HEALTH LITERACY FORUM: Informed consent issuesPROFESSOR HELEN KELEHER, MONASH UNIVERSITY15TH MAY 2012

QuestionsWhat are the issues in informed consent ?What are the barriers to giving informed consent?What is the reading age required for the informed consent forms used in your organisation?

Readability Assessment

Readability of the information is a factor in gaining informed consent

–most people prefer less complex language esp when they are under stressPlain language is generally clearer and easier to understand

Readability Assessment Tools Flesch-Kincaid Reading Level: An index that gives the years of education

required to comprehend a document. The Flesch Grade Level readability formula takes into consideration the total number of words, the number of syllables, and the total number of sentences in a piece of writing.  Flesch Reading Ease: Indicates on a scale of 0 to 100 the difficulty of comprehending a document. It is calculated using sentence length and the number of syllables in a word.  Simple Measure of Gobbledygook (SMOG): Estimates the years of education a person needs to understand a piece of text focusing on sentence and word length. Reading level is calculated using the number of polysyllabic words in a set number of sentences. Gunning Fox Index: Estimates the years of formal education needed to understand the text on a first reading. Texts for a wide audience generally need a fog index less than 12. Texts requiring near-universal understanding generally need an index less than 8.

Informed consent is a process….So how can people with low literacy give fully informed consent?

http://www.templehealth.org/ICTOOLKIT/html/ictoolkitpage16.html

Microsoft Word has a readability tool available as follows but only measures grade-level to Year 12:

Under the “Tools” menu, select “Options.”Click on “Spelling & Grammar” tab.Check “Show readability statistics” under the “Grammar” heading.

This function provides readability scores using the Flesch-Kincaid Reading Level tool and the Flesch Reading Ease tool.

Suitability of Assessment

Materials (SAM):Print material is ranked against 21 criteria using a 3

point likert scale based on 6 factors :ContentLiteracy demandGraphicsLayout and typographyLearning stimulation and motivationCultural appropriateness

PRISM Readability Toolkit

The PRISM recommendations for editing:Replacing jargon and other complex terms with familiar vocabularyCreating single-topic paragraphs and concise sentencesUsing reader-friendly formatting Checking the reading level—achieving a target of 8th grade or below in most cases.

Useful resourcesPRISM: Quick Reference Guide for Improving Readability. Document Readability Calculator http://www.online-utility.org/english/readability_test_and_improve.jsp Text Readability Scoreshttp://www.addedbytes.com/lab/readability-score/ The Readability Test Toolhttp://www.read-able.com/