Evaluating United States Air Force hearing conservation educational materials for compliance, readability, understandability, and actionability

Noise-induced hearing loss and tinnitus are two of the most prevalent service-connected disabilities of United States military veterans. Educational materials meant for hearing conservation program-eligible Airmen were evaluated from active-duty, continental United States (CONUS) Air Force bases for compliance with US Air Force (USAF), Department of Defense (DoD), and Occupational Safety and Health Administration (OSHA) regulations. Understandability and actionability were assessed using the Patient Education Materials Assessment Tool for Audiovisual Materials (PEMAT-A/V), while readability was assessed with Flesch-Kincaid Grade Level (FKGL). Educational materials were received from 44 of 61 (72%) active-duty, CONUS bases, with 27 bases sending one item and 17 bases sending multiple items, for a total of 67 educational materials, which were evaluated by three evaluators. Educational materials were categorized into one of four types: (A) supervisor's guide to hearing conservation (<i>n</i> = 21); (B) new worker hearing conservation training (<i>n</i> = 20); (C) two-page hearing conservation program training pamphlet (<i>n</i> = 14); and (D) other (<i>n</i> = 12). Overall mean compliance was 84% (CI: 63,100) (USAF), 83% (CI: 62,100) (DoD), and 88% (CI: 67,100) (OSHA), respectively. Overall mean understandability was 75% (CI: 63,87) and actionability was 89% (67,100). There was good agreement between the three evaluators for each of the criteria (87-90%). Overall mean readability was grade level 10.68 ± 1.68 on the FKGL scale. For educational materials, 65 of the 67 (97%) were above the recommended 6th-grade reading level, and 62 of the 67 (93%) educational materials were above the average American 8th-grade reading level. This study established compliance, understandability, actionability, and readability scores for educational materials that military service members receive upon entry into the hearing conservation program, gathered from active-duty, CONUS Air Force bases. Using the determined scores, recommendations, such as providing active feedback and condensing information, were given to improve future hearing conservation educational materials.