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(Stroke. 2000;31:2966.)
© 2000 American Heart Association, Inc.

Original Contributions

Anticoagulant Patient Information Material Is Written at High Readability Levels

Carlos A. Estrada, MD, MS; Mary Martin Hryniewicz, RN, MSN; Vetta Barnes Higgs, MD; Cathy Collins James C. Byrd, MD, MPH

From the East Carolina University Anticoagulation Clinic (C.A.E., M.M.H.); Brody School of Medicine at East Carolina University (V.B.H., C.C., J.C.B.); and the Clinical Information Support Office, University Health Systems (C.A.E.), Greenville, North Carolina.

Correspondence to Dr Carlos Estrada, Brody School of Medicine at East Carolina University, 600 Moye Boulevard, PCMH TA-389, Greenville, NC 27858-4353. E-mail estradac{at}mail.ecu.edu

Background—Warfarin therapy requires frequent monitoring and dose adjustment. Elderly patients with atrial fibrillation, prior stroke, and lower literacy skills may have difficulty reading brochures that explain dosing instructions, procedures to follow, and the risks and benefits of anticoagulants. In general, it is recommended that brochures be written at or below the 6th-grade level. We determined the readability of patient information material being offered to patients receiving anticoagulants.

Methods and Results—We used the SMOG grade formula to measure readability of written patient materials. We obtained 50 brochures commonly used in anticoagulation management units from industry and health advocacy groups. Patient information was related to atrial fibrillation (16%, n=8), warfarin (44%, n=22), low-molecular-weight heparins (12%, n=6), or other related topics (28%, n=14). The mean readability was found to be grade 10.7 (95% CI 10.1 to 11.2); none had a readability score at the 6th-grade level or below, 12% of the brochures had readability scores at the 7th- to 8th-grade levels (n=6), 74% at the 9th- to 12th-grade levels (n=37), and 14% at higher than 12th-grade level (n=7). The readability grade level was similar for brochures produced by industry or health advocacy groups (P=0.9) but higher for information obtained from the Internet (12.2±1.3 grades) compared with other sources (10.3±2.1 grades; P=0.01).

Conclusions—Patient education materials related to the use of anticoagulants are written at grade levels beyond the comprehension of most patients. Low-literacy brochures are needed for patients on anticoagulants.

Key Words: anticoagulants • deep vein thrombosis • health education • patient compliance • stroke prevention

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