Many studies have shown that the readability of the health information provided to consumers does not match their general reading levels (Rudd, Moeykens et al. 2000). Even with the efforts of healthcare providers and writers to make materials more readable, today most patient-oriented Web sites, pamphlets, drug-labels, and discharge instructions still require the consumer to have a tenth grade reading level or higher (Nielsen-Bohlman, Panzer et al. 2004). Not infrequently, however, consumer reading levels are as low as fourth grade. To address this problem, we propose developing a computer-based method for providing texts of appropriate readability to a consumer. Recent progress in statistical natural language processing techniques (Barzilay 2003;Barzilay and Elhadad 2003;Elhadad, McKeown et al. 2005) lead us to believe that computer programs can be developed to dramatically increase the range and amount of readable content available to consumers. It may also help improve comprehension, self management and eventually clinical outcome. The general goal of this project is to provide consumers with readable content through the automated translation of content from difficult to understand to easy to understand.
The specific aims are 1. To develop a computerized instrument for assessing the readability of health texts. We will enhance existing readability instruments (Zakaluk and Samuels March 1, 1988) by including measurements of health term difficulty, text cohesion, and content organization and layout. 2. To develop a """"""""Plain English"""""""" tool for translating complex health texts into new versions at targeted readability levels with no critical information loss, using statistical natural language processing techniques. 3. To conduct an evaluation study to verify that providing content with appropriate readability has a positive impact on reader comprehension. We will use as a test bed for our system a general internal medicine clinic and its diabetes patients. We will provide self-care materials to these patients. Relevance to public health: The proposed development of a readability assessment instrument and """"""""Plain English"""""""" tool will help translating complex health materials into reader-appropriate texts. It has the potential of making the vast amount of available information in the health domain more accessible to the lay public.

National Institute of Health (NIH)
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Research Project (R01)
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Application #
Study Section
Special Emphasis Panel (ZRG1-RPHB-B (50))
Program Officer
Hunter, Christine
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University of Utah
Schools of Medicine
Salt Lake City
United States
Zip Code
Keselman, Alla; Smith, Catherine Arnott (2012) A classification of errors in lay comprehension of medical documents. J Biomed Inform 45:1151-63
Smith, Catherine Arnott; Hetzel, Scott; Dalrymple, Prudence et al. (2011) Beyond readability: investigating coherence of clinical text for consumers. J Med Internet Res 13:e104
Kandula, Sasikiran; Curtis, Dorothy; Hill, Brent et al. (2011) Use of topic modeling for recommending relevant education material to diabetic patients. AMIA Annu Symp Proc 2011:674-82
Clauson, Kevin A; Zeng-Treitler, Qing; Kandula, Sasikiran (2010) Readability of patient and health care professional targeted dietary supplement leaflets used for diabetes and chronic fatigue syndrome. J Altern Complement Med 16:119-24
Liao, Katherine P; Cai, Tianxi; Gainer, Vivian et al. (2010) Electronic medical records for discovery research in rheumatoid arthritis. Arthritis Care Res (Hoboken) 62:1120-7
Kandula, Sasikiran; Zeng-Treitler, Qing (2010) Exploring relations among semantic groups: a comparison of concept co-occurrence in biomedical sources. Stud Health Technol Inform 160:995-9
Kim, Hyeoneui; Nakamura, Carlos; Zeng-Treitler, Qing (2009) Assessment of pictographs developed through a participatory design process using an online survey tool. J Med Internet Res 11:e5
Zeng-Treitler, Qing; Kim, Hyeoneui; Hunter, Martha (2008) Improving patient comprehension and recall of discharge instructions by supplementing free texts with pictographs. AMIA Annu Symp Proc :849-53
Kandula, Sasikiran; Zeng-Treitler, Qing (2008) Creating a gold standard for the readability measurement of health texts. AMIA Annu Symp Proc :353-7
Keselman, Alla; Logan, Robert; Smith, Catherine Arnott et al. (2008) Developing informatics tools and strategies for consumer-centered health communication. J Am Med Inform Assoc 15:473-83

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