key: cord-0957823-lp9lrb3g authors: Millar, Beverley C.; Moore, John E. title: Improving vaccine-related health literacy in parents: comparison on the readability of CDC Vaccine Information Statements (VIS) and Health and Human Services (HHS) patient-facing vaccine literature date: 2021-09-29 journal: Ther Adv Vaccines Immunother DOI: 10.1177/25151355211047521 sha: 41098875c4a32bba5b3c53b5aa8c612f3af868be doc_id: 957823 cord_uid: lp9lrb3g nan In the United States, there are numerous sources of information on vaccines for recipients, carers, and family on vaccine-preventable infectious diseases from federal, state, pharmaceutical, and charitable organisations. While the FDA produces vaccine package inserts, which are for healthcare professional, patient-facing information is formally given in the Vaccine Information Statement (VIS). A VIS is a document, produced by the CDC, that informs vaccine recipients, or their parents or legal representatives, about the benefits and risks of a vaccine they are receiving. All vaccine providers, public or private, are required by the National Vaccine Childhood Injury Act to give the appropriate VIS to the patient (or parent or legal representative) prior to every dose of specific vaccines. 1 (Tables 1 and 2) . Information from these sources were copied and pasted into the subscription-based Read ability (ContentPro) calculator (www.readable.com) and a readability assessment carried out examining 10 readability metrics, in accordance with the software instuctions. Calculated readability parameters for each of the vaccines are shown in Table 1 (VIS) and Table 2 (HHS). Of the 10 metrics examined, four of these parameters (Number of words, Number of sentences, Words per sentence, and Syllables per word) were absolute measurements, whereas the remaining six metrics were calculated parameters. Readability can be quantified by several metrics, of which the Flesch Reading Ease is the most commonly used. This metric gives a score of 0-100, with 0 being unreadable and 100 being most readable. It is based on the average number of syllables per word and the average number of words per sentence. Scoring between 70 and 80 is equivalent to school grade level 8 and college graduates can understand documents with a score of 0-30. This means Improving vaccine-related health literacy in parents: comparison on the readability of CDC Vaccine Information Statements (VIS) and Health and Human Services (HHS) patient-facing vaccine literature The effects of health literacy in influenza vaccination competencies among community-dwelling older adults in Hong Kong Promoting health literacy Assessing readability of patient education materials: current role in orthopaedics Health literacy as a public health goal: a challenge for contemporary health education and communication strategies into the 21st century Visit SAGE journals online journals.sagepub.com/ home/tav journals.sagepub.com/home/tav 5 text with a score of 60-70 should be fairly easy for the average adult to read. This index is commonly used by marketers, research communicators, and policy writers, which helps them assess the ease by which a piece of text will be understood and engaged with by their readership. A derivative of the Flesch Reading Ease score is the Flesch-Kincaid Grade Level index, which is a widely used readability formula which assesses the approximate reading grade level of a text. If a text has a Flesch-Kincaid Grade Level level of 8, this means the reader needs a grade 8 level of reading or above to understand it. Further interpretive criteria on the Gunning-Fog and SMOG indices are available. 3 When applied to patient-facing vaccine literature, we can see that VIS information was significantly less easy to read than HHS information, as supported by the Flesch Reading Ease, Flesch-Kincaid Grade Leve, Gunning-Fog, and SMOG parameters. Furthermore, the HHS materials employed less words per sentence and less syllables per word than the VIS information.The last 50 years has seen the steady evolution of guidelines, laws, and requirements, all supporting the use of plain language, culminating in the Plain Writing Act of 2010. Adoption of plain language approaches to scientific and medical communication will further support patients in their understanding of the background, diagnosis, and treatment of their disease conditions. The availability of free and subscription-based readability calculators now allow a simple and effective way to quantitatively measure and correct written text and web-based resources for the benefit of patients.Readability addresses functional health literacy, through improving communication of information to patients and service users. Nutbeam's Model of Health Literacy defines three components of Health Literacy, namely Functional Health Literacy, Interactive Health Literacy, and Critical Health Literacy. 4 With Functional Health Literacy, the transmission of easy-to-read materials on health risks and health service utilisation leads to improved knowledge for the individual, as well as increased participation in population health programmes, including vaccination. 4 Further work is now required to investigate the importance of readability in achieving optimal Funtional Health Literacy.In conclusion, preparation of patient-facing materials of a complex topic, such as describing vaccines, is difficult to accomplish successfully. Adoption of readability calculators and scrutiny of materials of their readability will help authors develop materials with improved understanding for vaccine recipients, carers, and family, potentially leading to improved health literacy and vaccine uptake. The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. The authors received no financial support for the research, authorship, and/or publication of this article. This article does not contain any studies with human participants or animals performed by any of the authors. John E. Moore https://orcid.org/0000-0002-5243-5108 All data relevant to the study are included in the article.