Average American cannot read patient education material related to opioids #HealthLiteracy

Analysis of the Readability of Patient Education Readability Formulae Used Unacceptable Words according to SAMHSA/CSAT Recommendations4 Material Related to Opioids Automated Readability Index (ARI) Courtney Erickson, BA, PharmD Candidate and Prashant Sakharkar, PharmD, MPH 4.71 x (characters/words) + 0.5(words/sentences) - 21.43 Coleman Liau Index Introduction 5.89 x (characters/words) - 0.3(sentences/words) - 15.8 § Abuse Flesch Kincaid Reading Ease § The average American adult reads between a 7th and 9th grade level.1 § Habit-Forming Low health literacy has been associated with poor health outcomes. 206.835 - 1.015 x (words/sentences) - 84.6 x (syllables/words) § Drug Seeking § The NIH recommends that patient education material (PEM) be written Flesch Kincaid Grade Level § Diversion between 4th and 6th grade level.1 § In 2017, more than 47,000 people in the US died due to opioid-related 0.39 x (words/sentences) + 11.8 x (syllables/words) - 15.59 overdose, and approximately 17,000 deaths involved prescription opioids.2-3 Gunning Fog Score § An estimated 18 million people have misused opioid prescriptions at least once in 2017.2-3 0.4 x ((words/sentences) + (hard words/words)) § We hypothesize that some of this misuse could be attributed to readability of Simple Measures of Gobbledygook (SMOG) Index the PEM. √(complex words) § Indirect assessment of reading level is often performed using a readability Discussion formula. A readability formula is an equation derived from a regression Average Grade Level was calculated as a combination of these Discussion: analysis that correlates prose and the reader’s skill level. § Our results are consistent with the finding in published literature assessing readability of scores. alcohol misuse measures, rheumatology medicine information sheet and PEM from surgical Objectives sub-specialty (grade 9th to 15th).5-7 § The prose and language of the PEM contribute to the patient’s understanding of their drug § To assess and compare the readability of PEM related to opioids using Reading Levels for PEM with different Readability Formulae and its use. PEM written at an appropriate grade level will facilitate users’ understanding of readability formulae. their prescribed opioids better. § To assess the use of unaccepted words as recommended by the Substance § Limitations: Readability formulae used have their own limitations in assessing the Abuse and Mental Health Services Administration’s (SAMHSA) Center for Average Grade Level readability level. Substance Abuse Treatment (CSAT) in these PEM.4 § We did not measure readability of PEM in patients who are actual opioid users. § Our results cannot be generalized to PEM related to other than opioids. Methods ARI Conclusions § Study Design: Descriptive and correlational design § Seventeen package inserts and 15 patient education sheets (PES) were Coleman Liau Index § PEM was written at higher reading level than recommended by the NIH. scanned for number of word, sentences, complex or long words (>3 syllables). § Efforts directed at improving the readability of PEM perhaps help us to § Lexile level, average grade level and appropriate age range were assessed. reduce some of the opioid use related issues. § Material that was not educational, hyperlinks, copyright notices, disclaimers, SMOG Index author information, and incomplete sentences were excluded. Disclosures: Authors have no financial or other conflicts of interest to declare Results Gunning Fog Score

§ A total of 171,629 words were scanned; the word counts ranged between 1,660 - 13,245, with an average of 5,335 words per PEM. Flesch Kincaid Grade Level § The average Lexile level ranged between 700-1550. Readability of PEM was between 7-17 grade level which correlated with reading ages 12-21+ 0 2 4 6 8 10 12 14 16 18 § On average, the overall grade level for the PES was 6 or 7 grade (age 11-13). § On the other hand, the reading level for the package inserts was that of a Patient Education Sheets Package Inserts college sophomore or junior. § Overall, a total of 665 words were found to be unacceptable based on Take a picture to SAMSHA/CSAT recommendations. download the full paper