Shared decision making for adults with hearing impairment : application of readability and quality measures.

Health consumers need readable, high quality information to support their health literacy and engagement in shared decision making. The purpose of this study was to assess whether the use of plain language improved the readability and quality of audiology consumer information on the American Speech-Language-Hearing Association (ASHA) website. Thirty two articles written in English were assessed. Reading grade levels for each article were calculated via the Flesch- Kincaid Grade Level (F-K), Gunning Fog Index (FOG), Fry (FRY) and the Simple Measure of Gobbledygook (SMOG) formulas. Results were compared to reading grade levels recommended by health literacy experts and historical assessments of ASHA audiology consumer information articles. Article quality was measured using the DISCERN tool. The relationship between article readability and quality was assessed. The article with the highest reading grade level and lowest quality score was revised to demonstrate the feasibility of improving both of these measures. The mean readability scores were significantly higher than the recommended grade level of six for all measures used. Comparison over time showed the use of plain language improved readability. No improvement was found between the results of that initial revision and the articles analysed in this present study. The mean quality score of the articles was 2.93 out of 5, with large variation in scores. This finding indicates potentially serious shortcomings for some of the material. No significant relationship between readability and quality was found. The application of plain language principles is insufficient to ensure consumer hearing health information is accessible or supports shared decision making