Does level of educational attainment and readability level of text affect understanding of health leaflets ? A questionnaire based study using readability formulae
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Objectives: To determine the effects of educational attainment and the readability levels of text on the effective understanding and comprehension of health leaflets. Methods: Forty-six female university students and forty-six female adults with no higher education qualifications were recruited. Two cervical cancer health leaflets were used in the study, which had different readability levels judged by the SMOG readability formula and Flesch reading ease and Flesch-Kincaid tests. Half the students and half the non-students were given the leaflet with the lower readability level to read, and the other half were given the more difficult leaflet. Participants answered two questionnaires, one before and one after reading the leaflet. These leaflets allowed an increase in knowledge on cervical cancer, number of symptoms known after the reading the leaflet, and rating of likeability and self-perceived understanding from the leaflet, to be measured. Results: Students significantly increased their knowledge on cervical cancer more than non-students (f (1, 88) = 10.53, p < 0.01). The readability level of the leaflet did not effect increase in knowledge on cervical cancer (f (1, 88) = 0.985, p > 0.05). However, there was an interaction between educational attainment and difficulty of leaflet in increasing knowledge on cervical cancer after reading the health leaflet (f (1, 88) = 9.84, p < 0.01). Educational attainment did not have a significant effect on the number of symptoms of cervical cancer the participants were able to list after reading the health leaflet (f (1, 88) = 3.84, p > 0.05), but those who read the leaflet with a lower readability level were able to list significantly more symptoms than those who read the leaflet with a higher readability level (f (1, 88) = 82.51, p < 0.001). There was also a significant interaction between the educational attainment of the participant and the readability level of the leaflet on the number of symptoms the participants were able to list (f (1, 88) = 11.45, p < 0.01). Students and non-students rated the leaflet the same in terms of likeability and self-perceived understanding of the leaflets (f (1, 88) = 2.40, p > 0.05). Participants who read the lower readability leaflet rated it higher than those who read the higher readability level leaflet (f (1, 88) = 17.00, p < 0.001), and there was a significant interaction between education level and readability level, on the participant’s rating of the health leaflet (f (1, 88) = 4.77, p < 0.05). Conclusions: Educational attainment and readability level of text appear to have effects on the successful understanding and comprehension of health leaflets to a certain extent, where the more education an individual has, and the lower the readability level of the text, results in more understanding.