Are You Sometimes Confused by Written Medical Instructions?
Now, imagine what it would be like if you were sick, scared and
had only third grade reading skills. Your doctor tells you, "You've
got to follow these instructions exactly, or you could die."
About 200 recent studies have shown the reading difficulty of
most health related materials FAR exceeds the average reading
abilities of the American adult. One of the biggest silent health
problems today is the gap between health materials and reading
In the United States, the average reading level is eighth grade.
In 1992, the Educational Testing Service determined that half
U.S. adults read at between first and eight grade level. That is
about 148 million people. It gets worse. One quarter of Americans
read BELOW FOURTH GRADE level, meaning 74 million people would
struggle with even the simplest, most well written health
Does it matter? Do you remember the anthrax scare, when someone
was putting deadly white powder into our mail system?
During that terrorist scare, the U.S. post office mailed millions
of post cards to Americans. The post cards told people how to
protect themselves from the deadly infection. They gave
instructions on how to handle and report suspicious mail. These
post cards were written at between ninth and eleventh grade
More than half the people who got that mailing could not read it
well enough to protect themselves and others. Does it matter? Do
148 million people matter? Will it matter the next time the
Do you remember the mailing the Surgeon General sent out
explaining how to avoid contracting HIV? He made every effort to
see that it was written in clear, simple language. He got
criticism for just how plain talking it was in places. A later
evaluation of that document showed that it was written at between
seventh and ninth grade level. Half the people receiving it read
at a level BELOW what was required to read it. No wonder the
infection keeps spreading.
Think about it. For millions of people, the problem is not just
the tiny print on prescription bottles. The problem is the words
themselves. What does "take on an empty stomach" mean exactly?
When should you "take four times a day"? Perhaps your doctor
explained to you at the office. Do you remember what the doctor
said a week later?
Have you ever read the instructions for testing and assessing
blood sugar levels? Have you ever tried to fill out a Medicare
form? Do you struggle with letters from your health insurance
Only 45% of asthmatics with literacy problems knew that they
should stay away from things they are allergic to even if they
WERE taking asthma medication. 89% of the people reading at high
school level were clear about the same information. It's not a
matter of intelligence. It's a matter of a missing skill which
well-educated health providers presume is present in their
readers when they sit down to write.
There are two parts to the problem: the writer and the reader.
Recently, the public health community has begun efforts to raise
awareness. They are alerting the medical providers to the impact
of health literacy issues. Some fledgling efforts are underway to
provide clearer, simpler materials for the public. People are
finding alternatives to reading for presenting the same
There is a long way to go. Sign up now with your local literacy
program as a volunteer.
Drop in on your elderly neighbor and help her learn to read the
specialized health material so critical in her life. (You may
want to ask her about her life first, to save embarrassment when
you learn you're talking to a retired English teacher). Start
with all those ridiculously obscure materials her doctor sent
home with her about glaucoma. You can go on to that Medicare form
she needs to send in tomorrow.
Do you want to know what eighth grade reading level is? You just
read 700 words of it. 74 million Americans reading at below
fourth grade level could have found it too hard for them to
The information contained in this article is for educational purposes
only and is not intended to medically diagnose, treat or cure any
disease. Consult a health care practitioner before beginning any
health care program.