For instance SMOG is calculated as:į K G L = ( 0.39 * w o r d s s e n t e n c e ) + ( 11.8 * s y l l a b l e s w o r d ) − 15.59 Most of these formulae were developed decades ago and estimate the complexity of the text mainly by word and sentence length. To assess the readability of health material, researchers have largely relied on readability formulae such as the Simplified Measure of Gobbledygook (SMOG), the Fry Readability Scale (FRY), and the Flesch-Kincaid Grade Level (FKGL). Researchers have tried to address this information need by developing more ‘readable’ health material. These statements suggest that communicating health information continues to be a challenge and good literacy skills, though necessary, are not sufficient to understand and use health information. According to an Institute of Medicine report, “Nearly half of all American adults-90 million people-have difficulty understanding and acting upon health information.” It stated that “Even people with strong literacy skills may have trouble obtaining, understanding, and using health information,” and “Although causal relationships between limited health literacy and (poor) health outcomes are not yet established, cumulative and consistent findings suggest such a causal connection.”
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