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Objectives: This study aimed to systematically identify and evaluate the readability and document complexity of currently available family history tools for the general public. Methods: Three steps were undertaken to identify family history tools for evaluation: (a) Internet searches, (b) expert consultation, and (c) literature searches. Tools identified were assessed for readability using the Simple Measure of Gobbledygook (SMOG) readability formula. The complexity of documents (i.e., forms collecting family history information) was assessed using the PMOSE/IKIRSCH document readability formula. Results: A total of 78 tools were identified, 47 of which met the criteria for inclusion. SMOG reading grade levels for multimedia-based tools ranged from 10.1 to 18.3, with an average score of 13.6. For print-based tools, SMOG ranged from 8.7 to 14.1, with an average score of 12.0. Document complexity ranged from very low complexity (level 1 proficiency) to high complexity (level 4 proficiency). Conclusion: The majority of tools are written at a reading grade level that is beyond the 8th grade average reading level in the United States. The lack of family history tools that are easy to read or use may compromise their potential effectiveness in identifying individuals at increased risk for chronic diseases in the general population.

Objective The study's purpose was to test the generalizability of an individualized information prescription model, which has been previously validated for educating patients about hypertension in emergency department and community health center settings. Study investigators assessed the effects of educational materials targeted to health literacy levels and learning styles on patients' diabetes knowledge in a community clinic setting. Methods From May to August 2012, 160 patients were recruited and randomized into intervention (n = 81) and control (n = 79) groups. Inclusion criteria included 18 years or older, English or Spanish speaker, and a type 2 diabetes diagnosis. Measures included modified versions of the Diabetes Knowledge Test and Subjective Numeracy Scale, along with brief health literacy and learning style assessments. Study team members contacted both groups after 2 and 6 weeks to reassess diabetes knowledge. Results The control group showed no significant change in diabetes knowledge at both follow-ups. In contrast, the mean number of diabetes knowledge questions answered correctly by the intervention group increased significantly after 2 weeks (Δ = 2.66, P = 0.000), which persisted at 6 weeks (Δ = 2.46, P = 0.00). Conclusions This study showed that patients' knowledge about diabetes increased significantly after exposure to educational materials targeted to their health literacy levels and learning style preferences and that the model is transferrable among health conditions.

Low health literacy is associated with poor health outcomes. Research is needed to understand the mechanisms and pathways of its effects. Computer-based assessment tools may improve efficiency and cost-effectiveness of health literacy research. The objective of this preliminary study was to assess if administration of the Short Test of Functional Health Literacy in Adults (STOFHLA) through a computer-based medium was comparable to the paper-based test in terms of accuracy and time to completion. A randomized, crossover design was used to compare computer versus paper format of the STOFHLA at a Midwestern family medicine residency program. Eighty participants were initially randomized to either computer ( n = 42) or paper ( n = 38) format of the STOFHLA. After a 30-day washout period, participants returned to complete the other version of the STOFHLA. Data analysis revealed no significant difference between paper- and computer-based surveys ( p = .9401; N = 57). The majority of participants showed “adequate” health literacy via paper- and computer-based surveys (100% and 97% of participants, respectively). Electronic administration of STOFHLA results were equivalent to the paper administration results for evaluation of adult health literacy. Future investigations should focus on expanded populations in multiple health care settings and validation of other health literacy screening tools in a clinical setting.