1. Gerd M Flodgren What Works Global Summit London 26-28 September 2016
Can the use of a readability calculator improve communication with the public?
Gerd M Flodgren
What Works Global Summit
London September 2016

2. Interactive Health Literacy Framework
Skills and abilities
Demands and complexity
“the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions”
Source: U.S. Department of Health and Human Services. 2000
Interactive health literacy framework.Source: Parker R. Measuring health literacy: what? So what? Now what? In Hernandez L, ed. Measures of health literacy: workshop summary, Roundtable on Health Literacy. Washington, DC, National Academies Press, 2009:91–98.

3. The European Health Literacy Survey
Almost half of the adults had limited health literacy.
Participating countries:
Austria, Bulgaria, Germany,
Greece, Ireland,
the Netherlands,
Poland and Spain
36%
Source: Sørensen et al.2015 Health Literacy in Europe: comparative results of the European health literacy survey (HLS-EU)).European Journal of Public Health

4. Limited health literacy is linked to:
less healthy choices
riskier behaviour
poorer health outcomes
higher hospitalisation rates
lower use of preventive services
Source: World Health Organisation, The Solid Facts. Health Literacy

5. One tool to improve health literacy
Please use plain language!
I don’t get this. This is Greek to me!

6. What is plain language?
«Plain language is communication that users can understand the first time they read (or hear) it. A plain language document is one in which people can find what they need, understand what they find, and act appropriately at that understanding»
Source: Plain Language Action and Information network. What is plain language? Available at

7. Plain Language Expectations for Authors of Cochrane Summaries (PLEACS)
One key point per sentence
Use short paragraphs
Avoid potentially misunderstood words
Avoid hard words
Introduce an acronym for repeated use
Write for an international audience
Use the active voice
Recommend the use of a readibility calculator

8. Text Readibility Consensus Calculator
Sentences
Characters
Words
Syllables
Consensus Reading Score 12 13 15 21

9. Example

10. The 7 readability scores

11. The Consensus Score

12. Word Statistics

13. Average Sentence Length

14. Average % of 3–syllable Words

15. Average Reading Level

16. Objectives
To assess the readability of Cochrane Plain Language Summaries (PLS) using the text readability concensus calculator
To pilot the readibility calculator on a convenience sample of PLSs judged difficult to read

17. Methods
Sample: N=143 PLSs from Cochrane reviews (2-3/ group) published Oct 2015 to March 2016
Analysis: the PLSs were analysed using the Text Readability Consensus Calculator was (and a proof reading function in Word)
Outcomes: words per sentence, proportion +3-syllable words, consensus readibility score (paragraph length, use of passive voice)
Pilot: the calculator was used to improve the readability of eleven PLSs judged to be very difficult to read

18. RESULTS

19. Sentence length Mean number of words per sentence: 21.7 (SD: 4.0)
Recommended length: words
Source:

20. +3-syllable words Mean proportion: 21.7%
Recommended proportion: <12-14%
"The summit where Tamatea, the man with the big knees, the slider, climber of mountains, the land-swallower who travelled about, played his nose flute to his loved one".
Sourse:

21. Readibility Concensus Score
Average score:
14 (SD 2.0), range 9 to 21
Public reading level: 7-8
Sourse:

22. ADDITIONAL RESULTS

23. Paragraph length
Average 3.4 sentences per paragraph (SD 1.5) (range 1.5 to 14)
Almost all PLSs were structured with sub- headings

24. Passive Voice 20 % of sentences in passive voice (range 0 to 50%)

25. Results of piloting of the tool
It was very difficult to improve the readability score to below 14
Source:

26. Conclusions Cochrane PLSs are very difficult to read
The average reading level is 14 which is not suitable for the general public
Too many hard words
Too long sentences
Passive voice is used too often
It is difficult to get a readibility score below 14

27. Thank you for listening!