Reassessing the Readability of British Association of Dermatologists’ Patient Information Leaflets in 2025: Progress Toward Improved Health Literacy and Accessibility

BACKGROUND: Patient Information Leaflets (PILs) are recommended to be written at or below a US Grade 6 reading level (UK Year 7; age 11-12) to ensure accessibility. They support patient understanding, self-management, and treatment adherence. Prior analyses from 2021 showed that most British Association of Dermatologists (BAD) PILs exceed this benchmark. This study provides an updated evaluation of their readability. OBJECTIVES: To reassess the readability of BAD PILs in 2025 and compare findings with 2021 data. METHODS: 230 BAD PILs were analysed using Readability Studio (Oleander Software, USA). Standard readability metrics included Flesch-Kincaid (FK), Simple Measure of Gobbledygook (SMOG), Gunning Fog Index (GFI), Fry, FORCAST, and Flesch Reading Ease (FRE). Results were compared with 2021 values (GraphPad Prism V10.4.1 and Psychometrica). RESULTS: Mean US grade levels for 2025 vs 2021 were: FK 9.64 vs 9.8, SMOG 12 vs 12.1, GFI 11.6 vs 11.8, Fry 11.2 vs 11, FORCAST 10.7 vs 10.7, and FRE 52.8 vs 52.2. Readability corresponded to UK Year 10-13. Only 1.3% of PILs (3/230) met the US Grade ≤6 benchmark. Effect sizes were negligible (Cohen's d, +0.115 to -0.164), with no meaningful improvement since 2021. Additionally, 40.4% of PILs were overdue for review. CONCLUSIONS: BAD PIL readability has not improved over four years and remains above recommended levels. Overdue reviews may contribute to this persistence. Improvement will require systematic redesign using plain-language principles alongside more consistent review processes.