Table 1—

Consensus criteria for evaluation of literacy-demand (n = 23) and behavioral activation (n = 9) characteristics of print patient education materials

Criteria literacy demandSpecificationsSources (refs.)*
    Word usage, reading level, and sentence lengthScientific jargon avoided; technical, concept, category, and value judgment terms introduced with understandable explanation or example68
Vocabulary uses common words; multisyllabic words (>2–3 syllables) avoided68
Sentence length <15 words6, 7
Writing in active (vs. passive) voice7, 8
Reading grade level <5th grade*7, 8
    TypographyText in uppercase and lowercase serif (best) or sans-serif68
Type size ≥12 points (including text, tables, and captions)68
Typographic cues (bolding, bullets, and size) emphasize key points68
Subheaders used; complex topics subdivided into smaller parts of ≤5 main points, ≤5 items per list6, 7
Line length ≤30–50 characters and spaces7, 8
Using all capital letters for long headers or running text avoided7, 8
    Graphics, illustrations, and tablesCover graphic shows purpose of brochure, attracts attention, and is friendly68
Graphics designed to be simple, age appropriate, and familiar to readers68
Explanatory captions included with each graphic68
Illustrations on page adjacent to related text6, 7
Illustrations present key messages so that reader can grasp key idea from illustration alone6, 7
Illustrations not distracting7, 8
    Layout, space, and paperLayout and organization enable predicable sequence/flow of information68
Visual cuing devices (e.g. shading, boxes, arrows) used to direct attention to specific points or key content68
Adequate white space and line spacing used to reduce appearance of clutter68
Contrast between type and paper is high68
Color use supports and does not distract from message. Readers need not learn color codes to understand and use message7, 8
Topics preceded by advanced organizers or headers >50% of the time7, 8
Behavioral activation
    Content, scope, and organizationScope limited to information directly related to purpose68
Content ≥50% behaviorally focused7, 8
Summary, information overview, or information review included7, 8
    Engagement, interaction, and action facilitationRecommended behaviors are modeled and specific (e.g. step by step)68
Questions or activities with records presented for reader response7, 8
“How to” information provided6, 8
Audience relevance and appropriatenessRecommendations sensible in the context of the audience's culture, values, and beliefs68
Language and experience(s) used match those of the intended audience68
Cultural images and examples presented in a positive manner68
  • Literacy demand, n = 23; behavioral activation, n = 9.

  • *

    * 5th-grade reading level or less is the superior criterion according to Doak et al. (6) and the recommended criterion for low literacy according to the National Cancer Institute (8).

  • No more than three to four main ideas and five to six items per list according to Centers for Disease Control (7) criteria; less than seven main ideas and three to five items per list for low literacy according to Doak et al. criteria (6).

  • A less stringent, adequate criterion according to Doak et al. is that <40% of information be nonessential to purpose.