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This presentation discusses: -Research on the readability of health insurance forms -Reading level assessment tools -Best practices for lowering the reading level of materials
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An Overview of
Health Insurance Literacy
Emily Vardell, MLSPhD Student and Teaching Fellow
School of Information and Library Science UNC Chapel Hill
February 20, 2014
In today’s session, we’ll discuss
o An overview of health insurance literacyo Commonly used readability testso Research on the reading levels of health
insurance formso The tools that can be used (by librarians and
others) to assess reading levelso What can be done to lower the reading level of
materials
Health Literacy
“the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions”
Ratzen, S. C., & Parker, R. M. (2000). Introduction. In: Selden, C. R., Zovn, M., Ratzen, S. C., & Parker, R. H. (Eds.), National Library of Medicine current bibliographies in medicine: Health literacy. NLM Pub N. CBM 2000-1. Bethesda, MD. National Institutes of Health, U.S. Department of Health and Human Services.
Health Literacy Categories• Below Basic indicates no more than the most simple
and concrete literacy skills.• Basic indicates skills necessary to perform simple and
everyday literacy activities.• Intermediate indicates skills necessary to perform
moderately challenging literacy activities.• Proficient indicates skills necessary to perform more
complex and challenging literacy activities.
Kutner, M., Greenburg, E., Jin, Y., & Paulsen, C. (2006). The health literacy of America's adults: Results from the 2003 National Assessment of Adult Literacy. NCES 2006-483. National Center for Education Statistics.
Text
Kutner, M., Greenburg, E., Jin, Y., & Paulsen, C. (2006). The health literacy of America's adults: Results from the 2003 National Assessment of Adult Literacy. NCES 2006-483. National Center for Education Statistics.
Health Literacy Level by Health Insurance Coverage
Kutner, M., Greenburg, E., Jin, Y., & Paulsen, C. (2006). The health literacy of America's adults: Results from the 2003 National Assessment of Adult Literacy. NCES 2006-483. National Center for Education Statistics.
Health Insurance Literacy
“a new concept that addresses the extent to which consumers can make informed purchase and use decisions”“knowledge, ability, and confidence to effectively choose and use health insurance”
Kim, J., Braun, B., & Williams, A. D. (2013). Understanding Health Insurance Literacy: A Literature Review. Family and Consumer Sciences Research Journal, 42(1), 3-13.
Does this look familiar?
Readability Tests• FORCAST - only test not designed for running narrative,
grade level based on number of monosyllabic words• Flesch-Kincaid - grade level based on sentence length
and syllable count• Gunning Fog – grade level based on number of
sentences and complex words• New Dale-Chall - grade level based on sentence length
and number of unfamiliar words
Readability Studio [computer program]. Version 1.2.0.0. Vandalia, Oh: Oleander Software, Ltd; 2013.
Reading level of Medicaid renewal applications
• 45 states had reading level guidelines • 24 (52.2%) of the states failed to meet their own
guidelines • 41 states (89.1%) failed the Flesch-Kincaid Grade
Level Index• None (0%) of the assessments passed the
FORCAST
Pati, S., Kavanagh, J. E., Bhatt, S. K., Wong, A. T., Noonan, K., & Cnaan, A. (2012). Reading level of Medicaid renewal applications. Academic pediatrics, 12(4), 297–301.
Assessment of Children’s Public Health Insurance Program enrollment applications
• A more holistic assessment of CHIP applications that assessed reading demands, layout characteristics, and document complexity through:– Lexile Analyzer (to assess reading demands)
• Reading Level = sentence length and word frequency– The User-Friendliness Tool (to assess layout)
• Font size; avoidance of capital letters, italics, and specialty fonts; use of ample white space; short paragraph lengths
– The PMOSE/IKIRSCH scale (to assess document complexity)• Complexity of structure (use of lists) and density (number of labels and items on
the list)
Wallace, L. S., DeVoe, J. E., & Hansen, J. S. (2011). Assessment of Children’s Public Health Insurance Program enrollment applications: a health literacy perspective. Journal of pediatric health care : official publication of National Association of Pediatric Nurse Associates & Practitioners, 25(2), 133–7.
•Collect•Assess –Oleander Readability Studio
•Compare
Examples
Examples
Affordable Care Act (ACA/Obamacare)
Readability
FORCAST
11.1
Gunning Fog
9
New Dale-Chall7-8
Company Administering Insurance Company
Number of Pages
FORCAST Test (grade level)
FORCAST Test (without common ins. words)
Aerostructures Manufacturer
Aetna 4 13.4 13.0Architecture Firm UnitedHealthCare 2 13.9 13.1Midwestern regional health system
Self-administered 2 10.9 9.9
Large, Southern public university
BlueCross/ BlueShieldNorth Carolina
8 13.4 13.2
Large, Midwestern public university
Medica 4 13.6 13.4
Large, Mid-Atlantic public university
Self-administered 5 12.5 12.4
National cable company
UnitedHealthCare and BlueCross/BlueShield
11 12.6 12.2
National pharmacy chain
BlueCross/ BlueShieldIllinois
½ 11.8 11.2
National, natural foods supermarket chain
UnitedHealthCare 1 12.6 12.3
Oleander Readability Studio
Readability Studio [computer program]. Version 1.2.0.0. Vandalia, Oh: Oleander Software, Ltd; 2013.
Oleander Readability Studio
Readability Studio [computer program]. Version 1.2.0.0. Vandalia, Oh: Oleander Software, Ltd; 2013.
http://www.oleandersolutions.com/readabilitystudioorder.html
Oleander Readability Studio (with Language Options)
Readability Studio [computer program]. Version 1.2.0.0. Vandalia, Oh: Oleander Software, Ltd; 2013.
http://www.oleandersolutions.com/ReadabilityStudioLanguagePackOrder.html
Oleander Readability Studio
Readability Studio [computer program]. Version 1.2.0.0. Vandalia, Oh: Oleander Software, Ltd; 2013.
http://www.oleandersolutions.com/ReadabilityStudioFeatures.html
Readability Studio: Difficult Words
Read-able.com
Testing MedlinePlus
Read-able.com
ReadabilityFormulas.com
http://www.readabilityformulas.com/
Microsoft Word (2010)1. Click the File tab, and then click
Options.2. Click Proofing.3. Under When correcting spelling and
grammar in Word, make sure the Check grammar with spelling check box is selected.
4. Select Show readability statistics.After you enable this feature, open a file that you want to check, and check the spelling. When Outlook or Word finishes checking the spelling and grammar, it displays information about the reading level of the document.
http://office.microsoft.com/en-us/word-help/test-your-document-s-readability-HP010354286.aspx#_Toc342546555
Microsoft Word (2010)
How to Adapt Your Materials• FORCAST - only test not designed for running
narrative, grade level based on number of monosyllabic words
• Flesch-Kincaid - grade level based on sentence length and syllable count
• Gunning Fog – grade level based on number of sentences and complex words
• New Dale-Chall - grade level based on sentence length and number of unfamiliar words
Readability Studio [computer program]. Version 1.2.0.0. Vandalia, Oh: Oleander Software, Ltd; 2013.
How to Adapt Your MaterialsMonosyllabic wordsShort sentence lengthMinimum number of sentences and complex words Lessen number of unfamiliar wordsPerhaps add: Increase the amount of white spaceUse clear fonts; avoid italics and other hard to read
features
Readability Studio [computer program]. Version 1.2.0.0. Vandalia, Oh: Oleander Software, Ltd; 2013.
In today’s session, we’ve discussed
An overview of health insurance literacyCommonly used readability testsResearch on the reading levels of health
insurance formsThe tools that can be used (by librarians and
others) to assess reading levelsWhat can be done to lower the reading level of
materials
Questions?
Emily Vardell, [email protected]