populations. Of the ten w itten o al health esou ces assesse , only d r r r r r d
r r r r r d r r
fou we e of an app op iate ea ing level fo clients with low lite acy.
Conclusions: This stu y evelope an teste an o al health ea ability tool to assess an d d d d d r r d d develop o al health p omotion esou ces. r r r r
rd Key wo s:
r r r r r r d
o al health lite acy, esou ces, tool, health p omotion, ea ability
rr d r
Co espon ing autho :
dr M d M r r M r r
An ea . e Silva, elbou ne Dental School, Unive sity of elbou ne, 720 Swanston St eet,
r r
Ca lton 3053, Aust alia
r d Int o uction
r r r d d r d d r d d
Health lite acy efe s to the ability of in ivi uals to gain access to, ea , un e stan an use
r r d d d d d
health info mation in ways that p omote an maintain goo health an enable in ivi uals to make
r d d
info me health ecisions (Institute of e icine, 2004)M d . Although the e is a link between a r
r r r r
pe son’s gene al lite acy level (thei ability to ea , w ite, speak, an compute an solve p oblems)r d r d d r
d r r r d rr r
an health lite acy, a high gene al lite acy oes not co elate with high health lite acy (Public
d d
Health Englan an UCL Institute of Health Equity, 2015). People with high levels of health lite acyr
r d r d d r r d r
a e able to un e stan an access healthca e mo e efficiently an have bette health outcomes;
r r r r
conve sely people with low health lite acy have poo e health outcomes (Ba att, 2008; rr A ams et d al., 2009; Mika et al., 2005). In 2006, the Aust alian Bu eau of Statistics (ABS)(r r Aust alian Bu eau ofr r Statistics, 2006) epo te that less than half (41 pe cent) of Aust alians age 15-74 yea s ha an r r d r r d r d
d r r r d r
a equate (o bette ) level of health lite acy. Ina equate health lite acy can affect an in ivi ual’s d d
d r r r d r r
ability to access an navigate health ca e systems, as well as thei ability to ea p esc iption
r r d r d r r r
inst uctions, communicate effectively on health elate matte s an seek tests fo sc eening o diagnostic pu poses (r Aust alian Bu eau of Statistics, 2006).r r An in ivi ual’s health lite acy is d d r
d r r d d r d
influence by a ange of facto s inclu ing socio-economic status, isability, age, esi ential
r d d
location, cultu e, language an social connecte ness (Aust alian Commission on Safety an Qualityr d r
in Health Ca e, 2014; Wo l Health O ganisation, 2013). r d r
r d d d r r
Health lite acy applies to both in ivi uals an healthca e systems. Healthca e systems can
r r r d d d d r
apply effective health lite acy st ategies by p ovi ing equal an easy access to, an elive y of,
r d r r
healthca e an health info mation (Nutbeam, 2008). This involves the integ ation of health
r d r d d r
lite acy consi e ations into planning, evaluation an patient safety an quality imp ovement
r d r r r r
(Depa tment of Health an Human Se vices, 2014). Healthca e p ofessionals can p omote
r r d r r
effective health lite acy by p esenting an communicating info mation in ways that imp ove
d r d d r
clients’ un e stan ing an ability to act on the info mation. One way to p omote health lite acy isr r
r r d r d r d
by imp oving the ea ability of w itten an quality of ve bal health communications, an
r d r d r r
enhancing the health p ofessionals’ un e stan ing of the impact of low health lite acy on thei
r r
clients’ ability to imp ove thei health (Nutbeam, 2008).
Adults at all ea ing levels lea n bette with simple an clea inst uctions (Davis et al., r d r r d r r 1998; Davis et al., 1996). P ovi ing simple esou ces fo use by health p ofessionals can be r d r r r r
r r d r d
valuable as it can p omote communication with clients that a e easy to un e stan , with minimum
d r
me ical ja gon (Depa tment of Health an Human Se vices, 2014; r d r A o a et al., 2014). r r Stu ies d
r r d r r d
specifically examining the elationship between health lite acy an o al health a e limite (Jackson
d r
an Ecke t, 2008; Khan et al., 2014). O al health lite acy has been efine as “r r d d the eg ee to whichd r
d d r d d r d r r d
in ivi uals have the capacity to obtain, p ocess an un e stan basic o al health info mation an
r d d r r d
se vices nee e to make app op iate health ecisions” (National Institute of Dental C aniofacial r
r d r
Resea ch an Se vices, 2005: page 176). This is mo e than the ability to ea , an inclu es othe r r d d d r
r d
skills such as nume acy, an the ability to navigate systems within health (Ho owitz an Kleinman, r d 2012). O al health lite acy has been i entifie as one of the key facto s influencing o al health r r d d r r
d
status an outcomes (Roge s, 2011)r . Clients with high o al health lite acy a e consi e e mo e r r r d r d r
r r d r r d r
likely to access o al health se vices an have bette o al health, although stu ies on this topic a e d
limite (Jones et al., 2007; Ho owitz an Kleinman, 2012).r d
r d r r r r
P ovi ing people with quality w itten o al health info mation can be useful to inc ease
r d r r r d d d
thei knowle ge; howeve , to have an effect, the info mation p ovi e nee s to be suitable (Wo l Health O ganisation, 2013)r d r . To ate, the e a e a numbe of inte national stu ies (d r r r r d Wo l r d
r
Health O ganisation, 2013; Ba att, 2008; rr A ams et al., 2009; d Mika et al., 2005) evaluating the
r r r r r r
r
info mation (Hen ickson et al., 2006; Kang et al., 2005; dr Ha woo an Ha ison, 2004; r d d rr A o a et al., r r 2014) have foun that many we e w itten fo people with high lite acy abilities an the esou ces d r r r r d r r
d r d
coul be imp ove .
r r r r d d r
The e a e seve al tools available to assess the ea ability an suitability of w itten resou ces. Rea ability fo mulae measu e the ifficulty of vocabula y an sentences in w itten r d r r d r d r resou ces (r McGee, 2010). Although each fo mula is calculate iffe ently, they p ovi e a g a e r d d r r d r d
r r r d r r d d r d
which measu es the numbe of yea s of e ucation equi e to un e stan the text (Rudd an d d r
An e son, 2006). Othe tools, such as a suitability checklist assesses the w iting style, esign, r r d
d r r r r r rr r
appeal an cultu al app op iateness of the esou ces. Cu ently the e is lack of consensus on the
r d d d d d d r r d r d
best ea ability tool(s) to use an to ate stu ies have use iffe ent ea ability fo mulae an
r r
suitability checklists to evaluate esou ces.
d d d r r d d
The aim of this stu y was to evelop an pilot an o al health ea ability tool that coul be
d r r d d r r r r
use a) by o al health p ofessionals to assess an evelop esou ces that a e w itten at an
r r r d d r d r r r
app op iate ea ing an comp ehension level, an b) to assess existing o al health esou ces
d d r r d r d r r r r d d
inten e fo efugees an asylum seeke clients to ete mine thei app op iateness an i entify
r r r
a eas fo imp ovement.
Metho sd
d d
I entification of nee
r r
Dental Health Se vices Victo ia (DHSV) was establishe in 1996 an is the lea ing public o al d d d r
r r r r r d
health agency in Victo ia, Aust alia. It aims to imp ove the o al health of those esi ents in the
r r r r r d d r
state of Victo ia, pa ticula ly vulne able g oups an those most in nee . The Victo ian State
r d r d r r r
Gove nment fun s DHSV to p ovi e clinical o al health se vices to eligible Victo ians. P io ity r r
r r d r d r d d
population g oups fo DHSV inclu e efugees an asylum seeke s an stu ies have shown that this
r r r r
population is mo e likely to have low levels of o al health lite acy, access to o al health
r d r r d r
info mation, inclu ing o al health se vices an t eatments (Riggs et al., 2014).
r r r d r r r d r d
This p oject a ose f om iscussions with o al health se vice p ovi e s an clinicians in
r r r r r r d r
Victo ia who use o al health esou ces specifically fo efugee an asylum seeke clients. Clinicians
r r r r r r d r r
felt that many o al health p omotion esou ces available we e not p esente o w itten at a level
d r d r d r d r d d
that enable efugee an asylum seeke clients to un e stan the cause of o al isease an ways
r r d d d d r d d
to p event it f om eveloping. Clinicians i entifie the nee fo a tool that coul be use to assess
r d d r r r r r
the ea ability an suitability of w itten o al health esou ces. Existing tools eithe focus on r dea ability o suitability but we wante a tool that was comp ehensive hence the ecision to r d r d develop a tool.
d r r r
I entification of available o al health esou ces
d r r r r d r d d r
Discussions with key stakehol e s (o al health se vice p ovi e s) i entifie a numbe of existing
r r r r r
o al health p omotion esou ces that we e designe an use in d d d public o al health clinics in r r
Victo ia fo imp oving the o al health of efugee an asylum seeke clientsr r r r d r . An online sea ch r d ru ing Feb ua y 2014 was also un e taken to i entify othe elevant o al health p omotion r r d r d r r r r resou ces in use ac oss Aust alia.r r r
d r d r d d r r r
I entification of ea ability tools to assess, sc een an evelop o al health esou ces
r d r r M r d
An online sea ch was un e taken by one of the autho s (KV) in a ch 2014 to i entify existing
r r d r d
r r r r r d r d
EBSCOHOST fo jou nals evaluating health esou ces using ea ability fo mulae an suitability
r r d r r d r d
checklists. Sea ch te ms use we e ‘ ea ability fo mula’ an ‘checklist’ in conjunction with
r r d r d r r r r
‘health’, ‘Aust alian’, ‘compa -e/ison’, an ‘p os an cons’. A g ey lite atu e sea ch was also
d r r d r d r d
un e taken using ‘health lite acy’ an ‘ ea ability fo mula’ an ‘checklist’ in conjunction with
r r d r d
‘health’, ‘Aust alian’, ‘compa -e/ison’, an ‘p os an cons’.
Results
d r r r r
I entification of o al health esou ces in use in Aust alia
r r r d r r
Ten English-language esou ces we e selecte th ough convenience sampling fo assessment; two resou ces we e fo o al health p ofessionals, an eight fo multilingual o efugee an asylum r r r r r d r r r d
r r r r d d r r
seeke clients. The esou ces comp ise of tips sheets, fact sheets an a b ochu e.
d r d
I entification of ea ability assessment tools
r r r d d d d d
Existing health lite acy tools we e eviewe an no single tool was i entifie which coul be r dea ily use to sc een an assess the w itten o al health esou ces. d r d r r r r Existing tools mostly efe e r rr d
r d r d r r r d r d
to using ea ability fo mulae, an the e we e few that p omote use of both a ea ability
r d r r r r
fo mulae an a suitability checklist to comp ehensively sc een esou ces. Th ee ea ability r r d
r r d d d d r d r M r d
fo mulae we e i entifie an consi e e fo use: online Simple easu e of Gobble ygook
M M d r r r d d
(S OG), manual S OG an manual F y. These fo mulae we e i entifie as they appea e to be r d
d r r r r r d r r
the most commonly use fo mulae in esea ch jou nals assessing ea ability of health esou ces
r r d d r d r d
fo patients; howeve they ha iffe ent metho s of calculating the g a e level to assess the r dea ing level. In addition to the ea ability fo mula, the p int communications ating checklist by r d r r r
r d r rd r r d
the Health Lite acy Stu ies Unit of Ha va Unive sity was sou ce (Rudd an An e son, 2006). d d r
r r d
Development of an o al health ea ability tool
d r r d d d d d
In this stu y, a new o al health ea ability assessment tool was evelope base on a aptation of
r r d r dd d d d d r
the manual F y ea ability fo mula in a ition to a mo ifie suitability checklist a apte f om
r d r rd r
Health Lite acy Stu ies Unit of Ha va Unive sity (Rudd an An e son, 2006)d d r to allow a mo e r
r r
comp ehensive assessment than using eithe alone. Afte an initial calculation an compa ison of r d r
r r r r d r r
the ten esou ces using each of the th ee fo mulae by KV, AH-L an anothe assesso , it was d d
conclu e that F y was bette suite fo esou ce evelopment, as well as assessment, as the r r d r r r d
r r r d r d
manual calculation gave mo e insight into the content than compute gene ate g a es (i.e.
M dd M d d r r
S OG online). In a ition, S OG oes not iffe entiate well at levels of lite acy below a 6th
r d r d r d
g a e (11-12 yea ol s) ea ing level (Rudd an An e son, 2006). d d r The F y ea ability fo mula was r r d r
r r r r r r d r r
mo e suitable fo low lite acy esou ces compa e to othe fo mulas, which was consistent with
r d r d r
othe stu ies ecommen ing F y (Bu ke an G eenbe g, 2010; r d r r McGee, 2010; Doak et al., 1996).
r r r r d
The 24 items within the o iginal p int communication ating section we e simplifie to 17
r d r r d r r r
items, with simila items combine o emove , to emove epetition. To enable assesso s to give
r r r d r d r r r r d d
a mo e accu ate sco e an to e uce va iation in sco ing, inst uctions we e inclu e on the
d r d r r r
checklist’s use an how to sco e items between 0 an 3, with easons to explain a pa ticula item.
r r r d d r r
To gene ate the ove all assessment, each item was sco e (between 0 an 3), these sco es we e
dd d d d r r r d r r d
a e an the assesse esou ces catego ise into one of th ee anges: caution, acceptable an
d d d r d d d r r r
goo . The a apte checklist (Figu e 1) was ivi e into th ee la ge sections: w iting style,
r d d d d dd d
o ganisation an esign, an appeal (to au ience). A non-applicable section was also a e to the
d d r r r r d d r r r
r r
health esou ce. It became appa ent that not all mate ials ha ja gon (item 6) o iag ams (item r r d r r d r
d r
10), so the non-applicable box only applies to two items which o not have to be p esent to
d r r d r r r
engage the au ience. All othe items we e foun to be p esent in some way fo all mate ials
d d r d r d r r r r d r
assesse , so these items shoul be p esent/ consi e e if the mate ial we e to be ec eate , o
d dd d r r
supplemente with a itional e ucation fo cla ification.
r r d
Piloting the o al health ea ability tool
r r d d r r r
The new o al health ea ability tool was pilote with a sample of ten o al health esou ces designe fo efugee an asylum seeke clients. d r r d r The ten esou ces we e evaluate by two r r r d
r d r r d r r
assesso s (KV an AH-L). Using the F y ea ability fo mula, it took app oximately 15 minutes to
r r r d r d r r r d r
evaluate each esou ce. Two sets of g a es we e calculate fo the F y ea ability fo mula -
r d r d r r r r d r d d
g a es using text f om iffe ent pa ts of a specific esou ce an g a es using the i entical text
r r d d r d r r
within the same esou ce. When assessing the text in epen ently f om iffe ent pa ts of each resou ce, simila g a es we e obtaine by the two assesso s fo five out of the ten esou ces, r r r d r d r r r r
r r r d d r r d r
while othe esou ces showe iffe ences of one to two g a es between the assesso s. In
r r r r r d d r
compa ison, when using the same text, eight out of ten esou ces we e g a e simila ly by the
r r r d d r r d r r r
two assesso s, while two esou ces ha a iffe ence of one g a e (See Table 1 fo esults of eview d
of i entical text). We i not un e take any fo mal assessment of eliability. A compa ison of thed d d r r r r
d d r d r r d r r r r r d
two in epen ent g a ings was pe fo me fo each esou ce but the esults we e not analyse statistically.
r r r d r d d
The Cent e fo Cultu e, Ethnicity an Health, a gove nment-fun e community
r r d
o ganisation in Victo ia an (Doak et al., 1996) ecommen a opting a ea ing level at o below r d d r d r the US 6th g a e (11-12 yea ol s) fo esou ces to ensu e that the info mation is un e stoo by r d r d r r r r r d r d
r r r r r r r d d
the majo ity of the population. Fo the pu pose of this evaluation, esou ces that we e g a e at, r
o below the 6th g a e we e consi e e app op iate. Rega less of assessing i entical o iffe ent r d r d r d r r rd d r d r
r r r r d r r r d
sections of the same esou ce, both assesso s sco e fou of the esou ces as Goo (at the 6th
r d r d r d r d r r r r r
g a e o un e ), an sco e the two esou ces available fo health p ofessionals’ at app oximately the 16th g a e. r d
r r r r
The suitability checklist took app oximately 15 minutes to evaluate each esou ce. Sco es
r r d r d r d d d
we e conve te to pe centages an sco es between 0-33% in icate that caution shoul be use
r r r d r r
when using the esou ce. A sco e of 34-64% in icates that the esou ce is acceptable, while
65-d r r d r r r d r d r
100% in icates that the esou ce is goo . No esou ces sco e below 30 pe cent, an the fou resou ces that sco e well in the ea ability component also sco e above 65 pe cent (Table 1). Inr r d r d r d r
r r d r r r r d
the checklist evaluation, the two esou ces use by o al health p ofessionals pe fo me well in the
r r d r d r r
a eas that elate to g ouping content into meaningful sections, an colou cont ast between text
d r r r r d r d d r d
an pape . A eas that equi e imp ovement inclu e the use of sho t, simple sentences an
rd r r r d r
wo s (without alte ing the meaning), the use of activities such as sto ies to engage the ea e ,
d r r r r d r d r d
an font size. The e we e 4 esou ces that ha a ea ability g a e of 6th g a e an un e . The r d d d r
r r r r d d d d r d d r d
a eas that these fou esou ces i well in inclu e summa ising main points an esi e
r d r d r d d r
behaviou changes, avoi ing humou , an having sho t an i ect sentences. Although they
r d r r r
sco e well in the suitability checklist, the e we e many a eas lacking which may affect the
r d rea e ’s ability to un e stan an use the info mation. Resou ces a ely use activities to engage d r d d r r r r d
r d r r
the ea e , such as sto ies.
d d r d d r
The pilot testing i entifie imp ovements of the mo ifie suitability checklist. As a esult,
d dd d r r r r
the layout was change with a section a e fo comments about that pa ticula sco e. The
non-d r
applicable section now only applies to two items which o not have to be p esent to engage the d
Discussion
r r r d r r
O al health lite acy is an impo tant ete minant of o al health status an dp ovi ing people with r d
r r r r r r d
quality, suitably w itten o al health info mation is impo tant to inc ease thei knowle ge (Wo l r d r
Health O ganisation, 2013). This stu y i entifie that no existing ea ability tool was available d d d r d d
that coul r dea ily be use to sc een an assess w itten o al health esou ces fo use by o al d r d r r r r r r
r r d r d d d d d r r d
healthca e p ovi e s. This stu y has now evelope an teste an o al health ea ability tool that
d d d r r r r
can be use to assess an evelop quality o al health p omotion esou ces.
r r r d r d d r
O al health se vice p ovi e s, inclu ing DHSV, have highlighte the impo tance of
r d d d r d r r r d
p ovi ing simple an easy to un e stan info mation fo health p ofessionals an clients.
r r r r r r
Imp oving w itten o al health info mation is just one component of imp oving the o al health
r r d r d r
lite acy of efugee an asylum seeke clients an the gene al population. Only fou of the ten o al r r
r r d r r r r d r r
health esou ces assesse we e at an app op iate ea ing level fo clients with low o al health r
lite acy. This is consistent with the fee back f om o al health se vice p ovi e s an cu ent d r r r r d r d rr d
stu ies (A o a et al., 2014; r r Ha woo an Ha ison, 2004; r d d rr Hen ickson et al., 2006; Kang et al., dr 2005) that i entifie the limite availability of app op iately w itten o al health info mation an d d d r r r r r d resou ces fo clients an health p ofessionals. The o al health ea ability assessment tool r r d r r r d develope he e is not inten e to ete mine which esou ces a e ‘goo ’ an which a e ‘ba ’. d r d d d r r r r d d r d
d d r r r d r r
Instea , the tool i entifies a eas fo imp ovement in evelopment of app op iate health
r d r r r r d r
info mation an esou ces that will p omote bette client engagement an pa ticipation in
health-r r r r r r r r
p omoting behaviou s. Whe e possible, ma ket testing the esou ce with the ta get client g oups
r d d r r r r r r d r r
will p ovi e the best in icato of what is an app op iate esou ce fo them. I eally, f om the fi st
r d d d d r d
time they ea it, clients must be able to ‘fin what they nee , un e stan it, then use it’ (Cent e r
r r d
fo Cultu e Ethnicity an Health, 2014).
d
Conclusions an Implications
r r d r d r r r d r
This new o al health ea ability tool p ovi es a p actical way of enabling healthca e p ovi e s to develop bette o al health esou ces that a e mo e likely to effectively p omote an suppo t o al r r r r r r r d r r
d r r
health in ive se community g oups.
d
Acknowle gments
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We woul like to thank Alexan e Filipov who eviewe an measu e the suitability of some of r d d r d
r r r d
r Refe ences
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Please ensu e that efe ences a e set co ectly
d dd M d d d
A ams, RJ, Appleton, SL, Hill, CL, Do , , Fin lay, C an Wilson, DH (2009) Risks associate with
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low functional health lite acy in an Aust alian population. M de ical Jou nal of Aust alia 191: r r 530-534.
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A o a, A, Lam, AS, Ka ami, Z, Do, LG an Ha is, F (2014) How ea able a e Aust alian pae iat ic
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o al health e ucation mate ials? B C O al Health 14: 111.M r
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Aust alian Bu eau of Statistics (2006) Health Lite acy, Aust alia, 2006 r Repo t no. 4102.0, r
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Aust alian Bu eau of Statistics, Aust alia, Available at:
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http://www.abs.gov.au/AUSSTATS/[email protected]/Lookup/4102.0 ain+Featu es20June+2009
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(accesse 24 Ap il 2014) -> estimate ate, unsu e if cite as website o epo t
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Aust alian Commission on Safety an Quality in Health Ca e (2014) Health lite acy: taking action to
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imp ove safety an quality. Repo t, ACSQHC, Sy ney.
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publishe ? Aust alian Commission on Safety an Quality in Health Ca e (ACSQHC),
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https://www.safetyan quality.gov.au/publications/health-lite acy-taking-action-to-imp
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safety-an -quality/ (accesse 14 a ch 2016)
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Ba att, A (2008) Evi ence Base e icine an Sha e Decision aking: the challenge of getting
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both evi ence an p efe ences into health ca e. Patient E ucation an Counselling 73: 407-d d 412.
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Bu ke, V an G eenbe g, D (2010) Dete mining Rea ability: How to Select an Apply Easy-to-Use
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Rea ability Fo mulas to Assess the Difficulty of A ult Lite acy ate ials. A ult Basic d
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E ucation an Lite acy Jou nal 4: 34-42.
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Cent e fo Cultu e Ethnicity an Health (2014) Health lite acy info mation sheet 8: W itten communication
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Available at : http://www.ceh.o g.au/wp-content/uploa s/2015/12/HL8_W
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Davis, TC, Bocchini, JA, J ., F e ickson, D, A nol , C, ayeaux, EJ, u phy, PW, Jackson, RH,
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Hanna, N an Pate son, (1996) Pa ent comp ehension of polio vaccine info mation pamphlets. Pe iat ics 97: 804-810.d r
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Davis, TC, Holcombe, RF, Be kel, HJ, P amanik, S an Dive s, SG (1998) Info me consent fo
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clinical t ials: a compa ative stu y of stan a ve sus simplifie fo ms. Jou nal of National r r
Cance Institute 90: 668-674.
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Depa tment of Health an Human Se vices. (2014) Health lite acy enabling communication an
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pa ticipation in health. Backg oun pape , Victo ian Depa tment of Health. elbou ne:
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Victo ian Gove nment
. Available at: http://www.healthissuescent e.o g.au/images/uploa s/ esou ces/Health-lite acy-r r d r r r
r d r r r d
backg oun -pape -Victo ian-Depa tment-of-Health.p f (accesse 26 Ap il 2016) d r
d r d d d
Doak, CC, Doak, LG an Root, JH. (1996) Teaching patients with low lite acy skills 2n e n e .: J.B. d
Lipponcott Company: Phila elphia. Available at:
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https://www.hsph.ha va .e u/healthlite acy/ esou
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Ha woo , A an Ha ison, JE (2004) How ea able a e o tho ontic patient info mation leaflets?
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Jou nal of O tho ontics 31: 210-219.
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Hen ickson, RL, Huebne , CE an Rie y, CA (2006) Rea ability of pe iat ic health mate ials fo
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Ho owitz, A an Kleinman, DV (2012) O al health lite acy: a pathway to e ucing o al health dispa ities in a ylan . r M r d Jou nal of Public Health Dentist y 72: S26-S30.r r
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Institute of e icine. (2004) Health Lite acy: A P esc iption to En Confusion. Washington,DC:
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National Aca emies P ess (US).
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Jackson, RD an Ecke t, GJ (2008) Health lite acy in an a ult ental esea ch population: a pilot d
stu y. Jou nal of Public Health Dentist y 68: 196-200.r r
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Jones, , Lee, JY an Rozie , RG (2007) O al health lite acy among a ult patients seeking ental r
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Kang, E, Fiel s, HW, Co nett, S an Beck, F (2005) An evaluation of pe iat ic ental patient
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Khan, K, Ruby, B, Gol blatt, RS, Schensul, JJ an Reisine, S (2014) A pilot stu y to assess o al health
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lite acy by compa ing a wo ecognition an comp ehension tool. B C O al Health 14: 135.M r McGee, J. (2010) Toolkit fo aking W itten ate ial Clea an Effective. Available at: r M r M r r d
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https://www.cms.gov/Out each-an -E ucation/Out each/W itten ate ialsToolkit/in ex.html? r d re i ect=/w ittenmate ialstoolkit/ (accesse 23 Ap il 2014) r r d r
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an its elationship with o al health. A epo t of a wo kg oup sponso e by the National
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Institute of Dental an C aniofacial Resea ch, National Institute of Health, U.S. Public Health
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Se vice, Depa tment of Health an Human Se vices. Jou nal of Public Health Dentist y 65: r r 174-182.
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Nutbeam, D (2008) The evolving concept of health lite acy. Society fo Science an er d M d 67: 2072-2078.
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Public Health Englan an UCL Institute of Health Equity. (2015) Local action on health
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inequalities: Imp oving health lite acy to e uce health inequalities. Lon on: Public Health d
Englan , Wellington House
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Riggs, E, Gussy, , Gibbs, L, van Geme t, C, Wate s, E an Kilpat ick, N (2014) Ha to each
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communities o ha to access se vices? ig ant mothe s' expe iences of ental se vices.
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Aust alian Dental Jou nal 59: 201-207. r
Roge s, JG. (2011) Evi ence-base o al health p omotion esou ced d r r r r . elbou ne: Depa tment of M r r Health.
dd d d r M r r d
Ru , RE an An e son, A (2006) The health lite acy envi onment of hospitals an health
r r r rd
cente s. Repo t, Boston: Ha va School of Public Health. d
(accesse 26th Feb ua y 2014) r r
r rd d r r r rr r
https://www.hsph.ha va .e u/healthlite acy/p actice/envi onmental-ba ie s/)
r r d r
The F y G aph Rea ability Fo mula. Available at: http://www. ea abilityfo mulas.com/f y-g aph-r d r r r r dea ability-fo mula.php.r
M d r
The S OG Rea ability Fo mula. Available at: http://www. ea abilityfo mulas.com/smog-r d r r dea ability-fo mula.php.r
r d r r d r r d
Wo l Health O ganisation. (2013) Health lite acy:The soli facts. Repo t, Wo l Health r
O ganisation: Copenhagen. Available at: http://www.eu o.who.int/en/health-topics/envi onment-r r
d r r d d r
an -health/u ban-health/publications/2013/health-lite acy.-the-soli -facts (accesse 13 Ap il 2016)
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Name of esou ce F y ea ability r r d r d
g a e
r
(ave age)
Suitability
r
checklist sco e
r
(ave age)
Suitability Rating
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Resou ces fo patients
1 Clean well, ink well, eat well dr (DHSV)
6th g a er d 73 Good
2 Dental ca e (VicSEG)r 8.5th g a er d 66 Good
3 Dental ca e fo chil en (VicSEG)r r dr 4th g a er d 66 Good
4 How to b ush you teeth (NRCH)r r 3rd g a er d 79 Good 5 How to keep you teeth healthy r
r (NSW Refugee Health Se vice)
5th g a er d 82 Good
6 Tooth tips 0-12 months (DHSV) 7th g a er d 62 Acceptable
7 Tooth tips 12-18 months (DHSV) 8th g a er d 61 Acceptable
8 Tooth tips 18 months-6 yea s r (DHSV)
7.5th g a er d 59 Acceptable
r r r
Resou ces fo o al health clinicians
9 Factsheet 1 -i entifying clients of d refugee an asylum seeke d r
r d
backg oun (VRHN)
16th g a er d 59 Acceptable
10 Factsheet 2 -wo king with efugee r r
d r
an asylum seeke clients (VRHN)
16.5th g a er d 53 Acceptable
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DHSV: Dental Health Se vices Victo ia; VRHN: Victo ian Refugee Health Netwo k; VicSEG:Victo ian r
r dr r r r r d
r
Figu e 1: o ifie p int communications ating checklist M d d r r
Key
0 =Does not apply The item is not p esent so it cannot be assesse . This applies to two items, which oes r d d
r d r r
not have to be p esent to engage the au ience. All othe items must be p esent. d
1 =Not one The mate ial i not follow the item’s specific c ite ia, o the equi e item is not r d d r r r r r d r
p esent.
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The mate ial followe some of the item’s c ite ia but was not consistent th oughout r
the mate ial.
3 =Done well The mate ial followe the item’s specific c ite ia consistently.r d r r
W iting style
r
0
1
2
3
r d r d d r d r
1. The mate ial emphasizes an summa ies the main points an esi e behaviou changes.
☐ ☐ ☐
Comments:
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2. The info mation is g oupe into meaningful sections.
☐ ☐ ☐
Comments:
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3. To make the mate ial appealing an easy to un e stan , the mate ial is w itten in
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a conve sational style (e.g. we, us) an in an active voice (the subject is
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pe fo ming an action e.g. ‘Chil en shoul eat f uits’ instea of ‘f uits shoul be dr
eaten by chil en’).
☐ ☐ ☐
Comments:
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4. The mate ial uses evices to engage an involve the ea e , such as sto ies, case
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stu ies, ialogues, o question an answe fo mat.
☐ ☐ ☐
Comments:
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5. The wo s an sentences a e gene ally sho t, simple an i ect.
☐ ☐ ☐
Comments:
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6. If me ical (e.g. osage, monito ing) o ifficult te ms a e use (consi e whethe
rd d r d d d r r d
wo s woul be familia to inten e au ience), they a e clea ly explaine with helpful examples.
☐ ☐ ☐ ☐
Comments:
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O ganisation an esign 0 1 2 3
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8. The mate ial uses clea hea ings o othe evices to signal what is coming next an to r d r
p ovi e message epetition.
☐ ☐ ☐
Comments:
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9. The mate ial looks unclutte e , with plenty of white space. ☐ ☐ ☐ Comments:
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10. If iag ams, tables, cha ts an g aphs a e use , they a e elevant, explaine clea ly d r d r r d
an a e place nea the text that int o uces them.
☐ ☐ ☐ ☐
Comments:
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11. The font size is 12 points o g eate . ☐ ☐ ☐
Comments:
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12. The e is goo colou cont ast between the p inte text an the pape . ☐ ☐ ☐ Comments:
Appeal 0 1 2 3
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13. The text uses CAPITAL lette s only when g ammatically nee e (wo s in capital
r r d r r d r d r
lette s a e not use to emphasise a behaviou o action as it may offen ea e s).
☐ ☐ ☐
Comments:
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14. The mate ial oes not use exagge ate ca toons, humou an ca icatu e, which may d r d
be misun e stoo .
☐ ☐ ☐
Comments:
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15. Photos, illust ations an othe visuals a e use to einfo ce key messages. ☐ ☐ ☐ Comments:
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16. The people an activities shown a e elevant to inten e au ience, in thei physical
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appea ance, behaviou an cultu al elements.
☐ ☐ ☐
Comments:
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17. The mate ial shows awa eness of an espect fo ive sity, by using cultu ally r r rd d r d d d
app op iate wo s an examples elevant to inten e au ience.
☐ ☐ ☐
