The Readability, Understandability, and Actionability of Craniomaxillofacial Printed Discharge Patient Education Materials

Background: Craniomaxillofacial surgery is a complex field with numerous conditions and treatments that can be difficult for patients to understand. This affects outcomes as patients with low health literacy experience worse outcomes, decreased use of preventive services, increased hospitalization rates, and ultimately increased mortality rates. The purpose of our study was to quantify the readability, understandability, and actionability of craniomaxillofacial printed patient educational materials as they serve a crucial role in patient care. Methods: Utilizing Elsevier’s content for the electronic medical record system by Oracle Health (formally Cerner), printed patient educational materials pertaining to craniomaxillofacial surgery were collected. The materials were assessed for readability, understandability, and actionability by analyzing the Flesch-Kincaid grade level, Flesch reading ease, passive sentence average, words per sentence, characters per word, and the Patient Education Materials Assessment Tool (PEMAT). The materials were further analyzed in categories as determined by The American Society of Maxillofacial Surgeons conditions and treatments: Congenital, Facial Trauma, Oncology, Reconstructive, and Cosmetic. Results: The 80 educational materials had an average Flesch-Kincaid grade level of 5.8. The Flesch Reading Ease was 71.9, the average of passive sentences was 15.5%, words per sentence was 10.5, and characters per word was 4.6. The average PEMAT understandability score was 82.1%, while the actionability score was 57.1%. Conclusion: The patient education materials met commonly-accepted standards in critical readability areas such as the Flesch-Kincaid reading level as well as understandability via the PEMAT scoring. Despite this, the materials were limited in PEMAT actionability scoring 57%, which is below the 70% target for adequacy. Improvements to increase actionability include creating visual aids, explicitly describing actions patients can take, and providing tangible tools such as checklists.