More than 90% of chronic kidney disease educational materials are written above the recommended health literacy level, putting patients at risk of poor management and health outcomes, according to a new study published in the June issue of the American Journal of Kidney Diseases.

“Our study reveals that most patient information materials are not fit for their purpose, and that materials may be too difficult for their intended audience to understand,” said Angela Webster, lead researcher and an Associate Professor Clinical Epidemiology at the University of Sydney.

The average adult patient has an 8th grade literacy level and one in five patients read at or below a 5th grade level. Among patients aged 65 or older, 40% read at or below a 5th grade level, according to the study. It is recommended that educational materials be aimed at the 5th grade level for CKD patients.

In the study, researchers looked at 80 English-language educational materials that were designed to be printed and read by CKD patients in the United States, Australia and the United Kingdom. These free educational materials were analyzed using both the Lexile Analyzer and the Flesch-Kincaid Grade Level formula.

The average readability score of all materials using either formula corresponded to a ninth-grade reading level. Only 23% of materials, using the Lexile Analyzer, and 44% of materials, using the Flesch-Kincaid measure, were pitched at the 8th grade level. Using both scales, only 5% of materials were written at the recommended 5th grade level.


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“These findings reveal that most information materials intended for patients with CKD are pitched well above the average patient’s literacy level. As a consequence, most patients wouldn’t be able to understand important health messages in these materials,” Webster said. 

Providing patients with reading materials outside their level of understanding could make it difficult to follow medication directives, dietary restrictions, and necessary lifestyle modifications for disease management.

Poor health literacy is a particular problem for elderly, ethnic minority, and socially disadvantaged people, all of whom are more likely to have CKD. People with low health literacy are less likely to feel engaged with their health care providers, less likely to participate in their treatment decisions, and have higher death and disease rates.

“Developing patient education materials that are appropriate for all literacy levels is a challenge, but a very important challenge for improving health outcomes,” said Thomas Manley, Director of Scientific Activities for the National Kidney Foundation. “All organizations need to make a thorough assessment on the readability of their patient information materials. Conducting formal readability testing, as suggested by the study authors, along with use of patient reviewers from a variety of educational and cultural backgrounds may provide important feedback to enhance the value of materials across a larger spectrum of health literacy levels.”