Patient recall of tinnitus information after initial audiological assessment

Aims: This study addressed the challenge of evaluating and improving patient education material as well as recall of information from a tinnitus counselling session. The first aim was to examine the readability and suitability of two tinnitus patient education brochures provided by an audiology clinic to new tinnitus patients. If the readability of the brochures were higher than international recommendations for reading grade level (RGL), then an attempt to rewrite a brochure to a suitable RGL would be made. The second aim was to investigate a) the amount of information tinnitus patients can successfully recall directly following their initial appointment, b) the amount of information that is retained one to two weeks following their appointment, c) whether the amount of information recalled is related to patient variables, and d) the themes that arose from interviews with the patients. Method: To address study aim 1, readability analyses were completed for two patient tinnitus brochures provided to new patients at a private hearing aid clinic using several readability formulas. If found to have a readability level over 5th grade level one brochure would be rewritten to an acceptable readability level while attempting to maintain the initial level of content. The suitability of the brochures was assessed by two experts in the area of health literacy using the Suitability Assessment of Material (SAM). To address study aim 2, eight participants consulting for tinnitus services were prospectively identified by a clinical audiologist at a private hearing aid clinic. Immediately following the initial tinnitus counselling session, participants took part in a digitally-recorded seven-item open-ended interview and provided demographic and audiological information. One to two weeks later, a second interview using the same questions was conducted. Results: After analyzing the readability of the brochures it was evident that both exceeded the recommended RGL on the Flesch-Kincaid (F-K), Fry, Fog, and Simple Measure of Gobbledygook (SMOG). The experts rated Brochure 1 as “unsuitable” for patient education and Brochure 2 as “adequate” for patient education using the SAM. Brochure 1 was revised and was within the internationally recommended RGL as measured by the F-K, Fry, and Fog, whilst keeping the content similar to the original. Overall, participants correctly recalled only a small amount of information in the immediate (36.8%) and one to two weeks later (33.7%). There was no significance difference in amount of correctly recalled information between appointments, and none of the correlations performed for recall and participant variables were statistically significant. Effect sizes were calculated and no trend was found for audiometric variables, although demographic variables did tend to explain more of the variance in recall in the short-term than immediately. The most notable themes identified in the interview immediately after the appointment were: Hearing aids, Understanding/Empowerment, and Masking/Music therapy. At the short-term follow up interview, Hearing aids, Cost, and Hope/Positive were commonly reported. Conclusions: As over half of New Zealanders do not have adequate health literacy skills to meet the demands of life and work (Ministry of Health, 2010) it follows that written and verbal health information should be easy understandable to allow patients to take an active role in their health care and experience the best possible health outcomes. Overall, participants only remembered modest amounts, only one brochure was adequate for patient education, and the RGL of both brochures were higher than recommended. There is a great need for more studies examining suitability, readability, and patient recall not only in tinnitus, but in all areas of healthcare