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Assessing the readability and patient comprehension of rheumatology medicine information sheets: a cross-sectional Health Literacy Study
  1. Michael Oliffe1,
  2. Emma Thompson2,
  3. Jenny Johnston3,
  4. Dianne Freeman1,
  5. Hanish Bagga1,
  6. Peter K K Wong1,2
  1. 1 Mid-North Coast Arthritis Clinic, Coffs Harbour, New South Wales, Australia
  2. 2 University of New South Wales Rural Clinical School, Coffs Harbour, New South Wales, Australia
  3. 3 School of Education, Southern Cross University, Coffs Harbour, New South Wales, Australia
  1. Correspondence to Dr Peter K K Wong; pkkw12{at}


Objectives Patients are often provided with medicine information sheets (MIS). However, up to 60% of patients have low health literacy. The recommended readability level for health-related information is ≤grade 8. We sought to assess the readability of MIS given to patients by rheumatologists in Australia, the UK and Canada and to examine Australian patient comprehension of these documents.

Design Cross-sectional study.

Setting Community-based regional rheumatology practice.

Participants Random sample of patients attending the rheumatology practice.

Outcome measures Readability of MIS was assessed using readability formulae (Flesch Reading Ease formula, Simple Measure of Gobbledygook scale, FORCAST (named after the authors FORd, CAylor, STicht) and the Gunning Fog scale). Literal comprehension was assessed by asking patients to read various Australian MIS and immediately answer five simple multiple choice questions about the MIS.

Results The mean (±SD) grade level for the MIS from Australia, the UK and Canada was 11.6±0.1, 11.8±0.1 and 9.7±0.1 respectively. The Flesch Reading Ease score for the Australian (50.8±0.6) and UK (48.5±1.5) MIS classified the documents as ‘fairly difficult’ to ‘difficult’. The Canadian MIS (66.1±1.0) were classified as ‘standard’. The five questions assessing comprehension were correctly answered by 9/21 patients for the adalimumab MIS, 7/11 for the methotrexate MIS, 6/28 for the non-steroidal anti-inflammatory MIS, 10/11 for the prednisone MIS and 13/24 for the abatacept MIS.

Conclusions The readability of MIS used by rheumatologists in Australia, the UK and Canada exceeds grade 8 level. This may explain why patient literal comprehension of these documents may be poor. Simpler, shorter MIS with pictures and infographics may improve patient comprehension. This may lead to improved medication adherence and better health outcomes.

  • health literacy
  • rheumatology
  • medication adherence
  • patient comprehension
  • readability

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  • Patient consent for publication None declared.

  • Contributors MO, ET: were responsible for data acquisition. MO: was responsible for drafting the manuscript and data analysis under the supervision of PKKW. PKKW, JJ, DF, HB: conceived and designed the study. All authors contributed to interpretation of data and revision of the manuscript and approve the final manuscript.

  • Funding This study was partially funded by an unrestricted research grant from Bristol Myers Squibb.

  • Competing interests None declared.

  • Ethics approval Approval as a low/negligible risk project was obtained from the New South Wales North Coast Human Research Ethics Committee (NCNSW HREC No LNR 150).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data available.

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