While there is evidence that PEMs written at 6 th to 8 th grade levels improve comprehension, few studies demonstrate the effect of readable PEMs on health-related behaviors. 7 found that reducing the reading level of a patient education pamphlet on allergic contact rashes from an 11 th to 7 th grade level improved comprehension by patients in a private dermatology practice. 60% of patients assigned to 6 th grade-level information understood it independently, whereas 21% understood the 9 th grade-level information, and 19% understood the 11 th grade-level information (p < 0.001). Patients were randomized to read food care information at 6 th, 9 th, or 11 th grade reading levels.
6 compared comprehension of diabetes education materials written at varied grade levels amongst 85 diabetic patients.
Studies have demonstrated that more patients comprehend PEMs written at lower grade reading levels. 11 This is despite the fact that greater than 50% of surveyed patients had a college education. In a study of 249 adults at a metropolitan Emergency Department, investigators found that nearly 80% could not correctly state that “hemorrhage” meant “bleeding”, “myocardial infarction” meant “heart attack”, or that “fractured” meant “broken”. 10 These statistics have implications for patients, including their ability to understand common medical terms. The average US resident reads at an 8 th grade level, 9 and the average Medicare beneficiary reads at a 5 th grade level. 5 – 7 The Joint Commission 8 states that PEMs should be written at or below a 5 th grade reading level, and encourages hospitals to use readability tests to revise written materials in order to address the health literacy needs of all patients. 2 – 4 Additionally, they are potentially effective at improving patient comprehension and influencing health behaviors, especially if they are written at appropriate reading levels for patients.
1 PEMs improve patient self-efficacy, thus supporting the growing trend towards disease self-management. In these stories, Julian Barnes displays the erudition, wit and uncanny insight into the human mind that mark him as one of today’s great writers, one whose intellect and humour never obscure a genuine affection for his characters.The 2008 Health Tracking Physician Survey from the Center for Studying Health System Change (HSC) reported that 75% of physicians routinely hand out patient education materials (PEMs). “The Fruit Cage” is narrated by a middle-aged man whose seemingly orderly upbringing is harrowingly undone when he discovers that his parents’ old age is not necessarily a time of serenity but actually an age of aroused, perhaps violent, passions. Of course, all they really have in common is a fondness for flat suede shoes and a propensity for thinking spiteful, unspoken thoughts about one another’s dead husbands. In “The Things You Know,” two elderly friends enjoy their monthly breakfast meetings that neither would ever think of missing. In “Appetite,” Viv has found a way to reach her husband: by reading aloud snippets of recipe books until he calls out indelible - and sometimes unfortunate - scenes locked away in his brain. Once her lover and friend, he is now Viv’s semi-helpless charge, who is daily sinking ever deeper into dementia.
“Life is just a premature reaction to death,” was what Viv’s husband used to say. Synopsis: Master prose stylist Julian Barnes presents a collection of stories whose characters are growing old and facing the end of their lives - some with bitterness, some with resignation and others with raging defiance.