• The average reading level is at the eighth- to ninth-grade level (between levels 2 and 3 in functional competency measures).
• About one in five read at the fifth-grade level and below (in functional competency terms, at about level 1).
• For older Americans (65 and over) and for inner-city minorities almost two out of five read below the fifth-grade level (at level 1). (Doak, Doak, & Root, 1996, p. 3)
• According to a recent AMA study, many physicians overestimate how much their patients understand about treatment following a hospital visit. Researchers found that physicians believed 88.9 percent of patients understood potential side effects of medication at discharge, but only 54.7 percent of patients said they understood. Similarly, physicians believed 94.7 percent of patients knew when to resume normal activities, but only 57.9 percent of the patients did. Suggestions for improving communication included comprehensive discharge planning. (American Hospital Association News, May 12, 1997)
• An editorial in JAMA (December 6, 1995) reports that adults with limited literacy face formidable problems using the health care system. They are less likely to use screening procedures, follow medical regimens, keep appointments, or seek help early in the course of a disease. These people struggle with essential information such as understanding emergency department discharge instructions, consent forms, oral instructions, educational materials, and labels on medication containers.
• On average, adults read at an eighth-grade level. The National Work Group on Literacy and Health recommends that health care professionals "get smart" about patient communication. All patients regardless of skill level prefer easy-to-read material. The work group says to aim for a fifth-grade level or lower. (Hospitals and Health Networks, September 5, 1997)
• Adults and children read at least one or two grade levels below their last school grade completed. (Hilts & Krilyk, 1989, p. 3)
• Only 32% of commonly used health education materials are able to be understood by the majority of patients. (Hilts & Krilyk, 1989, p. 4)
• Readability and its impact on the reader has serious implications for people who write health education materials. (Hilts & Krilyk, 1989, p. 4)

Key Point: Aim for a sixth-grade reading level!