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Associate Professor, Department of Pharmacy, Clinical and Administrative Sciences-Tulsa, College of Pharmacy, The University of Oklahoma, Tulsa, OK
Associate Professor, Department of Pharmacy Practice, College of Pharmacy and Health Sciences, Drake University, Des Moines, IA
PharmD Student, College of Pharmacy and Health Sciences, Drake University
PharmD Student, College of Pharmacy and Health Sciences, Drake University
Reprints: Dr. Miller, Department of Pharmacy, Clinical and Administrative Sciences-Tulsa, College of Pharmacy, 4502 East 41st Street, 2H36, Tulsa, OK 74135, fax 918/660-3009, michael-miller{at}ouhsc.edu
BACKGROUND: Written materials are commonly used to communicate pharmacy-relevant information to patients. However, they are often composed at a level that limits comprehension, mitigating a well-intended effect.
OBJECTIVE: To (1) use the cloze procedure (a test designed to assess reading comprehension) to evaluate an individual's understanding of a pharmacy-relevant educational pamphlet; (2) compare results of the cloze procedure with the reading comprehension component of the Short Test of Functional Health Literacy in Adults (S-TOFHLA); and (3) use results to demonstrate rewriting of the educational pamphlet.
METHODS: The cloze procedure was applied to a pharmacy-relevant educational pamphlet describing safe medication practices. A total of 162 subjects were recruited from university faculty, staff, and students; a local adult literacy center; and community senior centers. Subjects completed a background interview, the S-TOFHLA, and cloze procedure for the pharmacy-relevant educational pamphlet. S-TOFHLA and cloze procedure scores were described and compared. Cloze procedure responses were used to demonstrate revision of the pamphlet.
RESULTS: Of the 154 subjects analyzed, mean ± SD age was 56.5 ± 20.4 years. Subjects were predominantly white (93.5%), female (71.4%), and college graduates (42.2%). Mean score on the S-TOFHLA was 92.1%. A majority (95.5%, 147/154) of subjects demonstrated adequate functional health literacy. In contrast, mean score on the cloze procedure was 53.3%. Internal consistencies of the S-TOFHLA and the cloze procedure were 0.92 and 0.90, respectively. Scores on the cloze procedure and the S-TOFHLA were highly correlated (r = 0.71, p < 0.001). Performance on the cloze procedure indicated that 55.2% of subjects required supplemental teaching.
CONCLUSIONS: In this highly educated, health-literate sample, a majority did not understand the pharmacy-relevant educational pamphlet despite adequate performance on a standard measure of health literacy. The cloze procedure can be used to assess comprehension of educational materials, solicit feedback from intended users, and guide the revision of educational materials.
Key Words: cloze procedure, health literacy
Published Online, March 10, 2009. www.theannals.com, DOI 10.1345/aph.1L642
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