Medical textbooks: can lay people read and understand them?
The proliferation proliferation /pro·lif·er·a·tion/ (pro-lif?er-a´shun) the reproduction or multiplication of similar forms, especially of cells.prolif´erativeprolif´erous
n. of health information has created a rich field of resources that many lay people can use to make informed health care decisions. For a large segment of the population, these resources will go unseen and unused because they are written at a level that exceeds their reading recognition and comprehension skills. The study discussed in this article assessed the readability of information on six adult and two juvenile diseases in ten medical textbooks. Students in two library and information science (LIS LIS - Langage Implementation Systeme.
A predecessor of Ada developed by Ichbiah in 1973. It was influenced by Pascal's data structures and Sue's control structures. A type declaration can have a low-level implementation specification. ) schools read the same information and indicated the words they did not understand. Results showed that the medical material is written well above the average person's reading ability. Words the students could not understand included anatomical anatomical /ana·tom·i·cal/ (an?ah-tom´i-kal) pertaining to anatomy, or to the structure of an organism.
an·a·tom·i·cal or an·a·tom·ic
1. Concerned with anatomy.
2. and disease-related terms and drug names. More research needs to be done on lay people's comprehension of medical information.
On their Web site the National Center for the Study of Adult Learning and Literacy (n.d.) states that "more than 40 percent of working-age adults in the United States United States, officially United States of America, republic (2005 est. pop. 295,734,000), 3,539,227 sq mi (9,166,598 sq km), North America. The United States is the world's third largest country in population and the fourth largest country in area. lack the skills and education needed to succeed in family, work, and community life today." This figure indicates that almost half of the population may not be able to find, read, or understand health information and thus cannot make informed health care decisions.
A considerable amount of research exists on the need to improve access to health information by making it more readable for average readers. Lowering the readability level alone may not adequately address the issue of illiteracy illiteracy, inability to meet a certain minimum criterion of reading and writing skill. Definition of Illiteracy
The exact nature of the criterion varies, so that illiteracy must be defined in each case before the term can be used in a meaningful because other factors may affect a person's ability to read and comprehend written material. For example, Parikh, Parker, Nurss, Baker, and Williams noted that "the shame and embarrassment felt by some low literate patients may pose an important psychological barrier to asking for help or requesting low literate materials, even when they are available" (1996, p. 34). They found that some patients "did not seek care because of embarrassment about their illiteracy" (p. 34). Estey, Musseau, and Keehan included "anxiety, physical discomfort, and unfamiliarity with the hospital environment" (1994, p. 74) as further impediments IMPEDIMENTS, contracts. Legal objections to the making of a contract. Impediments which relate to the person are those of minority, want of reason, coverture, and the like; they are sometimes called disabilities. Vide Incapacity.
2. to understanding health instruction. Weaver (2003), one of the presenters in the Medical Library Association's teleconference, Reading Between the Lines Between the lines can refer to:
DEFINITIONS OF HEALTH LITERACY
What is health literacy? Several definitions were found in the literature. Healthy People 2010, the ongoing national promotion and prevention initiative aimed at improving the health status of individuals in the United States, defines health literacy as "the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions" (Office of Disease Prevention and Health Promotion, 2001, p. 15). The Medical Library Association's (MLA MLA
Modern Language Association
MLA n abbr (BRIT POL) (= Member of the Legislative Assembly) → miembro de la asamblea legislativa
MLA (Brit Net, 2003) definition goes further and includes the following set of abilities:
* Recognize a health information need
* Identify likely information sources and use them to retrieve relevant information
* Assess the quality of the information and its applicability to a specific situation
* Analyze, understand, and use the information to make good health decisions.
This definition incorporates elements of evidence-based practice and puts the onus on lay people to find quality information, analyze it, and use the evidence as a basis for making their decision.
The key elements in making an informed health care decision are the person's ability to read and understand the information. According to according to
1. As stated or indicated by; on the authority of: according to historians.
2. In keeping with: according to instructions.
3. Davis, Crouch, Wills, Miller, and Abdehou, "educators have measured the readability of written materials since the 1940s" but "medicine has only recently recognized problems in this area" (1990, p. 533). Health care professionals, they suggest, have taken "patients' educational and reading recognition levels to estimate literacy levels" (Davis et al, 1990, p. 533). While reading recognition (the ability to pronounce pro·nounce
v. pro·nounced, pro·nounc·ing, pro·nounc·es
a. To use the organs of speech to make heard (a word or speech sound); utter.
b. words) is important, "reading comprehension Reading comprehension can be defined as the level of understanding of a passage or text. For normal reading rates (around 200-220 words per minute) an acceptable level of comprehension is above 75%. is the most important" of all the literacy skills needed in health care (p. 533).
In the literature on readability, there is conflicting evidence on whether an association exists between reading comprehension and educational levels. A few examples are provided to illustrate both sides of this conflict. Gibbs, Gibbs, and Henrich (1987) informally interviewed fifty people chosen at random from patients in a primary care center in Connecticut that serves people in low socioeconomic so·ci·o·ec·o·nom·ic
Of or involving both social and economic factors.
of or involving economic and social factors
Adj. 1. levels. Each person was asked to define "15 medical terms taken from patient education brochures available in the clinic" (Gibbs, Gibbs, & Henrich, 1987, p. 176). The terms included atherosclerosis atherosclerosis (ăth'ərōsklərō`sĭs): see arteriosclerosis.
or hardening of the arteries , diarrhea, stroke, orally, and diabetes, to name a few. She/he was also asked about sources of information. The authors scored 63 percent of all responses as correct, 26 percent as "vague or wrong," and 11 percent as "no knowledge" (p. 176). Sources of information were visits to doctor (n = 22), reading (n = 12), television (n = 8), friends (n = 4), and none (n = 4). The authors found that readers had "significantly more education" and scored "significantly higher on the test than the other groups" (pp. 176-177).
Similar conclusions were drawn by Estey, Musseau, and Keehan (1994). The authors studied 189 randomly selected in-patients at three university-affiliated teaching hospitals. To assess their reading ability, the authors used the Wide Range Achievement Test-Revised (WRAT-R WRAT-R Wide Range Achievement Test-Revised ). They also constructed two Cloze tests Noun 1. cloze test - a test for diagnosing reading ability; words are deleted from a prose passage and the reader is required to fill in the blanks
diagnostic assay, diagnostic test - an assay conducted for diagnostic purposes from a handout on bronchoscopy Bronchoscopy Definition
Bronchoscopy is a procedure in which a cylindrical fiberoptic scope is inserted into the airways. This scope contains a viewing device that allows the visual examination of the lower airways. , one written at the grade five level, the other at the grade nine level. In this reading comprehension test, every fifth word is deleted from a written passage and the reader is asked to fill in the blanks. A score of 56 percent or above indicates that the reader is capable of understanding what was read; 44 percent to 56 percent indicates that the person will need additional instructions A charge given to a jury by a judge after the original instructions to explain the law and guide the jury in its decision making.
Additional instructions are frequently needed after the jury has begun deliberations and finds that it has a question concerning the evidence, a to understand the material read; and a score of 44 percent or less means the material is too difficult to comprehend (Estey, Musseau, & Keehan, 1994, p. 74). The authors noted that not all patients needed to have a bronchos-copy. The results revealed that 65 percent of the participants had a grade twelve or higher education higher education
Study beyond the level of secondary education. Institutions of higher education include not only colleges and universities but also professional schools in such fields as law, theology, medicine, business, music, and art. level, while 17 percent had a grade nine or lower education level. The authors found an average WRAT-R score of 7.3, which is equivalent to a grade seven education level. Further, 77 percent of the patients were able to comprehend the material on the grade five Cloze test, but only 30 percent were able to comprehend the material on the grade nine Cloze test. In this study, however, significant positive correlations Noun 1. positive correlation - a correlation in which large values of one variable are associated with large values of the other and small with small; the correlation coefficient is between 0 and +1
direct correlation were found between reported education level and the grade five and grade nine Cloze tests, respectively.
In other studies, however, educational level did not correlate with higher reading skills. Davis et al. (1990) assessed the reading comprehension level of 151 primary care patients in five different ambulatory care ambulatory care
Medical care provided to outpatients.
n the health services provided on an outpatient basis to those who can visit a health care facility and return home the same day. settings using the Peabody Individual Achievement Test (PLAT). In addition to measuring achievement in mathematics, spelling, and general information, the PIAT PIAT Peabody Individual Achievement Test
PIAT Projector Infantry Anti-Tank (British)
PIAT Pennsylvania Initiative on Assistive Technology
PIAT Putting It All Together
PIAT Public Information Assistance Team
PIAT perfect in all tests contains a reading recognition subtest and a reading comprehension subtest. The authors found that the mean educational level of patients in the public clinic settings was "just above 10th grade," while their mean comprehension level was at the fifth grade level (Davis et al., 1990, p. 535). Patients who used the private practice clinic had a mean educational level of thirteenth grade and a mean comprehension level of tenth grade Tenth grade is a year of education in many nations. United States
The tenth grade is the tenth school year after kindergarten and is called Grade 10 in some regions. Students are usually 15–16 years old. (p. 535). Because most "written education materials require comprehension grade levels of 11th to 14th," the authors concluded that "the average patient reading levels in all clinics were far below the comprehension level needed to read patient education materials" (p. 535).
Wilson, Mood, Risk, and Kershaw (9003) used the Rapid Estimate of Adult Literacy in Medicine (REALM) to test reading recognition and the Cloze test to measure reading comprehension in their study of 238 randomly selected patients receiving radiation therapy at two Midwest urban radiation oncology radiation oncology
The branch of radiology that deals with the use of ionizing radiation to treat cancers.
radiation oncology centers. The mean of the "self-report of highest grade completed in school" was 13 (SD = 3.3) (p. 72). The mean reading level score on the REALM was equivalent to seventh to eighth grade. The Cloze cloze
Based on or being a test of reading comprehension in which the test taker is asked to supply words that have been systematically deleted from a text.
[Alteration of closure.]
Adj. scores revealed that 52 percent understood the information they read, while 48 percent needed either supplemental instructions or "did not understand any of the information they read" (p. 73). The authors also found no relationship between comprehension and level of education, which led them to state that the "highest grade completed in school should not be used as a measure to infer a patient's comprehension level" (p. 73).
In the library and information science field, the authors did not find any studies that focused on reading comprehension; however, some studies on the readability of health material were retrieved. Baker and Wilson (1996) conducted one of the first studies assessing the readability of some medical and lay health-related books, as well as general and health-related newspaper articles. Using the "computer software program Grammatik-5, the Flesch-Kincaid readability formula was calculated" (p. 127). They found that the mean reading grade level of lay health materials was twelfth grade This article or section deals primarily with the United States and Canada and does not represent a worldwide view of the subject.
Please [ improve this article] or discuss the issue on the talk page. , the mean reading grade level for medically related newspaper articles was fourteenth grade (the general articles were at the twelfth grade level), and the mean reading grade level of medical texts was at the sixteenth grade level. In another study, Wilson, Baker, Brown-Syed, and Gollop (2000) selected a convenience sample of forty-nine documents from the National Cancer Institution's Web site, CancerNet[TM], to determine what level of reading skills would be required by lay people who accessed this Web site. Using the Flesch-Kincaid scale available on Microsoft[R] Word for Windows The name of the Windows version of the Microsoft Word word processor when Windows was becoming popular. See Microsoft Word.
(text, tool, product) Word for Windows - The version of Microsoft Word which runs under Microsoft Windows.
Version 6.0. 95, they found that the overall mean reading level was twelfth grade. The results of these two studies suggest that lay people may find that many health resources exceed their reading ability.
PURPOSE OF THE STUDY
Research has shown that people ask a variety of health-related questions at the reference desk (Marshall, Sewards, & Dilworth, 1989; Baker, Spang spang
Precisely; squarely: fell spang into the middle of the puddle.
[Probably from dialectal spang, to leap, jerk, bang, , & Gogolowski, 1998; Petty, 2001). On their lists of recommended books for consumer health collections, public librarians frequently include medical textbooks, which suggests that some people looking for Looking for
In the context of general equities, this describing a buy interest in which a dealer is asked to offer stock, often involving a capital commitment. Antithesis of in touch with. more in-depth information about a disease, a condition, or a treatment may use these conventional medical books. Such texts, written primarily for health care professionals and replete re·plete
1. Abundantly supplied; abounding: a stream replete with trout; an apartment replete with Empire furniture.
2. Filled to satiation; gorged.
3. with complex, detailed, medical language, can create inherent barriers for lay people unfamiliar with medical terminology Medical terminology is a vocabulary for accurately describing the human body and associated components, conditions, processes and procedures in a science-based manner. This systematic approach to word building and term comprehension is based on the concept of: (1) Word roots, (2) . These books may be more difficult to understand, not only for average readers but even for more educated readers, that is, people who have attained a college degree or beyond. Because individuals are being asked to take more responsibility for understanding their health care options and because the amount of available health information continues to grow, it is important to investigate how well highly educated people decipher Same as decrypt. complex medical texts they may consult.
The purpose of this study was to assess the readability and comprehensibility of a small number of standard medical books that are recommended for consumer health collections. The following questions guided the study:
1. What level of education is required to read the information in medical textbooks?
2. How easy to read is the information in these textbooks?
3. What percentage of words in the selected paragraphs of these medical textbooks are incomprehensible to students in a library and information science program who have a minimum of sixteen years of education?
Selection of Medical Textbooks
A number of print and Web-based lists of recommended books for consumer health collections were examined to determine whether they included standard medical textbooks. From the lists of the Consumer Health Information Service of the Toronto Public Library The Toronto Public Library is the largest public library system in Canada and the second busiest (by number of visits) in the world after the Hong Kong Public Library. It can trace its roots back to 1830. (2001) and Healthnet: Connecticut Consumer Health Information Network (2003), ten well-known medical textbooks were chosen for inclusion in this study. From these textbooks information on six common adult diseases (myocardial infarction myocardial infarction: see under infarction. , diabetes mellitus diabetes mellitus
Disorder of insufficient production of or reduced sensitivity to insulin. Insulin, synthesized in the islets of Langerhans (see Langerhans, islets of), is necessary to metabolize glucose. In diabetes, blood sugar levels increase (hyperglycemia). , colon cancer colon cancer, cancer of any part of the colon (often called the large intestine). Colon cancer is the second most common cancer diagnosed in the United States. , asthma, endometriosis endometriosis (ĕn'dəmē'trē-ō`sĭs), a condition in which small pieces of the endometrium (the lining of the uterus) migrate to other places in the pelvic area. , osteoporosis osteoporosis (ŏs'tēō'pərō`sĭs), disorder in which the normal replenishment of old bone tissue is severely disrupted, resulting in weakened bones and increased risk of fracture; osteopenia , asthma) and two common childhood diseases (juvenile diabetes mellitus Juvenile diabetes mellitus is a medical term referring to insulin dependent diabetes or type 1 diabetes in childhood. It is now considered somewhat obsolete as it has become clear that type 1 diabetes may develop in adults and type 2 diabetes has become more common in children. and asthma) was examined for readability level, reading ease, and comprehension. A list of the disease information from each textbook is outlined in Table 1.
The Readability Statistics (RS) option available on Microsoft[R] Word was used to assess the readability of the material on each disease from each textbook. The RS includes the Flesch-Kincaid Grade Level (FK) and the Flesch Reading Ease (FRE FRE French
FRE Freddie Mac (stock symbol)
FRE Federal Rules of Evidence
FRE Freedom Realty Exchange
FRE Freedom Party
FRE Food and Resource Economics
FRE Free Range Eggs
FRE French Real Estate ) readability formulas, which are calculated by averaging the number of syllables per word and words per sentence (Dollahite, Thompson, & McNew, 1996; Williams, French, & White, 2003). The FK indicates the "American grade-school level" that would be required to read a document (Williams, French, & White, 2003, p. 919). For example, a score often is equivalent to a tenth grade reading level. The higher the score, the more difficult the document is to read and understand. Unfortunately, the RS only assigns scores from third grade to twelfth grade reading levels and cannot "differentiate between information that is more difficult or easier [to read] than those levels" (Graber, Roller, & Kaeble, 1999, p. 59).
The FRE score, also available on Microsoft[R] Word's RS function, ranges from 0 to 100. Because standard writing is reported to be in the range of 60-70, the lower the FRE score, the more difficult the document is to understand (Williams, French, & White, 2003, p. 919).
The RS also provides information on other factors that affect readability. According to Doak, Doak, and Root (1996), material that is written in a conversational style (that is, in the active voice) is easier to understand. Sentences constructed in the passive voice contain "embedded Inserted into. See embedded system. information ... [which] slows down the reading process and generally makes comprehension more difficult" (Doak, Doak, & Root, 1996, p. 53). In addition, these authors advocated short sentences because sentences with ten to fifteen words are "easier to read and understand compared to long sentences" (p. 80). Therefore, the number of words per sentence and the percentage of passive sentences were also analyzed.
To determine the readability of the information on each of the six diseases, three one hundred-word paragraphs from each textbook were entered into Microsoft(r) Word to obtain the FK and FRE scores, the number of words per sentence, and the percentage of passive sentences. The paragraphs were taken from the beginning, the middle, and the end of each entry in order to obtain the overall scores for each item. The total number of paragraphs analyzed was ninety-six.
Comprehension of the Words
Readability formulas do not consider important items such as the technicality of the language (Baker & Wilson, 1996). Therefore, medical jargon may be incomprehensible not only to people with low reading skills but also to those who are well educated. To test this assumption, the graduate students in Baker's Introduction to the Library Profession course and Gollop's Information Resources (1) The data and information assets of an organization, department or unit. See data administration.
(2) Another name for the Information Systems (IS) or Information Technology (IT) department. See IT. and Services reference course were asked by independent facilitators to volunteer for the study. (The Human Investigation Committees of both universities approved the protocol before the study was undertaken.) Students with health sciences backgrounds or extensive health knowledge were asked to exclude themselves from the study. After briefly explaining the purpose of the study, the facilitator gave each volunteer (n = 32) the three paragraphs on one disease from one textbook and asked her/him to circle words she/he did not understand. It took each student approximately five to ten minutes to read the material and circle words they did not understand in the three paragraphs.
Flesch-Kincaid Readability Scores
The readability of information on six adult and two juvenile diseases found in ten medical textbooks was analyzed using the FK formula. The scores per paragraph ranged from a low of 8.9 to a high of 12. The overall mean FK was 11.9 (SD = .39). As outlined in Table 2, little variability in reading level was found among the textbooks. The mean reading level for seven of the textbooks was twelfth grade (SD = .00). For The Merck Manual of Diagnosis and Therapy (Beers & Berkow, 1999), the mean reading level was slightly lower (M = 11.9; SD = .26), as was also the case for Current Medical Diagnosis & Treatment (M =11.87; SD = .57) (Tierney, McPhee, & Papadakis, 2003). The information on osteoporosis in Current Diagnosis & Treatment in Orthopedics orthopedics (ôrthəpē`dĭks), medical specialty concerned with deformities, injuries, and diseases of the bones, joints, ligaments, tendons, and muscles. (Skinner, 2003) required ninth grade reading skills (M = 9; SD = 1.55). An analysis of variance revealed no significant difference in overall reading level among the paragraphs.
Flesch Reading Ease Scores
In addition to obtaining the FK score, the FRE for the six adult and two juvenile diseases was also analyzed. Per paragraph, the scores ranged from 0 (velN hard to read) to a high of 50.7 (easier to read). The mean Flesch Reading Ease score for all items was 14.08 (SD = 14.79). As can be seen in the FRE scores outlined in Table 3, the information in Current Diagnosis & Treatment in Orthopedics (Skinner, 2003) on osteoporosis was the easiest to read, while the information in Current Surgical Diagnosis and Treatment (Way & Doherty, 2003) on colon cancer or endometriosis was the most difficult to read. Analysis of variance revealed significant differences (p [less than or equal to] .05) among *** paragraphs for Conn's Current Therapy (F = 5.80, df = 2, 15) (Rakel & Bope, 2002) and for Nelson Textbook of Pediatrics (F = 11.59, df = 2, 3) (Behrman, Kliegman, & Jenson, 2000). In Conn's the means of the paragraphs were linear, that is, the first paragraph had the lowest mean (M = 3.75) and was the most difficult to read, the mean of the second paragraph (M = 9.57) was higher, and the mean of the last paragraph (M = 27.37) revealed that the third paragraph was the easiest one of the three to read. No linearity among the paragraphs was noted for Nelson.
Number of Words Per Sentence and Passive Sentences
The overall average number of words per sentence by disease ranged from a low of 14.8 words on adult asthma in Current Medical Diagnosis & Treatment (Tierney, McPhee, & Papadakis, 2003) to a high of 33.2 words per sentence on myocardial infarction in Cecil Textbook of Medicine (Goldman & Bennett, 2000). The RS option on Microsoft[R] Word also provides the percentage of passive sentences in its calculations. In this study, the percentage of passive sentences across all textbooks ranged from 0 percent to 100 percent. The mode, or most frequently occurring number, was 40 percent, indicating that slightly less than half of all the material was written in the passive voice.
A total of 23 of the 96 paragraphs (24 percent) had no passive sentences. Three instances of completely passive sentences occurred in the second paragraphs of Cecil Textbook of Medicine (Goldman & Bennett, 2000) on asthma and Conn's Current Therapy (Rakel & Bope, 2002) on endometriosis, and in the third paragraph of Conn's Current Therapy on colon cancer.
Comprehension of the Words
Each student was asked to circle the words she/he did not understand in the three paragraphs about one disease from one medical textbook. While most students circled each unique word they did not understand, others were not as discriminatory dis·crim·i·na·to·ry
1. Marked by or showing prejudice; biased.
2. Making distinctions.
dis·crim and circled a string of words in a sentence. This practice made it more difficult to assess which term(s) they did not comprehend. For example, one student included the two words "mast cells Mast cells
A type of immune system cell that is found in the lining of the nasal passages and eyelids, displays a type of antibody called immunoglobulin type E (IgE) on its cell surface, and participates in the allergic response by releasing histamine from " in one circle, perhaps indicating that she/he did not understand the concept "mast cells." One could assume that the student does know the meaning of the word "cells." Another student, however, included the words "myocardial infarction" in one circle. In this case, it is possible that this lay reader did not understood the concept or either of the two individual words.
To determine the percentage of words that were incomprehensible to the students, the following rules were applied:
1. The same word circled more than once in a document was counted only once
2. Hyphenated hy·phen·at·ed
1. Having a hyphen: a hyphenated adjective.
2. Often Offensive Of or relating to naturalized citizens or their descendants or culture. words were counted as two words, unless the terms represented a specific entity, for example, ST-segment
3. Variations of the same word were counted as different words, for example, infarct infarct /in·farct/ (in´fahrkt) a localized area of ischemic necrosis produced by occlusion of the arterial supply or the venous drainage of the part. and infarction infarction, blockage of blood circulation to a localized area or organ of the body resulting in tissue death. Infarctions commonly occur in the spleen, kidney, lungs, brain, and heart.
As outlined in Table 4, the material on diabetes mellitus contained fewer incomprehensible words (n = 28) than did the material on colon cancer (n = 90) or myocardial infarction (n = 94). Anatomical terms, disease-related terms, and the names of drugs and chemicals were some of the words that stumped stump
1. The part of a tree trunk left protruding from the ground after the tree has fallen or has been felled.
2. the students. A few examples include: endometriosis, myocardial infarction, peritoneum peritoneum (pĕrətənē`əm), multilayered membrane which lines the abdominal cavity, and supports and covers the organs within it. The part of the membrane that lines the abdominal cavity is called the parietal peritoneum. , lymphocytes Lymphocytes
Small white blood cells that bear the major responsibility for carrying out the activities of the immune system; they number about 1 trillion. , sigmoid sigmoid /sig·moid/ (sig´moid)
1. shaped like the letter C or S.
2. sigmoid colon.
sig·moid or sig·moi·dal
1. Having the shape of the letter S. , GnRH agonists, streptokinase streptokinase /strep·to·ki·nase/ (-ki´nas) a protein produced by ß, which produces fibrinolysis by binding to plasminogen and causing its conversion to plasmin; used as a thrombolytic agent. , t-PA, verapamil verapamil /ve·rap·a·mil/ (ve-rap´ah-mil) a calcium channel blocker that dilates coronary arteries and decreases myocardial oxygen demand, used as the hydrochloride salt in the treatment of angina pectoris and of hypertension and the , hypoxemia hypoxemia /hy·pox·emia/ (hi?pok-sem´e-ah) deficient oxygenation of the blood.
Insufficient oxygenation of arterial blood. , [Pa.sub.CO2], hypercholesterolemia Hypercholesterolemia Definition
Hypercholesterolemia refers to levels of cholesterol in the blood that are higher than normal.
Cholesterol circulates in the blood stream. It is an essential molecule for the human body. , reduction, occlusion occlusion /oc·clu·sion/ (o-kloo´zhun)
2. the trapping of a liquid or gas within cavities in a solid or on its surface.
3. , and diltiazem.
The results of this study revealed that the information found in medical textbooks on the diseases under examination would be difficult for the average layperson lay·per·son
A layman or a laywoman.
Noun 1. layperson - someone who is not a clergyman or a professional person
layman, secular to read. With very few exceptions, the FK readability formula showed that a layperson would need at least twelve years of education in order to read this material. Given the limitations of the FK scoring on Microsoft[R] Word, it is impossible to determine what reading level is required to read this material. A better indication may be obtained from the FRE scores. As noted above, standard writing is in the range of 60-70. The means of the FRE of the various textbooks were considerably lower than 60, clearly demonstrating that the medical material is very difficult to read. In addition, the length of the sentences (that is, number of words per sentence) greatly exceeds the ten to fifteen words per sentence as recommended by Doak, Doak, and Root (1996). Finally, a considerable amount (40 percent) of the material is written in the passive voice, a factor that may further contribute to making the information on these diseases in these textbooks difficult to read.
The results revealed that students were unable to comprehend some of the very terms they would need to know to get a clear understanding of the disease in question. This finding suggests that the terminology in medical textbooks written for physicians and other health care professionals would stump many well-educated people. To satisfy their information needs and to be able to make an informed, knowledgeable decision, lay people would have to supplement their reading of medical textbooks with material that is more lay-oriented or consult appropriate reference sources, such as medical dictionaries A medical dictionary is a lexicon for words used in medicine. The three major English language medical dictionaries are Stedman's, Taber's, and Dorland's medical dictionaries. .
This study is unique because it did not include the use of a standardized standardized
pertaining to data that have been submitted to standardization procedures.
standardized morbidity rate
see morbidity rate.
standardized mortality rate
see mortality rate. reading comprehension test, which has been employed in many readability studies. Instead, well-educated people were asked to identify specific terms that they did not understand in the medical literature on six adult and two juvenile diseases. The results provide a better indication of the problems involved in reading medical materials and of additional factors that librarians, health educators, and health care professionals should be aware of as they continue to help lay people in their quest to read and understand medical terminology.
The generalizability of the results of this study is limited by the small sample size, as well as by the small number of students who participated. It is possible that a larger corpus of material, participants, or both may yield different results. In addition, although the FK and FRE readability tests Readability tests are formulaic protocols for evaluating the readability of text, which may be used instead of conducting an actual statistical survey of human readers, or perhaps may be used in conducting such a survey, known as a readability survey. are widely recognized and used to determine reading levels of material, they are limited and may not be as accurate as other tests. In their book, Doak, Doak, and Root (1996) recommend the use of the SMOG smog (smŏg) [smoke+fog], dense, visible air pollution. Smog is commonly of two types. The gray smog of older industrial cities like London and New York derives from the massive combustion of coal and fuel oil in or near the city, test. Further research should be conducted using SMOG to determine the readability level of medical textbooks. The SMOG scores could be compared to FRE and FK scores to assess which tool provides more accurate results.
While academic health sciences librarians must have medical textbooks in their libraries, public librarians are still faced with the difficult decision of whether to purchase them for their collections. The results of this study suggest that library and information science professionals should test the reading comprehension of medical textbooks so that they can tailor medical and health material to the specific needs of their communities.
Table 1: Textbooks and Diseases Used in the Evaluation Textbook Diseases Merck Manual of Geriatrics Osteoporosis Merck Manual of Diagnosis & Therapy Cancer: Principles and All 6 Adult Diseases * Practice of Oncology Colon Cancer Nelson Textbook of Pediatrics Diabetes Mellitus; Asthma Current Medical Diagnosis & Treatment All 6 Adult Diseases * Current Diagnosis & Treatment in Cardiology Myocardial Infarction Current Diagnosis & Treatment in Orthopedics Osteoporosis Current Surgical Diagnosis & Treatment Colon Cancer; Endometriosis Cecil Textbook of Medicine All 6 Adult Diseases * Conn's Current Therapy All 6 Adult Diseases * * Asthma, colon cancer, diabetes, endometriosis, myocardial infarction, and osteoporosis Table 2: Mean Flesch-Kincaid Score by Textbook Standard Textbook N * Mean Deviation Nelson Textbook of Pediatrics 6 12 .00 Merck Manual of Geriatrics 3 12 .00 Current Surgical Diagnosis & Treatment 6 12 .00 Conn's Current Therapy 18 12 .00 Cecil Textbook of Medicine 18 12 .00 Current Diagnosis & Treatment in Cardiology 3 12 .00 Cancer: Principles and Practice of Oncology 3 12 .00 Merck Manual of Diagnosis & Treatment 18 11.91 0.26 Current Medical Diagnosis & Treatment 18 11.87 0.57 Current Diagnosis & Treatment in Orthopedics 3 10.50 1.55 * N = number of paragraphs analyzed per textbook. Total number of paragraphs = 96. Table 3: Mean Flesch Reading Ease Score * by Textbook Standard Textbook N ** Mean Deviation Current Surgical Diagnosis & Treatment 6 3.02 2.63 Nelson Textbook of Pediatrics 6 8.62 10.29 Cecil Textbook of Medicine 18 12.05 12.16 Merck Manual of Diagnosis & Therapy 18 13.27 15.16 Conn's Current Therapy 18 13.56 15.66 Current Medical Diagnosis & Treatment 18 13.80 14.56 Current Diagnosis & Treatment in Cardiology 3 17.57 6.41 Cancer: Principles and Practice of Oncology 3 25.97 25.37 Merck Manual of Geriatrics 3 26.17 9.10 Current Diagnosis & Treatment in Orthopedics 3 40.87 14.18 * Score ranges from 0 (very difficult to read) to 100 (easy to read) ** Number of paragraphs analyzed per textbook. Total number of paragraphs = 96. Table 4: Number of Incomprehensible Words by Disease Total Number Total of Words Number of Percentage of Incomprehensible Words per Incomprehensible Disease to Students Disease Words Diabetes Mellitus 28 1,550 1.81 Osteoporosis 63 1,847 3.41 Asthma 66 1,532 4.31 Endometriosis 69 1,513 4.56 Colon Cancer 90 1,828 4.92 Myocardial Infarction 94 1,546 6.08
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