American Society of Regional Anesthesia and Pain Medicine February 2018 - 46

medication names, procedure names, and other medical
terminology can dramatically inflate the readability level of the text.
Although the scales are not intended to yield precise scores with
isolated words, checking them can confirm suspected problematic
terms and phrases. For example, "anesthesiologist" rates at a
grade level of 49 when input into the Readability Test Tool online.
"Doctor," however, rates at a grade level of 7. "Epidural anesthesia"
comes out at 28, but even the simplified phrase of "pain medicine"
still rates at 13. By substituting words and phrases to reduce the
reading level, authors risk sacrificing the scientific integrity of the
education materials.
The Centers for Medicare and Medicaid Services (CMS) and the
National Institutes of Health (NIH) provide recommendations for
authors to assist in writing PEMs at a reasonable grade level.
These include directions to limit paragraph size, use bullet points
and lists, use underlining, include images, and use meaningful
headings. Thepainlesspush.com website uses these design
principles to make the scientifically accurate information more
engaging and accessible.
Analyzing the text of thepainlesspush.com results in a SMOG
score of 9, FKGL of 9.5, and Gunning FOG of 12. The simplified
print resource and audio voice-over, by design, have lower
reading levels: SMOG 6.2, FKGL 5, and Gunning FOG 7.6. The
diversity in reading levels allows readers and patients with varying

46

backgrounds to access information in a format that is right for
them. Having it all available online for download or reference
means that patients can choose the education material that they
find most helpful.
By designing PEMs with limited-literacy and non-English-speaking
patients in mind, as well as following the recommendations from
CMS and NIH, we feel that we have created a unique combination
of scientifically sound materials that are easily accessible to our
patients. We believe that this tool can help patients be better
informed of their options to moderate pain relief during labor and
delivery, including the relevant risks and benefits of each.
REFERENCES
1.

De Oliveira GS Jr, Jung M, McCaffery KJ, McCarthy RJ, Wolf MS. Readability
evaluation of internet-based patient education materials related to the
anesthesiology field. J Clin Anesth. 2015;27:401-405. doi: 10.1016/j.jclinane.
2015.02.005.

2.

Patel SK, Gordon EJ, Wong CA, Grobman WA, Goucher H, Toledo P. Readability,
content, and quality assessment of web-based patient education materials
addressing neuraxial labor analgesia. Anesth Analg. 2015;121:1295-1300. doi:
10.1213/ANE.0000000000000888.

3.

Goodman MF, Mohadjer L, Krenske T, Jacquie H. Literacy, Numeracy, and
Problem Solving in Technology-Rich Environments: Framework for the
OECD Survey of Adult Skills. Paris, France: OECD Publishing; 2012. doi:
10.1787/9789264128859-en.

4.

New Mexico Coalition for Literacy. NM literacy overview. Available at: https://
newmexicoliteracy.org/literacy-facts. Accessed August 21, 2017.

American Society of Regional Anesthesia and Pain Medicine
2018
http://www.Thepainlesspush.com http://www.thepainlesspush.com https://newmexicoliteracy.org/literacy-facts https://newmexicoliteracy.org/literacy-facts
Table of Contents for the Digital Edition of American Society of Regional Anesthesia and Pain Medicine February 2018
