American Society of Regional Anesthesia and Pain Medicine February 2018 - 45

Letter to the Editor
Developing an Online and Print Patient
Education Tool for Pain Relief Options in
Labor

I

n today's technologic climate, patients and their families are
routinely seeking out medical information on the internet. A
study of 96 websites with anesthesia-related patient education
materials (PEMs) showed they were all written above the
recommended 6th-grade reading level.1 Online PEMs for pain
relief options in labor have also been shown to be above the
recommended reading level and lack critical information on risks,
benefits, and alternatives.2 The Program for the International
Assessment of Adult Competencies (PIACC) evaluates literacy in
the adult population on a five-level scale, with literacy defined as
"understanding, evaluating, using, and engaging with written texts
to participate in society, to achieve one's goals, and to develop
one's knowledge and potential."3

Lauren Faber, BA

Kylee Greider, BS

University of New Mexico School of Medicine
Albuquerque, New Mexico

In New Mexico, 46% of the population is considered functionally
illiterate, which is designated as a level-two proficiency or lower on
the PIACC scale.4 Many of those individuals fail to identify a total
on a sales receipt or identify information in a news article. This low
literacy proficiency in the state makes providing accessible PEM
while retaining scientific accuracy and integrity a challenge.
With this in mind, we aimed to develop a comprehensive patienteducation tool covering pain relief options for labor and delivery,
including online, print, and audio information aimed at patients
with all literacy levels. This culminated in the development of a free
online resource (http://thepainlesspush.com), currently available
in English and Spanish, with simplified print and audio material
also available online for
download. Appropriately
designed PEMs should be
available to all patients
prior to hospitalization
as well as during their
time in labor and delivery
to improve the informed
component of the
informed consent process.

Nicole Nesiba, BS
University of New Mexico
School of Medicine
Albuquerque, New Mexico

Katherine M. Seligman, MD
Department of Anesthesiology and
Critical Care Medicine
University of New Mexico
Albuquerque, New Mexico

Frequency of Gobbledygook
(Gunning FOG). The FKGL
score focuses on word
length (in syllables) and
sentence length (in number
of words used). Longer
sentences and more
syllables lead to higher
scores. The SMOG focuses
on polysyllabic words and sentence count. The Gunning FOG relates
word count per sentence to the proportion of polysyllabic words.
Thus, the main predictors for readability levels include polysyllabic
words and sentence length and structure. The Readability Test Tool,
available for free online (https://www.webpagefx.com/tools/readable), uses the FKGL, SMOG, Gunning FOG, and other indices to
score websites and text items for readability.

"Low literacy proficiency in the state makes
providing accessible patient education
material while retaining scientific accuracy
and integrity a challenge."

Assessing a patient population's educational level is at best an
indirect means to determine typical patient reading ability. No
available correlation exists between PIACC literacy level and
completed United States school grade level. Numerous preexisting
validated analytic methods are available to check the readability
of PEMs, and all reference a corresponding grade level for ease of
interpretation. Three validated tools to assess readability and give
an estimated score are the Flesch-Kincaid Grade Level (FKGL),
the Simple Measure of Gobbledygook (SMOG), and the Gunning

The characteristics that increase texts' reading difficulty are
particularly relevant for scientific literature and PEMs, where

American Society of Regional Anesthesia and Pain Medicine
2018

45
http://www.thepainlesspush.com https://www.webpagefx.com/tools/readable https://www.webpagefx.com/tools/readable
Table of Contents for the Digital Edition of American Society of Regional Anesthesia and Pain Medicine February 2018
