Want Help Explaining A Medical Procedure? Ask A 9-Year-Old

The average American reads at an 8th-grade level, but the patient information that doctors and hospitals provide often presumes that people have much more advanced reading skills.

So some researchers decided to see what happens when 9-year-olds write the patient guides.

Dr. Catrin Wigley at University Hospitals Coventry and Warwickshire NHS Trust and colleagues analyzed six National Health Service patient information leaflets from across England for total hip replacement and found that the average readability level was age 17, even though the average Brit reads at a 4th-grade level. You'd have to have the reading comprehension of a high school senior to understand from these brochures what a hip replacement is, why you need it and what complications might occur.

The researchers recruited 57 nearby elementary school children ages 8 to 10 to help revise the content.

After a lesson about hip replacement, the children were asked to write their own leaflet and draw an image to illustrate it. They were given four headings: indications for surgery, complications of surgery, before the procedure, and the procedure.

What the children came up with was clear, concise and without sugarcoating.

"Your hip is old and rotten," says Mohammed.

"It is past its sell-by date," adds Jaime.

What is not allowed before surgery? Coca Cola, fries, and chocolate, according to Lilly.

Of course, no one is suggesting we actually let children write the guides, but maybe we can learn something from their approach.

The authors write: "What better way to write a new leaflet than by engaging with 9-year-old children, so that we can begin to appreciate the disparity in the language we use to convey information through formal patient information leaflets."

It's a novel experiment, but can't really work in practice, according to Cynthia Baur, director of the Horowitz Center for Health Literacy at the University of Maryland's Public School of Health.

"While children may be able to say things simply, they don't have the context and experience to recognize aspects of topics that might need more in-depth information or explanation, and they can't anticipate adult concerns," Baur says.

But it may shed fresh light on a problem that has been percolating for decades.

Low health literacy leads to poor outcomes for patients and millions of dollars in unnecessary health costs. Countless commissions and organizations have developed plans for improvement. In 2010, the U.S. Department of Health and Human Services published a 73-page action plan to improve health literacy and called for making it a public health priority.

The proliferation of computer-generated patient leaflets was supposed to help. Yet measurement tools with great names like Simple Measure of Gobbledygook (SMOG) and Gunning Fog (GFI) show that these patient education materials are often too complex for the average person.

"I definitely think patient materials have improved, but they are still far from where they need to be," says Baur, who edited the HHS action plan and created the Centers for Disease Control and Prevention's health literacy site prior to her appointment at Maryland. "These tools, along with audience testing, of the materials will make health materials much better much faster."

So can we learn something from the experiment? Maybe simplicity. "Let's take our cue from the children and begin speaking honestly and to the point with our patients in a language they understand," Wigley and her colleagues write in their analysis.

What works, says Bauer, is involving the intended recipients. "Health care organizations that truly care about excellent patient experiences and well-being will find ways to involve patients, caregivers and others in the routine development of all types of health communication, even forms and facility signs," she says.

The paper was published this week in the Christmas edition of the British Medical Journal.

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