Readability of Patient Education Materials From RadiologyInfo.Org: Spanish vs. English-Language Materials

From the 2018 HVPAA National Conference

Paul Yi (Johns Hopkins Department of Radiology), Eric Huh (Johns Hopkins Department of Radiology), Ferdinand Hui (Johns Hopkins Department of Radiology)


The USA has the second-largest group of Spanish-speaking citizens in the world with 41 million native Spanish speakers. However, little attention has been paid towards assessing patient comprehension of Spanish-language healthcare educational materials. In contrast, numerous studies have shown English-language patient educational materials to be written at high readability levels.


The purpose of this study was to compare the readability of patient educational materials from the website written in Spanish versus English.


All patient education articles available in 2017 from the American College of Radiology (ACR) and Radiological Society of North America (RSNA)-sponsored patient education library were reviewed; articles written in both Spanish and English were included. We assessed each article for readability using 6 quantitative English readability scales and 3 quantitative Spanish readability scales. The number of articles with readability ≤ the 8th grade level (average reading ability of US adults) and the 6th grade level (National Institutes of Health [NIH]-recommended level for patient education materials) were determined. Readability levels were compared between English and Spanish-language articles using t-tests.


262 patient education articles were reviewed for both Spanish and English-languages (131 articles for each language). The mean readability grade level was greater than the 11th grade reading level for all readability scales in both languages. Only 1 of the Spanish-language articles and none of the English-language articles were written at ≤8th grade or 6th grade levels. There was no significant difference in readability levels between Spanish and English-languge articles (p>0.5).


Both Spanish and English-language patient educational materials provided by the ACR and RSNA-sponsored website are written at levels too high for the average patient. These findings are consistent with several prior studies assessing patient educational materials written in English for radiology and numerous other medical specialties. Future efforts should be made to improve the readability of these patient education materials for English and Spanish-speakers alike.

Implications for the Patient

Poorly-readable patient educational materials may lead to poor health literacy in both English and Spanish-speaking patients, which is linked to worse health outcomes and increased healthcare expenditures. Improving readability of these materials represents a potential area for improvement to bring high-value educational interventions to patients undergoing radiological studies and procedures.

What are academic medical centers across the country doing to improve healthcare value?

Value improvement guides: Published reviews in JAMA Internal Medicine coauthored by experienced faculty from multiple leading medical centers, with safety outcomes data and an implementation blue print.

Review article detailing 25 labs to refine for high value quality improvement | July 2020

MAVEN campaign: Free 4 year high value care curriculum online.

Join the Alliance! Membership is free with institutional approval and commitment to improving value in your medical center.

Learn more about HVPA on Health Affairs Blog