One element of this readability is how easy the material is to understand, and to measure this the SMOG readability tool was developed (McLaughlin 1969), a tool used to calculate the comprehensibility of written material based on the number of words of three or more syllables contained within the text. The SMOG readability tool is often used to assess the quality of written healthcare information (Sand-Jecklin 2007). Using the SMOG readability tool, both manually and via McLaughlin’s online SMOG calculator (McLaughlin and Trottier 2009) it was possible to calculate an approximate reading age for the leaflet which indicates ‘some high school’ reading level (McLaughlin 1969b).
Although the SMOG tool is generally accepted to be a reliable and simple way to calculate the readability of health education literature, the strict criteria may result in higher reading grade scores (Sand-Jecklin 2007b) for example in the leaflet where a key word of three syllables ‘Hepatitis’ is repeated, therefore this leaflet may be judged to be closer to the Hoffmann and Worrall (2004f) advocated reading age than the SMOG tool indicates.
A possible criticism of the leaflet according to the recommendations put forward by Hoffmann and Worrall (2004g) is the use of judgmental language such as ‘Don’t start injecting drugs’ which may appear patronising to the reader (NHS 2006c).
The voice of the leaflet however enhances the leaflet’s readability using an active, conversational style, which will both lower the reading level of the material and engage the reader (Godsell and Scarborough 2006b). The leaflet aims to target high risk groups, however a growing number of hepatitis C cases are emerging from amongst the South Asian immigrant population which poses ethical considerations on the accessibility of hepatitis C awareness information (Panou 2009c) such as whether this leaflet is available in appropriate languages.
This leaflet is available to print for display in multilingual formats (DOH 2009) however whether the leaflet is available in a clinical area is dependant on healthcare staff printing and promoting an appropriately translated version which was not evident at the source of this leaflet.
This is important to note as Health messages can be easily missed due to language barriers, and therefore health information is recommended to be available in several languages (Smith 2006). In conclusion the leaflet is appropriately placed, eye catching and appears to have an adequate readability level and current evidence based content. The leaflet does however appear to have some design flaws which may affect its impact on a target audience including poor use of illustration, font size and limited availability in formats aimed towards increasingly high risk minority ethnic groups. Further discussion in this assignment would have been welcomed by the author, though limited by the specified word count.
Subsequently while researching health education leaflet design, the author perceived a significant gap in current research, specifically in terms of impact of text layout and engagement of the reader in written health education information and therefore would recommend or aim to undertake further research in this area. In terms of practice the author would suggest that awareness of simple readability tests, guidelines and the impact of appropriate graphics would inform the nurse in selecting written health education material which are appropriate for individual service users. Appendix 1: Leaflet: Hepatitis C: Get tested,Get treated. Reference List Boyce,T. (2009) Encouraging changes in health behavior. Practice Nursing, 20( 2), 77-82 Caress,A,L (2003) Giving information to patients. Nursing standard 17(43) , 47-54 Demir,F.(2008)
The quality and suitability of written educational materials for Patients. Journal of clinical nursing. 17, 259-265 Hill-Briggs, F. and Smith A,S. (2008) Evaluation of Diabetes and Cardiovascular Disease Print Patient Education Materials for Use With Low-Health Literate Populations. Diabetes Care, 31(4), 667-71. Houts,P,S. Doak C,C. Doak L,G, Loscalz M,J. (2006) The role of pictures in improving health communication: A review of research on attention, comprehension, recall, and adherence. Patient Education and Counseling 61, 173-190 Hoffmann,T. Worral, L. (2004) Designing effective written health education materials: considerations for health professionals. Disability and Rehabilitation. 26(19), 1166-1173.
Godsell M, Scarborough K (2006) Improving communication for people with learning disabilities. Nursing Standard. 20(30), 58-65 Griffith,J. McKenna,K. tooth,L. (2003) Written health education materials:making them more effective. Australian Occupational Therapy Journal 50, 170-177 McLaughlin H,G. (1969) SMOG Grading – A New Readability Formula, Journal of Reading. 639-645. McLaughlin. H,G. (1974) Temptations of the flesch. Instructional Science 367-384 Panou,m. and Catt,J. (2009) raising awareness of hepatitis C infection. |Primary Health Care 19 (4) , 16-20 Sand-Jecklin,K. (2007) The Impact of Medical Terminology on readability of patient education materials. Journal of Community Health Nursing, 24(2), 119-129.
Smith S (2006) Cross-cultural information leaflets. Nursing Standard. 21(4), 39-41 UK Department of Health (2008) High Quality Care For All. NHS Next Stage Review Final Report by Lord Darzi. UK Department of Health (2009) Publication Hepatitis C, are you at risk? NHS (2006) Toolkit for Producing patient information. NHS (2009)
Hepatitis C. Get tested, get treated: Available from http://www. nhs. uk/hepatitisc/Pages/default. aspx accessed on 18/06/2009 WHO (2009) Hepatitis C factsheet: Available from http://www. who. int/mediacentre/factsheets/fs164/en/ accessed on 18/06/2009 McLaughlin G,H and Trottier A. Online SMOG test: Available from http://www. wordscount. info/ accessed on 20/06/2009.