Health Literacy and the JAMA Patient Page—Reply

In Reply: The readability and the reading level of the JAMA Patient Page are among our major concerns in writing and producing the page each week. Making the page helpful and understandable are our main priorities. To that end, we instituted a number of changes at the beginning of this year in an effort to make the page easier to read, including increasing the font size and spacing between lines.¹ Our own Flesch-Kincaid grade level analyses of all the pages produced from January through the end of March of this year showed that the reading levels are between 9.4 to 12.0, which fall within our target high school reading level. One of the reasons for the high reading level scores of the Patient Pages is that we routinely use technical medical terms (in bold face) followed by a lay definition in parenthesis. The medical terms and the definitions add complexity and length to the sentences. When we reanalyzed the Patient Pages with the technical terms and parenthetical definitions removed, the reading level decreased anywhere from 1 to 5 grade levels. Focus groups that we surveyed late last year found that patients liked the use of technical terms on the Patient Page because they heard the terms from their physicians or in the media, but they did not know what they meant until they saw them defined on the Patient Page. The focus group patients also said that the pages were easy to read and understand.