Written communication in patient education

The role of written information in patient education

Providing written materials has a number of benefits. Written materials can serve as standalone educational tools, particularly when reaching broad patient populations, or, more commonly, can be used to supplement our verbal discussions during clinical encounters.

One of the most obvious and direct benefits of written communication is to address the issue of poor retention of verbal information following a patient consultation. Studies indicate that patients recall only 20–30% of verbal information provided during a healthcare consultation (Kessels, 2003). This means that without supplementary written materials, essential details may be lost or misinterpreted. Written resources therefore allow patients to review information at their own pace, revisit key points when needed, and share information with family members or others involved in their care.

Written information can also help bridge gaps in patient understanding when complex or detailed concepts need to be conveyed. In busy clinical settings, time constraints often limit the depth of discussion we can have especially where there are many concepts to cover. Well-designed written materials enable us to introduce a topic succinctly in-person while offering patients the opportunity to explore more in-depth details later. This is particularly valuable in chronic disease or persistent pain management, post-operative care, and rehabilitation, where sustained engagement with educational content may be needed.

Written information can also be used to support patient autonomy to allow patients to make informed health decisions. Patient-centred approaches emphasise the importance of equipping individuals with the knowledge and confidence needed to take an active role in their care (Wijma et al., 2017). By providing well-structured and accessible written information, we can contribute to shared decision-making and more long-term, to improved health literacy. This might be especially relevant where a patient needs to weigh up information – such as procedure information, complication risks, success rates – to make an important decision regarding their care. Providing written information allows patients to reflect on their options at their own pace, and follow-up discussions can help address any concerns or questions that arise during this process.

What are the characteristics of effective written patient education materials?

To maximise the impact of written materials, they should be designed with clarity, and patient engagement in mind. It may be helpful to consider the following key design points:

• Plain language: Use simple, direct wording and avoid medical jargon. Terms that might seem routine to us may be unfamiliar or intimidating to patients. The use of lay-friendly language enhances understanding (Paasche-Orlow et al., 2005).
• Short, clear sentences: Keep sentences as concise as possible, ideally under 15 words, to improve readability and comprehension (Matthews & Folivi, 2023).
• Logical structure: Consider organising content using headings, subheadings, and bullet points to facilitate easy navigation (Findeis & Patyk, 2020). This ensures that patients can quickly locate the information most relevant to them.
• Use of visuals: Diagrams, infographics, and pictures significantly enhance comprehension, particularly for patients with lower health literacy (Wilson et al., 2012). Visual aids can clarify anatomical structures, demonstrate exercises, or illustrate step-by-step instructions for teaching skills.
• Tailoring to the patient: Personalised materials that address a patient’s specific condition, treatment plan, or concerns are far more effective than generic handouts (Slama-Chaudhry & Golay, 2019). Customising written content specifically to your patient’s situation helps improve relevance and engagement.
• Culturally and linguistically appropriate content: Consider cultural differences in health beliefs and literacy levels. Providing translations or incorporating culturally relevant examples can improve accessibility and effectiveness (Betancourt et al., 2003).
• Readability considerations: Aim for a reading level of approximately Grade 6–8 (USA) (approximately age 11-14) to accommodate the average literacy level in the population. Readability assessment tools, such as the Flesch-Kincaid Grade Level score, can help ensure that materials are accessible to a broad audience (Haider & Wallace, 2024).

Flesch-Kincaid Grade Level and readability assessment

The Flesch-Kincaid Grade Level is a widely used readability test that estimates the U.S school grade level needed to understand a given text. Numerous free online tools can assess the readability of written materials using the Flesch-Kincaid Grade Level. It is particularly useful in health communication to ensure patient education materials are accessible. The formula considers sentence length and syllable complexity to determine readability.

Table: Flesch-Kincaid Grade Level Interpretation

By aiming for a readability level of Grade 6–8, we can improve accessibility and comprehension, particularly for patients with lower levels of literacy. Readability assessment tools, such as Microsoft Word’s built-in Flesch-Kincaid readability calculator, can help ensure that educational materials align with best practices.

Limitations of written patient education materials

While written materials may be a helpful tool for patient education, they also have several limitations. One significant drawback is their inability to address individual patient questions in real-time, which can leave gaps in understanding or lead to uncertainty. Additionally, written resources are often generic and may not fully capture the nuances of a patient’s unique condition, treatment plan, or personal concerns.

Patients with limited literacy, cognitive impairment, or vision difficulties may struggle to engage with written content effectively. Without proper guidance, some patients may misinterpret information, leading to misconceptions about their health condition or treatment. Therefore, written materials should always be complemented by verbal explanations and opportunities for discussion.

Following up with a patient after they have been given written materials is a good idea to ensure that questions can be asked, and clarifications made. A useful approach might be to ask the patient at a follow-up consultation:

• “How did you find the reading material?”
• “Did this fit with your understanding of what we discussed?”
• “Did you have any questions after reviewing this?”

Practical considerations for implementing written education materials

• Assess patient preferences: Some patients may prefer digital resources, while others might benefit more from printed materials. Understanding patient preferences ensures that educational efforts align with individual needs.
• Encourage active engagement: Encourage patients to read the materials and ask questions. Simple strategies, such as asking, “What stood out to you the most in what you read?” can promote discussion and reinforce understanding.
• Ensure consistency across formats: Information provided in verbal discussions, written materials, and digital resources must be consistent to avoid confusion or conflicting messages. So, it’s important to check the consistency of what you’ve said with the written material you provide.
• Regularly review and update materials: If using generic resources, these should be regularly reviewed and updated to reflect the latest evidence-based practices and guideline recommendations.