Research Platform
Issue Date: July 2015
Published Online: July 01, 2015
Updated: April 30, 2020
Assessing and Adapting Patient Educational Materials: Addressing Low Health Literacy in an Inpatient Rehabilitation Setting
Author Affiliations
  • University of Kentucky
  • Georgia Regents University
Article Information
Rehabilitation, Participation, and Disability / Prevention and Intervention
Research Platform   |   July 01, 2015
Assessing and Adapting Patient Educational Materials: Addressing Low Health Literacy in an Inpatient Rehabilitation Setting
American Journal of Occupational Therapy, July 2015, Vol. 69, 6911515150.
American Journal of Occupational Therapy, July 2015, Vol. 69, 6911515150.

Date Presented 4/17/2015

Written patient education materials from an inpatient rehabilitation setting were assessed. The average reading level was 16th grade. Twenty documents were revised, and the average reading level was lowered to 5th grade. Focus groups with clinicians and clients were conducted to assess the materials.

SIGNIFICANCE: Low health literacy has been shown to negatively affect health outcomes and medical self-management. Little health literacy research has been focused on physical rehabilitation settings. Important health literacy concepts—such as medication management, prevention, and health behaviors—closely tie into the physical rehabilitation goals and outcomes. The problem is compounded if the patient requiring rehabilitation is from a rural environment. One basic tool for supporting people with low health literacy is clear written communication. In this presentation, we describe results from an investigation carried out as part of a National Cancer Institute (NCI)-funded project exploring health literacy issues among people from Appalachia who received cancer rehabilitation in an inpatient setting.
INNOVATION: There is currently limited research in occupational therapy related to health literacy. A 2011 editorial in Volume 65 of the American Journal of Occupational Therapy (AJOT) by Sharon Gutman and Diane Smith states, “Occupational therapy practitioners have the unique opportunity to become key players in the promotion of client health literacy” (p. 368). This project was an initial attempt to begin to explore health literacy and written health information for an inpatient rehabilitation population. The topic is important for both the clinical and research branches of occupational therapy.
METHOD: Written patient education materials were collected from each unit and each discipline at a large, free-standing physical rehabilitation hospital. The materials were analyzed for reading level and readability with the Flesch–Kincaid reading assessment. Focus groups were held by discipline (occupational therapy, physical therapy, speech-language pathology, nursing, and psychology) to discuss the materials and to begin to develop a plan to adapt them. Focus groups were also held with each program manager (brain injury unit, spinal cord unit, pulmonary unit, and stroke unit) to explore educational materials that pertain specifically to the unit/diagnosis. Finally, a focus group of former inpatient rehabilitation users and one-on-one interviews with former cancer rehabilitation patients were conducted to explore the end users’ perceptions of the original and revised materials.
RESULTS: Ninety-seven pieces of patient education materials were initially assessed. The average reading level of the original educational materials was 16.02, ranging from 2.4 to 18.24. A subset of 22 documents was chosen for revision. A template based on the “Ask Me Three” public health campaign was developed. All materials were formatted to be 1 to 2 pages and were divided into the following questions: What is (problem/diagnosis)? What do I need to do? Why is it important?
After the template was agreed on, materials were edited to fit the format. The average reading level was lowered to 4.7, with a range from 1.9 to 8.2. Focus groups with end users were the final steps to assess the revised documents. The two largest problems with the original materials were vocabulary level and amount of information provided. The amount of information provided was a difficult topic/decision for both clinicians and clients.
CONCLUSION: Physical rehabilitation needs to begin to focus more strongly on issues related to health literacy. Clear communication in patient educational materials is a crucial first step to providing the best client-centered care.